Right Distal Tibial Oblique Fracture Open Reduction and Internal Fixation (ORIF) with Medial Neutralization Non-locking Plate
Andrew M. Hresko, MD; Edward Kenneth Rodriguez, MD, PhD
Beth Israel Deaconess Medical Center
Diaphyseal tibial fractures are common injuries that are most often treated with intramedullary nailing. However, certain patient factors may necessitate alternative treatment strategies such as open reduction internal fixation (ORIF) with plates and screws. Presence of a total knee arthroplasty (TKA) in the injured extremity is one such factor. TKA is a common operation that is only increasing in popularity, and management of tibia fractures distal to TKA may be a frequently encountered clinical scenario.
This video presents a technique for ORIF of a distal diaphyseal tibia fracture distal to a TKA that precludes intramedullary nail fixation. The fracture is fixed with lag screws and secured with an anatomically-contoured distal tibia locking-compression plate (LCP) in neutralization mode.
Carbon Fiber Implant for Fixation of a Pathologic Subtrochanteric Fracture
Paul A. Rizk, MD; Joseph O. Werenski; Santiago A. Lozano-Calderon, MD, PhD
Massachusetts General Hospital
This case presents a patient with a pathologic subtrochanteric femur fracture secondary to an undiagnosed primary lung adenocarcinoma. The fracture, occurring in the context of persistent atraumatic thigh and knee pain, prompted swift identification of its pathological nature in the Emergency Department. The treatment plan involved open reduction and internal fixation utilizing a carbon fiber nail, considering the immediate need for stabilization and underlying oncologic factors.
This article highlights the strategic use of carbon fiber implants in managing pathologic fractures, offering advantages in postoperative imaging, disease monitoring, and precision in radiation therapy planning. The multidisciplinary approach underscores the importance of considering implant selection nuances, especially in metastatic bone disease, to optimize outcomes.
Brostrom-Gould Procedure for Lateral Ankle Instability
William B. Hogan1; Eric M. Bluman, MD, PhD2
1Warren Alpert Medical School of Brown University
2Brigham and Women’s Hospital
Acute ankle sprains are most frequently treated conservatively, although some surgeons may advocate acute repairs in certain situations. Surgery is indicated for chronic sprains with persistent ankle instability despite well-designed conservative management. Several anatomic and nonanatomic operative procedures are available. The Broström-Gould procedure is a widely-used operative intervention for the treatment of chronic lateral ankle sprains. It consists of an anatomic repair or reconstruction of the injured lateral ankle ligament complex (Broström procedure), followed by suturing of the inferior extensor retinaculum to the periosteum of the distal fibula (Gould modification).
This article describes the standard Broström-Gould procedure starting with the identification of the anatomic landmarks. The skin incision follows the anterior border of the distal fibula, and careful subcutaneous dissection is carried out to expose the extensor retinaculum and the torn ligaments. This is followed by bone preparation and ligament repair utilizing a box stitch technique while holding the ankle in an appropriate position. Finally, the Gould portion of the procedure is demonstrated.
Corneal Staining with Fluorescein
Alexander Martin, OD
Boston Vision
Patient ocular complaints often center around discomfort, foreign body sensation, and/or recent trauma. Determining the cause of the ailment is not always straightforward, and the use of fluorescein can provide valuable information that aids in clinical diagnosis. Many corneal conditions and emergencies can be identified with the aid of fluorescein such as corneal erosion, superficial punctate keratitis, corneal abrasion, foreign bodies, and tracking patterns of foreign bodies. This article and video will demonstrate proper technique to instill fluorescein and examine ocular tissues, as well as some examples of staining defects characteristic of compromised ocular tissues.
Pulsed Dye and Fractional CO2 Laser Therapy for Treatment of Burn Scars
Robert Dabek, MD1; Harrison McUmber2; Branko Bojovic, MD1,3
1Massachusetts General Hospital
2Tufts University School of Medicine
3Shriners Hospitals for Children – Boston
Burn injuries are often devastating accidents that result in long-term physical and psychosocial consequences and the formation of hypertrophic scars. Laser treatment is a low risk minimally invasive approach to treating such burn scars.
This video discusses the pulsed dye laser (PDL) and fractional ablative CO2 laser, and demonstrates their use in treating the scars on a pediatric patient who suffered from burn injuries 7 years ago in Vietnam.
