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Live Surgery Tuesday at Badia Hand to Shoulder Center - Officer Ramirez 3rd and 4th Phalanx ORIF
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Live Surgery Tuesday at Badia Hand to Shoulder Center - Officer Ramirez 3rd and 4th Phalanx ORIF
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Language: EN.
Segment:0 .
DR. ALEJANDRO BADIA: All right. So we're with our illustrious motorcycle police officer who's now been a patient of mine twice. And this time this had to go, not at work. So he had the luxury of not having to follow the system. I've already fixed one of his phalanx fractures. You can see they're and you can see the other. You can see the other.
DR. ALEJANDRO BADIA: There is a fracture. So here was a fracture. Now we fixed it and now we're going to do the same to the ring finger. So you got here just in time for the second digit. All right. Knife please. So these factors oftentimes are the same very similar pattern in both fingers and sort of twisting injury.
DR. ALEJANDRO BADIA: The wonderful case I'd love to post if people are interested about what not to do. I had a patient, I went to one of the hospitals, was seen by the person I called who was a plastic surgeon, which is fine, but if they're not particularly trained in hand, it can be a disaster. And you cannot fix that kind of fracture with pins. It needs it needs compression screws. So my colleagues who are listening know that these are called lag screws.
DR. ALEJANDRO BADIA: [inaudible[ I believe he was driving a golf cart when it happened. Yeah Yeah. You'd be surprised how many, had a guy once who was from flew in from Dubai had a horrendous fracture to his little finger, which people think, oh, that's not a big deal.
DR. ALEJANDRO BADIA: So pinkie, you know, we call it the pinkie. Your football coaches tell you pull on it or jam. And I absolutely hate that because let me tell you, you have a problem with your little finger. All the strength in the hand, comes from these two fingers. These are 4 from microsurgery or threading a needle. Right knife, please. And I can tell you that. If these fractures are not fixed correctly, this is extremely disabling.
DR. ALEJANDRO BADIA: His fingers were rotated. I think we have pictures that we can post, but his two fingers were rotated, facing the other direction. So ihand surgery is one of those things where people don't think about it much until they have it. Thank you.
DR. ALEJANDRO BADIA: So we're all old pros here because we just did the same thing on the other finger. It's really the same exact fracture pattern. What is the rehab like after? Is he going? He'll he'll start a little bit next week just to start gently moving. But, you know, the problem is a fracture doesn't heal.
DR. ALEJANDRO BADIA: The fracture doesn't heal for for about four weeks. So during that time, you're depending on the little mini screws. So this is all hematoma blood within that's within the fracture site. And that's going to keep us.
DR. ALEJANDRO BADIA: So we're going to irrigate some of that out now. You can see. So the problem with the mix is tricky is that there's what we call a butterfly fragment. So it's not just two pieces. There's a little third piece here. And that often interferes with the reduction.
DR. ALEJANDRO BADIA: Reduction means putting the bone back in place. So you can do closed reduction like you might do with a minor fracture and the wrist that hopefully will hold or what we call open reduction. So this is in orthopedic terms is called ORIF, open reduction internal fixation because we're fixing it internally. Irrigation one more time, please, and then I'll need the dental instrument.
DR. ALEJANDRO BADIA: I will tell you, my dental colleagues are the ones who kind of invent everything in orthopedics first. They did the first little mini x-rays already titanium implants were used. They all started in the dental world. So kudos to my dental colleagues. So there's a piece. If I don't get these little pieces of hematoma and bone fragments out and I can't get a good reduction because it'll be blocking it.
DR. ALEJANDRO BADIA: So us hand surgeons often say that these are some of the actually toughest cases there are to get a really perfect result. Requires a lot of experience. He's lucky. He was our patient previously and already knew how to find you.
DR. ALEJANDRO BADIA: Now he's going to be at the orthopedic conference with a cast to share his other story. Yeah so we actually won because of the case that some of you may have seen where he broke his collarbone, this same arm. He broke that collarbone and tore the ligament on the opposite thumb. And he's a motorcycle police officer here for the city of Miami. So he's going up with us to Orlando.
DR. ALEJANDRO BADIA: We're going to get this award, which is nice. You know, it's the injured worker award, but he didn't do this at work. So it's a little bit of a different category, but same thing. He's going to be looking to get back on a motorcycle to keep all of us safe. Right OK. [inaudible] Let's see if we can get this in there.
DR. ALEJANDRO BADIA: You can slide out. Very good. Get right down here and lift up the tendon and take. There are all sorts of instruments designed. This is designed by a surgeon, actually, this by a company called Innomed.
DR. ALEJANDRO BADIA: See how tough to remember on the last finger. I want you to pull on this. We're going to pull and rotate. There you go. See if you had a rotation is really what reduces it. Problem is, is that butterfly fragment, which fits right in there.
DR. ALEJANDRO BADIA: So now if this is good, we are set and these screws will stay there. It's not necessary to. No, no. I have a friend. A buddy of mine is a big jujitsu guy. And he broke his gosh 25 years ago. And I see him all the time and I forget to even ask him. Can't even see the can't even see the little scars anymore.
DR. ALEJANDRO BADIA: But he's got the screws in his finger, you know. It's distracting, right? No, I got it now. Hopefully that. OK so that looks it looks pretty good. Yeah OK. What's important.
