Discusión entre pares / 65 female , what do u suggest , also do u think coronoid is fractured ?

65 female , what do u suggest , also do u think coronoid is fractured ?
  • Manikandan Jeyaprakash Go for proximal ulna lcp
  • Ashutosh Chaudhari Thanks was planning to use the Synthes olecrenon plate , what about radial head and what do u think about the coranoid
  • Gopal Goel in the current x ray coronoid does not apear to be fractured. # Prox unla with displaced # neck radius. I would go for excision neck radius + fixation of ulna. At this age i would not think in terms of head prosthesis unless patient wants it
  • Arvind Jain Coronoid not fractured. increase flexion to achieve reduction.radius head can be excised .
  • Sudheer Ks K S No coronoid. Radial head excision. Lcp ulna
  • Ajayakumar Thankappan Orif ulna, use cancellous bone from radial head as bone graft
  • Animesh Kumar Assess MCL n LCL also. I will suggest, if in doubt, go for CT scan with 3D recon
  • Animesh Kumar I think the capsule attached over coronoid is avulsed with small bony fragment
  • Anuj Agrawal There seems to be a tip of coronoid fracture, which would not affect management. I too would go with ulna plating with radial head excision.
  • Ashutosh Chaudhari i agree with u anuj ,and animesh ,i feel that tip of coronoid is frac ,wondering if thru the rad head exicion portal shoud put a suture anchor and take sutv orv leave alone with slab in more than 90 deg flexion for 3 weeks,any one in favour of radial head replacement ?
  • Ashutosh Chaudhari anuj would u use a standard lcdcp with cancellous screws or an olecrenon lcp
  • Kamlesh Dutta Tiwari take xray ap view of elbow in supination and in pronation this will give u additional information.then proceed.
  • Ashutosh Chaudhari ajaykumar ,that was in my head as well since we will getv a source of cancellous bone
  • Bharat Durgia OLECRANON HOOK PLATE
  • Animesh Kumar If cost is not an issue den go for olecranon plate cos with normal plate u will not get 3 screws proximally. U can safely excise radial head. However, I still insist on assesing LCL n MCL n keep sutures anchors, hinged ext fixator, Steinman pin handy
  • Anuj Agrawal Ashutosh Chaudhari Any plate would do in this case. I would use a standard LCDCP. You will get 3 screws proximally. The bone does not seem to be too osteoporotic to necessitate a locked plate.
    Don’t attempt to fix the coronoid piece. Three weeks of immobilization should stabilise the elbow.
  • Ashutosh Chaudhari Anuj which surface would u plate if I use a dcp then I need to plate one of the sides , instead of post so screws don’t enter the joint ( and don’t irritate pt ) and we get 6 cortices proximally , she is not porotic , but its a metaphsiodiaphseal junc , so contemplating
  • Anuj Agrawal I would expose the posterolateral surface of ulna and proximal radius through a single incision (Boyd’s approach) and apply the plate laterally.
  • Ashutosh Chaudhari That was my plan for exposure – boyds , thanks Anuj
  • Mufazzal Bohra olecronon hook plate will be best for this case as it give extra hold proximally, in TRAUMACON i have seen a custom made olecronon plate made by a surgeon by a surgeon by manipulating low profile semitubular plate by cutting its end hole and giving shape of claw to its end , this pointed 2 spike penetrated prox fragment and then 2 screw are sufficient in prox frag u can try this too
  • Mufazzal Bohra olecronon hook plate will be best for this case as it give extra hold proximally, in TRAUMACON i have seen a custom made olecronon plate made by a surgeon by a surgeon by manipulating low profile semitubular plate by cutting its end hole and giving shape of claw to its end , this pointed 2 spike penetrated prox fragment and then 2 screw are sufficient in prox frag u can try this too
    olecronon hook plate will be best for this case as it give extra hold proximally, in TRAUMACON i have seen a custom made olecronon plate made by a surgeon by a surgeon by manipulating low profile semitubular plate by cutting its end hole and giving shape of claw to its end , this pointed 2 spike penetrated prox fragment and then 2 screw are sufficient in prox frag u can try this too
  • Rajasekhar Rao P trust me give a trail of usg for bone healing for 6 wks and then plan what u wan t
  • Feroz Khan Fracture proximal ulna with radial neck with coronoid…..triad…fix ulna fix radius and fix coronoid. …if we excise the head will elbow become more unstable?? What does the forum feel
  • Sadique Ahmed Khan Fix ulna with lcdcp or locked plate.
    Radial head already compltely # n detached just u need to remove.
    Coronoid tip #, nothing to do for that.
  • Nitin Bhagali Without posterior angulation deformity at the # it is unlikely to have a coronoid #. Synthes olecranon plate, excision head radius needs to be done. I normally transfix inferior R U joint with a K wire to prevent prox migration of radius for 3 wks.
  • Ashutosh Chaudhari nitin bhagali ,how does that help ,i thought the problem was instability
  • Rakesh Agarwal fix ulna with whatever pate you like even recon plate will give you good result with proximal screw directed towards upper surface. radius head seems t be comminuted remove it, can go for radial head prostheses if pt affordabl

