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Re: Несращение шейки бедра
Carlo Bellabarba 02 Декабрь 2002, 19:07
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I agree with your assessment re: the neck, and think that ORIF of the femoral shaft is a good option. However, why not address the shaft
component with a retrograde nail? You could perform the osteotomy in the usual way, secure the side plate to the proximal shaft initially with unicortical screws, complete the retrograde nailing procedure, then re-secure the side plate with bicortical screws directed around the nail.
This would eliminate your concerns regarding the stress riser, and might be more practical then ORIF in this obese patient. I haven't done this with proximal femoral osteotomies per se but I've done it for shaft fractures with certain associated femoral neck or intertrochanteric fx patterns treated with a retrograde nail and DHS.
One potential problem with recommending treatment options for the femoral neck nonunion is that we have no idea what the femoral neck alignment looks like on the lateral view
Carlo
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