DR. ALEJANDRO BADIA: You see this finger. So we judge a rotation by looking at the nails. So the nails are in the same plane. Now see here we've got to really pronate him. Your viewers are commenting. Great job. Carry on.
DR. ALEJANDRO BADIA: All right, let's. So this time, I'm going to put the middle one first just because I have put them a little more. Yeah there you go. OK sharp. Yes, you. So so as the surgeons know, listening, you know, we like this, means that this screw, we all redraw this cortex.
DR. ALEJANDRO BADIA: So that. See that the screw actually compresses. So the screws not really grabbing the near cortex, it's grabbing the far cortex and pulling it. So that's we call that a lag screw. Yes I'll share the pre-op X-ray in one second.
DR. ALEJANDRO BADIA: Yes as soon as we put the screw we can. I would probably I'll probably lose an 11 on the next one.
DR. ALEJANDRO BADIA: [Inaudible] So the screw falls right into that hole because it's the same size. I didn't follow the same trajectory. So OK. That's it's got to be very precise. OK all right, I have a question for you, Dr. B. For a lag screw, are you using a differential drill bit?
DR. ALEJANDRO BADIA: Or is it screw partially threaded? Very good question. No, it's a fully threaded screw. But this drill bit, you can see it's short. So it's not going to go all the way through the fracture. It's going to go through the near cortex and it's a little bit larger diameter. So the screw will glide through this cortex and then grab the far cortex and compress it.
DR. ALEJANDRO BADIA: Whereas that's a very good question. So sometimes we might use the same drill bit. That's a slight. Yeah, I'm Yeah. See there's the, the lag screw up the. Hold on a second. That's a little dicey part.
DR. ALEJANDRO BADIA: She's got that dental instrument. He's got that. But this is just a sliver of bones, so I can't really do much with this. Let's get flow in here a minute just to see if this looks OK. I think so.
DR. ALEJANDRO BADIA: OK great. OK OK.
DR. ALEJANDRO BADIA: This one's a little bit this screw just because of that lateral I'm putting the screw really right next to the other one. We're just going to do it a little. A little diversion. OK, let's get an 11 here.
DR. ALEJANDRO BADIA: And then we'lll remove the clamping and put another screw. 11? Believe this is a fellow commenting that says, I feel the lag screw should be directed more perpendicular to fracture sites as pattern is long oblique. Yep yeah, I agree. But sometimes, you know, when you're in here, you kind of do what you can.
DR. ALEJANDRO BADIA: But I don't have an argument with that. Right now. Right now. Right here. Right but see, here we have a good reduction. You see, now the question is, do you do anything with that little shell of a, you know, I may do something with that little. Yeah, let me see.
DR. ALEJANDRO BADIA: Because I don't want that moving. I'm going to actually which is unusual. I'm going to counter sync this. OK we're going to go we're going to put a screw in the actual. So this is dental here. So what we're doing the same thing.
DR. ALEJANDRO BADIA: So go ahead and give me the... So I'm actually going to put a screw in the butterfly fragment because it's so large. I don't want that floating around. [inaudible] It is underneath the extensor. So I'm going to I'm going to countersink it.
DR. ALEJANDRO BADIA: [inaudible] We're probably just touching up against the other screw, but I got it past. I have a question, can that small piece of bone, can it be put anterior posterior direction?
DR. ALEJANDRO BADIA: That slither of bone. Yeah, I'm putting it where it belongs. I mean, it's just. There's no other place to put it. It's just, I'm afraid, because it's so big. OK that gave. So what I'm going to do, though, is counter sink because its sitting right under the extensor.
DR. ALEJANDRO BADIA: [inaudible] Yeah. OK I'll take the nine. I'm going to go a little on the short side because the tip is going to be running into the flexor tendon. I was hoping this would be a good lesson for laypeople to understand what fixing a fracture entails.
DR. ALEJANDRO BADIA: Do you want to comment? Yep so we're going to counter sink. No, it's OK. A little bit. The screw head sits a little bit into that fragment. So these are the sides of the screw. So now you know where they cost a little more than what you get at Costco or Home Depot.
DR. ALEJANDRO BADIA: All right. That's good. That sunk it in nicely. OK that's nice. OK, let's. [inaudible] Yep yeah, this is good.
DR. ALEJANDRO BADIA: OK let's go here and see what happens. You can't do that. You need to reach in and do that. If but yeah, if you can just if you can just hold that down like that just for a moment. Oh, Yeah. [inaudible] Let me know when you're ready for another question, Dr. B?
DR. ALEJANDRO BADIA: Yes, I'm ready. OK so for the approach, did you splint, sorry, split the extensor tendon. And if not, what is your opinion? Should we split or go laterally and retract? Yeah I'm going laterally. He's retracting the extensor now. I'll show it to you.
DR. ALEJANDRO BADIA: The time I split it is when I'm putting a dorsal plate, which anybody who knows me knows that I can. I avoid that at all costs. I'm not a fan of plates in the [inaudible] because you often have to remove them and the scars. Whereas with this it's I almost never have problems but to get the right, to get the plate. You don't have room here so you do you do split the extensor, which I'll show.
