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Re: Рефрактура?
Alexander Chelnokov 24 Октябрь 2004, 23:16
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Иногда надо и учебники читать. Порылся в аошном Principles of Fracture Management (2001) - на CD он у многих есть, на странице 725 там есть определение рефрактуры и ее отличие от "вторичного перелома" (secondary fracture):
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Definition of refracture
All five of the following criteria must be fulfilled,
without exception:
1. The original fracture focus is involved.
2. Uncomplicated healing of a technically
perfect osteosynthesis or appropriate
conservative treatment.
3. Correct aftercare.
4. Appropriately timed removal of metal
implants.
5. Absence of an adequate new trauma.
Definition of secondary fracture
At least one of the above criteria is invalid.
Определение рефрактуры
Все пять следующих критериев должны присутствовать без исключения:
1. Вовлечен очаг исходного перелома.
2. Неосложненное заживление при технически безупречном остеосинтезе
или при соответствующем консервативном лечении.
3. Правильное последующее ведение.
4. Своевременное удаление имплантатов.
5. Отсутствие адекватной новой травмы.
Определение вторичного перелома
По крайней мере один из вышеуказанных критериев не соблюден.
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Re: Рефрактура?
Tom DeCoster 25 Октябрь 2004, 07:23
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Alex
Excellent definition and reference.
Is there some funtional point to all of this? Is a "refracture" considered a complication of the initial treatment and therefore a negative aspect of that particular form of treatment? Are "refractures" associated with any particular complications themselves, like nonunion, delayed union, further fractures...? Why would the vice-chair care whether or not you called this particular case a "refracture"? What difference does it make if you call it a refracture or not? If you don't call it a refracture, what other terms could it be? Secondary fracture? New fresh fracture?
What is the significance of a "secondary fracture"? It sounds like it's a similar category but somehow not quite as "bad".
Perhaps this concept is more commonly discussed in Europe or elsewhere?
TDeCoster
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Re: Рефрактура?
Отправитель: Alexander Chelnokov 25 Октябрь 2004, 07:57
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TAC> Is there some funtional point to all of this? Is a "refracture" considered a
TAC> complication of the initial treatment and therefore a negative aspect of that
TAC> particular form of treatment?
I am not sure. Of course meaning of phrase "technically perfect osteosynthesis" is not constant, and what earlier we took as the one like ideal open reduction of the shaft now is interpreted as a common mistake. Maybe it also should be considered as a variation of patient response?
TAC> Are "refractures" associated with any particular complications
TAC> themselves, like nonunion, delayed union, further fractures...?
In my experience all refractures are quite well healed without any further problem.
TAC> Why would the vice-chair care whether or not you called this particular
I'll explore her view this week.
TAC> What is the significance of a "secondary fracture"? It sounds like it's a
TAC> similar category but somehow not quite as "bad".
I also don't know, and have to search the manual and other literature for this - maybe it means fractures due to screw holes, local osteoporosis etc, including peri-implant ones?
TAC> Perhaps this concept is more commonly discussed in Europe or elsewhere?
No idea.
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Re: Рефрактура?
Krunoslav.Margic 25 Октябрь 2004, 08:05
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What term will you suggest for a teenager patient who in April every second year comes with the same fracture at the same place (transverse fracture of the diaphysis of fifth metacarpal: 2000,2002,2004)?
Sincerely,
Krunoslav Margic
Prim. dr. Krunoslav Margić, dr.med.
Department of plastic and reconstructive surgery
General hospital
SI-5290 Sempeter pri Gorici
Slovenija
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Re: Рефрактура?
Отправитель: V. M. Iyer 25 Октябрь 2004, 19:59
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" Biannual habitual fracture" !!!
V M Iyer
. Iyer Orthopaedic Centre,
103,Railway lines Solapur India.
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Re: Рефрактура?
Отправитель: John Wood 25 Октябрь 2004, 20:00
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Unlucky! Is the patient very atheletic? A long jumper is more at risk of repeat fracture.
Is it a midshaft or a metaphyseal/diaphyseal (Jones type) of the base as these have a high rate of non-union in the athelete and require ORIF. I assume that a metabolic bone disease has been excluded is this correct? Are there any x-rays
John Wood
London UK
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Re: Рефрактура?
Отправитель: John Wood 25 Октябрь 2004, 20:05
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Sorry forgot to ask for mechanism of injury
John Wood
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