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Name:
PHILOS DS 2
Description:
PHILOS DS 2
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https://cadmoremediastorage.blob.core.windows.net/f683d5e2-feb7-4ad9-87d3-36e93ca5e229/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H34M57S
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Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/f683d5e2-feb7-4ad9-87d3-36e93ca5e229/PHILOS DS 2.mp4?sv=2019-02-02&sr=c&sig=qk66USKK17n4g5jWBegUn4juqPJ%2BNPbHDMzk3OW53es%3D&st=2024-11-21T17%3A46%3A03Z&se=2024-11-21T19%3A51%3A03Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
DIPIT SAHU: Yes.[INTERPOSING VOICES] OK yes, please. Eagerly waiting. So can you tell us what approach you're using? So this will be deltopectoral regular approach. OK? OK.
DIPIT SAHU: You see the cephalic? Yes, yes. OK, can I have the small retractor? [INTERPOSING VOICES] Now, uh, is the arm abducted? Because. Right now it's just normal, lying like this. OK. We will abduct when necessary. OK.
DIPIT SAHU: Scissors please. Scissors. That's it. Do you ever use a deltoid split approach? I've used it, yeah, I've used the deltoid split also, eventually [INAUDIBLE] OK deltoid split is easier approach to expose.
DIPIT SAHU: It's just that it is more damaging to the nerves and all, so- Yes. This is [INAUDIBLE] One second, I'll just show you.
DIPIT SAHU: Can you see anything? Yes, yes. You saw the [INAUDIBLE] when you showed it. Is that the uppermost triangular space between the deltoid? Yeah so I'm just trying to locate the space, [INAUDIBLE] please? [INAUDIBLE] So the French call it the moraline fossa. This is the moraline fossa, OK? No, the deep one.
DIPIT SAHU: So this goes in the moraline fossa. Again. Retractor, please.
DIPIT SAHU: Any Hohmann's retractor? Yeah, [INTERPOSING VOICES] Any Hohmann's retractor? Do you prefer to take the vein on the medial side or the-? This has gone laterally. [INTERPOSING VOICES] Generally there are a lot of tributaries which go into the delta [INTERPOSING VOICES]
DIPIT SAHU: You have to ligate them. And what is the distal extent of the split? Well, it's just to show you better, I've taken more, but it's still the deltoid attachment. OK. Yeah. Mostly still there. Yes. You can see the upper back by the [INTERPOSING VOICES].
DIPIT SAHU: OK we'll just release it a bit. OK. Is it because this is a three year old? Yeah, it's a little. Yeah that's why. Otherwise we won't- [INTERPOSING VOICES] You wouldn't have- Yeah no, no, of course not. But I think in this age group it doesn't make it- And you know, when we do an arthroplasty, we release it.
DIPIT SAHU: I mean, I think it's not a problem, we'll repair it in the end. [INAUDIBLE] Now, I'll show you the anatomy of it. This is your seal ligament, I'm just clearing it out. Can I have a forceps?
DIPIT SAHU: And can I have a nibbler if you please, seal ligament? Yes OK. This is a bursal bleed, I'll just remove a bit of it. Do you release the seal ligament just for-? No, no, we are not releasing it. OK.
DIPIT SAHU: I'm just showing the anatomy. I'll just take time to do the exposure. Yes, absolutely. Suction. [INAUDIBLE] OK.
DIPIT SAHU: These older fractures, a lot of times the deltoid is literally plastered to the - [INTERPOSING VOICES] Deltoid will be plastered, you're right - segments. So [INTERPOSING VOICES] and painful, isn't it? Can I have my, my [INAUDIBLE] So now how to go subdeltoid, OK. Now, you know, the subacromial space is here, OK? Yeah.
DIPIT SAHU: Now, this connects with subdeltoid space, so I'll abduct, I'll go in the subdeltoid space. This is your subdeltoid space. OK, so you go from subacromium to the subdeltoid. Fantastic. OK? Really, the bit- Is that the biceps tendon we see on the left side? We'll see,
DIPIT SAHU: yeah so we'll see the biceps also very soon. More please. I have my [INAUDIBLE] retractor. So this is your LT. OK can I have a right angle, please?
