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Re: Еще один перелом "около фиксатора"
Tom DeCoster 16 Январь 2004, 08:23
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That's a great case illustration provided by Bill and HWBF and the blade plate/valgus producing osteotomy looks like a good option for Alex's case.
A particularly interesting aspect of Alex's case is the 2 years since screw placement. We've been leaving proximal screws in place indefinitely for years and haven't seen very many late fractures around them. The problems, if they occur, tend to be loss of fixation or early fracture from distal or large or many drill holes or the occasional arthritic hip requiring screw removal for femoral prosthetic placement. Perhaps this fracture at two years post op is merely a very uncommon and unlucky patient? Or have others seen this specific problem more frequently?
TD
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Re: Еще один перелом "около фиксатора"
Отправитель: 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"
Отправитель: 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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