DR. ALEJANDRO BADIA: Yeah your colleague says that he personally feels that it damages the blood supply. Yeah but, you know, fortunately, in a hand, it's so robust. Let me have a go back to the last 12. But we'll see now.
DR. ALEJANDRO BADIA: Let's go to 12, that's when you get to things this small the depth gauge just to me is not always that accurate. OK so lags go right in. You see the dial right in. And now. Now the threads are grabbing and bam. There we go.
DR. ALEJANDRO BADIA: Now, maybe I should have listened to myself. This this is not grabbing. OK, now, I hope it's not in a fracture site. I don't think so. But let me have any other actually. Let me see. No, no, I'm going to let me see the X-ray for a second. So come out with it. Come out?
DR. ALEJANDRO BADIA: Yes Yes. That should be good. It should be good. Let me see. [inaudible] So I'm going to drill it proximally.
DR. ALEJANDRO BADIA: Clamp to me. Screw out. I'm going to redrill the screw a little bit. So I'm not able to see the other side. I need a regular clamp. And then let me have the same drill bit, the far one, in that little one.
DR. ALEJANDRO BADIA: OK, here's the pre-op X-ray. [inaudible] I'm going to direct it.
DR. ALEJANDRO BADIA: Greetings from Indonesia. Oh, we have a great relationship with our Malaysian colleagues and Indonesia and I plan to go to Borneo. OK OK. Thank you. I have a question for you, Dr. B. Yes.
DR. ALEJANDRO BADIA: What do you think about headless, cannulated screws for this fracture? I don't think they're necessary. You know, these are low profile. This is Medartis And these are great. I mean, this is great Swiss technology. This is, you know. All right.
DR. ALEJANDRO BADIA: I'll take that same screw. [inaudible] [Spanish] I believe you see some of our patients.
DR. ALEJANDRO BADIA: Yes tell me what's on the list of. Please, please. No, I don't like it. I don't like it. I'm drilling a whole new drill, start the whole process over. I don't like it. It's probably at the tip. There's a little bit of fragmentation.
DR. ALEJANDRO BADIA: Are these AO screws and how many millimeters? No, this is Medartis Which which is, these are 1.5 millimeter. But that screw wasn't holding, so we'll use the same screw. I'm just going to drill a hole. New hole. So let me see which direction.
DR. ALEJANDRO BADIA: We have it right here. Yeah politics right. Problem is it was in the fracture. [inaudible] Can you repeat the company for the screws Dr. B? Medartis.
DR. ALEJANDRO BADIA: We'll show you the tray. I was. [inaudible] Colleagues from physiotherapy is commenting on the team. He said, you have the best team, there you go and hopes to see you in Guayaquil, Ecuador again. Well, I'm going the first week of October, but I'm going to Quito.
DR. ALEJANDRO BADIA: But I will stop for sure. So I changed directions. Folks, I'm on the edge. I'm not crazy about this, hold that. Same screw. Reloading, here we go.
DR. ALEJANDRO BADIA: OK that's much better. All right. So for the question about the extensor, about the approach. So here's the extensor. That was a very good question. So I don't disturb the FET, which is these little fibers that give blood supply to the tendon.
DR. ALEJANDRO BADIA: So I go in on the lateral side, you see. So, so this should not this should not the therapy will be directed at gaining full extension. So we have Gigi from my office is here to put on our new type of splint, which we put on pre operatively. And now she's going to remold it so we can let her know. She's outside. OK She's watching us live, she knows.
DR. ALEJANDRO BADIA: Oh, so we're working with a company from Finland, a new type of splinting. So we splinted them in the, in the, in the office. Now we're going to heat up the splint and I'm going to put on actually as I'm putting the dressing on, we'll heat it up and now it's going to be better molded. And then he'll start therapy next week. We'll actually make him we'll probably make him a thermoplast.
DR. ALEJANDRO BADIA: OK so you start next week. All right, let's see. Let's go the vertical if you think you can do that, too. [inaudible] OK so important thing is, print, please.
DR. ALEJANDRO BADIA: We look here, all the fingers, all the fingers point to the skate point tubercle. So that's. That's what we want. Looking at it this way. So that's why the proximal phalanx is so critical. Even though that ring finger fracture is a lot more difficult. OK irrigation, please. The splint is made out of recycled wood material, and we don't use a heat gun.
DR. ALEJANDRO BADIA: We actually use an oven. I can show it to you in a minute. You know what? Let me get one last lateral. We printed that. There's a question about the proximal most screw is it very near the fracture site.
DR. ALEJANDRO BADIA: Would that be an issue? But you know what? Your beggars can't be choosers. And and, you know, I'm happy with it. It's just, you know, when these fractures are fragmented like that, you know, it's a problem. Print. So you know, the enemy of good is better. And every surgeon knows that. You know, I'm not I'm not treating the X-ray.
DR. ALEJANDRO BADIA: What what I'm happy about is the rotation of the finger. The fracture is stable. So there's not a lot of there's just not a lot of, you know, real estate there to be putting, You can see there's multiple screws, but it's very it's stable. So right. That's perfect, Picasso. Greetings from Rome.