DIPIT SAHU: Well I'm just going to like subdurate it, Kobilka [?]. OK. So this is a subscap. OK. [INAUDIBLE] OK. Let me hold this. Yeah [INAUDIBLE]. OK, hold this. Yeah.
DIPIT SAHU: Hold this. So what I'll do is I'll just open it a bit. So so you've positioned the coils [?] in the deltapectoral interval or beneath the conjoint [?] I can do it below the conjoint also it gives me but probably is not needed.
DIPIT SAHU: I can see the subscap very well. So I'll just find the biceps, which is here. Can I have a report [?]? So see, this is devoid. The head is bare because the GT has gone. Forcep [?] please. See, this is the GT.
DIPIT SAHU: This is a LT. This is a subscap attached, OK? And if you see, it's all open here. The head is visible, the rotator is exactly open, there's nothing, there's nothing over here. OK? So this is all here is a biceps tendon.
DIPIT SAHU: Yes, absolutely. OK well, there's no point, I'm going to see. This is all this is in the groove here, but everything else lateral is broken. Yes. So over here everything is broken. This is still in the groove. Yes. Probably not. I'll just leave it like this, it's OK.
DIPIT SAHU: So it's already open. Everything is open here. Do you think it interferes with the reduction? Yeah then I'll remove it. But I think it's OK. It's not interfering right now. Can I take a suture?
DIPIT SAHU: So what I'll do is This is [INAUDIBLE] This will be more of a soft tissue surgery, OK. Not like yesterday. It was more of an orthopedic surgery. And more of this rotator cuff sutures and all. OK, so this is one.
DIPIT SAHU: One more, please. So this is one, OK, and now the forceps please. [INAUDIBLE] So I've taken to 81 [?] and in the subscapularis, OK. One will go through the plate. One will not go in the plate.
DIPIT SAHU: One will go below the plate because that will help me in reduction. So what I'll do is this one will be below the plate. Can you cut the needle, please? So we'll cut the needle off this.
DIPIT SAHU: So this will be just for reduction purposes. What I'll do is I'll tie a knot in this. OK so this will be for deduction. This will go in the plate. Now can I have two or three forceps [?]? If you see, the GT will come into vision now.
DIPIT SAHU: OK you know, can you see the GT? [INAUDIBLE] Yes, sir, it is. Can you see the GT here? Is there a cuff attached to it, sir? Yeah, I think it's. Yeah, I think so. Can I have my Cobbs?
DIPIT SAHU: You see, but it is all fibrosis of the elevator. OK? Yep. You'll see. This is all fibrosis here. And here. Yes, sir.
DIPIT SAHU: One of the delegates wants to know if there is any risk of axillary nerve injury. So that's why I went from the subacromial space, to subdeltoid space. So I've taken the axillary along with the deltoid. Because even that can get plastered in such chronic. Yes that's why we went in the subdeltoid space.
DIPIT SAHU: You see this? OK sutures again. [INAUDIBLE] The infraspinatus has probably pulled it way posteriorly Infrasupra has pulled it back. I'm delivering it out.
DIPIT SAHU: Forceps [?] One more.
DIPIT SAHU: Can you see the GT? Can you see the GT? Yes, yes. OK so this is the non-traumatic artery forceps. We've just named it today. Like the instrument we've named this. Nikhil can use it from now. This is a non-traumatic, because the question will be it can crush the GT.
DIPIT SAHU: OK. You see this is the GT. Yes, yes, we can see. Are you going behind? Yeah, I'm trying to go behind in the face of cuff and bone.
DIPIT SAHU: So do you prefer using a T bone [?] or fiber wire? The T bone number 5 is what advantages this is a big needle It helps me pass nicely. The sutures. Yes yes, it can go through the strong one. OK so I can pass in depth now with the fiber while I'll be struggling a bit. It's got a very small curvature needle. So see this?
