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Re: Перелом "около пластинки"
послал Alexander Chelnokov 04 Январь 2004, 17:00
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TAC> the knee), but there are advantages like better distal fixation and control.
This strongly depends on a particular nail design - number of holes, distance between them, distance from the distal tip of the nail to the most distal hole. The latter distance can be minimized in antegrade nail to literally 3-4 mm while retrograde nails have to reserve more space for the threaded canal of the nail connecting screw.
TAC> The antegrade nail in the case shown is probably into the knee joint slightly.
Not in this case. Though i have a couple of similar cases with 3-4 mm prominince of the nail - looks asymptomatic or covered by pre-existing problems.
TAC> This case looks great but there must be some risk of splitting the condyles or
TAC> other knee joint injury when driving an antegrade nail this distal.
The risk is minimized by using of a distractor with some olive wires.
Also canal in the condyles can be prepared by a long awl.
TAC> difficulties. Overall the entry site problems seem about the same for the two
TAC> techniques.
Isn't early knee mobilization easier without a recent local wound?
TAC> If that is the case then the decision might come down to which one
TAC> offers better distal fixation and that might be retrograde nail.
Why retrograde nails offer better distal fixaton? Maybe holes for locking scrws are threaded?
TAC> nail driven very distal in the femur looks extremely good.
TAC> Without a comparative series we are left to base decisions on
In our settings same nails are used for ante- and retrograde insertion.
For distal cases presuming particular design of the nail i prefer antegrade. Retrograde is reserved for unilateral femur+tibia fractures, problems in the hip region (implants, excessive scars, neck fractures).
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