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Re: Еще несращение distal tibia
послал Alexander Chelnokov 14 Апрель 2005, 23:41
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DMP> I would consider gradual correction by distraction, and when the fragments
DMP> are well aligned, compress the fracture.
It will result at least with 2 cm of shortening. Maybe more.
DMP> just above the syndesmosis. I would try to have a wire transfixing the lower
DMP> tibial and fibular fragments.
Yes, it is considered.
DMP> (As you well know) The exfix would allow me to continue "adding" compression
DMP> to the fracture site as needed, which I think is quite likely.
Weight-bearing with dynamically locked nail must provide something
similar...
DMP> heal uneventfully after the nailing or is there a significant requirement
DMP> for things like dynamisation or bone grafting.....
The things are not equal. Grafting is much more invasive procedure.
Never performed it on any nail. Dynamization is routine for cases
where no distraction regenerate is seen in 2-3 month of static locking
in tension. If no need to keep distraction gap, primary dynamic
nailing can be performed.
DMP> Also, how many other cases have you done with a long duration of
DMP> nonunion (2 years as in this case)
About 30. One case of 1 year nonunion can be worse than another of 5
year.
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