Open fracture Lower 3rd forearm | Ex-fix forearm | Open Wrist injuries | Adamya Hospital Videos

Summary

This video showcases a complex case of a patient who was hit by a car, resulting in a severe open fracture and dislocation. The medical team quickly stabilized the limb using a splint, performed a thorough wound cleaning, and reduced the fracture. An external fixator was applied for further stabilization, and excision of damaged bone fragments was necessary. The patient’s condition improved with excellent oxygenation levels, and the wound was carefully closed and dressed. The video emphasizes the skill and teamwork of the medical professionals, offering a detailed look at emergency orthopedic care.

Takeaways

• 😀 The patient suffered a severe open fracture and dislocation from a car accident while trying to stop the vehicle.
• 😀 Immediate action involved splinting the limb and cleaning the wound with XYO gel and normal saline.
• 😀 An initial thorough wash and sterile dressing were applied to the injury site, followed by a temporary slab.
• 😀 Oximeter monitoring was performed, and pulse improvement was observed after fracture reduction.
• 😀 The fracture site was assessed using palpation to ensure correct reduction without causing further vascular injuries.
• 😀 An external fixator was used to stabilize the wrist and hand, with precise placement of shan pins in the second metacarpal.
• 😀 Drilling for the shan pins was done carefully to avoid additional damage, with the use of CR pins for added precision.
• 😀 The alar head was excised due to its comminuted fracture, with bone pieces being used as grafts for the radius.
• 😀 The wound was cleaned, and no new incisions were made, ensuring that all procedures were done through the original open wound.
• 😀 Postoperative care included applying sterile dressings and a volar slab for pain management, with oxygen saturation improving to 99%.
• 😀 The team of doctors, anesthesiologists, and staff worked collaboratively to ensure the patient's recovery, even during off-hours.

Q & A

What was the nature of the injury sustained by the patient?

The patient was hit by a car and tried to stop it, sustaining a severe open fracture dislocation in their right arm along with vascular insufficiency.

What initial treatment was provided to the patient after the injury?

The injury was initially cleaned, a thorough wash was given, and sterile dressing was applied. A temporary slab was also placed to provide support.

What was the role of the oximeter in the treatment process?

The oximeter was used to monitor the patient's oxygen levels, ensuring proper oxygenation during the treatment process.

How was the fracture reduced?

The fracture was reduced using a bone lever to align the fractured site. Care was taken to avoid any further vascular injuries during the reduction.

Why was an external fixator used in this case?

An external fixator was applied to stabilize the arm and wrist while the wound healed, ensuring proper alignment and preventing further complications.

What is the significance of using Shan pins in the procedure?

Shan pins were used to fix the fracture in place, with careful drilling to avoid damaging surrounding structures. They were also used for stability during the healing process.

How was the radial shaft treated during the procedure?

An incision was made to expose the radial shaft, and drilling was performed to position the Shan pins. This was necessary for stabilizing the fracture and facilitating healing.

What was done to address the comminuted fracture of the alar head?

The alar head was excised due to the comminuted nature of the fracture. The same bone pieces were then used as grafts for the lower end of the radius.

How was the wound closure carried out?

The wound was closed with interrupted mattress sutures, and the shape of the forearm and wrist was observed to be improving after the reduction and external fixation.

What post-operative care was provided after the surgery?

Postoperative care included cleaning the forearm with saline, applying sterile dressings, and providing a volar slab for analgesia to manage pain after surgery.