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Re: Несращение бедра
послал Steven Rabin 10 Апрель 2002, 08:46
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i'd do a closed reamed IM nailing, with the plan of coming back in 6-12 weeks to do a quadricepsplasty plus or minus bone graft then. I wouldn't do it together because i would not want to destroy the endosteal blood supply with my reaming and then destroy the periosteal blood supply with the soft tissue disection necessary for the quadriceps plasty. (She may also need lysis of intra-articular adhesions.) (If I am unable to do the rodding closed - as sometimes the medullary canal is walled off - then I would open it, and if I had to open it, then I would bone graft at the same time, probably with a
quadricepsplasty as well. There are sharp awls that can be introduced from above through the medullary canal to open up a canal that is closed off, and these sometimes work, and sometimes they don't depending on how hard the bone is.) Static locking to control rotation, which could be dynamized later.
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