Edgar T Araiza, MD, 1441 N Beckley Ave (2026)

09/10/2023

Happy PA week to these amazingly talented, caring and most importantly tolerating individuals who help us take care of our patients and each other. Could not come do what we do without you!

$The subtleties of fracture work is what makes it fun and challenging for me. This 24F was seen approximately three weeks...$

31/08/2022

The subtleties of fracture work is what makes it fun and challenging for me.

This 24F was seen approximately three weeks after sustaining a ground level fall. She was placed into a Velcro splint in the ED and was given outpatient follow up with a “non-displaced” distal radius fracture. She had excellent range of motion of the fingers but really weak grip strength and difficulty with prono-supination.

On initial survey of the PA view the DRUJ widening caught my eye but I really wanted to focus on the “why”. The oblique and lateral views helped me identify the multiple fragments that lead to radial shortening, anterior translation and dorsal tilt. These characteristics are what lead me to recommend surgery.

I prefer an extensile FCR approach to allow for proper exposure and decompression of the dorsal comminution along with restoration of the radial height. This was an outpatient consult that I would have considered obtaining a pre-operative CT scan in ED had I been notified prior to discharge for better characterization of the fracture lines. Contralateral PA views of the wrist will also help.

It’s always good to learn what others would and would not fix.

$SER ankle fracture is always a nice way to end the week. This patient is a young laborer who had a crushing injury at wo...$

27/08/2022

SER ankle fracture is always a nice way to end the week. This patient is a young laborer who had a crushing injury at work. He had blistering and swelling for three weeks after external fixation to allow for wound care. He was placed in an Unna boot twice, which finally allowed for definitive fixation.

Almost a month after injury makes it tempting to fix in situ and avoid an open approach. I’ve certainly done that in the geriatric low demand patient with a poor soft tissue envelope. In this young laborer, however, I still believe in a true anatomic reduction and approach.

$SER ankle fracture is always a nice way to end the week. This patient is a young laborer who had a crushing injury at wo...$

27/08/2022

SER ankle fracture is always a nice way to end the week. This patient is a young laborer who had a crushing injury at work. He had blistering and swelling for three weeks after external fixation to allow for wound care. He was placed in an Unna boot twice, which finally allowed for definitive fixation.

Almost a month after injury makes it tempting to fix in situ and avoid an open approach. I’ve certainly done that in the geriatric low demand patient with a poor soft tissue envelope. In this young laborer, however, I still believe in a true anatomic reduction and approach.

25/08/2022

Geriatric patients fall and it is certainly a challenge to push those giblets of bone together to make a joint.

Tibial plateau fractures with extension distally can be plated but in this subset of patients I’m a fan of nail/plate combos. The advantage of primary compression at the joint along with biologically friendly long intramedullary fixation allows for earlier return to weight bearing in this frail population.

As with any segmental injury, I treat each individual segment as I would if not for the extension. I prefer stabilizing the plateau first and using my rafting fixation as pseudo “blocking screws” to protect the nail pathway.

$Open fracture trauma weekend!This 41F was involved in a rollover MVC with her forearm out of the window. She presented w...$

24/08/2022

Open fracture trauma weekend!

This 41F was involved in a rollover MVC with her forearm out of the window. She presented with an open distal radius fracture, DRUJ dislocation, CMC dislocation, scaphoid fracture and FHL laceration.

Complex injuries are daunting if we overlook the basic principles. A thorough debridement was performed. All open joints were reduced and stabilized. The distal radius was stabilized using long plate and screw fixation to bypass the zone of injury. The tendon was repaired and the scaphoid had a compression screw placed.

The biggest learning point for me during this case… one injury at a time. The patient followed up at one week for splint removal and to start therapy.

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$This is an 81F with a periprosthetic distal humerus fracture after a ground level fall. These pathologic fragility fract...$

22/08/2022

This is an 81F with a periprosthetic distal humerus fracture after a ground level fall. These pathologic fragility fractures present a challenge because of limited real estate for fixation. The patient is wheelchair dependent therefore stabilizing her arm is essential for stability.

Goals of care are stable fixation to allow for early range of motion and weight bearing. A Gerwin extensile approach allows for excellent visualization of the radial nerve and bone available for fixation.

I used a cable above the most proximal screw to minimize motion proximally and to decrease the likelihood of stress fracture.

