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Re: Операция на переднем полукольце таза при налич
David Zamorano 31 Май 2007, 20:30
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I'm currently working on a manuscript with Dr. Matta on this topic. his protocol which i use now is to prep the SP catheter into the field, do your normal approach, repair bladder as indicated and place a new SP catheter or foley.
no other special measures
no infections in 19 patients
dave
David P. Zamorano, MD
Assistant Chief, Orthopaedic Trauma Service
Dept. of Orthopaedic Surgery
Harbor/UCLA Medical Center
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Re: Операция на переднем полукольце таза при налич
Alexaander Chelnokov 04 Июнь 2007, 17:23
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DZ> topic. his protocol which i use now is to prep the SP catheter
DZ> into the field, do your normal approach, repair bladder as
DZ> indicated
Can you pls add some details? What do you mean as "prep the SP catheter into the field"? What bladder repair do you mean? Is it temporary closure of the fistula and re-opening it again after closure of the
"orthopaedic" aproach?
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Re: Операция на переднем полукольце таза при налич
Отправитель: David Zamorano 04 Июнь 2007, 17:45
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Alexander,
here are some more details:
What do you mean as "prep the SP catheter into the field"?
the suprapubic catheter is clamped and disconnected from the collection bag. It is then scrubbed and prepped and draped into the field. We then do an ilioinguinal or Pfannenstiel depending on the fracture.
What bladder repair do you mean?
usually the bladder has been repaired already but some times it has not been or it has been repaired inadequately. The typical scenario is a patient who is transferred from another hospital for definitive care for their pelvic fractures. Often they have an emergent ex-lap by the general surgeons and a suprapubic catheter placed by the urologist but don't have an orthopaedist to fix the pelvis. When we do our approach, we inspect the bladder and if it needs to be repaired, the urologist does this.
Is it temporary closure of the fistula and re-opening it again after closure of the
>"orthopaedic" aproach?
the fistula is allowed to heal on it's own and the new catheter is placed through a "clean" site in the skin. sometimes a catheter is not needed and a foley can be placed. if there is a urethral repair that is needed, this is done at another time by the urologist
hope this helps
Dave
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Re: Операция на переднем полукольце таза при налич
Отправитель: Alexander Chelnokov 04 Июнь 2007, 19:05
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THX for your expalanation.
> bag. It is then scrubbed and prepped and draped into the field. We
> then do an ilioinguinal or Pfannenstiel depending on the fracture.
Got it.
> transferred from another hospital for definitive care for their
> pelvic fractures. Often they have an emergent ex-lap by the general
> surgeons and a suprapubic catheter placed by the urologist but don't
> have an orthopaedist to fix the pelvis.
Our most typical scenario.
> When we do our approach, we inspect the bladder and if it needs to
> be repaired, the urologist does this.
The difference is that we don't have urologists avalaible. And more often the tube is in place because of urethra injury.
>not needed and a foley can be placed. if there is a urethral repair
>that is needed, this is done at another time by the urologist
This case is most actual - in case of further delayed urethral repair the "old" SP tube also should be removed and new one incerted through the intact skin after the ORIF? THX again.
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Re: Операция на переднем полукольце таза при налич
Chip Routt 09 Июнь 2007, 13:47
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Sorry to be late...here’s an old reference.
Chip
Internal fixation in pelvic fractures and primary repairs of associated genitourinary disruptions: a team approach.
Routt ML, Simonian PT, Defalco AJ, Miller J, Clarke T.
Harborview Medical Center, Department of Orthopaedic Surgery, Seattle,
Washington 98104, USA.
Associated urological and orthopedic injuries of the pelvic ring are complex with numerous potential complications. These patients are treated optimally using a team approach. The combined expertise is not only helpful initially when managing these difficult patients, but also later as problems develop.
This study describes a treatment protocol and reports the early results of 23 patients with unstable pelvic fractures and associated bladder or urethral disruptions, or both, treated surgically with open reduction and internal fixation of the anterior pelvic ring injuries at the same anesthetic and using the same surgical exposure as the urethral realignments or bladder repairs or both. Early complications occurred in four patients (17%): one patient sustained a fifth lumbar nerve injury caused by the pelvic reduction procedure, and three patients had anterior pelvic internal fixation failures. Late complications occurred in eight patients (35%).
There was one deep wound infection (4.3%) that presented 6 weeks after injury. Late urological complications occurred in seven patients (30%). Four of the nine male patients with urethral disruptions had urethral stricture after their primary urethral realignments (44%). Three of the 18 male patients admitted to impotence (16.7%). One of the three had a residual thoracic paraplegia caused by a burst fracture. One of the five female patients had urinary incontinence and required a bladder suspension operation to restore normal function (20%). A low infection rate can be
expected despite the use of internal fixation. Early urethral "indirect" realignments avoid more difficult delayed open repairs; however, late urological complication rates are still high. Early "direct" bladder repairs are easily performed at the time of anterior pelvic open reduction and internal fixation. Suprapubic tubes are not necessary to adequately divert the urine when large diameter urethral catheters are used in these patients.
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