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Re: Еще один перелом "около фиксатора"
Alexander Chelnokov 17 Январь 2004, 19:03
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TAC> That's a great case illustration provided by Bill and HWBF and the blade
TAC> plate/valgus producing osteotomy looks like a good option for Alex's case.
I am not sure abut is it even technically doable in the such fracture with splitiing in frontal plane.
I wonder why so little colleagues supported option of IM nailing.
TAC> femoral prosthetic placement. Perhaps this fracture at two years post op is
TAC> merely a very uncommon and unlucky patient? Or have others seen this specific
TAC> problem more frequently?
In our settings it is uncommon injury.
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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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Re: Еще один перелом "около фиксатора"
Отправитель: Alexander Chelnokov 20 Январь 2004, 19:24
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Еще одна боковая проекция. На сегодня назначен закрытый интрамедуллярный остеосинтез. Реконструкционного гвоздя для этой больной не нашлось, придется делать обычным.
Another lateral view. A closed nailing is scheduled for today. No reconstuction nail is available so a usual one is planned.
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