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Re: Несращение шейки бедра
послал Clifford B. Jones, M.D. 02 Декабрь 2002, 19:04
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This is a good example of sub optimal placement of the neck screws. Young patients with neck/shaft combo fxs have a high Pauwells' angle. This is counteracted by open reduction and internal fixation in order to reduce caudal portion of fem neck. The screws are angled differently by placing them perpendicular to the fem neck fx line (typical AO technique) or horizontal to the floor. The screws here are similar to elderly fem neck fx types. Therefore, no biomechanical advantage exists and the nonunion is produced.
You need to perform a valgus osteotomy with 130 osteotomy plate. This will improve the relative Pauwells' angle and improve the union rate. Problem is the probable nonunion or partial union to the shaft. The osteotomy plate is
only made with 6 holes which will not allow for bypassing the shaft problem.
You will probably require an open plating and bone grafting. Try to angle your distal ost and prox shaft screws so that they overlap and theoretically decrease the stress riser created with the double plates.
Cliff Jones
Grand Rapids MI
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