AANA24 Knee All-Access Pass-CONCURRENT SCIENTIFIC SESSION 4E: AANA Member "On Call"

Video Transcription

Video Summary

The ANA member on-call session covered a broad spectrum of urgent orthopedic and sports medicine cases encountered during general and trauma call. Initial principles emphasized by Dr. Megan Bishop highlight the need to "do no harm," rely on backup and partners, manage true orthopedic emergencies (compartment syndrome, septic joints, open fractures, major dislocations, vascular injuries), and refer complex cases to tertiary centers as needed. Several illustrative cases were discussed, such as stable intertrochanteric fractures, severe necrotizing fasciitis requiring damage control surgery, and complex tibial fractures.<br /><br />Regarding tibial plateau fractures, Dr. Alexander Gallant reviewed classifications, imaging (importance of CT scans), and management with a focus on soft tissue preservation, meniscus repair, and staged surgery. Arthroscopy can aid the assessment and fixation of cartilage and ligament injuries in ankle and tibial trauma; needle arthroscopy offers a quick, minimally invasive tool for intraoperative assessment, promoting improved reduction.<br /><br />Dr. Alicia Harrison covered proximal humerus fractures, emphasizing avoiding varus, ensuring adequate tuberosity fixation, medial calcar support, and selecting appropriate surgical or replacement treatments, with nonoperative management reserved for select cases. Nonoperative management of pectoralis major ruptures is uncommon; early traction, conservative rehab, and careful surgical technique, including primary repair and dermal allograft augmentation, were described.<br /><br />Additional talks addressed patellar tendon rupture revisions with suture anchors and allograft augmentation, locked patellar dislocations emphasizing loose body removal and consideration of medial patellofemoral ligament reconstruction, and knee dislocations with vascular compromise requiring reduction, prompt neurovascular assessment, and collaboration with vascular surgery.<br /><br />Financial considerations of call were reviewed, noting stable call compensation despite increased practice expenses and emphasizing the significance of understanding one’s value to hospital revenue.<br /><br />The session concluded with elaborated case discussions on complex multiligamentous knee injuries, chronic proximal hamstring ruptures, irreducible patellar dislocations, and humeral shaft fractures with radial nerve palsy, focusing on individualized management, surgical timing, interdisciplinary cooperation, and highlighting the importance of close follow-up to avoid complications. Overall, the session stressed teamwork, thorough assessment, damage control principles, and the evolving role of arthroscopy and minimally invasive techniques in on-call orthopedic trauma management.

Asset Caption

Introduction by Moderators: Michael A. Zacchilli, M.D., Meghan Bishop, M.D.

Keywords

orthopedic emergencies

sports medicine

compartment syndrome

septic joints

open fractures

vascular injuries

tibial plateau fractures

arthroscopy

proximal humerus fractures

pectoral major rupture

patellar tendon rupture

knee dislocations

vascular compromise

damage control surgery

minimally invasive techniques