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Re: Несращение бедра
David Goetz 16 Апрель 2002, 00:22
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We have had two open femoral fractures nailed through the knee that developed late knee sepsis along with their delayed presentation of femoral
osteomyelitis [4-6 months post op]. Is there hesitancy to nail a femoral nonunion [and therefore possibly a septic nonunion] through the knee?
David R. Goetz MD
Medical Director, Orthopaedic Trauma
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Re: Несращение бедра
Отправитель: Adam Starr 16 Апрель 2002, 00:24
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We haven't had that problem down here. But it's something to worry about, I agree.
Maybe Tom's idea of doing a lateral approach to free the quadriceps from the femur would decrease that risk some. I suppose you could also mobilize the nonunion site through that same lateral exposure...but a retrograde nail would still leave you with a hole in the femur and a conduit for the bugs to swim into the knee joint.
Antegrade nailing works fine. Maybe an antegrade nail would be the best choice, if you were concerned about pus after you'd seen the fracture site.
Adam Starr
Dallas
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Re: Несращение бедра
Отправитель: Steven Rabin 18 Апрель 2002, 00:15
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I presented a poster at the OTA 2 years ago where we reported both acute and late presentations of knee infection after
retrograde nailing of open fractures. Our paper did not have enough of a sample size to draw any firm conclusions, but I think it is a concern. I have continued to treat some open fractures with retrograde roddings when the indications are strong, but I do think there should be a high index of suspicion when a previously open fracture of the femur goes on to nonunion.
steve rabin
loyola
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