Treatment Plan Discussion With Dr. Austin Fragomen & Dr. Beth Shubin Stein скачать в хорошем качестве

Treatment Plan Discussion With Dr. Austin Fragomen & Dr. Beth Shubin Stein

Complex Reconstruction Conversation 10/01/2024 Dr. Fragomen Enters Call ~ 12:00 Dr. Fragomen Talks About Surgery While Beth Listens ~ 18:00 Talking About Timing of The Surgeries ~ 24:00 Dr. Shubin Stein ~ HPI: This is a follow up visit for Daniel Wandeloski via telehealth with Dr. Austin Fragomen. He reestablishes care with us to discuss surgical options for his RIGHT knee. Due to insurance complications last year he was unable to follow through with treatment plan He has history of congenital short femur, fibular hemimelia, short stature (prior GH treatment), functional scoliosis. He has a history of R syme amputation at age 1y (2000). Dan reports that he was able to function well through adolescence, but has noticed progressive limitations and compensations in adulthood that have started to cause additional problems. He has seen Dr. Bartlett at UVM who has discussed various treatments. He has had difficulty finding the right plan of care at a place that his insurance will accept. Exam: Patient is alert and oriented x 3. No acute distress. Imaging: MRI from March of 2023 was re reviewed. Impression/ Plan: R congenital malformation of extensor mechanism, congenital short femur, fibular hemimelia, short stature, functional scoliosis, R syme amputation Remote, Vermont -Treatment options reviewed with the patient and Dr. Fragomen Will need RIGHT knee / distal femur CT and repeat RIGHT knee MRI Discussed 3 weeks prior to surgery is ideal time for imaging at HSS Plan to work with HSS financial assistance for coverage of care. Consult with Ross Sadler Plan for RIGHT knee soft tissue fixation Adductor sling MPFL aLLo, lateral lengthening + DFO with lengthening (Fragomen) No TTT at this time Will need second stage procedure for TTT and MPFL with bony fixation Discussed patient will come down for same day surgical clearances and imaging to be done same day Will work with Fragomens office to find a time in January Plan for follow up after imaging to finalize surgical plan RIGHT knee soft tissue fixation Adductor sling MPFL aLLo, lateral lengthening + DFO with lengthening (Fragomen) Dr. Fragomen ~ Daniel R Wandeloski is 25 y.o. male who presents for informational video visit presents for evaluation of right lower extremity. He has history of malformation of extensor mechanism, congenital short femur, fibular hemimelia, short stature (prior GH treatment), functional scoliosis. He has a history of R syme amputation at age 1y (2000). Last visit we discussed possible treatment plan to be done in 3 stages. Stage 1 would likely be tibial tubercle osteotomy, a MPFL reconstruction, and a lateral release with Dr. Shubin Stein. Stage 2 would be a femoral lengthening and stage 3 would involve revision transtibial amputation with either a standard socket versus revision insertion of an osseointegration implant. Patient would like to lengthen femur to have equal knee heights. He is also leaning towards OI vs socket use. 25 year old with history of malformation of extensor mechanism, congenital short femur, fibular hemimelia, and R syme amputation presents today to continue surgical discussion. Dr. Shubin Stein was present for this discussion as we finalized the plan. The details of surgery and the usual postoperative routine were discussed with the patient. Material risks of the surgery were reviewed with the patient. All their questions were answered. Dr. Fragomen will need AP/Lat of R femur before stage 1 surgery. Plan Stage 1 - right femur osteotomy with insertion IMN, about 8 cm of length will be the goal. Adductor sling/soft tissue releases (Dr. Shubin Stein). Will have to watch him closely during the lengthening phase for dislocation. Bracing, ex-fix, or stopping lengthening before meeting the goal are all possibilities. Stage 2 - MPFL and TTT to be done after femoral lengthening complete. Stage 3 - revision tibia amputation, likely with insertion osseointegration implant First surgery likely to be done in January 2025 @dr.fragomenlimblengthening7953 (YouTube) Fellowship Director Limb Lengthening @bethe.shubinsteinmd2256 (YouTube) Sports Medicine Surgeon