SCREWS PLATE

CLAVICLE FRACTURE

Operative Technique:

• The patient was positioned supine under interscelence nerve block
• The operative field was prepared with betadine solution and sterile towels were applied for draping.
• A skin incision was made using the anteriosuperior approach.
• Both superficial and deep dissection were performed to expose the proximal and distal bone fragments.
• The periosteum was denucleated to facilitate bone fragment reduction and evacuation of hematoma.
• Fracture reduction was achieved using a bone clamp, followed by internal fixation with a plate and screws.
• An 7-hole S -Clavicle Plate was applied with six screws:
• Two 14 mm screws were placed at both ends of the plate.
• Four 16 mm screws were placed near the fracture site.
• Fracture stability was verified through manual mobilization of the shoulder.
• The surgical site was thoroughly irrigated with normal saline, and the surrounding area was cleansed with Betadine.
• Wound closure was performed in layers: 
• Deep soft tissue was closed using 1-0 Vicryl sutures.
• Superficial soft tissue was closed using 2-0 Nylon sutures.
• Skin closure was completed with 3-0 Nylon sutures.
• A sterile gauze dressing was applied over the wound.

SUPRACONDYLAR OF LEFT FEMUR FRACTURE WITH WOUND

Procedure: 

• Place the patient in a supine position with knee flexion 30 degree under spinal anesthesia
• Skin antiseptic by betadine scrubbing, and draping except surgical site 
• Incision through the skin and subcutaneous above 10cm in anterolateral approach to the distal femur 
• Dissection the fascia and muscle to bone fragments
• Bone reduction and stabilization
• Temporary fixation to the bone fragments with K-wires
• Insert 7 holes compressive plate with four cancellous lag screws in distal fragment and five context screws in proximal fragment
• Remove the temporary k-wires fixation 
• Washing surgical site with normal saline
• Close fascia with 1-0 vicryl 
• Subcutaneous with 2-0 vicryl and skin closure with 2-0 nylon
• Skin closer with nylon then dressing with sterile compressive

SALTER HARRIS TYPE IV OF LEFT TIBIAL PLATEAU FRACTURE

Procedure: 

• Place the patient in a supine position with knee flexion 30 degree under spinal anesthesia
• Skin antiseptic by betadine scrubbing, and draping except surgical site 
• Incision through the skin and subcutaneous above 10cm in anterolateral approach to the proximal tibia 
• Dissection the fascia and tibialis anterior muscle to the bone fragments 
• Bone reduction and stabilization 
• Temporary fixation to the bone fragments with K-wires
• Insert 10 holes compressive plate with threes cancellous lag screws + one context screws in proximal fragment and four context screws in distal fragment
• Remove the temporary k-wire fixation
• Washing surgical site with normal saline
• Close fascia with 1-0 vicryl 
• Subcutaneous with 2-0 vicryl and skin closure with 2-0 nylon
• Skin closer with nylon then dressing with sterile compressive

GALEAZZI FRACTURE OF RIGHT FOREARM

Procedure: 

• Place the patient in supine position with right hand on the table under reginal block anesthesia
• Skin antiseptic by betadine scrubbing and cover draping 
• Make a longitudinal incision of henry approach to and in line of flexsor carpi radialis tendon
• Identify superficial radial nerve
• Ligate the branches of the radial artery
• Dissect the periosteum to the radius bone
• Religne the fracture with distractor and clamps
• Reduction and stabilization of bone fragment
• Place Dynamic Compressive Plate with 7 holes
• Drill the radius in a anterior to superior direction and drive six screws with bicortically in each side
• Drill a syndesmosis pin of radioulnar joint
• Washing with normal saline
• Subcutaneous suture by vicryl 2-0
• Skin suture by nylon 3-0
• Dressing with sterile compressive

RADIUS DIAPHYSIS FRACTURE

ULNAR DIAPHYSIS FRACTURE

Procedure:

• Place the patient in supine position with right hand on the table under reginal block anesthesia
• Skin antiseptic by betadine scrubbing
• Incision through the skin and fascia over the fracture in line with the olecranon and the ulnar head
• Religne the fracture with distractor and clamps
• Reduction and stabilization of bone fragment
• Place Dynamic Compressive Plate with 7 holes
• Drill the ulnar in a anterior to superior direction and drive six screws with bicortically in each side
• Washing with normal saline
• Suture subcutaneous with vicryle 2.0  then skin suture closing with nylon 3.0
• Washing with normal saline then dressing with sterile compressive.

MALLEOLUS FRACTURE

POST OPERATION TREATMENT:

PIV NSS 0.9% 1000ml/24H
Ceftriaxone (1g): 1fl x 2 (IVL)
Gentamycine (80mg): 1A x 2 (IM)
Metronidazole (500mg): 1fl x 2 (PIV)Paracetamol (1g): 1fl x 3 (PIV)
Tramadol (100mg): 1A x 2 (IM)
Cimetidine (200mg): 1A x 2 (IVL)