DR. ALEJANDRO BADIA: From Rome? Who is it? Dr. Lucien Makovici. He's always. I will be in Rimini next year, as my friend is the president of the European Congress next year in Rimini, Italy.
DR. ALEJANDRO BADIA: I wouldn't miss it for the world. [inaudible] Yeah your fellow Devon Hsu who commented on the screws on the fracture site said he agrees the functional outcome is what we should bother. And greetings from India. [inaudible] Who's in India?
DR. ALEJANDRO BADIA: Your fellow who was commenting on the screws being close to the fracture site. Oh, Devon Hsu. Oh, OK. Well, that's the fellow's job is to bust my balls, so I like having them here. They have good questions. So we use is everyone knows who've been with us.
DR. ALEJANDRO BADIA: I've been doing it for gosh almost 30 years like a repeat patient is like. He said ha ha sorry. And Dr. Lucien said I use this technique and it's great over 100 cases. I applaud them for knowing how many cases I have has always been a problem. I have I. You've lost count. I just know.
DR. ALEJANDRO BADIA: I just. Well, I don't miss my I don't document anything. But, you know, you can tell everybody The last thing you want is for somebody to give you yet another task. So we just I just realized a long time ago we're documenting the volar plates. That's true.
DR. ALEJANDRO BADIA: We did. So we're using currently we're using two different volar plates that they give me as we're about to publish a paper or say submit for publication on a plate that corrects the volar, tilt with the lever arm that sits under the subchondral bone. And that, you know, hopefully it's accepted.
DR. ALEJANDRO BADIA: I won't say what Journal because I don't want to unduly influence them. Although I will say I was a reviewer for 12 years on that Journal. But that's enough. [inaudible] OK we'll need just a few fluff dressings. Irrigation, please. Of course.
DR. ALEJANDRO BADIA: What's nice about the repeat is you can evert the skin edges. And you don't have to worry about difficulty of removing because you don't you're not removing a stitch. Whereas if you did this with nylon, sometimes this it's. And to be a little difficult to remove.
DR. ALEJANDRO BADIA: So we have a. The shoulder with a subpectral bicep tenodesis in the other room that they're just about ready for me. So ready. We have a little bit of sterile cats padding.
DR. ALEJANDRO BADIA: OK we won't put DV because here your new cast splint has enough padding that with the finger and there's just little screws holding it. Anybody going to Boston listening? But we're waiting. Oh, I have a question about fellowship, though. Do you provide fellowship short term or long term?
DR. ALEJANDRO BADIA: No, it is short term because, you know, unfortunately, Thanks to ridiculous rules that society continues to impose on us is the Fellows aren't allowed to scrub with me and they used to be able to. So it goes to show that in our society where we're literally letting you. No worries, because obviously I accept all the liability, but we're so obsessed with liability. And the worst part about this is that we're exporting.
DR. ALEJANDRO BADIA: The US is exporting this nonsense to Europe and all of a sudden all this compliance bullshit is, you know, is more important than, you know, patient care and learning and education. And it's really sad. But, you know, it doesn't matter because I'm not at this point in my career, but it's unfortunate. So the answer is, no, we don't do long term fellowship because, you know, the surgeons really don't get to operate.
DR. ALEJANDRO BADIA: So Dr. Devon Hsu said, I really want to work under your guidance. I have completed my master's in orthopedics from Mumbai, India, and I'm interested in hand surgery. Can I email you? Absolutely just my website is Drbadia.com I answer myself. The link is in our bio.
DR. ALEJANDRO BADIA: Dr. Devon Hsu. Sure you can find the link in our to the website www.drbadia.com and you can click on Ask me a question to send him an email and he answers those himself.
DR. ALEJANDRO BADIA: Ola Dr. Silva. Dr. Silva is watching you from Chile. She's preparing the cast.
DR. ALEJANDRO BADIA: Please after this surgery, we would be done going live and we'll go live again next Tuesday.
DR. ALEJANDRO BADIA: Doctor Badia's in I'll post the schedule. We usually go live on Tuesdays. Today was just a special case, so we decided to go live Thursday as well. So it's like karma. It's like Karma.. Wednesdays are Sundays on combat.
DR. ALEJANDRO BADIA: That was ice cream company. Yeah ice cream. So now you'll see the splint we're putting on. But not always at this time. It varies on the case. So we'll select the case on Monday and post on Monday. What time will be going live on tuesday? Now, if you guys can share the hashtag, but a live surgery Tuesday.
DR. ALEJANDRO BADIA: Yeah well, either way, she's coming in now with the splint, so I'm. So we'll keep you guys posted on this case. And on his recovery. Thank you so much for watching. We can post the splinter. Trying to.
DR. ALEJANDRO BADIA: OK all right. Here's our can split from recycled wood material. It's warm. So she's able to mold it to the patient. OK Dr. Badia. great reduction.
DR. ALEJANDRO BADIA: [inaudible] and yes, it does get hard and stiff.
DR. ALEJANDRO BADIA: Then about two or three minutes will be hard. It starts to harden now. [inaudible] I know he wanted to show, we're still live.
DR. ALEJANDRO BADIA: He wanted to show the tray of the screws. Which one is it? Medartis. Aptus. This is the material inside. Wonderful Thank you. [inaudible] Thank you guys so much for watching. Look out for Mondays.
