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34th Annual Conference of Gujarat Orthopaedic Association

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Date: 5-7th February 2016
Event: 34th Annual Conference of Gujarat Orthopaedic Association
Venue: Vadodara, Gujerat, India
Speaker: Dr Khong Kok Sun

(1) Why Fracture Fixation Fails? Evaluation

All fractures want to heal and sometimes it is the surgeon that disturbs the biological milieu to the point where delayed union and non-union occurs. This transfers excessive load to the fracture implant which then breaks or loosens.

There are 5 main factors which may lead to fixation failures, namely:

  1. Is the fracture fixation planned well
  2. Are the fracture ends reduced adequately in 3 planes
  3. Have the right implants been selected and implanted
  4. Has the surgeon performed the operation in a tissue-friendly manner
  5. Have the patient and injury factors been taken into consideration

The speaker will show examples of fixation failures and the techniques to avoid them. In the final analysis there are really no “mistakes” nor “failures”, only lessons to be learnt.

(2) Plating in Subtrochanteric Fracture – My Perspective

Subtrochanteric Fractures are still an enigmatic clinical problem despite being identified as a special type of injury in 1970. Over the decades, both plating and nailing have been used, and each one have their own set of problems and technical difficulties.

The speaker will show the mechanobiological basis of the fracture pattern and how best to reduce the fragments, which play a crucial role in the success of surgery. In addition, he will show why plating is superior both in fracture reduction and stability. New plates and techniques will be showcased.

(3) Fracture Reduction in MIPO for Proximal Humerus

Minimally Invasive Plate Osteosynthesis (MIPO) is currently in vogue and is widely applied in the proximal humerus and other limbs. Through small incisions, many parts of the fracture surface may not be visualised except by the use of the C-arm. This results in additional radiation to the surgeon and his team.

There are direct and indirect methods of achieving fracture reduction using traction, manipulation and the many reduction tools a surgeon has at his disposal. With these methods, harmful radiation may be avoided or at least minimised.

(4) Anterior Column Acetabular Fracture Management

Compared to posterior column and wall fractures of the acetabulum, those of the anterior column and wall are quite uncommon. Some are associated with hip dislocation. By the AO-OTA classification, they comprise the 62-A3 and 62-B3 fractures. Close study of the Xrays are required but the fracture is well-defined on CT scans. This allows good pre-operative planning and surgical tactic.

The ilio-inguinal, iliofemoral, Stoppa and MIS approaches allows direct reduction and fixation of the fracture using screws alone or in combination with pelvic plates.

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