Case discussion dr leal

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Case # 1 40Y Male Supracondylar Femoral Fracture & ORIF After 11 months of pain an no bone healing, He had Deeop venous thrombosis and Pulmonary Embolysm. Due to a possible complication he was sent to us for ESWT treatment. I performed ESWT. He did well for almost ayear an the X ray were preetty good,. When he started muscle rehab, he had pain again and the xrays were not as good. There is a gap again on the X rays. Question: WOULD YOU TRY ESWT AGAIN OR WOULD YOU GO FOR SURGICAL TREATMENT FOR THE PSEUDOARTHROSIS ????? Carlos Leal MD Fenway Medical Bogota

$jhkhkjhjk April 2010 11 months after ESWT Pain during Physical Therapy X rays show fracture site again Jun 2009 10 Months after surgery Complicated with DVT and Pulmonary embolism ESTW Treatment for delayed union Dec 2009 6 months after ESWT No pain, stable knee no crutches. Starts physiscal activity Male 40yr Horse traimer Horse backriding accident AP X-RAYS Carlos Leal MD Fenway Medical Bogota$

$April 2010 11 months after ESWT Pain during Physical Therapy X rays show fracture site again Jun 2009 10 Months after surgery Complicated with DVT and Pulmonary embolism ESTW Treatment for delayed union Dec 2009 6 months after ESWT No pain, stable knee no crutches. Starts physiscal activity Male 40yr Horse traimer Horse backriding accident LATERAL X-RAYS Carlos Leal MD Fenway Medical Bogota$

$Case # 2 35Y Male – Orthopedic Surgeon Parachute Accident 16 months ago This colleague was treated with ORIF and did not heal. The tyibia healed well, and the metaphyseal region looks good. Hoverer, the last x-rays show a n oblique fracture line onb the distal diaphysis. No infection found, He was treated for the delayed union with open surgery, allografts – Autografts, growth factors and osteoconductors. He is in crutches at the moment. Question: WOULD YOU TRY ESWT IN THIS CASE, AFTER SURGICAL TREATMENT AND GRAFTING ???? Carlos Leal MD Fenway Medical Bogota$

Aug 2009 7 Months after surgery Tibial Hardware removed. Part of femoral hardware removed. Grafted and augmented with Growth Factors Carlos Leal MD Fenway Medical Bogota

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Case discussion dr leal

1. Case # 1 40Y Male Supracondylar Femoral Fracture & ORIF After 11 months of pain an no bone healing, He had Deeop venous thrombosis and Pulmonary Embolysm. Due to a possible complication he was sent to us for ESWT treatment. I performed ESWT. He did well for almost ayear an the X ray were preetty good,. When he started muscle rehab, he had pain again and the xrays were not as good. There is a gap again on the X rays. Question: WOULD YOU TRY ESWT AGAIN OR WOULD YOU GO FOR SURGICAL TREATMENT FOR THE PSEUDOARTHROSIS ????? Carlos Leal MD Fenway Medical Bogota

2. jhkhkjhjk April 2010 11 months after ESWT Pain during Physical Therapy X rays show fracture site again Jun 2009 10 Months after surgery Complicated with DVT and Pulmonary embolism ESTW Treatment for delayed union Dec 2009 6 months after ESWT No pain, stable knee no crutches. Starts physiscal activity Male 40yr Horse traimer Horse backriding accident AP X-RAYS Carlos Leal MD Fenway Medical Bogota

3. April 2010 11 months after ESWT Pain during Physical Therapy X rays show fracture site again Jun 2009 10 Months after surgery Complicated with DVT and Pulmonary embolism ESTW Treatment for delayed union Dec 2009 6 months after ESWT No pain, stable knee no crutches. Starts physiscal activity Male 40yr Horse traimer Horse backriding accident LATERAL X-RAYS Carlos Leal MD Fenway Medical Bogota

4. Case # 2 35Y Male – Orthopedic Surgeon Parachute Accident 16 months ago This colleague was treated with ORIF and did not heal. The tyibia healed well, and the metaphyseal region looks good. Hoverer, the last x-rays show a n oblique fracture line onb the distal diaphysis. No infection found, He was treated for the delayed union with open surgery, allografts – Autografts, growth factors and osteoconductors. He is in crutches at the moment. Question: WOULD YOU TRY ESWT IN THIS CASE, AFTER SURGICAL TREATMENT AND GRAFTING ???? Carlos Leal MD Fenway Medical Bogota

5. Aug 2009 7 Months after surgery Tibial Hardware removed. Part of femoral hardware removed. Grafted and augmented with Growth Factors Carlos Leal MD Fenway Medical Bogota

Case discussion dr leal

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