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Re: LISS?
Enes Kanlic 15 Ноябрь 2004, 09:14
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Alex,
I do realize that you are master surgeon, and congratulations on another excellent, spectacular case (result), but,
- Your last posted case: how is possible to have secure fixation with applied construct without additional casting, bracing or Ilizarov?
- I believe that one technique is good and to be recommended to others, only if most of the surgeons in most of the cases could achieve acceptable (more than 70%) good result (importance of large series, multiple surgeons results published in peer reviewed journals).
Again, Locking Plating is minimally invasive, SUBCUTANEOUS INTERNAL FIXATION and I believe for the most surgeons preferred method of treatment for distal femur fractures (I do not have any financial interest with any of the manufacturers, parties).
Thanks,
Enes M. Kanlic,
MD, MS, PhD, FACS
Associate Professor
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Re: LISS?
Alexander Chelnokov 15 Ноябрь 2004, 20:31
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Dear Enes,
Sunday, November 14, 2004, 8:57:21 PM, you wrote:
KEMMD> I do realize that you are master surgeon,
I'd like to avoid personal appraisals...
KEMMD> and congratulations on another excellent, spectacular case (result),
THX, initial images are
1,
2.
KEMMD> - Your last posted case: how is possible to have secure fixation with
KEMMD> applied construct without additional casting, bracing or Ilizarov?
At that moment we had in stock only the 10 mm solid nails so of course there was no idea about early weight bearing. But it was quite enough for early knee ROM excersises (see attached). Two locking screws through the distal block provided that.
KEMMD> - I believe that one technique is good and to be recommended to others, only
KEMMD> if most of the surgeons in most of the cases could achieve acceptable (more
KEMMD> than 70%) good result
Imagine if G. Ilizarov adopted this approach - the technique would had never been released from his clinic :-)
Of course if we talk about antegrade nailing in distal femoral fractures with the particular technique even better than 70% results can be achieved - after appropriate learning curve, not so long.
Another problem may be dominant - in the US AFAIK one can not use Ilizarov rings and other part as a reduction tool for internal fixation because the Ilizarov's parts are single-use, so total cost of implants for one surgery is to be too high.
KEMMD> (importance of large series, multiple surgeons results
KEMMD> published in peer reviewed journals).
Large series are needed to reveal nuances and slight differencies between techniques. In the discussed case capabilities of the technique are self-evident.
KEMMD> Again, Locking Plating is minimally invasive, SUBCUTANEOUS
KEMMD> INTERNAL FIXATION
Characteristic of locking nailing hardly ever sounds less attractive...
KEMMD> and I believe for the most surgeons preferred
KEMMD> method of treatment for distal femur fractures
A new toy is more interesting and fashionable. And anyway it is not panacea, i have already seen presentations with LISS failures like the attached one presented by D.Seligson. And people also demonstrated incisions say that the method is not so LESS invasive as it supposed to be.
KEMMD> (I do not have any financial interest with any of the
Maybe we here do - if equal or better results are reached with $100 implant, why use the $1100 one?
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