DR. ALEJANDRO BADIA: We'll share when our next live surgery will be. Usually on Tuesdays, time will to be announced. Thank you.
Segment:0 .
DR. ALEJANDRO BADIA: All right. So we're with our illustrious motorcycle police officer who's now been a patient of mine twice. And this time this had to go, not at work. So he had the luxury of not having to follow the system. I've already fixed one of his phalanx fractures. You can see they're and you can see the other. You can see the other.
DR. ALEJANDRO BADIA: There is a fracture. So here was a fracture. Now we fixed it and now we're going to do the same to the ring finger. So you got here just in time for the second digit. All right. Knife please. So these factors oftentimes are the same very similar pattern in both fingers and sort of twisting injury.
DR. ALEJANDRO BADIA: The wonderful case I'd love to post if people are interested about what not to do. I had a patient, I went to one of the hospitals, was seen by the person I called who was a plastic surgeon, which is fine, but if they're not particularly trained in hand, it can be a disaster. And you cannot fix that kind of fracture with pins. It needs it needs compression screws. So my colleagues who are listening know that these are called lag screws.
DR. ALEJANDRO BADIA: [inaudible[ I believe he was driving a golf cart when it happened. Yeah Yeah. You'd be surprised how many, had a guy once who was from flew in from Dubai had a horrendous fracture to his little finger, which people think, oh, that's not a big deal.
DR. ALEJANDRO BADIA: So pinkie, you know, we call it the pinkie. Your football coaches tell you pull on it or jam. And I absolutely hate that because let me tell you, you have a problem with your little finger. All the strength in the hand, comes from these two fingers. These are 4 from microsurgery or threading a needle. Right knife, please. And I can tell you that. If these fractures are not fixed correctly, this is extremely disabling.
DR. ALEJANDRO BADIA: His fingers were rotated. I think we have pictures that we can post, but his two fingers were rotated, facing the other direction. So ihand surgery is one of those things where people don't think about it much until they have it. Thank you.
DR. ALEJANDRO BADIA: So we're all old pros here because we just did the same thing on the other finger. It's really the same exact fracture pattern. What is the rehab like after? Is he going? He'll he'll start a little bit next week just to start gently moving. But, you know, the problem is a fracture doesn't heal.
DR. ALEJANDRO BADIA: The fracture doesn't heal for for about four weeks. So during that time, you're depending on the little mini screws. So this is all hematoma blood within that's within the fracture site. And that's going to keep us.
DR. ALEJANDRO BADIA: So we're going to irrigate some of that out now. You can see. So the problem with the mix is tricky is that there's what we call a butterfly fragment. So it's not just two pieces. There's a little third piece here. And that often interferes with the reduction.
DR. ALEJANDRO BADIA: Reduction means putting the bone back in place. So you can do closed reduction like you might do with a minor fracture and the wrist that hopefully will hold or what we call open reduction. So this is in orthopedic terms is called ORIF, open reduction internal fixation because we're fixing it internally. Irrigation one more time, please, and then I'll need the dental instrument.
DR. ALEJANDRO BADIA: I will tell you, my dental colleagues are the ones who kind of invent everything in orthopedics first. They did the first little mini x-rays already titanium implants were used. They all started in the dental world. So kudos to my dental colleagues. So there's a piece. If I don't get these little pieces of hematoma and bone fragments out and I can't get a good reduction because it'll be blocking it.
DR. ALEJANDRO BADIA: So us hand surgeons often say that these are some of the actually toughest cases there are to get a really perfect result. Requires a lot of experience. He's lucky. He was our patient previously and already knew how to find you.
DR. ALEJANDRO BADIA: Now he's going to be at the orthopedic conference with a cast to share his other story. Yeah so we actually won because of the case that some of you may have seen where he broke his collarbone, this same arm. He broke that collarbone and tore the ligament on the opposite thumb. And he's a motorcycle police officer here for the city of Miami. So he's going up with us to Orlando.
DR. ALEJANDRO BADIA: We're going to get this award, which is nice. You know, it's the injured worker award, but he didn't do this at work. So it's a little bit of a different category, but same thing. He's going to be looking to get back on a motorcycle to keep all of us safe. Right OK. [inaudible] Let's see if we can get this in there.
DR. ALEJANDRO BADIA: You can slide out. Very good. Get right down here and lift up the tendon and take. There are all sorts of instruments designed. This is designed by a surgeon, actually, this by a company called Innomed.
DR. ALEJANDRO BADIA: See how tough to remember on the last finger. I want you to pull on this. We're going to pull and rotate. There you go. See if you had a rotation is really what reduces it. Problem is, is that butterfly fragment, which fits right in there.
DR. ALEJANDRO BADIA: So now if this is good, we are set and these screws will stay there. It's not necessary to. No, no. I have a friend. A buddy of mine is a big jujitsu guy. And he broke his gosh 25 years ago. And I see him all the time and I forget to even ask him. Can't even see the can't even see the little scars anymore.
DR. ALEJANDRO BADIA: But he's got the screws in his finger, you know. It's distracting, right? No, I got it now. Hopefully that. OK so that looks it looks pretty good. Yeah OK. What's important.
