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Re: Перелом стержня
Zsolt Balogh 23 Июнь 2002, 22:27
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" To provide early weight bearing 6 mm locking
screws were used so sll static holes were drilled accordingly."
The locking "screws" (bolt is a better term) has
nothing to do with earlier weight bearing! The
weightbearing determined by the fracture pattern and the bony interfaces after reduction, not by the number of bolts and the type (static or dynamic) of bolts.
How many distal holes are on your IMN?
Thanks,
Zsolt
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Re: Перелом стержня
Alexander Chelnokov 23 Июнь 2002, 23:07
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ZB> The locking "screws" (bolt is a better term)
Bolt in Russian is a threaded rod with head and nut.
ZB> has nothing to do with earlier weight bearing! The
ZB> weightbearing determined by the fracture pattern and
See ROBERT J. BRUMBACK, THOMAS R. TOAL, M. SIOBHAN MURPHY-ZANE, VINCENT P. NOVAK, and STEPHEN M. BELKOFF Immediate Weight-Bearing
After Treatment of a Comminuted Fracture of the Femoral Shaft with a Statically Locked Intramedullary Nail, J Bone Joint Surg Am 1999 81: 1538-44
ZB> How many distal holes are on your IMN?
Two.
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Re: Перелом стержня
Отправитель: Zsolt Balogh 23 Июнь 2002, 23:12
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Thanks for bringing up the JBJS paper!
It is one of the basic references I think everyone of us keep in mind.
The basic sience part of it shows, that the failure is usually at the distal nail/screw interfaces. Usually the srew breaks of course. It may be not true for cyclic loading, but if you increase the strenght of the screw more likely that the nail will fail...
The clinical part of the study (28! patients) has less practical relevance. But it is clear from their design, that fractures extending within 12.5 cm of the knee joint were excluded! Your case I think would have been exclude from this study.
But anyway all these could be empty reasoning,
looking at your x-rays your reconstruction was superb. An usually we are happy and relaxed if we have such post-op x-ray, they heal in 99% of the cases. Bad luck here...
I would recommend to carry on with IM method.
Best Regards,
Zsolt
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Re: Перелом стержня
Dr.Saleh W Alharby 23 Июнь 2002, 23:15
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In brief because it is his only lower limb I would consider applying ilizarov with or without broken implant removal to avoid possible infection following second attempt.
Dr Saleh W Alharby
Associate Professor and Consultant Orthopedic Surgeon
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Re: Перелом стержня
Tom Toal 24 Июнь 2002, 00:14
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There's actually some literature on size, number and configuration of locking bolts with regard to fatigue in immediate weight bearing:
J Bone Joint Surg Am 1999 81: 1538-44. [Abstract] [Full Text]
Tom Toal
Portland, OR
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