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Re: Неудачный остеосинтез голени гвоздем
William T Obremskey 20 Декабрь 2003, 12:58
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These can be challenging. I agree w/ all Dr. Carr's points. My preference to prevent the deformity is to use an anteromedial plate. See attached case.
Bill
William T Obremskey MD MPH
Vanderbilt University
Orthopedic Trauma Division
131MCS 2100 Pierce Ave
Nashville, TN 37232-3450
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Re: Неудачный остеосинтез голени гвоздем
Alexander Chelnokov 20 Декабрь 2003, 13:03
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Do you suppose reduction by temporary external fixator is less successful or more harmful/risky than site opening and plate placement? How dynamization here is performed if necessary?
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Re: Неудачный остеосинтез голени гвоздем
Отправитель: William T Obremskey 20 Декабрь 2003, 13:04
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The temporary ex fix is a good idea. I have used it for shaft fxs when an assistant is not available. I think it would be more difficult to control the proximal fragment intra and post op w/ a temporary fixator of any kind w/ these proximal fxs. Surgeons in North America are also in general less familiar w/ thin wire fixators.
Healing has not been a problem in these proximal metaphyseal fxs and dynamization not necessary. Dynamization could also be done in the segmental shaft component if needed.
Bill
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Re: Неудачный остеосинтез голени гвоздем
Отправитель: Alexander Chelnokov 23 Декабрь 2003, 00:18
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OWT> The temporary ex fix is a good idea. I have used it for
OWT> shaft fxs when an assistant is not available.
Yes, sterile team can include only a surgeon and a nurse.
OWT> I think it would be more difficult to control the proximal
OWT> fragment intra and post op w/ a temporary fixator of any kind w/
OWT> these proximal fxs.
I mean ex fix only intraoperatively, post op alignment is kept by the nail and locking screws. A poller screw(s) can be also added after nail insertion prior fixator removal if any doubts.
OWT> Surgeons in North America are also in general less familiar w/
OWT> thin wire fixators.
:-) I think it was so 10-15 years ago because to date there is a lot of highest quality papers on the topic from North America.
OWT> metaphyseal fxs and dynamization not necessary. Dynamization
OWT> could also be done in the segmental shaft component if needed.
The plate still remains a splint preventing axial compression. Of course i don't have any proves that this is crucial in the particular сircumstances.
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