DIPIT SAHU: I've taken one, OK? Now I'll take another one. What I'll do is I will pull, OK, I will pull like this. I will take another one. OK one more, please. So this we'll use for reduction. Cut please. [INAUDIBLE]
DIPIT SAHU: OK. What I'll do is I'll tie a knot. So I know that this for reduction. So there are two for reduction. This one and this one, OK? We'll tie-in the end like this. See it's reducing already. Can you see this? Yes yes, it's reducing nicely.
DIPIT SAHU: Reducing very well. OK, [INAUDIBLE] position. OK so what we'll do is we'll just tie and keep, so it will reduce. But before that, we need to reduce the head a bit. But this is reduction of the GT/LT [?]. Yes. Agree? Yes, sir. So what we'll do is we'll take I'll take one more suture.
DIPIT SAHU: Are you planning to tie them now or to tie- No after the reduction of the head Let's see how the head reduces. So you plan to go through the fracture site? To the fracture site Or wherever the head is visible. That is probably a bit of varus, not much.
DIPIT SAHU: We'll try and see. Yes. Yes. And also, do we have a curved [INAUDIBLE] or something? OK yes. No, that's fine. So this I'll go even more posteriorly, if you can see. OK. OK. So bone tendon junction?
DIPIT SAHU: Yes. OK. So these two will go in the plate. The front will go in the plates. This will be tied with this one like this, OK? This will be reduced. Now, let's see what is happening with the- We'll just see what is happening with the head.
DIPIT SAHU: Parker's [?] [INAUDIBLE] please?
DIPIT SAHU: Go caucus, [?] please. We will reduce the head with this if it needs a bit of reduction, I think. Shoot. Shoot. [INAUDIBLE] OK [INAUDIBLE] We can't see the images very clearly.
DIPIT SAHU: Yeah, that's better. Thank you. Cobb's, please. Yes. OK shoot.
DIPIT SAHU: Shoot. Punch. Yeah, we'll just tamp it up. OK. Water please [?] [INAUDIBLE] Shoot please. OK, up. But the spike has gone out. Earlier it was in, if you saw the CT scan.
DIPIT SAHU: Yes. Sir there is a question from one of the delegates, will you like to fill this void with some kind of [INAUDIBLE]? Yeah, I think that's a good idea in this age group. But we should be OK. Shoot. [INAUDIBLE] See.
DIPIT SAHU: Bursa [?], that's it. Shoot. OK shoot. Internal [?] Shoot. Shoot. So this is how it is lining up. Yes, this looks perfect. You can just sit there and just log [?] the orientation of GT at the head.
DIPIT SAHU: Yeah so we'll put a K-wire link in. We'll fix the GT's position. And head with shaft. Yeah. Yeah. OK that's it.
DIPIT SAHU: Shoot. Yeah, I think that's fine. OK. How do you remove this? [INAUDIBLE] OK. [INAUDIBLE] K-wire? More please.
DIPIT SAHU: Press. Press [INAUDIBLE]. [INAUDIBLE] The audio visual version intermittently shows the surgical field so that we understand what is physically being done. Go more.
DIPIT SAHU: Thank you. Shoot. I think it's fine. One more please. Can I put a plate after this? Yes. Oof! Somebody can join on a mobile on a Zoom call and they can keep it on the C-arm [?] so that we can see both. Shoot.
DIPIT SAHU: Do you think we can do that? [INAUDIBLE] [INAUDIBLE]
DIPIT SAHU: Shoot. [INAUDIBLE]. OK. [INAUDIBLE] So, see we put just three K-wires. What I'll do is I'll just tie the GT. It's already in place because of the K-wire, OK? But it can be further tied. Do not [INAUDIBLE]. This one. Not this one. The knot.
DIPIT SAHU: So these two. These two are for provisional reduction, OK? I'll probably just tie them. OK? Now actually, the K-wire is not needed once this is in. So I'll just keep it like this. OK. Can you see this?
DIPIT SAHU: Yes, sir. So this is the infra. This is the subscap. I'll take it through the plate. The sutures hold the fracture really well. And because LT in this case is intact, we have an advantage. So the subscap sutures will really hold very well. Yeah. [INAUDIBLE] Take it from behind this.
