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Re: Locked nailing femur
Alexander Chelnokov 01 Декабрь 2004, 00:55
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VMI> What do we do now?
VMI> 2) Do an exchange nailing with a thicker nail.
This is a way to go.
VMI> Kindly note. a) the nail is going towards the medial aspect
VMI> of the lower end thus causing a 5* varus at the # site. b) there
VMI> is a slight overiding causing a centimeter of shortening.
Such slight defomation must be possible to correct acutely using a distractor.
VMI> Implant removal may not be easy with the distal screw broken and
VMI> the nail broken too.
Exactly. We removed recently such a distal part of a hollow nail using a guide pin inserted from the knee through the stab wound. The hole in the notch was made by a cannulated awl. Then the pin passed to the proximal end of the femur, and a cannulated nail inserted to push the broken part distally over the guide pin. There is a set for broken
nail removal.
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Re: Locked nailing femur
V. M. Iyer 01 Декабрь 2004, 00:57
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Alex,
Will the distractor work with such a sticky fracture? One may be able to angulate this but not distract
Vishu
V M Iyer
. Iyer Orthopaedic Centre,
103,Railway lines Solapur India
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Re: Locked nailing femur
Отправитель: Alexander Chelnokov 01 Декабрь 2004, 00:59
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Well, you never know it before you try. Two tensioned 2 mm wires provide very much power. In case acute indirect correction failed - there is a lot of bailouts. Exchange nailing may be postponed and gradual traction by more powered external fixator performed. One may try closed flexion/rotation osteoclasis for mobilization and then repeat attempt of acute reduction. Sometimes it is more practical to perform perQ osteotomy - either through the old fracture line or a new one.
Anyway, bone already has a prepared canal, so it can be possible to ream and insert a thicker nail. It will result with angular correction "automagically", and the 1 cm shortening can be neglected.
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