Tibial plateau fractures (fracture at the top of the tibia - shin bone - involving the knee joint) are a perfect example. These fractures can range from simple splits in the joint surface all the way to comminuted (smashed) fractures where the top half of the tibia is basically not connected to the rest of the leg below the break. These fractures are often difficult to treat by experts here in the United States with ample resources. Here in the United States, we have specially-designed plates for each side of the tibia (even the back of the tibia) with screws in them that allow you to capture the fragments of a badly broken tibial plateau and restore the anatomy. These plates are really nice...and really expensive...which means Tenwek doesn't have them.
Tenwek, being a mission hospital, is subject to donations from surgeons, orthopedic companies, hospitals, etc with implants that have either expired or just simply aren't used. One such device is the ringed external fixator - a device shaped like a horseshoe that rests outside the skin attached to wires drilled through the bone and coming out both sides. Basically, you turn the bone into a pin cushion and then attach these rings to the wires to stabilize the fracture. Very few people in the US are trained to use these and those tend to be in large academic centers. Tenwek, somewhere along the road, received a large donation of these devices that sat on a shelf until Dan Galat, a Mayo Clinic trained orthopedic surgeon there at Tenwek, found them. He had never put one on before coming to Tenwek but with limited resources, you do what you can with what you got! So, here is what he did!
Case #1: 50 year old male involved in a RTC. Came in on my first call night. Closed right comminuted tibial plateau fracture.
|Right Tibial Plateau Fracture involving both side of the knee joint with significant comminution.|
Case #2: 38 yr old male involved in a RTC with a left comminuted closed Tibial Plateau Fracture
|Left Tibial Plateau Fracture|
|Axial (Cross-Section) CT Scan through fracture|
|Postop AP Xray. Pleased with Articular Reduction and Overall Mechanical Alignment|
|Patient is able to bend his knee right away and to partially bear weight with his hybrid fixator in place.|
|These Hybrid Ringed Fixators will stay on for 3 months barring any disastrous infections from the pin sites. The patients are instructed in doing daily pin site care and caring for the device as a whole.|
More to come...