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Re: Open supracondylar femur fx
Frederic B. Wilson, M.D. 31 Октябрь 2004, 12:01
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Alex,
Re LISS: Easier. Less difficulty with controlling the intercondylar segment.
No further damage to the knee joint (retrograde). No involvement of the hip area (antegrade). Better options for controlling Varus/valgus, procurvatum/recurvatum at the fracture with this segmental defect.
FredFrederic B. Wilson, M.D.
Trauma & Adult Reconstruction
ETMC First Physicians - Orthopaedic Trauma
700 Olympic Plaza Circle, Suite 510
Tyler, TX, 75701
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Re: Open supracondylar femur fx
Alexander Chelnokov 31 Октябрь 2004, 12:05
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FBWMD> Re LISS: Easier.
AFAIR there are specific pitfalls of the technique.
FBWMD> Less difficulty with controlling the intercondylar segment.
Temporary wires solve the problem.
FBWMD> No further damage to the knee joint (retrograde).
Do you really mean tissue dissection needed for the plate placement provides no further damage of the joint and periarticular structures?
FBWMD> No involvement of the hip area (antegrade).
This hardly ever is of great importance for a case like this. BTW modern nail design for lateral insertion minimizes the involvement.
FBWMD> Better options for controlling Varus/valgus,
FBWMD> procurvatum/recurvatum at the fracture with this segmental defect.
Using of some wires secured to the Ilizarov ring or arc provides any needed control.
Dynamization can also be a useful option.
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Re: Open supracondylar femur fx
Отправитель: Terry Finlayson 02 Ноябрь 2004, 01:11
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I would make a strong argument that lateral soft tissue dissection for plate placement (especially since debridement of open fracture is necessary anyway) is much less damaging to the articular surface than a retrograde nail.
Also, even though antegrade nailing is possible, all the discussion about using Ilizarov wires, rings and/or arcs takes this method from the realm of straightforward to the complex IMHO.
I think retrograde IM nail is a good option, but one needs to be sure that the fracture is out to length with this comminuted metaphysis.
I have used 95 degree blade plates, condylar screws w/ side plate, supracondylar nails, long retrograde IM nails and now, more recently the locking anatomic plates. The locking plate technology is a big step forward in my hands to achieve better reduction and more stable fixation
while preserving blood supply in these fractures.
Terry I. Finlayson, M.D.
Logan, UT USA
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