Can you please video on the shattered femur from sub troch to distal third femur, implant of choice
@Justorthothings2 күн бұрын
Sure, will add soon
@MrShivsena3 күн бұрын
Great presentation... You are God for Complex trauma💯
@mohamedmagdy454 күн бұрын
Why the augment????
@Justorthothings4 күн бұрын
Severe osteoporosis
@parkaviyanr63974 күн бұрын
Age of the patient?
@Justorthothings4 күн бұрын
85 years
@akramtaha82446 күн бұрын
Excellent 👍🌷
@AreKonSaHandle9 күн бұрын
Thank you ❤
@aakashvishwanath735611 күн бұрын
thankyou
@pratyushchaudhary127412 күн бұрын
perfect explanation
@AhmedYadak13 күн бұрын
Plz we need video about basics of plates and screw 😊
@AhmedYadak13 күн бұрын
Your method of explanation is so helpful plz upload more topics about basic principles of orthopedics and trauma if u can
@teluguinfo939714 күн бұрын
nice sir
@srinivasaraosirasapalli510414 күн бұрын
So nice doctor
@ashishpareek2417 күн бұрын
👍🏻
@darwq19 күн бұрын
Brilliant ! May Allah bless you. we need more stuff from you
@thanhdo536221 күн бұрын
Can I send you some xray my patients and would like to have your advice?
@Justorthothings21 күн бұрын
Sure, you can mail me at [email protected] or whatsapp on +91 8178605393
@AlpKili23 күн бұрын
Thanks
@sushilshah384228 күн бұрын
excellent loved it. Thank you
@RMO4MLI29 күн бұрын
Do the end cap of pfna nail prevents the toggling / migration ?
@Justorthothings28 күн бұрын
So, different nails have their own mechanism to block the blades or screws from free sliding. In J&J ones, the set screw sufficiently blocks the sliding, but in some other designs there is long-tip end cap that blocks free sliding.
@RMO4MLI29 күн бұрын
Thanks for the immensely informative video on IT fractures . Removing a medial piece of bone is a great point to prevent wedging If somehow wedging infact does happen - 1. it ll not allow to fully compress the fracture ? 2. Do reduction k wire placed anterior need to be removed while tightning the lag screw ? 3 . In wedging the screw length required increase ( more than 95 even in females ) - should be still screw with a long screw to achieve TAD ?
@Justorthothings28 күн бұрын
Thanks for your feedback. 1. Compression may still happen at medial cortex, and fracture may still unite. The issue that will persist will be varus and some shortening, which may be apparent. But wedge effect + distracted fracture and large gap medially may bring a non-union also. 2. If bone is good quality then yes K wire needs to be pulled back, but in osteoporotic, it wont affect much. Usually when we see that compression is not happening, we pull the k wire 3. Yes, TAD is important for screw, it should be within the defined limits of 2.5 cm in AP+Lat view, BUT for blade, it should be kept on higher side to avoid future cut-out, especially in poor bone quality.
@user-tv6wf7io1wАй бұрын
nice work .... do you use torniqute????
@JustorthothingsАй бұрын
Thanks for your feedback! I use tourniquet only in infected cases and follow zero tourniquet policy in other cases. It helps a lot, you achieve hemostatis during surgery and accidental injury to bleeders is simultaneously controlled and no need to wait for tourniquet deflation, and most importantly good healing as there no tissue hypoxia because of hampered blood flow. Overall wound complications become negligible.
@KARANSINGH-rn5njАй бұрын
Sir you helps tremendously . As a young orthopedic surgeon, it’s hard to find quality operating techniques with clear instructions . Amazing work, impeccable knowledge and skills and most importantly, being able to disseminate and teach the information to other surgeons in a clear and excellent manner.....We love your way to do each surgery . I just think if you would have been my mentor in learning phase.....Thank you so much sir,God Bless you sir....
@VijayKumar-vm5eiАй бұрын
Thanks,rehab protocol pls
@JustorthothingsАй бұрын
Our standard is to start range of motion exercises from day 1 in all these patients. In case of major triceps injuries involving more than half of its circumference, we ensure that repair is done using strong no.5 fiberwire. Rest the post op rehab mainly focuses on movements only without carry any extra load. No brace, no splint. Without these patient gains more confidence.
@sheejasoni6775Ай бұрын
Well explained, could you please explaine the tkr instrumentation.?