DIPIT SAHU: Yeah, yeah, yeah. Yeah, OK. And, yep. OK. Yeah. One again. Yeah so we've taken the sutures through the plates and we'll apply the plate.
DIPIT SAHU: So the K-wires are hard [?] actually, play strategically away from the plate area. Are you cutting it? [INAUDIBLE] [INAUDIBLE] Pass me that. And this you'll see the image also along with [INAUDIBLE]
DIPIT SAHU: [INTERPOSING VOICES] Can you see the C-arm image or the sagittal image? No no no, we can't see. We can't see. Can somebody join the Zoom link on mobile and show so that you don't have to change the camera switch to gallery view or over there [?]
DIPIT SAHU: Gallery view switch [INAUDIBLE]. [INTERPOSING VOICES] Yeah. OK. Turn [?] K-wire.
DIPIT SAHU: Shoot. Is this position regular [?] [INAUDIBLE], you want. Well, this is holding. Shoot. [INAUDIBLE] Shoot. Shoot, OK. K-wire.
DIPIT SAHU: OK. [INAUDIBLE] [INAUDIBLE] And OK. I think that's good [?]. Yeah it's in the shaft. Middle of the shaft.
DIPIT SAHU: Yeah one more. OK. OK good. That's fine. So this is what we have right now. Can you see here?
DIPIT SAHU: OK so these two sutures are through the plate of subscap. These are infra [?] Then the plate is fixed with two K-wires. The we have to put the bottom screw and if there is a chance, we'll use the technique of Dr. [INAUDIBLE], the one I learned yesterday, the medialization and what was that? The push screw technique.
DIPIT SAHU: Probably to not be required in this case, since the [INAUDIBLE] structure was not required for this. Only not because our [INAUDIBLE] structure is already going medially. Yeah so the other. OK, let's see if required we'll do it. I want to desperately perform that after yesterday. It is a very good technique.
DIPIT SAHU: OK? Take one K-wire down there. Yeah. And take a 26 [INAUDIBLE] screw [?] OK, one K-wire, and then one screw, a sharp screw [?]
DIPIT SAHU: Now, this is a 72-year-old lady. The bones are going to be really bad in the head. So we will not drill in the head at all. I will just drill proximally, and then do everything with the depth case. Anyone? OK? Yeah. Yeah. [INAUDIBLE]
DIPIT SAHU: OK. Fine. OK. Shoot. OK fine. [INTERPOSING VOICES] [INAUDIBLE] OK [INAUDIBLE] [INAUDIBLE] drill a ligate [?] here please?
DIPIT SAHU: OK, it's fine. OK good. Drill, and screw the [?] 26. Ready? I'll hold it.
DIPIT SAHU: OK. Better [?] [INAUDIBLE] Push the [INAUDIBLE] OK, fine. In a second, OK [?] We are in the [INAUDIBLE]. OK. Yeah. 26 screw down [?]. Ready? OK. Sir do you want to confirm your plate positioning?
DIPIT SAHU: Yeah, we'll do that. Just lock it up [?]. OK, OK. Yeah so we just put this through and we'll confirm it. OK. [INAUDIBLE] OK, down there. OK. Shoot. Shoot. OK, push in.
DIPIT SAHU: [INAUDIBLE]. Push in, OK. Shoot, shoot. Now shoot. Moving OK? Yes. Shoot. Shoot. Yeah [INAUDIBLE]. Shoot. So, how does it look?
DIPIT SAHU: It's looking fantastic. Looks OK? Fantastic. Now we'll use the technique of [INAUDIBLE]. Or Pushwala [?] I think it is well aligned, we can see. OK, stop [?]. We can take out the retractor Yeah I will take out the retractor.
DIPIT SAHU: So these retractors I use only because it is a very expensive retractor. It is not really helping, I think. This is a Nova [?] retractor. Very, very expensive. OK, shoot. [INAUDIBLE] It's well [INAUDIBLE] We are very well aligned.
