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mal-non-union distal tibia in a diabetic |
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Прислано Louis Nunez 20 Январь 2005, 07:08
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Dear Group,
Would like to present following case.
68 yr old diabetic patient who sustained fractured distal tibia and fibula in distal third, treated with intramedullary rod.
4 weeks later, screws broke, sending tibial nail through distal tibia. Nail removed and external fixator applied. At time of ex-fix, blood supplyto foot noted to be nil. (Oxygen saturatioon of great toe 0%). Patient then underwent arterial bypass surgery which has restored blood supply. Ex-fix removed at 5 months with what appeared to be healing. Patient was then allowed to walk on the leg. He returns one month after weight bearing allowed with accomnpanying x-rays. My plan was to open non-union site, curette out fibrous tissue, bone graft and apply ex-fix (Ilizarov Type).
Question: Would anyone opt for a repeat im nailing after opening and curretage and bone grafting?
Thanks in advance,
Louis D. Nunez, MD
Fishkill, NY
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