Bavonratanavech Suthorn Bangkok Medical Center Every osteosynthesis is justified only significant advantages can be accomplished. The surgeon has to consider the risk benefit ratio before doing any kind of surgical procedure.
A Magyar Ortopéd Társaság és a Magyar Traumatológus Társaság évi Közös Kongresszusa
Although the surgeons are aware of complication and do not want to happen unfortunately there are still many complications that cause mortality and a térd condyles gyulladása. The common complications of osteosynthesis are infection, neurovascular injury, implant failure which result in non union. Infection can be prevent by improving the environment of the operating theatre and the personnel has to follow all aseptic precaution and sterile technique.
In order to avoid neuro vascular injury, the surgeon has to study carefully the anatomical landmark for surgical approach especially in some areas.
In this presentation the main focus will be about implant failure and how to solve these difficult complication but the most important is how to prevent not to happen. AO strongly believe that with good education and understanding of the AO principle with correct application there will be less complication happens. There are several etiologies that cause complications which can be summarize into 10 rules that the surgeons have to remember Rule no. Rule no.
Parameters, such as the strain of the repair tissue, have been identified as important factors influencing bone healing.
Nyilall, duzzadt, merev, kattog: így kezeljük a térdfájdalmat
Correct timing is needed to preserve the soft and hard tissues and with it the blood supply to bone. Last but not least what is the level of your competency? Every trauma case the surgeon has to realize the mechanism of the injury, make the correct diagnosis, classify bone and soft tissue condition in order to select the appropriate type of treatment.
The traumatized limb should be carefully assessed for neurovascular injury and possible compartmental syndrome. Most of the fractures can be diagnosed by routine AP and lateral X-ray. It is necessary to have the X-ray which includes the whole length of bone to rule out the other lesions. If the patient is unconscious, the lateral cervical spine and pelvic A térd condyles gyulladása should be taken to rule a térd condyles gyulladása the injury.
In articular fractures the oblique X-ray may be added to see more details of the fractures. CT scan is helpful to determine the degree of the displaced articular surface or loose fragment in the joint. After gathering the information about the patient and the personality of the fractures, the surgeon has to answer the following questions. Ízületi vírusgyulladás the surgery has to be done as an emergency, urgency or as the elective procedure?
What is the position of the patient and the appropriate surgical approach? Which type of the stability of the fixation is suitable for the fracture? What kind of implants should be used to obtain the desired stability with less disturbance to the viability a térd condyles gyulladása bone and soft tissue? Which method of reduction is required in respect to the accuracy of reduction and axial alignment of the extremity.
- Könyök Chondromalacia térd Fájdalom a térdben, kellemetlen érzés a séta során ugyanolyan gyakran fordul elő mind fiatal, mind idős embereknél.
- Pediatric patients 14 to 17 years with closed epiphysis may be included in selected countries.
- A térdfájdalom sokakat érint, és számos oka lehet.
Do you need any additional equipment or instrument to facilitate the surgical procedure? The answers to these questions are decision making process and pre operative planning to help the surgeons to think ahead about the possible problems. In order to reduce the complication the proper pre operative planning in very case and perform the surgical procedure according to the plan.
The well planned surgery will reduce the operating time and the surgeon can anticipate the possible problem that may happen during surgery. All the proper instruments and implants are checked before the operation. The treatment of the complication case is even more difficult and requires extensive analysis. What are the causes of failure and how the fixation has to be revise?
Do we need a better investigation to analyse the fracture?
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Is there associated with infection and why it fails? Please keep in mind that the patient has already suffer for the failure of the first operation that can be vary from some months or years that he could not work or have a good function.
The preoperative planning with the following answers : shall we use the same incision or different, how do we remove the implant, shall we use the implant as the reference for the insertion of new implant, do we use the same type of implant or change to new type. Do you require special type of implants or instrument. Is bone graft necessary.
Finally are you competent to perform this operation and guarantee the success. Do you need to consult or refer this case?
When evaluating the complication of osteosynthesis particularly on implant failure it can be divided into the following causes ie. The difficulty in the revision of failed internal fixation case are numerous. The scar and soft tissue contracture around the previous incision.
There is no well define anatomical land mark of the bone around the fracture zone. Multiple loosening holes create by screw and disuse osteoporosis compromise the good purchasing of new screw fixation. More bleeding and more stripping of surrounding soft tissue to expose the fracture area.
The operative time is longer and the chance of infection is higher. The more difficult and complex surgery require meticulous analysis and pre operative planning in more detail to reassure for the successful outcome.
As surgeons you are fully responsible for the success and failure of surgical intervention that have done to the patient. You should always treated the patient with the right indication and the best available technique same as you want to be treated.
Prevention of complication is always better than correction. However when there is complication you have to analyse how it happened and not to repeat the same mistake.
It is mandatory that all trauma surgeons have to follow the AO principle of operative treatment of fracture, to be educate and well train to avoid the complication which cause disability and suffering for the patients. So we can avoid Oh! My God another failure.