RaquelBorja
Contributor
Our trauma (Dr. A) and joint replacement (Dr. B) providers both performed this procedure, our trauma provider performed the arthrotomy and IM nail removal, while the ortho provider performed the irrigation and debridement and insertion of antibiotic spacer. At first, I thought we could ill the IM removal for the trauma provider and I&D and spacer insertion for the ortho provider, but now I am not so sure. Will you please share your thoughts on this case?
Trauma Dr. A:
We open the 2 scars proximally for the interlocks of the thigh. These were percutaneous incisions. Fluoroscopic guidance was
used in both screws were encountered and removed without complication.
We then returned our attention distally. The knee was flexed over a triangle. Prior incision was opened over the midline. A lateral
parapatellar arthrotomy was reopened in line with her traumatic rent more proximally. The lateral distal interlocking screws were
encountered. There still was attachment to the lateral trochlea through the nail with 2 of the locking screws. These were both
removed. Percutaneous incisions were made medially and the anterior medial and medial to lateral interlocking screws removed.
The nail was then removed without complication. Fluoroscopy confirmed complete removal of the nail.
At this point Dr. B came in for his portion of the procedure
Ortho Dr. B:
Dr. A performed the approach and removed the intramedullary nail. I took over at this point. Abundant grossly inflamed
tissues were encountered. All fracture fragments were removed and all infected appearing tissue was debrided. The wound was
then irrigated and the femoral and tibial canals were then debrided. The entire wound was then soaked in a Betadine-peroxide
lavage followed by a 3 L normal saline rinse. Bactisure was then used followed by a 3 L normal saline lavage. Next, the wound
was bathed in Irrisept for 1 min and irrigated with copious normal saline. The wound was then packed with Betadine soaked lap
sponges and a new top layer of drapes were placed.
External fixator rods were used to create cemented femoral and tibial dowels on the back table. The femoral and tibial rods then
inserted into host bone and were connected with the small bar connector.
Trauma Dr. A:
We open the 2 scars proximally for the interlocks of the thigh. These were percutaneous incisions. Fluoroscopic guidance was
used in both screws were encountered and removed without complication.
We then returned our attention distally. The knee was flexed over a triangle. Prior incision was opened over the midline. A lateral
parapatellar arthrotomy was reopened in line with her traumatic rent more proximally. The lateral distal interlocking screws were
encountered. There still was attachment to the lateral trochlea through the nail with 2 of the locking screws. These were both
removed. Percutaneous incisions were made medially and the anterior medial and medial to lateral interlocking screws removed.
The nail was then removed without complication. Fluoroscopy confirmed complete removal of the nail.
At this point Dr. B came in for his portion of the procedure
Ortho Dr. B:
Dr. A performed the approach and removed the intramedullary nail. I took over at this point. Abundant grossly inflamed
tissues were encountered. All fracture fragments were removed and all infected appearing tissue was debrided. The wound was
then irrigated and the femoral and tibial canals were then debrided. The entire wound was then soaked in a Betadine-peroxide
lavage followed by a 3 L normal saline rinse. Bactisure was then used followed by a 3 L normal saline lavage. Next, the wound
was bathed in Irrisept for 1 min and irrigated with copious normal saline. The wound was then packed with Betadine soaked lap
sponges and a new top layer of drapes were placed.
External fixator rods were used to create cemented femoral and tibial dowels on the back table. The femoral and tibial rods then
inserted into host bone and were connected with the small bar connector.