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Re: Еще один перелом "около фиксатора"
Tom DeCoster 17 Январь 2004, 19:10
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Regarding this specific patient, it is quite difficult for me to discern the exact fracture pattern and therefore treatment suggestions. It appears to be a spiral fracture starting just proximal to the less trochanter and extending distally 6 or more cm into the shaft with medial displacement of the distal fragment. The lesser troch is a seperate fragment. The 2 year old femoral neck fracture appears to have healed in good position I really can't tell where the fracture starts laterally, but presumably it's near the distal most screw.
I can't tell if there is further comminution of the shaft or the greater trochanter. I can barely see the fracture on the lateral radiograph. I'm not sure but I don't see AVN of the femoral head nor OA of the hip. Her overall bone quality appears normal for a 68 year old. I don't see any loosening of the screws but I can't tell for sure.
The fracture extention well into the shaft makes intramedullary fixation somewhat more appealing than plate fixation and contrasts with the case posted by Bill. A reconstruction nail with proximal locking into the femoral head and neck after screw removal and reduction would be reasonable.
TD
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