infected gap nu, poor skin
DESCRIPTION
treatment of an infected nonunion with poor skin condition, advised amputation elsewhere, treated by the use of a monorail fixator.TRANSCRIPT
Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Advised amputation came to us as a ‘last resort’
• 23 yr old male• RTA• Grade IIIC compound fracture distal
1/3rd Tibia• Neurovascular Injury• Exfix, LD Flap & Skin Grafts, Multiple
Debridements• 3 Toes amputated• 9 months - Infected Nonunion
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
AP View
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Lateral
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Skin Condition
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Angiography
• No Flow middle portion of ATA, PTA & Peroneal
• Back filling from Collaterals
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Extent of Infection - PET CT
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Sequestrum
• Incise Grafted areas straight to bone and raise as a sleeve
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai 8
Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Debridement
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Fixation
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Postop
• Antibiotic Cement Spacer
• LRS Fixator
• Good Alignment
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Evolution of Wound
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
6 Weeks Postop
• Infection Settled
• CRP normal• Bone Quality
Improved
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Osteotomy
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Bone Transport
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Fixator Removal
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Post Fixator Removal
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Lateral
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Skin Condition - Incison Through Graft
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Function
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Center for Limb Lengthening & Reconstruction, MumbaiCenter for Limb Lengthening & Reconstruction, Mumbai
Issues Remaining
• Equinus• Hind Foot Varus
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Center for Limb Lengthening & Reconstruction, Mumbai
• equinus has since been corrected using a six axis (Ortho-SUV)
• Unfortunately the video cannot be put on slideshare.
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