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Re: Перелом "около пластинки"
послал Tom DeCoster 03 Январь 2004, 13:06
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Those are all the arguments against retrograde nailing (surgical injury to the knee), but there are advantages like better distal fixation and control.
The antegrade nail in the case shown is probably into the knee joint slightly.
This case looks great but there must be some risk of splitting the condyles or other knee joint injury when driving an antegrade nail this distal. The antegrade nail also has entry site problems including variable injury to the hip muscles, heterotopic ossification, femoral neck fracture, and positioning difficulties. Overall the entry site problems seem about the same for the two techniques. If that is the case then the decision might come down to which one offers better distal fixation and that might be retrograde nail. If there are more entry site problems with retrograde nail than antegrade the antegrade nailing might be preferable even if the distal fixation isn't quite as good or reliable.
So, to me, it is a trade-off between benefits and risks for specific fracture patterns. In this case of a very distal femur shaft fracture the antegrade nail driven very distal in the femur looks extremely good. Without a comparative series we are left to base decisions on general principles, theory and related experience.
TD
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