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Re: застарелое повреждение таза
послал Adam Starr 28 Март 2003, 17:15
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I didn't see it either - can anybody re-send me the CT images?
Presuming the patient DID have a nonunion of an ischial fracture, I'm not sure what the right course of treatment would be. You'd have to make yourself pretty darn sure that the symptoms were actually coming from the nonunion...and sometimes pain around the hip/butt is hard to
pinpoint.
If you decided that the pain and symptoms WERE due to a nonunion, then you'd have to talk with the patient about whether the treatment to fix
the nonunion would be worth it. Open reduction, plating and possible bone grafting of the ischium (presumably via a Kocher) is a pretty big
operation. The guy might decide the treatment is worse than the disease.
The option of percutaneous stabilization exists at a few centers, but I don't know that anybody has a big series of pelvic nonunions treated percutaneously so that we can say "this method works". There are a couple case reports in the literature.
I've done a number of sup ramus nonunions, and they seem to work okay.
I've treated one transverse acetabular fx nonunion percutaneously, and it worked - pain went away and the fx healed. But, that's just a
handful of anecdotes.
Adam Starr
Dallas, Texas
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