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
- Uncategorized
- Comentarios desactivados en Discusión entre pares / 15yrs/male presented with compound type 3a communited s/c with intercondylar fracture femur


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.
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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 ? -
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Rahul B Tanga Thanks Dr Ashwini Sood. I give triple antibiotics. 3rd generation cephalosporins for 7 days iv.3days metro and 5 days amikacin
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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….. -
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.
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Santosh Mali Great job…… Plz comment on your plan of implant removal in view of physeal growth arrest?
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Praveen Bhoj In some kind of splint or with physiotherapy going on simultaneously in that 2 month period…
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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.
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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.
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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.
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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
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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.
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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.
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Ashwini Sood I asked a opinion few days back.
How many of us will treat Open 3 B # in this manner ?
Any other takers ? -
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.
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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.
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Rahul B Tanga Dr Ashwini sood I regularly operate I same way most of open type 3 a and 3 b fractures.?
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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.
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Médico Especialista y Subespecialista
CERTIFICADO POR EL CONSEJO MEXICANO DE ORTOPEDIA Y TRAUMATOLOGIA AC, MIEMBRO DE LA SOCIEDAD MEXICANA DE ORTOPEDIA PEDIATRICA INR, UNAM
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