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Re: Неудачный остеосинтез голени гвоздем
послал V.M.Iyer 22 Декабрь 2003, 22:48
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I am joining rather late for the discussion cos I was away at our national annual conf at Chennai for the past 4 days.
The case was posted on 18th by you and at that time the nailing (unhappy) had been done 3 days earlier. I also went through the opinions of others.
Dr Martin says that the entry point is correct. I am surprised. It is prominently medial. I do not know how closed manipulation can bring the butterfly fragment near. Only if it comes in opposition will the minimally invasive approach work. If plating is to be done the whole # site has to be opened, the butterfly fragment has to be fxed accurately with IF screws and a neutralisation plate applied as per the rules of the ASIF. Dr Chris Wilson says that the nail is too long. It is not as already explained by Dr Simon Reuben. Dr Andrea Salvi wishes to manage by ExFix alone. Best of luck and months of praying.
Someone else has mentioned Ring fixator, definitely a better option than mono fixator.
I would remove the nail, change the entry point see that the guidewire passes parellel to the anterior cortex in the prox fragment, (press the fragment posteriorly) and complete the nailing, almost similar to how Simon Reuben has described. I might use the same nail if it does not seem too short. As regards "Blocking-Poller screws", I have to say this.I find using 3mm Kwires for the same purposes is as good. It saves time but have to be removed at the end of the surgery Anyway, we are interested to know how it was tackled finally. The patient need not panic even if decison to plate has been made as long as it is redone in any one of the correct ways.
Regards V M Iyer
. Iyer Orthopaedic Centre,
103,Railway lines Solapur.413001.
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