DIPIT SAHU: Can we see external version [?] ? AP view? External version [?] AP view? [INTERPOSING VOICES] Yes. It looks pretty well aligned. Really. Shoot. A little bit internal rotation.
DIPIT SAHU: This is [INAUDIBLE]. OK? OK. Yes. OK. We'll just put the last of the screws.
Segment:0 .
DIPIT SAHU: Yes.[INTERPOSING VOICES] OK yes, please. Eagerly waiting. So can you tell us what approach you're using? So this will be deltopectoral regular approach. OK? OK.
DIPIT SAHU: You see the cephalic? Yes, yes. OK, can I have the small retractor? [INTERPOSING VOICES] Now, uh, is the arm abducted? Because. Right now it's just normal, lying like this. OK. We will abduct when necessary. OK.
DIPIT SAHU: Scissors please. Scissors. That's it. Do you ever use a deltoid split approach? I've used it, yeah, I've used the deltoid split also, eventually [INAUDIBLE] OK deltoid split is easier approach to expose.
DIPIT SAHU: It's just that it is more damaging to the nerves and all, so- Yes. This is [INAUDIBLE] One second, I'll just show you.
DIPIT SAHU: Can you see anything? Yes, yes. You saw the [INAUDIBLE] when you showed it. Is that the uppermost triangular space between the deltoid? Yeah so I'm just trying to locate the space, [INAUDIBLE] please? [INAUDIBLE] So the French call it the moraline fossa. This is the moraline fossa, OK? No, the deep one.
DIPIT SAHU: So this goes in the moraline fossa. Again. Retractor, please.
DIPIT SAHU: Any Hohmann's retractor? Yeah, [INTERPOSING VOICES] Any Hohmann's retractor? Do you prefer to take the vein on the medial side or the-? This has gone laterally. [INTERPOSING VOICES] Generally there are a lot of tributaries which go into the delta [INTERPOSING VOICES]
DIPIT SAHU: You have to ligate them. And what is the distal extent of the split? Well, it's just to show you better, I've taken more, but it's still the deltoid attachment. OK. Yeah. Mostly still there. Yes. You can see the upper back by the [INTERPOSING VOICES].
DIPIT SAHU: OK we'll just release it a bit. OK. Is it because this is a three year old? Yeah, it's a little. Yeah that's why. Otherwise we won't- [INTERPOSING VOICES] You wouldn't have- Yeah no, no, of course not. But I think in this age group it doesn't make it- And you know, when we do an arthroplasty, we release it.
DIPIT SAHU: I mean, I think it's not a problem, we'll repair it in the end. [INAUDIBLE] Now, I'll show you the anatomy of it. This is your seal ligament, I'm just clearing it out. Can I have a forceps?
DIPIT SAHU: And can I have a nibbler if you please, seal ligament? Yes OK. This is a bursal bleed, I'll just remove a bit of it. Do you release the seal ligament just for-? No, no, we are not releasing it. OK.
DIPIT SAHU: I'm just showing the anatomy. I'll just take time to do the exposure. Yes, absolutely. Suction. [INAUDIBLE] OK.
DIPIT SAHU: These older fractures, a lot of times the deltoid is literally plastered to the - [INTERPOSING VOICES] Deltoid will be plastered, you're right - segments. So [INTERPOSING VOICES] and painful, isn't it? Can I have my, my [INAUDIBLE] So now how to go subdeltoid, OK. Now, you know, the subacromial space is here, OK? Yeah.
DIPIT SAHU: Now, this connects with subdeltoid space, so I'll abduct, I'll go in the subdeltoid space. This is your subdeltoid space. OK, so you go from subacromium to the subdeltoid. Fantastic. OK? Really, the bit- Is that the biceps tendon we see on the left side? We'll see,
DIPIT SAHU: yeah so we'll see the biceps also very soon. More please. I have my [INAUDIBLE] retractor. So this is your LT. OK can I have a right angle, please?
DIPIT SAHU: Well I'm just going to like subdurate it, Kobilka [?]. OK. So this is a subscap. OK. [INAUDIBLE] OK. Let me hold this. Yeah [INAUDIBLE]. OK, hold this. Yeah.
