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Re: Перелом "около пластинки"
Tom DeCoster 26 Декабрь 2003, 09:39
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In this case a 52 year old male sustained a distal femur (supracondylar) fracture 1.5 years after plate treatment of a proximal tibia fracture which appearantly healed well.
Apparently this was a low energy trauma and Alex suggests post traumatic osteopenia of the limb as a contributing or causative factor. In addition to the question of how to treat this individual patient, he poses the question how common is post-traumatic regional osteoporosis and how should it be treated or prevented and specifically is there a role for bisphosponates or somatotropins?
I'm not certain this patient has that condition but it seems logical. I'm not certain how to make the diagnosis. I would think 100% of patients have the phenomena of post-fracture osteoporosis to some degree, so the matter of defining the degree to which it causes clinical problems would be desirable. I would think the incidence of a distal femur fracture after a plated proximal tibia fracture is in the realm of 1/1000. That's probably the same rate for other parts of the body (fracture of an adjacent bone months after an initial fracture.) I would think the incidence would be less after operative treatment than after non-operative treatment, so perhaps there is some historical information available on this topic.
I think mobilizing the patient as soon as possible with progressive return to normal activities would be the usual scenario and perhaps watch for the occasional patient with radiographic signs of more extreme forms of regional osteoporosis and diagnose and treat those somewhat more aggressively.
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