With the global COVID-19 pandemic, orthopaedic surgeons are being challenged to consider whether many of the fractures that we have become accustomed to treating surgically can actually be managed non-operatively. As our ability to carry out general anaesthesia and specialist blocks becomes constrained and our desire to keep patients out of hospital intensifies, this webinar considers the fundamental question of which fractures can be safely managed non-operatively, and what that treatment looks like.
Join us on Wednesday 15th April at 8pm to hear our panels thoughts and discuss with them. Sign up here.
Wrist Fracture
34 yr old, non dominant wrist. Motorbike accident. Closed, NV intact.
Points for consideration
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Tibial Plateau
35 yrs female - pedestrian vs her dog. Hit from behind with posterolateral depression. CT shows no medial extension.
XRay AP
XRay Lateral
CT Coronal
CT Saggital
CT Axial
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Ankle Fracture
60 yrs bus driver, tripped down a step. Closed injury, no NVD. PMH - Cirrhosis, SLE, DM (tablet controlled). COVID-19 +VE.
XRay AP
XRay Lateral
Post Cast AP
Post Cast Lateral
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Elderly Fracture Neck of Femur
81 yrs female. Advanced dementia, unwitnessed fall on the medical ward having tested positive for COVID-19. Noted to be hypoxic (sats 85% on 4L Oxygen), fast AF, heart not great. Anaesthetist says over 90% chance of death if we operate!
Pelvic XRay
Chest X-Ray
This is genuine!
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Summary
Our panel have their opinions! We would love it you post your opinions and discussion below. Please also bring your them to the live webinar to discussion on Wednesday 15th April 2019. More information, and to sign up details.
Why total contact casting in patient who does not have a diabetic neuropathy? No evidence for using TCC in fractures not sure why this is even an option? Similar to using distal femoral replacement for simple knee OA, wrong treatment and wrong diagnosis.
The TCC reduces force transmission through the sole of the foot for diabetic foot ulcer off loading, allows wt bearing whilst also off loading. This man will be NWB so TCC is the wrong treatment.
Hi Geraint, what we are actually referring to is a close contact cast. As you correctly point out TCC is for neuropathic feet. Apologies for any confusion.
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Why total contact casting in patient who does not have a diabetic neuropathy? No evidence for using TCC in fractures not sure why this is even an option? Similar to using distal femoral replacement for simple knee OA, wrong treatment and wrong diagnosis.
The TCC reduces force transmission through the sole of the foot for diabetic foot ulcer off loading, allows wt bearing whilst also off loading. This man will be NWB so TCC is the wrong treatment.
Hi Geraint, what we are actually referring to is a close contact cast. As you correctly point out TCC is for neuropathic feet. Apologies for any confusion.
Video on close contact cast application