DIPIT SAHU: Hold this. So what I'll do is I'll just open it a bit. So so you've positioned the coils [?] in the deltapectoral interval or beneath the conjoint [?] I can do it below the conjoint also it gives me but probably is not needed.
DIPIT SAHU: I can see the subscap very well. So I'll just find the biceps, which is here. Can I have a report [?]? So see, this is devoid. The head is bare because the GT has gone. Forcep [?] please. See, this is the GT.
DIPIT SAHU: This is a LT. This is a subscap attached, OK? And if you see, it's all open here. The head is visible, the rotator is exactly open, there's nothing, there's nothing over here. OK? So this is all here is a biceps tendon.
DIPIT SAHU: Yes, absolutely. OK well, there's no point, I'm going to see. This is all this is in the groove here, but everything else lateral is broken. Yes. So over here everything is broken. This is still in the groove. Yes. Probably not. I'll just leave it like this, it's OK.
DIPIT SAHU: So it's already open. Everything is open here. Do you think it interferes with the reduction? Yeah then I'll remove it. But I think it's OK. It's not interfering right now. Can I take a suture?
DIPIT SAHU: So what I'll do is This is [INAUDIBLE] This will be more of a soft tissue surgery, OK. Not like yesterday. It was more of an orthopedic surgery. And more of this rotator cuff sutures and all. OK, so this is one.
DIPIT SAHU: One more, please. So this is one, OK, and now the forceps please. [INAUDIBLE] So I've taken to 81 [?] and in the subscapularis, OK. One will go through the plate. One will not go in the plate.
DIPIT SAHU: One will go below the plate because that will help me in reduction. So what I'll do is this one will be below the plate. Can you cut the needle, please? So we'll cut the needle off this.
DIPIT SAHU: So this will be just for reduction purposes. What I'll do is I'll tie a knot in this. OK so this will be for deduction. This will go in the plate. Now can I have two or three forceps [?]? If you see, the GT will come into vision now.
DIPIT SAHU: OK you know, can you see the GT? [INAUDIBLE] Yes, sir, it is. Can you see the GT here? Is there a cuff attached to it, sir? Yeah, I think it's. Yeah, I think so. Can I have my Cobbs?
DIPIT SAHU: You see, but it is all fibrosis of the elevator. OK? Yep. You'll see. This is all fibrosis here. And here. Yes, sir.
DIPIT SAHU: One of the delegates wants to know if there is any risk of axillary nerve injury. So that's why I went from the subacromial space, to subdeltoid space. So I've taken the axillary along with the deltoid. Because even that can get plastered in such chronic. Yes that's why we went in the subdeltoid space.
DIPIT SAHU: You see this? OK sutures again. [INAUDIBLE] The infraspinatus has probably pulled it way posteriorly Infrasupra has pulled it back. I'm delivering it out.
DIPIT SAHU: Forceps [?] One more.
DIPIT SAHU: Can you see the GT? Can you see the GT? Yes, yes. OK so this is the non-traumatic artery forceps. We've just named it today. Like the instrument we've named this. Nikhil can use it from now. This is a non-traumatic, because the question will be it can crush the GT.
DIPIT SAHU: OK. You see this is the GT. Yes, yes, we can see. Are you going behind? Yeah, I'm trying to go behind in the face of cuff and bone.
DIPIT SAHU: So do you prefer using a T bone [?] or fiber wire? The T bone number 5 is what advantages this is a big needle It helps me pass nicely. The sutures. Yes yes, it can go through the strong one. OK so I can pass in depth now with the fiber while I'll be struggling a bit. It's got a very small curvature needle. So see this?
DIPIT SAHU: I've taken one, OK? Now I'll take another one. What I'll do is I will pull, OK, I will pull like this. I will take another one. OK one more, please. So this we'll use for reduction. Cut please. [INAUDIBLE]
DIPIT SAHU: OK. What I'll do is I'll tie a knot. So I know that this for reduction. So there are two for reduction. This one and this one, OK? We'll tie-in the end like this. See it's reducing already. Can you see this? Yes yes, it's reducing nicely.