DR. ALEJANDRO BADIA: You see this finger. So we judge a rotation by looking at the nails. So the nails are in the same plane. Now see here we've got to really pronate him. Your viewers are commenting. Great job. Carry on.
DR. ALEJANDRO BADIA: All right, let's. So this time, I'm going to put the middle one first just because I have put them a little more. Yeah there you go. OK sharp. Yes, you. So so as the surgeons know, listening, you know, we like this, means that this screw, we all redraw this cortex.
DR. ALEJANDRO BADIA: So that. See that the screw actually compresses. So the screws not really grabbing the near cortex, it's grabbing the far cortex and pulling it. So that's we call that a lag screw. Yes I'll share the pre-op X-ray in one second.
DR. ALEJANDRO BADIA: Yes as soon as we put the screw we can. I would probably I'll probably lose an 11 on the next one.
DR. ALEJANDRO BADIA: [Inaudible] So the screw falls right into that hole because it's the same size. I didn't follow the same trajectory. So OK. That's it's got to be very precise. OK all right, I have a question for you, Dr. B. For a lag screw, are you using a differential drill bit?
DR. ALEJANDRO BADIA: Or is it screw partially threaded? Very good question. No, it's a fully threaded screw. But this drill bit, you can see it's short. So it's not going to go all the way through the fracture. It's going to go through the near cortex and it's a little bit larger diameter. So the screw will glide through this cortex and then grab the far cortex and compress it.
DR. ALEJANDRO BADIA: Whereas that's a very good question. So sometimes we might use the same drill bit. That's a slight. Yeah, I'm Yeah. See there's the, the lag screw up the. Hold on a second. That's a little dicey part.
DR. ALEJANDRO BADIA: She's got that dental instrument. He's got that. But this is just a sliver of bones, so I can't really do much with this. Let's get flow in here a minute just to see if this looks OK. I think so.
DR. ALEJANDRO BADIA: OK great. OK OK.
DR. ALEJANDRO BADIA: This one's a little bit this screw just because of that lateral I'm putting the screw really right next to the other one. We're just going to do it a little. A little diversion. OK, let's get an 11 here.
DR. ALEJANDRO BADIA: And then we'lll remove the clamping and put another screw. 11? Believe this is a fellow commenting that says, I feel the lag screw should be directed more perpendicular to fracture sites as pattern is long oblique. Yep yeah, I agree. But sometimes, you know, when you're in here, you kind of do what you can.
DR. ALEJANDRO BADIA: But I don't have an argument with that. Right now. Right now. Right here. Right but see, here we have a good reduction. You see, now the question is, do you do anything with that little shell of a, you know, I may do something with that little. Yeah, let me see.
DR. ALEJANDRO BADIA: Because I don't want that moving. I'm going to actually which is unusual. I'm going to counter sync this. OK we're going to go we're going to put a screw in the actual. So this is dental here. So what we're doing the same thing.
DR. ALEJANDRO BADIA: So go ahead and give me the... So I'm actually going to put a screw in the butterfly fragment because it's so large. I don't want that floating around. [inaudible] It is underneath the extensor. So I'm going to I'm going to countersink it.
DR. ALEJANDRO BADIA: [inaudible] We're probably just touching up against the other screw, but I got it past. I have a question, can that small piece of bone, can it be put anterior posterior direction?
DR. ALEJANDRO BADIA: That slither of bone. Yeah, I'm putting it where it belongs. I mean, it's just. There's no other place to put it. It's just, I'm afraid, because it's so big. OK that gave. So what I'm going to do, though, is counter sink because its sitting right under the extensor.
DR. ALEJANDRO BADIA: [inaudible] Yeah. OK I'll take the nine. I'm going to go a little on the short side because the tip is going to be running into the flexor tendon. I was hoping this would be a good lesson for laypeople to understand what fixing a fracture entails.
DR. ALEJANDRO BADIA: Do you want to comment? Yep so we're going to counter sink. No, it's OK. A little bit. The screw head sits a little bit into that fragment. So these are the sides of the screw. So now you know where they cost a little more than what you get at Costco or Home Depot.
DR. ALEJANDRO BADIA: All right. That's good. That sunk it in nicely. OK that's nice. OK, let's. [inaudible] Yep yeah, this is good.
DR. ALEJANDRO BADIA: OK let's go here and see what happens. You can't do that. You need to reach in and do that. If but yeah, if you can just if you can just hold that down like that just for a moment. Oh, Yeah. [inaudible] Let me know when you're ready for another question, Dr. B?
DR. ALEJANDRO BADIA: Yes, I'm ready. OK so for the approach, did you splint, sorry, split the extensor tendon. And if not, what is your opinion? Should we split or go laterally and retract? Yeah I'm going laterally. He's retracting the extensor now. I'll show it to you.
DR. ALEJANDRO BADIA: The time I split it is when I'm putting a dorsal plate, which anybody who knows me knows that I can. I avoid that at all costs. I'm not a fan of plates in the [inaudible] because you often have to remove them and the scars. Whereas with this it's I almost never have problems but to get the right, to get the plate. You don't have room here so you do you do split the extensor, which I'll show.
DR. ALEJANDRO BADIA: Yeah your colleague says that he personally feels that it damages the blood supply. Yeah but, you know, fortunately, in a hand, it's so robust. Let me have a go back to the last 12. But we'll see now.
