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Re: Прошло полгода - Re: Что делать? Гвоздь в tibi
V. M. Iyer 30 Июнь 2004, 22:54
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You have mentioned "middle 1/3" fracture. One should not have any difficulty and should not get a valgus malalignment unless there vis a lot of comminution. Getting the guidewire in the center of the distal fragment is the trick.
Only in the upperthird fractures do we change the entry point. Otherwise it should be in the middle.
I will not accept anything more than 5* valgus.
Regards
V M Iyer
Iyer Orthopaedic Centre,
103,Railway lines Solapur India.
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Re: Прошло полгода - Re: Что делать? Гвоздь в tibi
Alexander Chelnokov 30 Июнь 2004, 23:01
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de> 1\3 tibial fracture, ending in a valgus mal alignment. Do you
de> think that lateralizing the entry point as in the discussion
Alignment can be controlled without change of entry point 1) use blocking ("poller") screw or better wire(s) to lever the nail on and change its direction, and/or 2) use a distractor (we prefer small wire ones).
de> how much valgus can be accepted?
From Rockwood & Green "Fractures in Adults", 2001:
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The main determinant of an acceptable closed reduction is that the limb appears normal by clinical evaluation to allow prompt restoration
of function with healing. [...]
Consequently, to answer the question of what is an acceptable reduction, one must focus on the appearance and function of the patient's fractured limb and not merely on the x-ray.
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Re: Прошло полгода - Re: Что делать? Гвоздь в tibi
Theophilus Asumu 01 Июль 2004, 18:17
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When nailing proximal tibial fractures:
1) Choose a lateral entry point. i.e. in line with the lateral tibial spine. This prevents valguls angulation at the frature.
2) Choose an entry point that is slightly more posterior than usual while avoidng intra-articular penetration. This avoids apex anterior angulation.
3) Reduce the fracture before nailing. If appropriate apply pointed reduction clamps percutaneously across the fracture.
4) If the fracture still tends to dosplace consider the use of "blocking" or "Poller" screws in the proximal fragment.
Mr Theophilus Asumu FRCS (Tr & Orth)
Consultant in Trauma and Orthopaedic Surgery
Oldham
United Kingdom
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