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Re: Рефрактура?
Tom DeCoster 23 Октябрь 2004, 10:01
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Alex
There is no definition of "refracture" that I have ever seen. There are principles and concepts:
1. One key element is whether the fracture occurred at the same site within the bone as the original fracture. If so, refracture.
2. Another is whether or not the fracture was completely healed radiographically and retrospectively before the second episode.
3. Another is delineation of the difference between an unrecognized nonunion and a refracture. Related to #2. Not so much an issue after 6 months as in your case.
4. If the amount of force associated with the second fracture wasn't enough to expect a fracture (e.g. misstep walking and a femur shaft fracture) then a weakend bone and "refracture" would be more likely.
5. Fracture after plate removal is similar but different from refracture, although the first 4 items all apply. Implicating the plate removal as a contributor to the new fracture would include the new fracture line being through one of the screw holes or other stress riser from the plate removal, the amount of time after plate removal, the amount of bone that had filled in the various
stress risers, the amount of bone remodelling that had occurred, the appearance of dead (avascular, not completely remodelled) or infected and weak bone (if any such).
Let us know what you and your department chairwoman's perspectives are on this.
Tom DeCoster
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