Open Reduction and Internal Fixation of Mandibular Body and Parasymphyseal Fractures with Maxillomandibular Fixation and Broken Tooth Extraction
Derek Sheen, MD1; Cheryl Yu, MD2; Sarah Debs, MD2; Peter Kwak, MD2; Nima Vahidi, MD3; Daniel Hawkins, DDS2; Thomas Lee, MD, FACS2
1University of Texas Southwestern Medical Center
2Virginia Commonwealth University Medical Center
3Upstate Medical Center
This is a case discussing a 21-year-old male who suffered from both non-comminuted mandibular parasymphyseal and body fractures as a result of a motor vehicle accident, requiring open reduction internal fixation (ORIF) without postoperative maxillomandibular fixation (MMF). The fracture was complicated by a broken tooth root, which required extraction.
After intraoperative MMF, ORIF was performed. The parasymphyseal fracture was plated using two locking four-hole 2-mm thick miniplates utilizing two locking screws on either side of the fracture with one plate along the alveolar surface (monocortical screw) and one along the basal surface (bicortical screw). For the right body fracture, a three-dimensional locking ladder plate was used via a transbuccal trocar approach for additional exposure needed for proper screw placement. Once the hardware was secured, the patient was taken out of MMF and restoration of premorbid occlusion was confirmed. Lastly, watertight mucosal closure was performed using absorbable sutures and Dermabond (cyanoacrylate adhesive).
Microscope Drape for Aerosol-Generating Procedures During COVID-19 Pandemic
C. Scott Brown, MD1; Paulo Dominaitis, CST2; Fred F. Telischi, MEE, MD, FACS1
1 University of Miami Miller School of Medicine
2 Bascom Palmer Eye Institute
Coronavirus disease 2019 (COVID-19) has emerged as a worldwide pandemic, profoundly impacting healthcare systems. Despite the use of personal protective equipment, concerns remain over the potential transmission of SARS-CoV-2 for otolaryngologists. Transmission occurs via respiratory droplets and aerosolized virus particles, which are generated during specific interventions such suctioning, bone drilling, and the application of diathermy. The mastoid and middle ear mucosa are connected to the nasopharyngeal mucosa and can serve as a potential source of viral particles in an infected patient. This highlights the need for the development and implementation of strategies that minimize aerosol spread.
Contracture Release and Full-Thickness Skin Graft to Volar Index Finger with K-Wire Insertion
Ryan P. Boyle1; Jonah Poster2; Jonathan Friedstat, MD3
1Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
2Icahn School of Medicine at Mount Sinai
3Shriners Hospitals for Children – Boston
The complications stemming from a poorly-healed burn wound can lead to functional deficits and overall aesthetically unfavorable results leading to psychological distress. Due to the inquisitive nature of infants and toddlers, and their nature to learn the world with their hands, their sensitive regions like the hands become likely targets for burns.
Superficial burns can be managed on an outpatient basis with spontaneous healing expected in 2 or 3 days with minimal scarring. Deep burns, particularly in pediatric populations, need considerable attention to avoid secondary contracture that leads to deformity.
Many treatment options exist, but in sensitive areas like the hands and face, full-thickness skin grafts are favored due to their superior healing and decreased likelihood of secondary contracture. This article aims to guide the surgeon in managing a pediatric burn wound with an arsenal of treatment options with the goal of achieving full mobility and functionality of the hand.
Flexible Bronchoscopy and Bronchoalveolar Lavage (BAL)
Marcus S. Alpert, MD; Yu Maw Htwe, MD
Penn State Health Milton S. Hershey Medical Center
Flexible bronchoscopy is a commonly utilized endoscopic procedure allowing for direct visualization of the airways, as well as a variety of therapeutic and diagnostic interventions. Common indications of flexible bronchoscopy include evaluation of pulmonary infiltrates, hemoptysis, airway obstruction, foreign body aspiration, tracheal stenosis, bronchopleural fistula, and post-lung transplant.
The procedure involves the insertion of a flexible bronchoscope through the vocal cords and into the lumen of the trachea and bronchi. Direct visualization is provided by fiberoptic video imaging. Bronchoalveolar lavage (BAL) further refers to instillation and subsequent recovery of sterile saline into the airways. In this article, we will detail the technique, considerations, and complications of flexible bronchoscopy and BAL.
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