DIPIT SAHU: Reducing very well. OK, [INAUDIBLE] position. OK so what we'll do is we'll just tie and keep, so it will reduce. But before that, we need to reduce the head a bit. But this is reduction of the GT/LT [?]. Yes. Agree? Yes, sir. So what we'll do is we'll take I'll take one more suture.
DIPIT SAHU: Are you planning to tie them now or to tie- No after the reduction of the head Let's see how the head reduces. So you plan to go through the fracture site? To the fracture site Or wherever the head is visible. That is probably a bit of varus, not much.
DIPIT SAHU: We'll try and see. Yes. Yes. And also, do we have a curved [INAUDIBLE] or something? OK yes. No, that's fine. So this I'll go even more posteriorly, if you can see. OK. OK. So bone tendon junction?
DIPIT SAHU: Yes. OK. So these two will go in the plate. The front will go in the plates. This will be tied with this one like this, OK? This will be reduced. Now, let's see what is happening with the- We'll just see what is happening with the head.
DIPIT SAHU: Parker's [?] [INAUDIBLE] please?
DIPIT SAHU: Go caucus, [?] please. We will reduce the head with this if it needs a bit of reduction, I think. Shoot. Shoot. [INAUDIBLE] OK [INAUDIBLE] We can't see the images very clearly.
DIPIT SAHU: Yeah, that's better. Thank you. Cobb's, please. Yes. OK shoot.
DIPIT SAHU: Shoot. Punch. Yeah, we'll just tamp it up. OK. Water please [?] [INAUDIBLE] Shoot please. OK, up. But the spike has gone out. Earlier it was in, if you saw the CT scan.
DIPIT SAHU: Yes. Sir there is a question from one of the delegates, will you like to fill this void with some kind of [INAUDIBLE]? Yeah, I think that's a good idea in this age group. But we should be OK. Shoot. [INAUDIBLE] See.
DIPIT SAHU: Bursa [?], that's it. Shoot. OK shoot. Internal [?] Shoot. Shoot. So this is how it is lining up. Yes, this looks perfect. You can just sit there and just log [?] the orientation of GT at the head.
DIPIT SAHU: Yeah so we'll put a K-wire link in. We'll fix the GT's position. And head with shaft. Yeah. Yeah. OK that's it.
DIPIT SAHU: Shoot. Yeah, I think that's fine. OK. How do you remove this? [INAUDIBLE] OK. [INAUDIBLE] K-wire? More please.
DIPIT SAHU: Press. Press [INAUDIBLE]. [INAUDIBLE] The audio visual version intermittently shows the surgical field so that we understand what is physically being done. Go more.
DIPIT SAHU: Thank you. Shoot. I think it's fine. One more please. Can I put a plate after this? Yes. Oof! Somebody can join on a mobile on a Zoom call and they can keep it on the C-arm [?] so that we can see both. Shoot.
DIPIT SAHU: Do you think we can do that? [INAUDIBLE] [INAUDIBLE]
DIPIT SAHU: Shoot. [INAUDIBLE]. OK. [INAUDIBLE] So, see we put just three K-wires. What I'll do is I'll just tie the GT. It's already in place because of the K-wire, OK? But it can be further tied. Do not [INAUDIBLE]. This one. Not this one. The knot.
DIPIT SAHU: So these two. These two are for provisional reduction, OK? I'll probably just tie them. OK? Now actually, the K-wire is not needed once this is in. So I'll just keep it like this. OK. Can you see this?
DIPIT SAHU: Yes, sir. So this is the infra. This is the subscap. I'll take it through the plate. The sutures hold the fracture really well. And because LT in this case is intact, we have an advantage. So the subscap sutures will really hold very well. Yeah. [INAUDIBLE] Take it from behind this.
DIPIT SAHU: Yeah, yeah, yeah. Yeah, OK. And, yep. OK. Yeah. One again. Yeah so we've taken the sutures through the plates and we'll apply the plate.
