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Discusión entre pares / 15yrs/male presented with compound type 3a communited s/c with intercondylar fracture femur

Posted by victor valdes
Posted on mayo 26, 2014
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Indian-Orthopaedic Research-Group

Rahul B Tanga ha añadido fotos al álbum “May 25, 2014“.

15yrs/male presented with compound type 3a communited s/c with intercondylar fracture femur. patient was treated with orif with 6.5mmcc screw + DFLCP 5months back. present xray shows good consolidation at fracture site with functional outcome.

Rahul B Tanga critical comments?

Ayer a las 3:45 · Me gusta
Srikant Konchada Good job….how many months follow up ?? Any LLD ??

Ayer a las 3:52 · Me gusta · 1
Rohit Raj nice work…

Ayer a las 3:55 · Me gusta · 1
Alok Jain Great work Rahul…
One joke…
Ur depth gauge is Perfect….

Ayer a las 4:01 · Me gusta · 3
Praganesh KV admirable.. u saved the joint…

Ayer a las 4:05 · Me gusta · 1
Doc Umair Rana In open wound u direct applied locking plate or manage initially with ex fix???

Ayer a las 4:06 · Me gusta · 3
Ujagar Singh Excellent outcome. Well done and well presented…

Ayer a las 4:15 · Me gusta · 1
Rahul B Tanga thanks dr srikant

Ayer a las 4:19 · Me gusta
Vijay Singh Good job

Ayer a las 4:22 · Me gusta · 1
Rahul B Tanga dr shrikant konchade its 5months old and there is no LLD

Ayer a las 4:23 · Me gusta
Rahul B Tanga thanks dr rohit

Ayer a las 4:23 · Me gusta
Rahul B Tanga thanks dr alok jain and nice one.

Ayer a las 4:24 · Me gusta · 1
Rahul B Tanga thanks dr pragnesh

Ayer a las 4:24 · Me gusta
Rahul B Tanga doc umair rana wound debridement and primary plating was done.

Ayer a las 4:25 · Me gusta
Rahul B Tanga thanks dr ujagar singh.

Ayer a las 4:26 · Me gusta
Ashwini Sood excellent results.Near perfect.
How many of us will fix a open gr.3B # in this way.?
Dear Rahul Tanga –What antibotics coverage given and for how many days ?

Ayer a las 4:34 · Me gusta · 2
Lokesh Bhatia Good Job.

Ayer a las 4:34 · Me gusta · 1
Pankaj Nalawade Hw much is shortening

Ayer a las 4:37 · Me gusta · 1
Ahmed Abbashar Very good job

Ayer a las 4:41 · Me gusta · 1
Drgirish Gupta Nicely done

Ayer a las 4:57 · Me gusta · 1
Jatin Orthopaedic Its 3B

Ayer a las 4:57 · Me gusta · 2
Rahul B Tanga Thanks Dr Ashwini Sood. I give triple antibiotics. 3rd generation cephalosporins for 7 days iv.3days metro and 5 days amikacin

Ayer a las 4:59 · Me gusta · 1
Anurag Sharma Excellent job good thing that the surgeon has posted the functional results

Ayer a las 5:29 · Me gusta · 1
Mohamad Almayah Nice done

Ayer a las 5:59 · Me gusta · 1
Hanume Gowda S N very good results…
I hope you are preparing a paper out of all your open fractures and also. proximal tibia fracture…
pls publish…..

Ayer a las 6:16 · Me gusta · 1
Ashish Agarwal what’ were the negative things that u did it one sitting. if we go it in two sitting ,1’st ex fix and after healthy wound 2nd sitting orif what u done.

Ayer a las 6:19 · Editado · Me gusta
Gokul Krishnan What abt epiphysis?

Ayer a las 6:27 · Me gusta · 1
Mohamad Atef Abdelaziz Unfortunate choice

Ayer a las 6:42 · Me gusta
Dinesh Patil Grt

Ayer a las 8:33 · Me gusta · 1
Dheeraj Sonawane Good job

Ayer a las 9:27 · Me gusta · 1
Praveen Bhoj Good job Dr rahul sir….

Ayer a las 10:28 · Me gusta · 1
Santosh Mali Great job…… Plz comment on your plan of implant removal in view of physeal growth arrest?

Ayer a las 10:29 · Me gusta · 1
Praveen Bhoj Wud like to know for how long u adviced pt not to bear weight in postop period…?

