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Re: Open supracondylar femur fx
послал Chip Routt 15 Ноябрь 2004, 15:58
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Tim-
You've recommended a technique in Alaska based on perceived technical speed?? Would you choose/advocate that for your surgeon...your surgeon chooses your operation based on how fast he/she can accomplish the procedure?
Do you also suggest that we speed the irrigation because one liter is faster than six or twelve? Do you advocate that we limit the debridement to the easily visualized field because extending the wound margins to further explore would take more time? If speed is the focus, why advocate cannulated screws...why not just sling in a few cheaper screws? Chop-chop!
Please consider the patient management based on quality of care principles (debridement, reduction, stability, wound management, rehab) rather than operative speed and resident allocations.
We learned a long time ago that a fast operation/surgeon does not necessarily reflect improved surgical skill and result. We also know that an expensive implant does not always equal a good implant.
Surgery should not be a race, unless we have a patient in a dire situation.
Many surgeons also realize that helping residents-in-training learn how to care for patients does not necessarily facilitate an operative event.
Let's accept that we're all trying to be efficient, but please don't lose sight of the patient and his/her situation.
There are numerous ways to successfully treat this patient's open femur fracture, and each method has its own issues and benefits.
Wound and fracture debridement, articular reduction, axial alignment and rotation, and stability must be prioritized, and in turn should diminish infection risk and speed recovery.
A planed and methodical initial operation likely avoids subsequent іcorrective/recovery procedures.
Quality-
Chip
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