@JustorthothingsАй бұрын
Sure, Will add soon
@aliasgermoaiyadi7080Ай бұрын
Why no bone grafting?
@JustorthothingsАй бұрын
I think your concern is very much valid. But, as I told in the video, this case was taken in emergency OT by a resident, who thought that it would be just another neck femur fracture as the patient had given false history to get admission. The old nature of the injury was realized only when the patient was on a fracture table under general anesthesia. Now, in that situation, you don't have any backup implant or consent for a bone graft. Ideally, as I told in the video end, I would have planned for valgus osteotomy with a fibular strut.
@nagarvind5480Ай бұрын
Brilliant presentation🔥 little bit longer plate could have been used?
@JustorthothingsАй бұрын
Thanks! Yes, a 2 hole longer plate could have been better. But main principle is that the plate length should be 2-3 times the comminuted zone and with scope of at least 3 locking screws with screw density of 50% in diaphyseal segment spanned by the screws. That ensures almost negligible stress on last screw. So when putting the top screw, if it is close to second screw, it will result in stress concentration, but if is it 1-2 hole away, it will not.
@SREEHARI70Ай бұрын
What about pfn
@JustorthothingsАй бұрын
Two screw PFN should never be used in unstable trochanteric fractures (screws loosening, collapse and Z effect issues), pfna can be used with blade in suboptimal bone quality but to be avoided in severely osteoporotic bones. Nails that control rotation and some sliding of blade/screw should be preferred.
@orthopod47Ай бұрын
How to approach if medial condylar split with posteromedial apex?
@JustorthothingsАй бұрын
If isolated medial condyle with split then medial parapatellar approach would do. If medial condyle split with simple lateral condyle, then also medial parapatellar would do. If medial condyle and lateral condyle both split (with additional posterolateral and posteromedial apices) then dual medial+ lateral approach. This has been explained with illustrations and case examples here kzbin.info/www/bejne/Y5nUZXhroL6sgZosi=AGt-4q31Dd_YZ46z
@hossamelsayed399Ай бұрын
Great work but the sound is not good
@JustorthothingsАй бұрын
Really sorry for this issue. If speed is the issue then you can adjust it to 0.75 around in youtube player settings. Otherwise if have any specific query I can address that in comment or will add a small video addressing the same. Thanks
@hossamelsayed399Ай бұрын
@@Justorthothings Thanks
@HomeAustralia-p5wАй бұрын
Great work nicely explained 👍
@nunurosАй бұрын
Hi thank you for the enlightenment.. i am curious, does the patient allow to partial weight bearing on the 2 months post op? Maybe around 10 percent/30 percent? Or no weight bearing at all?
@JustorthothingsАй бұрын
Hi, thanks for your feedback. Most patients do bear some weight despite advice against doing so. We instruct them to avoid weight bearing till we are sure that there is radiological bridging bone. So, considering the noncompliance to non-weight bearing and to avoid full weight bearing, we ask patients to use a walker and then avoid weight bearing. So, with a walker, we have at least some security that the patient will not bear full weight. Partial weight bearing, I feel, should not be an issue because the forces around the hip without weight-bearing are also high and may equate to the load-bearing forces.
@nunurosАй бұрын
@@Justorthothings thank you very much. Its verys clear now. Btw, should x ray performed every months or every 2 months enough? ANd before you apply weight bearing after 2,5 month. Is it directly weightbearing or start slowly
@JustorthothingsАй бұрын
@@nunuros We follow every 4-6 weeks until radiological healing and consolidation are evident. After that, 3-6 months. Yes, weight bearing is gradual so that the patient develops some proprioception and muscle balance.
@dranilbhattarai6469Ай бұрын
Valgus osteotomy is joint preserving procedure for obtaining union in femoral neck nonunion fractures. Union rates are high. Low risk of AVN. Technically demanding. Larger angle devices (120,130 degrees ) preferable for high Pauwell angles. Well planned osteotomy and implant placement=Well execution of the technique=desired results. Avoid double angle devices to prevent malalignment.
@kevinpaulsebastian3938Ай бұрын
Nice explanation
@srinivasaraosirasapalli5104Ай бұрын
Nice
@jaganekorapala2949Ай бұрын
How to avoid proximal entry in to fracture line
@JustorthothingsАй бұрын
See, in some fractures, you are invariably going to merge the nail entry with the fracture line, even if you don't intend to do so. The main thing is to avoid the wedge effect, even if your entry merges with the fracture line. See this video; you ll get it: kzbin.info/www/bejne/qmTPlquAhbB2obs
@aastiw2721Ай бұрын
Releasing the traction twice means? Do we again increase the traction after placing the guide wire in head or traction is loosened and further loosening during screw tightening?
