| ВХОД ДЛЯ ПАЦИЕНТОВ
|Re: Перелом около протеза
послал Alexander Chelnokov 29 Май 2004, 12:08
Friday, May 28, 2004, 9:04:37 PM, you wrote:
TAC> Do you think the femoral component is solidly fixed or loose?
There were no signs of loosening prior the recent fracture.
TAC> I think retrograde nails through total knees give good distal fixation. I'm
TAC> not sure what kind of TK prosthesis
AFAIK it is Corin (UK).
TAC> but nearly all of the designs in the US have a big enough space
TAC> to accept a 10 mm retrograde nail between the condlyles of the
The patient is about 100 kg, so a thicker nail would be favourable...
I am not certain about whether a thicker nail can be inserted through the notch, and it seems to me cruciate ligaments are at risk.
TAC> My concern in this case would be the deformity of the old fractures might
TAC> not allow for a straight nail but might be more amenable to a locking plate;
Locking plates are still not available in our unit. And at recent EuroTrauma 2004 i've just heard a very good presentation of D.Seligson from the US about distal femoral fractures whrere he was a bit skeptical about lockig plates, demonstrated broken ones, and proposed that nails are still a way to go. And anyway it would be some kind of open reduction, muscle separation...
TAC> or particularly in Russia, XF.
Even here people are very restricted about XF for definitive fixation over endoprosthesis because of extremely high cost of pin/wire tract infection. So my primary plan is antegrade nailing with a solid nail.
If the attempt to pass through the area of union at the shaft level is failed, i switch to the retrograde approach. Which i will try to avoid by any means because the TKA was performed in another unit and in case of problems with the implant any later it is a reason to say - you see, ortho trauma guys broke our ideally implanted knee. I suppose you realize what i mean.
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