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Re: Неудачный остеосинтез голени гвоздем
Simon Reuben 18 Декабрь 2003, 17:17
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Current situation is unacceptable.
1 medial entry point
2 overriding fracture in valgus.
3 proximal locking bolt missing the static locking hole. Or maybe a poller screw!?
4 the Nail is not too long. in fact it maybe too short once fracture reduced and nail fully inserted distally!
Minimal procedure that you suggest unlikely to work in anticipated fashion as force required (with nail in situ) to correct is as likely to produce proximal extension fracture into locking bolt territory as to correct the alignment (unlikely)
It has been suggested with this type of deformity that you can use the angle within the nail to effect correction of valgus by removal of all
locking bolts and after distraction(with nail removed) reinsert nail in an in internally rotated position. this can lead to partial correction
of the deformity by the nails angle pointing posterolaterally.
However I suggest situation can be managed with a nail but requires
1 complete removal of nail and all screws
2 fresh entry site more laterally located
3 poller screws
a. proximal A-P at entry site of previous nail 3cm below joint
b. distally and laterally in proximal fragment
c. leave these screw in permanently as part of construct even
after nail has been locked (statically)
Simon Reuben
Stockport UK
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