@JustorthothingsАй бұрын
No, once guidewire has been put, no traction should be increased. See releasing traction at the first time is to align the medial cortex levels and is thus can be controlled, the second time its for relaxing muscle tension which will be perceived as the difficulty in gaining compression. As I have shown in second example, the amount of traction release can be negligible at times when medial cortex spikes are at same level even if fracture is slightly distracted. So, you have the indicators (medial cortex levels and force for compression) for sequential release of traction at two steps and the amount will vary from case to case.
@parkaviyanr6397Ай бұрын
If I may ask where do you work and is it possible to know who are...or do you want to keep it private
@JustorthothingsАй бұрын
Hi, Sorry, at this stage, I won't be able to make it public due to professional commitments, but maybe later I will.
@user-qp2ew7tq9fАй бұрын
Thank you
@nileshkumarsingh4738Ай бұрын
Our consultants straight away go for bipolar
@JustorthothingsАй бұрын
Could have thought that, but here the patient was less than 20 years old, so saving the hip is worth it!
@amitbisht624Ай бұрын
Amazing concepts thnx🎉
@saurabhchandra6267Ай бұрын
Very good work. Keep it up. I have a question. Seniors in my college are used to releasing gross traction before compression. What happens then is that sometimes shaft goes into the proximal fragment. So should be release traction gradually by releasing fine traction and giving compression simultaneously or should we release gross traction at once? Thank you
@JustorthothingsАй бұрын
Thanks! See, as I told in the video, once you have inserted the screw, the excess traction is of no use. You can release the traction gradually so that muscle tension is relaxed. The compression actually pulls the shaft towards the proximal fragment in a direction parallel to the direction of the screw/or blade. If your reduction is positive and medial spikes (calcar ends) are at the same horizontal level, then after placing the screw, the excess release of traction won't be an issue. Problems can occur when there is a wedge effect or when the guide wire is inserted in a distracted position.
@AshikurRahmanRupamАй бұрын
Excellent... But pls sound is very poor. Pls increase it & reupload
@KARANSINGH-rn5njАй бұрын
god bless you sir....wonderfully explained sir
@anonymousrussia123Ай бұрын
Well explained
@dratchyutАй бұрын
Excellent , this is called actionable knowledge, best way to teach a complex topic like medial approach to femur ....Evidence cleared the Dogma
@Dr.ATUL-YADAV-ORTHOАй бұрын
for putting the plate ,after removal of k wire for transfixation ,will talus again migrate proximal ?? or k wire removed after screw fixation ??
@JustorthothingsАй бұрын
Yes, the K wire shall be removed only after some length stable fixation is done. Either you can secure that length with some lag screws when K wire is still in place and when that is not feasible, you can put plate with a screw hole over the K wire, the lock few proximal and distal screws and then remove the k wire.
@Dr.ATUL-YADAV-ORTHOАй бұрын
Thanku sir
@AbhishekYadav-kj8oc2 ай бұрын
Nice presentation. You can use a longer plate.
@JustorthothingsАй бұрын
Thanks! Yes, a 2 hole longer plate could have been better. But main principle is that the plate length should be 2-3 times the comminuted zone and with scope of at least 3 locking screws with screw density of 50% in diaphyseal segment spanned by the screws. That ensures almost negligible stress on last screw. So when putting the top screw, if it is close to second screw, it will result in stress concentration, but if is it 1-2 hole away, it will not.
@rajamani11472 ай бұрын
Nice.. good job
@JustorthothingsАй бұрын
Thanks for your feedback! 🙏
@TanvirmahmoodShahriar2 ай бұрын
Thanks a lot.... It was really helpful
@Justorthothings2 ай бұрын
Thanks for your feedback!
@parkaviyanr63972 ай бұрын
Thank you for the video when we asked for it
@Justorthothings2 ай бұрын
Thanks for your feedback!
@parkaviyanr63972 ай бұрын
So CT angiography is must for this kinda cases right?
@Justorthothings2 ай бұрын
@@parkaviyanr6397 In cases with extensive diaphyseal comminution, definitely yes.