Ayer a las 10:32 · Me gusta · 1
Rahul B Tanga Thanks everyone

Ayer a las 11:38 · Me gusta
Rahul B Tanga Dr ashish agarwal are you not happy with results?

Ayer a las 11:39 · Me gusta
Rahul B Tanga Dr Praveen bhoj 2 months of nwb .

Ayer a las 11:40 · Me gusta
Praveen Bhoj In some kind of splint or with physiotherapy going on simultaneously in that 2 month period…

Ayer a las 11:42 · Me gusta · 1
Lokesh Bhatia Dr Rahul B Tanga, I was reading one of your comments on your Antibiotic Regime, I have small comment on that, of course with all due respects to you and your Gr8 job done, Last year I presented a talk on Antibiotic Prophylaxis, I had gone through many articles for it, as We were in process of developing Antibiotic Policy for our Hospital. So my Point is 3rd Gen. Cephalosporins (e.g. Cefotaxime) and Amikacin with Metro, Just to share with you Literature doesn’t supports this regime, In Prophylaxis Triple antibiotic Regime, Broad Spectrum Antibiotics i.e. 1st Gen Cephalosporins commonly we use Cefazolin, which acts on Gm Positive, (whereas third Generation acts predominantly on Gm negative,) combining with Amikacin again works on Gm Negative. Metro as such there is no obvious literature support but yes, If we are scarred of anaerobes better to cover it.So may I request you to enlighten us with your thought process on this Regime.Is it your routine policy to use in all such cases or in this case only you thought of using it. If Policy then do you have any articles to back up. If used in this case only then why so.

Ayer a las 12:31 · Me gusta · 2
Rahul B Tanga Thanks Dr Lokesh Bhatia.i give cefaperazone+ sulbactum 1.5gm iv tid for 7 days .metro 100ml iv tid for 3 days and followed by amikacin 50m iv bid for 5 days only in compound type 3 a or 3 b cases.

Ayer a las 12:39 · Me gusta
Lokesh Bhatia Anyway, in India there is no restriction you can do the way you want it, but abroad its not so. this kind of regime our Pharmacy and Therapeutic committee would never agree, as it seems more of personal choice and less of any scientific basis.

Ayer a las 12:45 · Me gusta · 2
Drgirish Gupta Thanks dr Lokesh Bhatia for valuable information

Ayer a las 12:52 · Me gusta
Prabir Bala Asper text book recommendation Cegazolin is the drug of choice in case of open fracture as stated by dr Lokesh Bhatia.it is a comperatively very cheap drug.may be that is one reason not many company market it nd its not easily available

Ayer a las 13:18 · Me gusta · 3
Ashish Agarwal no dr rahul result is good in this case.but I mean to say in these type of cases infection rate is high then why u done in one sitting, because every time you can’t be lucky.

10 horas · Me gusta · 2
Ashwini Sood Thanks Dr Lokesh Bhatia for your information.In my set up I am giving Cefuroxime ( 2nd generatipn ) + genta + flagyl.I can continue Cefuroxime & Genta orally even after discharge from hospital.

9 horas · Me gusta · 1
Ashwini Sood I asked a opinion few days back.
How many of us will treat Open 3 B # in this manner ?
Any other takers ?

9 horas · Me gusta · 1
Lokesh Bhatia Genta is not recommended prophylactically to be given more 48 post op. If needs to be given more than 72 hrs needs Renal function test to be done every 72 hrs. I have seen people developing Ottotoxicity and ZnrphrotoxicityCefuroxime can be given Orally, but I think there has to be clear reason for antibiotics, I mean distinguish clearly your reason are we giving for Prophylactic or Therapeutic Purpose. If you are using for Prophylactic purpose. Do not give more that 48 hrs. I understand this is one area where we differ a lot in theory and practice. Everybody thinks why take up a chance so we tend to overuse Antibiotics.

9 horas · Me gusta · 1
Rahul B Tanga Dr ashish agarwal I take calculated risk and operate type 3 a and 3 b with primary nailing and plating.me and my patients are lucky till date.hope it continues.

8 horas · Me gusta
Rahul B Tanga Dr Ashwini sood I regularly operate I same way most of open type 3 a and 3 b fractures.?

8 horas · Me gusta
Praveen Bhoj compound 3a 3b fractures can be treateed with primary fixation …..if presentation is early say with in few hrs….also the condition of would should not be very contaminated…..although its not a hard and fast rule….each case is a different case and surgeons may have different views on intervention.

5 horas · Me gusta
Ashish Agarwal dr rahul there should be logically, on basis of luck its not advised.