DIPIT SAHU: So the K-wires are hard [?] actually, play strategically away from the plate area. Are you cutting it? [INAUDIBLE] [INAUDIBLE] Pass me that. And this you'll see the image also along with [INAUDIBLE]
DIPIT SAHU: [INTERPOSING VOICES] Can you see the C-arm image or the sagittal image? No no no, we can't see. We can't see. Can somebody join the Zoom link on mobile and show so that you don't have to change the camera switch to gallery view or over there [?]
DIPIT SAHU: Gallery view switch [INAUDIBLE]. [INTERPOSING VOICES] Yeah. OK. Turn [?] K-wire.
DIPIT SAHU: Shoot. Is this position regular [?] [INAUDIBLE], you want. Well, this is holding. Shoot. [INAUDIBLE] Shoot. Shoot, OK. K-wire.
DIPIT SAHU: OK. [INAUDIBLE] [INAUDIBLE] And OK. I think that's good [?]. Yeah it's in the shaft. Middle of the shaft.
DIPIT SAHU: Yeah one more. OK. OK good. That's fine. So this is what we have right now. Can you see here?
DIPIT SAHU: OK so these two sutures are through the plate of subscap. These are infra [?] Then the plate is fixed with two K-wires. The we have to put the bottom screw and if there is a chance, we'll use the technique of Dr. [INAUDIBLE], the one I learned yesterday, the medialization and what was that? The push screw technique.
DIPIT SAHU: Probably to not be required in this case, since the [INAUDIBLE] structure was not required for this. Only not because our [INAUDIBLE] structure is already going medially. Yeah so the other. OK, let's see if required we'll do it. I want to desperately perform that after yesterday. It is a very good technique.
DIPIT SAHU: OK? Take one K-wire down there. Yeah. And take a 26 [INAUDIBLE] screw [?] OK, one K-wire, and then one screw, a sharp screw [?]
DIPIT SAHU: Now, this is a 72-year-old lady. The bones are going to be really bad in the head. So we will not drill in the head at all. I will just drill proximally, and then do everything with the depth case. Anyone? OK? Yeah. Yeah. [INAUDIBLE]
DIPIT SAHU: OK. Fine. OK. Shoot. OK fine. [INTERPOSING VOICES] [INAUDIBLE] OK [INAUDIBLE] [INAUDIBLE] drill a ligate [?] here please?
DIPIT SAHU: OK, it's fine. OK good. Drill, and screw the [?] 26. Ready? I'll hold it.
DIPIT SAHU: OK. Better [?] [INAUDIBLE] Push the [INAUDIBLE] OK, fine. In a second, OK [?] We are in the [INAUDIBLE]. OK. Yeah. 26 screw down [?]. Ready? OK. Sir do you want to confirm your plate positioning?
DIPIT SAHU: Yeah, we'll do that. Just lock it up [?]. OK, OK. Yeah so we just put this through and we'll confirm it. OK. [INAUDIBLE] OK, down there. OK. Shoot. Shoot. OK, push in.
DIPIT SAHU: [INAUDIBLE]. Push in, OK. Shoot, shoot. Now shoot. Moving OK? Yes. Shoot. Shoot. Yeah [INAUDIBLE]. Shoot. So, how does it look?
DIPIT SAHU: It's looking fantastic. Looks OK? Fantastic. Now we'll use the technique of [INAUDIBLE]. Or Pushwala [?] I think it is well aligned, we can see. OK, stop [?]. We can take out the retractor Yeah I will take out the retractor.
DIPIT SAHU: So these retractors I use only because it is a very expensive retractor. It is not really helping, I think. This is a Nova [?] retractor. Very, very expensive. OK, shoot. [INAUDIBLE] It's well [INAUDIBLE] We are very well aligned.
DIPIT SAHU: Can we see external version [?] ? AP view? External version [?] AP view? [INTERPOSING VOICES] Yes. It looks pretty well aligned. Really. Shoot. A little bit internal rotation.
DIPIT SAHU: This is [INAUDIBLE]. OK? OK. Yes. OK. We'll just put the last of the screws.
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