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Re: Перелом вертлужной впадины +
Enes M. Kanlic 07 Декабрь 2003, 15:23
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We do not have all information's, like: Judet views, CT, approach used at the time of total hip arthroplasty... what would help, but in general, I would do similar as it is presented with this 75 years old lady:
1. Dislocation of prosthesis
2. Removal of prosthesis head
3. Removal of the cup:we have available some nice, round cutters causing minimal damage of surrounding bone
4. Fix the acetabular fracture (fracture seems to be transverse type!?; it is a real fun to do it with femoral head removed)
5. New metal back cup with multiple holes for screws - improves
osteosynthesis
6. New poly insert and reduction.
7. Femoral fracture - if it is enough space retrograde nail (through the knee), or some plate, fixed angle device.
Sincerely,
Enes M. Kanlic, MD, PhD
Associate Professor
Department of Orthopaedics
TTUHSC in El Paso, Texas
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Re: Перелом вертлужной впадины +
Alexander Chelnokov 08 Декабрь 2003, 08:41
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EKTE> We do not have all information's, like: Judet views, CT, approach used at
EKTE> the time of total hip arthroplasty...
So don't i. Sometimes we have to offer decision based on incomplete data... ;-)
EKTE> what would help, but in general, I would do similar as it is
EKTE> presented with this 75 years old lady:
EKTE> 1. Dislocation of prosthesis
[...]
Ys, it looks like transverse fracture. At the moment, as i realize, colleagues in that hospital need to choose either non-operative or operative treatment. If the latter, next alternatives are to be discussed. Do you exclude attempt of reduction and fixation of the acetabulum with th implant in place?
EKTE> 7. Femoral fracture - if it is enough space retrograde nail (through the
EKTE> knee), or some plate, fixed angle device.
Yes, this will depend on what hospital the patient receives definitive treatment.
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Re: Перелом вертлужной впадины +
Отправитель: Enes M. Kanlic 08 Декабрь 2003, 08:43
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As you know, in general, if prosthesis is not loose (and from the x-ray cup seems to be well fixed), we do not have to replace it.
1. Problem is that would be very hard to provide good stability - good job fixing the fracture with cup in place, although, of course,it is possible.
2. My preference would be to remove the cup. Having excellent view, approach to the acetabulum and good fixation can be accomplished (this has to be the premice, fracture well fixed before the cup in order to put in it); now, if you use the metal cup with multiple holes, it does work like nice plate and additional fixation to the fracture. If the cup is coated with hydroxy appatite, that will make healing and incorporation even better.
I hope this helps, sincerely
Enes M. Kanlic, MD, PhD
Associate Professor
Department of Orthopaedics
TTUHSC in El Paso, Texas
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