Welcome to ST3 Interview – ‘Success in Trauma & Orthopaedics’
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I would divide my management plan into early management and surgical management.
In the acute setting, there are several Early Management interventions to consider:
– After reduction, an above-knee plaster will immobilise the limb and provide analgesia, stability and rest for the soft tissues. It also allows for repeated neurovascular examinations.
– I would immobilised the knee to 20° of flexion as this prevents posterior subluxation of the tibia.
– Post-reduction X-rays are vital.
– I would consider application of an external-fixator if there was: a) vascular injury b) gross instability.
– I would also arrange an MRI to assess for bone and soft tissues injuries and also for potential surgical planning.
– Ongoing surgical treatment should ideally be performed by knee surgeon familiar with multi-ligament injuries
In the longer-term, important factors influence Surgical Management:
– Non-operative management results in inferior outcomes
– Regarding timing, there is increasingly a consensus that early surgery should be performed (within 2–3 weeks)
– A staged approach is still the practice of some authors, opting to reconstruct the PCL ± medial and lateral structures acutely and the ACL later
Yes, the Allman Classification with Neer’s Modification. This broadly classifies the fracture according to their location on the clavicle. Group 1 are middle third fractures and are the most common, Group 2 is lateral third fractures and can be subdivided as per Neer’s classification, and Group 3 is medial third fractures.