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Re: Open supracondylar femur fx
Tim Kavanaugh 02 Ноябрь 2004, 01:17
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Having trained under orthopaedic traumatologists in residency I have a huge amount of respect for the opinions that have been recorded on this topic. Since I have been in private practice for over two years now,h I know how this would be treated. In private practice this would get cannulated screws across the intra-articular component and a retrograde nail. This is a no brainer. All of the opinions about the LISS plate are great, but if you dont have residents, this takes too much time. No one can argue about the healing potential of a retrograde nail in this situation.
Tim Kavanaugh MD
Anchorage, AK
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Re: Open supracondylar femur fx
Frederic B. Wilson, M.D. 15 Ноябрь 2004, 15:54
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Tim,
Level I Trauma Center, ETMC in Tyler Texas. No residents. This is about a 30-40 minute case for us. More stable, less worry about varus/valgus toggle, less damage to the knee joint.
Fred
Frederic B. Wilson, M.D.
Trauma & Adult Reconstruction
ETMC First Physicians - Orthopaedic Clinic
700 Olympic Plaza Circle, Suite 510
Tyler, TX, 75701
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Re: Open supracondylar femur fx
Chip Routt 15 Ноябрь 2004, 15:58
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Tim-
You've recommended a technique in Alaska based on perceived technical speed?? Would you choose/advocate that for your surgeon...your surgeon chooses your operation based on how fast he/she can accomplish the procedure?
Do you also suggest that we speed the irrigation because one liter is faster than six or twelve? Do you advocate that we limit the debridement to the easily visualized field because extending the wound margins to further explore would take more time? If speed is the focus, why advocate cannulated screws...why not just sling in a few cheaper screws? Chop-chop!
Please consider the patient management based on quality of care principles (debridement, reduction, stability, wound management, rehab) rather than operative speed and resident allocations.
We learned a long time ago that a fast operation/surgeon does not necessarily reflect improved surgical skill and result. We also know that an expensive implant does not always equal a good implant.
Surgery should not be a race, unless we have a patient in a dire situation.
Many surgeons also realize that helping residents-in-training learn how to care for patients does not necessarily facilitate an operative event.
Let's accept that we're all trying to be efficient, but please don't lose sight of the patient and his/her situation.
There are numerous ways to successfully treat this patient's open femur fracture, and each method has its own issues and benefits.
Wound and fracture debridement, articular reduction, axial alignment and rotation, and stability must be prioritized, and in turn should diminish infection risk and speed recovery.
A planed and methodical initial operation likely avoids subsequent іcorrective/recovery procedures.
Quality-
Chip
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