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Re: Огнестрельный перелом бедра в аппарате
послал Alexander Chelnokov 05 Май 2002, 11:31
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BB> Watson and Kuldjanov said they had an 88% infection rate with late,
BB> non-staged exfix-IM nail exchanges - even with *pristine* pin sites.
Don't you know what nails were used in their series - solid or hollow?
BB> possibility of pin tract colinization, why not take the added precaution of
BB> staged pre-nailing pin tract biopsies?
Do you mean to take a culture with fixator in place? Or you ask why not operate after a period of time to allow pin sites to heal? I wouldn't trust too much our bacteriology reports.
In view of so discouraging infection rates as reported Dr Watson for the non-staged group definitely the lag period is necessary.
The only problem is what to do with the leg (and patient) after external device removal before nailing. If the patient has been mobile recent weeks, he would not be too enthusiastic about bed traction.
Maybe it is worth to insert new pins/wires prior to remove the old ones, to keep external fixator in place and allow the level of activity?
Our modest exchange experience was more optimistic so i proceed with the nailing (UFN 11 mm) before i read answers :-(
So 5th day i am about a nervous breakdown. After the surgery except the cold shower from the group a laboratory report was received that he is also HIV and hep. C infected. So i keep fingers crossed. I attached xrays and current view of the leg. All looks calm at the moment... How long to proceed with antibiotics and heparin?
The patient feels fine, no fever, ambulates with crutches, knee ROM is 0/90, and he is going to leave for home tomorrow.
Comments and moral support are welcome... THX in advance.
--
Best regards,
Alexander N. Chelnokov
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