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Re: Неудачный остеосинтез голени гвоздем
Enes Kanlic 18 Декабрь 2003, 10:08
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I agree with Dr. Wilson,
Good surgeon is more important than particular implant, and surgeon should
use the method what is he/she comfortable with and if he/she has adequate
equipment.
In general:
1. Nailing proximal tibias: Starting point has to be high (still not to
penetrate knee capsule) and a little bit lateral from midpoint. Blocking
screws are very helpful and sometimes necessary, see attached Slides 1 and
2).
2. Plate could be used, just needs to be done right (minimally invasive,
preservation of soft tissues, slides 4 and 5)
3. If it is impossible to get reduction trying to pass the nail distally,
plate could be added (as on slides 5 and 6).
In this particular patient, if soft tissues are good, I would:
A) Exchange (closed method) the nail (shorter one, starting point a little
bit more lateral) and blocking screws probably would be needed, and if that
does not work
B) I would open the fracture, would help my reduction with forceps or plate
and still nail it.
If somebody is not comfortable with this techniques, probably the safest way
(not and most comfortable and convenient for the patient) is to go for ring
external fixator (Ilizarov type).
I hope this helps, sincerely
Enes M. Kanlic, MD, PhD
Associate Professor
Department of Orthopaedics
TTUHSC in El Paso, Texas
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