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Re: Ятрогенный перелом
DR T. I. GEORGE 17 Июнь 2003, 21:41
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All of us do have complications and each of these do teach us what could go wrong so that we can attempt to prevent them in future. But for these happenings how will the text books have the section on operative complications. The "funny" thing about it is that only few are gracious enough to admit their complication and discuss them in public.
I feel the problem could have been that the entry hole that got extended. How do you make the opening in the entry point? Do you use an awl and find your way with oscillating movements or do you use any instrument that needs banging? Other possibilty is or added factor could be that a small crack that was present during making the entry hole got extended during the nail entry with the nail impacting on the posterior cortex. Some how I make it a point to screen the lateral view during making the entry hole with an awl and nail entry number of times, since even during the most confident of times, I have seen the image betraying my confidence and found awl and nail hitting the posterior cortex.
Having said so much, I suppose this fracture can be managed in a number of ways. An above knee slab or a cast that immobilises the knee could get the upper fracture to unite. An ex fix or long oblique screws or even a small plate could be considered. I feel any of these fixations may not be adequate to mobilse the knee confidently and hence why not just immobilisation of the knee?
Do let us know what you have done.Best of luck.
DR T I GEORGE.
Head of Orthopaedics Unit III
Little Flower Hospital,
Angamaly,Kerala State,
India.
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