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Re: Неписанное правило?
послал Tom DeCoster 13 Февраль 2003, 08:42
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Regarding appropriate strategy for failed fixation, I would take the opposite position. All else equal, if a well done well indicated plate failed I would tend to revise to a nail and if a well done well indicated nail failed I
would tend to revis to a plate. To me it is somewhat foolhearty to repeat the same mistake and expect a different outcome. I have had good success with this strategy. For example, when faced with a failed plating of a subtrochanteric femur fx IMHO might revise with an IM nail whereas a failed nail IMHO might be revised with a plate.
However, there is a big advantage to sticking with the same type of implant, namely the surgical approach. The surgical approach necessary to remove the failed implant can be utilized to perform the same kind of fixation again.
There is also the theoretical advantage of preserving the "other" blood supply (endosteal vs periosteal). So there are many indications to stay with the same type of fixation, especially if there is some identifiable not
repeatable cause for the nonunion. For example, a tibia nonunion after an 8 mm unreamed nail is efficiently managed with exchange nailing to a larger reamed nail.
Tom DeCoster
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