DR. ALEJANDRO BADIA: Let's go to 12, that's when you get to things this small the depth gauge just to me is not always that accurate. OK so lags go right in. You see the dial right in. And now. Now the threads are grabbing and bam. There we go.
DR. ALEJANDRO BADIA: Now, maybe I should have listened to myself. This this is not grabbing. OK, now, I hope it's not in a fracture site. I don't think so. But let me have any other actually. Let me see. No, no, I'm going to let me see the X-ray for a second. So come out with it. Come out?
DR. ALEJANDRO BADIA: Yes Yes. That should be good. It should be good. Let me see. [inaudible] So I'm going to drill it proximally.
DR. ALEJANDRO BADIA: Clamp to me. Screw out. I'm going to redrill the screw a little bit. So I'm not able to see the other side. I need a regular clamp. And then let me have the same drill bit, the far one, in that little one.
DR. ALEJANDRO BADIA: OK, here's the pre-op X-ray. [inaudible] I'm going to direct it.
DR. ALEJANDRO BADIA: Greetings from Indonesia. Oh, we have a great relationship with our Malaysian colleagues and Indonesia and I plan to go to Borneo. OK OK. Thank you. I have a question for you, Dr. B. Yes.
DR. ALEJANDRO BADIA: What do you think about headless, cannulated screws for this fracture? I don't think they're necessary. You know, these are low profile. This is Medartis And these are great. I mean, this is great Swiss technology. This is, you know. All right.
DR. ALEJANDRO BADIA: I'll take that same screw. [inaudible] [Spanish] I believe you see some of our patients.
DR. ALEJANDRO BADIA: Yes tell me what's on the list of. Please, please. No, I don't like it. I don't like it. I'm drilling a whole new drill, start the whole process over. I don't like it. It's probably at the tip. There's a little bit of fragmentation.
DR. ALEJANDRO BADIA: Are these AO screws and how many millimeters? No, this is Medartis Which which is, these are 1.5 millimeter. But that screw wasn't holding, so we'll use the same screw. I'm just going to drill a hole. New hole. So let me see which direction.
DR. ALEJANDRO BADIA: We have it right here. Yeah politics right. Problem is it was in the fracture. [inaudible] Can you repeat the company for the screws Dr. B? Medartis.
DR. ALEJANDRO BADIA: We'll show you the tray. I was. [inaudible] Colleagues from physiotherapy is commenting on the team. He said, you have the best team, there you go and hopes to see you in Guayaquil, Ecuador again. Well, I'm going the first week of October, but I'm going to Quito.
DR. ALEJANDRO BADIA: But I will stop for sure. So I changed directions. Folks, I'm on the edge. I'm not crazy about this, hold that. Same screw. Reloading, here we go.
DR. ALEJANDRO BADIA: OK that's much better. All right. So for the question about the extensor, about the approach. So here's the extensor. That was a very good question. So I don't disturb the FET, which is these little fibers that give blood supply to the tendon.
DR. ALEJANDRO BADIA: So I go in on the lateral side, you see. So, so this should not this should not the therapy will be directed at gaining full extension. So we have Gigi from my office is here to put on our new type of splint, which we put on pre operatively. And now she's going to remold it so we can let her know. She's outside. OK She's watching us live, she knows.
DR. ALEJANDRO BADIA: Oh, so we're working with a company from Finland, a new type of splinting. So we splinted them in the, in the, in the office. Now we're going to heat up the splint and I'm going to put on actually as I'm putting the dressing on, we'll heat it up and now it's going to be better molded. And then he'll start therapy next week. We'll actually make him we'll probably make him a thermoplast.
DR. ALEJANDRO BADIA: OK so you start next week. All right, let's see. Let's go the vertical if you think you can do that, too. [inaudible] OK so important thing is, print, please.
DR. ALEJANDRO BADIA: We look here, all the fingers, all the fingers point to the skate point tubercle. So that's. That's what we want. Looking at it this way. So that's why the proximal phalanx is so critical. Even though that ring finger fracture is a lot more difficult. OK irrigation, please. The splint is made out of recycled wood material, and we don't use a heat gun.
DR. ALEJANDRO BADIA: We actually use an oven. I can show it to you in a minute. You know what? Let me get one last lateral. We printed that. There's a question about the proximal most screw is it very near the fracture site.
DR. ALEJANDRO BADIA: Would that be an issue? But you know what? Your beggars can't be choosers. And and, you know, I'm happy with it. It's just, you know, when these fractures are fragmented like that, you know, it's a problem. Print. So you know, the enemy of good is better. And every surgeon knows that. You know, I'm not I'm not treating the X-ray.
DR. ALEJANDRO BADIA: What what I'm happy about is the rotation of the finger. The fracture is stable. So there's not a lot of there's just not a lot of, you know, real estate there to be putting, You can see there's multiple screws, but it's very it's stable. So right. That's perfect, Picasso. Greetings from Rome.
DR. ALEJANDRO BADIA: From Rome? Who is it? Dr. Lucien Makovici. He's always. I will be in Rimini next year, as my friend is the president of the European Congress next year in Rimini, Italy.
