Description
The video features a discussion led by Michael Archdeacon regarding the management of tibial shaft nonunions. He acknowledges his familiarity with the subject, revealing he's aware of various complications, emphasizing the importance of considering patient history, underlying health conditions, and previous treatments when assessing nonunion cases. Archdeacon highlights critical factors influencing bone healing, including patient factors (like smoking and malnutrition), injury mechanics, and surgical techniques. He elaborates on the importance of soft tissue management, noting that open fractures usually accompany soft tissue damage that can complicate recovery. Archdeacon presents a case study involving a patient with an infected nonunion from a ballistic injury, detailing a staged treatment protocol that includes debridement, reaming, and the use of antibiotic-impregnated intramedullary nails. He stresses a conservative approach to treating infections, often requiring temporary hardware removal and re-assessment. Throughout the lecture, he underscores the necessity for effective communication with patients and the need to tailor treatment based on individual circumstances, advocating for a holistic view of patient care rather than focusing solely on radiographic results.
DOI: 10.1302/3114-250980