ML Chip Routt
@ChipRoutt
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We are sad to say goodbye to this crew of fantastic fellows, but also excited for all that’s ahead for them! Go do great things!
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The AC frx surfaces had brisk bleeding so we quickly cleaned them and reduced the AC with manual limb traction and a spiked pusher. This quick maneuver stopped the frx related bleeding. Our preop plans and the sequence of exposure should always account for such circumstances.
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The plain pelvic and axial CT images demonstrate bladder displacement most likely due to bleeding from the left associated both column acetabular fracture. The surgeon should be well prepared to work expeditiously if/when the fracture surfaces bleed excessively at surgery.
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Asymmetrical upper sacral dysmorphism is seen in this pediatric patient - these surface rendered images in pediatric (and adult too!) patients offer us excellent opportunities to better understand the natural history and details of this condition.
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The upper sacral osseus fixation pathway obliquity is seen on the axial image. The second sacral segment shows much more bone area available for fixation screws. It’s crucial to understand sacral dysmorphism in order to accurately plan and perform safe posterior pelvic fixation.
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Upper sacral dysmorphism is seen on these images. The outlet rendering shows the upper sacrum colinear with the iliac crests, residual disc, residual transverse processes (mamillary bodies), noncircular upper nerve root tunnel exits, and more acute alar slopes. The axials confirm
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Our annual UTH Ortho research day has started - so much enthusiasm for excellent research - it gets us to the clinical solutions that we need. Plus Huge Congratulations to our resident graduates!!
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Communication and safety routines are very important - once we positioned prone, there were unequal breath sounds and ventilation difficulty-we can check extrinsic factors quickly as the C arm is positioned to check the tube depth, and then again to confirm successful adjustment
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We thrive on our early morning weekly pelvic/acetabular educational sessions - we held our last session today for this group of young surgeons!! Go get ‘em!!!!
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Deep iliac abscess formation is shown on the CT image 3weeks after iliac/SI ORIF and anterior pelvic ext-fix. Using this combination risks the frame pin tract directly contaminating the deep surgical wound. This should be avoided whenever possible using other techniques.
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The postop CT images reveal the result/implant details. It’s more common to perform pubic ORIF however certain clinical situations prevent this. This technique can be used if/when the pubic closed reduction is sufficient. This example shows the added benefit of the lag screw.
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A fully threaded iliosacral screw was added to provide additional fixation - the reduction was maintained after the taping was removed.
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Internal Rotation Taping of the LEs improved the pubic reduction. These sequential outlet pelvic intraop fluoroscopic images show the pubis being further indirectly compressed/reduced when the transiliac transsacral lag screw is tightened.
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Equestrian accidents can cause traumatic and symptomatic symphysis pubis disruptions - this active senior patient could not get up from the ground after the accident. The left SI joint has evidence of injury as well. He has chronic issues that complicate routine pubic ORIF.
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An additional oblique lag screw was added percutaneously to finalize the construct. The postop CT reveals the reduction quality and implant details. Stay alert and ready - things may not always be what we initially think them to be! The “open books” don’t always close easily!
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The percutaneously inserted cannulated iliosacral oblique lag screw reduced, compressed, and stabilized the SI joint injury.
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The plate was applied and the clamp was removed - but the “incomplete” SI joint injury did not indirectly reduce! We underestimated the SI injury extent. So as you can see, we then prepared the upper sacral pathway for a cannulated lag screw reduction/fixation.
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An anterior exposure was used to reduce and clamp the pubis. You can see that the clamp tines can be docked in either bone or soft tissue as long as the tissues are dense enough to hold the clamp reduction. The clamp is positioned to correct deformity and not obstruct the plate.
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