I Thought Everyone Knew That RICE Is Effective in Treating Acute Ankle Sprains!

http://www.healio.com/orthopedics/journals/atshc/%7B0b0277bb-bfdf-4840-8488-bb044d4464b8%7D/i-thought-everyone-knew-that-rice-is-effective-in-treating-acute-ankle-sprains

EDITORIAL 

I Thought Everyone Knew That RICE Is Effective in Treating Acute Ankle Sprains!

Thomas W. Kaminski, PhD, ATC, FACSM, FNATA
  • Athletic Training and Sports Health Care
  • November/December 2012 – Volume 4 · Issue 6: 247-248
  • DOI: 10.3928/19425864-20121026-01
Forgive me if I return to a favorite topic of mine for this editorial message—evidence-based medicine. As another semester of teaching “Evidence-Based Sports Medicine” to this year’s group of graduate students comes to a close, the topic is fresh in my mind. In addition, J. Timothy Sensor’s eloquent guest editorial1in the July/August 2012 issue of Athletic Training & Sports Health Care continues to stress the importance of athletic trainers staying in touch with the latest evidence in support of their clinical practice.
Perhaps that message has become more clear following the release of an article in the August 2012 issue of the Journal of Athletic Training, titled “What is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?”2 Perhaps as American as “Apple Pie” has the acronym RICE (Rest, Ice, Compression, Elevation) become, not only in athletic health care but in most acute injury situations. I can still remember being told by my mother, when I would get a bump or bruise as a child, to just “RICE” it!
The excellent exposition by van der Bekerom et al2 set out to answer a simple question: What is the evidence to support the effectiveness of applying RICE therapy within 72 hours after trauma for patients in the initial period after ankle sprain? I thought—as I’m sure many others who read that article also did—hasn’t this question already been answered? RICE therapy has been such a foundational aspect of sports health care in the United States over the past 60+ years that most clinicians probably thought its effectiveness was a given. So much for believing all that you hear and are taught! Amazingly, the systematic review by van der Bekerom et al2 was able to include only 11 randomized controlled studies to make their case that RICE is not very effective in treating acute ankle sprains. Eleven studies in 60+ years on an injury intervention protocol that is so popular among sports health care professionals is unbelievable! So much for progress!
Here is the bottom-line message from those authors: “Insufficient evidence is available from the randomized controlled trials to determine the relative effectiveness of RICE therapy for acute ankle sprains in adults.2 Say what? Will this cause clinicians to stand up and take notice? Clinicians must begin to realize that even some of our most prevalent and commonplace treatment interventions have not been properly scrutinized by randomized controlled trials to ensure their effectiveness. Clinicians need to be vigilant in utilizing only treatment schemes that have proven effectiveness, even if it means getting rid of those they believeare effective.
We health care professionals must wake up to the evidence around us and continually question “why” we provide treatment interventions in an effort to return athletes back to competition swiftly and effectively. I urge clinicians and researchers to develop partnerships to find ways to better study and understand many of the treatment routines we have so robustly accepted and instituted through the years, despite any real evidence to support their effectiveness. We cannot wait; our client base is depending on us to choose the most effective treatment.
Season’s greetings from all of us here at Athletic Training & Sports Health Care! This 6th issue closes the 4th volume of the journal. Many thanks to our editorial board and staff for their hard work and dedication and for their contributions to the success we have enjoyed these past 4 years. Best wishes as we move forward in 2013 with Volume 5.

References

  1. Sensor JT. We have met the enemy, and it is us. Athletic Training & Sports Health Care. 2012;4(4):147–150. doi:10.3928/19425864-20120629-01[CrossRef]
  2. van der Bekerom MP, Struijs PA, Blankevoort L, Welling L, Van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?J Athl Train. 2012;47(4):435–443.