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Re: LISS failure
послал Peter Trafton 12 Сентябрь 2004, 02:50
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Difficult case!
Lateral x-ray does not adequately show proximal shaft & plate alignment with it. Do you think the plate was too anterior. This is an acknowledged mode of failure, as tangential unicortical screws may have minimal purchase, inspite of drill-tip passing through hard bone, and of course “good torque” as screw is tightened (into plate). If not easy to confirm intra-operatively, a short proximal incision can help to ensure correct alignment of plate with shaft.
Condyles have separated. Would separate (peripheral ? 3.5mm, lag screws, medial to lateral or lateral to medial outside LISS footprint) lag screws have been helpful? Intercondylar fracture needs open reduction and good interfragmentary compression.
LISS is a bit proximal, and screws are not parallel with joint line. Is there excessive valgus on appropriate AP views? You might want to check the mechanical axis using electrocautery cord stretched across knee, from center of femoral head to middle of talus.
I think revision is appropriate, if patient is in satisfactory condition. I bet proper length unicortical screws would do well in the shaft, if the plate is applied closely to its midline. Revision should address the other issues as well.
Good luck.
PG Trafton
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