DR. ALEJANDRO BADIA: I wouldn't miss it for the world. [inaudible] Yeah your fellow Devon Hsu who commented on the screws on the fracture site said he agrees the functional outcome is what we should bother. And greetings from India. [inaudible] Who's in India?
DR. ALEJANDRO BADIA: Your fellow who was commenting on the screws being close to the fracture site. Oh, Devon Hsu. Oh, OK. Well, that's the fellow's job is to bust my balls, so I like having them here. They have good questions. So we use is everyone knows who've been with us.
DR. ALEJANDRO BADIA: I've been doing it for gosh almost 30 years like a repeat patient is like. He said ha ha sorry. And Dr. Lucien said I use this technique and it's great over 100 cases. I applaud them for knowing how many cases I have has always been a problem. I have I. You've lost count. I just know.
DR. ALEJANDRO BADIA: I just. Well, I don't miss my I don't document anything. But, you know, you can tell everybody The last thing you want is for somebody to give you yet another task. So we just I just realized a long time ago we're documenting the volar plates. That's true.
DR. ALEJANDRO BADIA: We did. So we're using currently we're using two different volar plates that they give me as we're about to publish a paper or say submit for publication on a plate that corrects the volar, tilt with the lever arm that sits under the subchondral bone. And that, you know, hopefully it's accepted.
DR. ALEJANDRO BADIA: I won't say what Journal because I don't want to unduly influence them. Although I will say I was a reviewer for 12 years on that Journal. But that's enough. [inaudible] OK we'll need just a few fluff dressings. Irrigation, please. Of course.
DR. ALEJANDRO BADIA: What's nice about the repeat is you can evert the skin edges. And you don't have to worry about difficulty of removing because you don't you're not removing a stitch. Whereas if you did this with nylon, sometimes this it's. And to be a little difficult to remove.
DR. ALEJANDRO BADIA: So we have a. The shoulder with a subpectral bicep tenodesis in the other room that they're just about ready for me. So ready. We have a little bit of sterile cats padding.
DR. ALEJANDRO BADIA: OK we won't put DV because here your new cast splint has enough padding that with the finger and there's just little screws holding it. Anybody going to Boston listening? But we're waiting. Oh, I have a question about fellowship, though. Do you provide fellowship short term or long term?
DR. ALEJANDRO BADIA: No, it is short term because, you know, unfortunately, Thanks to ridiculous rules that society continues to impose on us is the Fellows aren't allowed to scrub with me and they used to be able to. So it goes to show that in our society where we're literally letting you. No worries, because obviously I accept all the liability, but we're so obsessed with liability. And the worst part about this is that we're exporting.
DR. ALEJANDRO BADIA: The US is exporting this nonsense to Europe and all of a sudden all this compliance bullshit is, you know, is more important than, you know, patient care and learning and education. And it's really sad. But, you know, it doesn't matter because I'm not at this point in my career, but it's unfortunate. So the answer is, no, we don't do long term fellowship because, you know, the surgeons really don't get to operate.
DR. ALEJANDRO BADIA: So Dr. Devon Hsu said, I really want to work under your guidance. I have completed my master's in orthopedics from Mumbai, India, and I'm interested in hand surgery. Can I email you? Absolutely just my website is Drbadia.com I answer myself. The link is in our bio.
DR. ALEJANDRO BADIA: Dr. Devon Hsu. Sure you can find the link in our to the website www.drbadia.com and you can click on Ask me a question to send him an email and he answers those himself.
DR. ALEJANDRO BADIA: Ola Dr. Silva. Dr. Silva is watching you from Chile. She's preparing the cast.
DR. ALEJANDRO BADIA: Please after this surgery, we would be done going live and we'll go live again next Tuesday.
DR. ALEJANDRO BADIA: Doctor Badia's in I'll post the schedule. We usually go live on Tuesdays. Today was just a special case, so we decided to go live Thursday as well. So it's like karma. It's like Karma.. Wednesdays are Sundays on combat.
DR. ALEJANDRO BADIA: That was ice cream company. Yeah ice cream. So now you'll see the splint we're putting on. But not always at this time. It varies on the case. So we'll select the case on Monday and post on Monday. What time will be going live on tuesday? Now, if you guys can share the hashtag, but a live surgery Tuesday.
DR. ALEJANDRO BADIA: Yeah well, either way, she's coming in now with the splint, so I'm. So we'll keep you guys posted on this case. And on his recovery. Thank you so much for watching. We can post the splinter. Trying to.
DR. ALEJANDRO BADIA: OK all right. Here's our can split from recycled wood material. It's warm. So she's able to mold it to the patient. OK Dr. Badia. great reduction.
DR. ALEJANDRO BADIA: [inaudible] and yes, it does get hard and stiff.
DR. ALEJANDRO BADIA: Then about two or three minutes will be hard. It starts to harden now. [inaudible] I know he wanted to show, we're still live.
DR. ALEJANDRO BADIA: He wanted to show the tray of the screws. Which one is it? Medartis. Aptus. This is the material inside. Wonderful Thank you. [inaudible] Thank you guys so much for watching. Look out for Mondays.
DR. ALEJANDRO BADIA: We'll share when our next live surgery will be. Usually on Tuesdays, time will to be announced. Thank you.
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