ВХОД ДЛЯ ПАЦИЕНТОВ
вверх
поиск
админ
главная
исходное
|
Re: Клинковая пластина вырезалась
послал V. M. Iyer 19 Февраль 2004, 08:01
|
Real challenging case to treat now.
Points to be thought about:
The osteotomy seems to be showing bony union. (New bone at the medial aspect). There is a big step in the union. The distal fragment is way out laterally.There is overiding of the neck over the head. The screws are out superiorly and the blade also coming out. There is no union of the neck fracture. The head does not seem to be normal- distorted in shape and probably starting of AVN too.
It will be a futile attempt now to get the neck fracture unite. The head has to come out and has to be replaced. Then comes the problem of the malaligned upper shaft. If it has united ( as what I think now) the union has to be undone and fragments aligned before introducing the stem.
What I would do: The first step would be removing the implants. At that time the union status of the osteotomy will be known. Heavy skeletal traction for a couple of weeks will bring the neck inferiorly. Fresh Xray that time will also show
the head more clearly to decide if it is worthwhile to attempt a reosteosynthesis. If yes, then insert a D H Screw into the neck and head to err on the inferior and posterior aspect) taking care that no thread is crossing the fracture site. Break the osteotomy. push the distal fragment
medially and also abduct it and fix a 140* barrel. That way when brought to neutral position, the fracture line will become horizontal. A wedge of bone may have to be removed to have a full cortex contact and also abduction.
If replacement is considered, the osteotomy has to be realigned as mentioned earlier.
Possible reasons why this happened: 1) There is not sufficient purchase of the screws into the head. In fact one can see some threads crossing the fracture site. This will prevent union across. Even the blade probably has less purchase. 2) After the osteotomy the distal fragment will have to be pushed more medially ( as we used to do McMurray's osteotomy 30 years ago) or abducted and fixed so the the fracture line becomes horizontal when the limb is brought to neutral.There is no abduction (so it is not a valgus osteotomy) and in fact the fragment is pulled out laterally. The fracture line has remained vertical and on weight bearing the shearing forces have pulled the implants superiorly. I am waiting for the answer from the replacement specialists.
Regards
V M Iyer
. Iyer Orthopaedic Centre,
103,Railway lines Solapur India.413001
|
| Послать ответ |
Обратите внимание: Поля с жирными названиями обязательны.
Старайтесь отвечать в рамках обсуждаемой темы, а не начинать новые обсуждения.
Указывайте адекватную тему сообщения, чтобы было ясно, о чем оно.
Не послайте сообщений не по теме (оффтопик), раздраженных, грубых или обидных комментариев. Здесь это неуместно.
|
