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Re: Многооскольчатое бедро
Zsolt Balogh 14 Май 2002, 00:27
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Are you sure you want to operate this patient?
He survived 1 month on traction, the most difficult part of it!
The best healing is anticipated if the fracture site is not opened (virtually the whole thigh in your tough case!).
ExFix could be good biologically, what kind of frame would you use?
IM nailing, may be retrograde (for sure not
antegrade), either way it would be very-very
difficult.
I am sure that you assessed adequately the condylar fractures, they may need fixation (eg. percutaneous screws).
I tried to think of LISS, but it would be difficult to perform after a month (no fracture hematoma but there is fibrosus callus formation). And even the longest LISS would be short here, not to mention the very small distal piece.
ORIF would not be good for the fracture healing and a disaster for the patient.
What is your decision?
Best Regards,
Zsolt
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Re: Многооскольчатое бедро
Alexander Chelnokov 14 Май 2002, 00:56
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ZB> Are you sure you want to operate this patient?
It must be great entertainment!
ZB> ExFix could be good biologically, what kind of frame
ZB> would you use?
Hybrid based on the Ilizarov set.
ZB> IM nailing, may be retrograde (for sure not
ZB> antegrade), either way it would be very-very
I'll try antegrage, why not? I already have dome some distal cases this way.
ZB> I am sure that you assessed adequately the condylar
ZB> fractures, they may need fixation (eg. percutaneous
Definitely.
ZB> I tried to think of LISS, but it would be difficult to
Not available around yet.
ZB> ORIF would not be good for the fracture healing and a
ZB> disaster for the patient.
Even limited?
ZB> What is your decision?
Attempt to apply external fixator and perform reduction and provisional fixation by wires, then antegrade closed nailing.
--
Best regards,
Alexander N. Chelnokov
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