The patient was allowed early range of motion and weight bearing.

$90 year old female presents to the office for routine follow up after fixation of a left impacted femoral neck fracture....$

09/08/2022

90 year old female presents to the office for routine follow up after fixation of a left impacted femoral neck fracture.

Options include protected weight bearing, percutaneous screw fixation, femoral neck fixation with newer devices or arthroplasty.

Leg length and offset are the main reasons why I’ve switched to controlled collapse internal fixation. Can it heal with screws? Yes and predictably well. The symptomatic screws and shortened hip can lead to additional morbidity and potential mortality with further trauma.

This patient is at her 3 month follow up, pain free and does not require the use of an assistive device.

30/07/2022

Baseball ⚾️ pathologic injury.

This 27M pitcher snapped his arm while throwing a ball. He noted immediate pain and deformity and had no antecedent pain or symptoms.

Closed Supracondylar fracture was identified. Metabolic work up and supplementation was given.

Due to the fact that this behaves like a pathologic fracture, absolute stability and primary bone healing is the goal. I highly recommend a Gerwin approach to minimize damage to the soft tissues.

The fracture was reduced and stabilized with three lag screws. The plate was then utilized to neutralize the fixation.

Immediate range of motion was allowed along with weight bearing.

The patient healed his fracture at three months and is back to throwing for this summer.

30/03/2022

A tale of two hips.

Who do we fix? Who do we replace? And if we do? Partial versus Hemi? Cemented versus press-fit? Monopolar vs the partial bipolar (does it turn into a monopolar after time).

The first patient is a 67M who fell from the attic and landed on his hip. The second is an 85F who fell in the tub.

Both patients were done using the direct anterior approach on the Hanna Table.

Mechanism of injury plays an important role in my decision tree. Higher energy injuries usually but not always, result in patients who are more active and therefore I tend to lean total hip on them. Ground level fall patients usually are lower energy and poor bone quality so I’m quick to switch to a cemented hemi on them.

The key is to not be rigid in your decision tree and to really involve the patient and family.

What do they want and what are their expectations for post operative level of function and recovery. That will go a long way towards choosing not the perfect surgery for the injury, but rather the most patient specific.

Interested to hear your thoughts.

07/03/2022

This 59 year old patient presented with a high energy injury to the bilateral knee joints. Important points here are urgent traction and immobilization in the ED.

A thorough neurovascular exam as well as high index of suspicion for compartment syndrome are essential care parameters.

The patient underwent staged reconstruction with dual plating. The medial distal key allowed for indirect reduction of the joint, followed by direct visualization to confirm anatomical reduction of the articular surface. High index of suspicion for maniacal entrapment with these injuries.

$Fragility fractures in the elderly can be quite debilitating injuries. This is a 75M who presented to our institution wi...$

03/03/2022

Fragility fractures in the elderly can be quite debilitating injuries. This is a 75M who presented to our institution with an isolated anterior ring injury from a fall approximately 2 weeks old. He was originally seen at an OSH and discharged home with pain control and a walker.

The patient did not mobilize for two weeks due to severe pain and discomfort. He presented to our institution for repeat evaluation.

His plain films and CT scan demonstrated this p***c root fracture with no posterior ring injury.

In my opinion, the patient has already failed conservative treatment, therefore he was offered percutaneous screw fixation.

Seeing as to how this involved the root of the rami, I felt it necessary to achieve anterior column anchorage with my screws.

I prefer to obtain an obturator oblique outlet first before I make incision with a guide pin to see if there is a safe bony corridor to place a column screw.

Next, I switch my image to the right, make my incision and make sure my guide pin start site matches my planned trajectory.

I then advance the guide pin alone above the column, unless I feel it is not rigid enough to follow the desired path such as this case.

At this point I use my drill oscillating to achieve the desired trajectory.

I did have to redirect it but ultimately I was able to place a fully threaded 7.0 screw fastener into the column.

The patient noted immediate improvement of his symptoms and mobilized the next day.

I’m always looking for additional tips and tricks for column screws.

Edgar T Araiza, MD

09/10/2023

31/08/2022

27/08/2022

27/08/2022

25/08/2022

24/08/2022

22/08/2022

09/08/2022

30/07/2022

30/03/2022

07/03/2022

03/03/2022

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