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Re: Анте- или ретроградно?
Enes M. Kanlic 26 Август 2003, 02:07
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You did not tell us what was the reason to have circular ExFx frame on at the first place: any problems with soft tissues, any fractures around hip (proximal femur, acetabulum, pelvis, the size of patient (access to the piriformis fossa or greater trochanter), medical condition...!?
In general, it is risky (intramedullary infection) to have IM nail after pins transfixing the bone longer than 1-2 weeks (especially if it was any drainage around them and probably has to be after 6 weeks); it is better (not and easier; I prefer lateral decubitus) to avoid unnecessary violation of the knee joint (rare, but devastating complication of infection)...
Retrograde mostly if: distal fcatures, bilateral femur fractures, need for additional later proximal surgeries (acetabulum), polytrauma (abdominal, thoracic, neurowork), overweight and short patient (150 kg), soft tissue damage in hip area...
Sincerely
Enes M. Kanlic, M.D., Ph.D.
Associate Professor
Ortho Department at TTUHSC
El Paso, Texas
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Re: Анте- или ретроградно?
Alexander Chelnokov 26 Август 2003, 02:28
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EKTE> You did not tell us what was the reason to have circular ExFx frame on at
EKTE> the first place: any problems with soft tissues, any fractures around hip
I suppose closed nailing was not available there, so they preferred ex-fix rather than open plating or plaster cast.
EKTE> In general, it is risky (intramedullary infection) to have IM nail after
EKTE> pins transfixing the bone longer than 1-2 weeks (especially if it was any
Our series of ex-fix to nail conversion now consist of more than 30 cases, and about 15 were acute conversion of fixators 3-11 months old with calm pin sites - no infection to date (knock-knock).
EKTE> Retrograde mostly if: distal fcatures, bilateral femur fractures, need for
Also ipsilateral femur+tibia. But AFAIR some colleagues in the list told about more excessive use of retrograde nails...
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