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Re: Еще несращение distal tibia
Mangal Parihar 14 Апрель 2005, 22:43
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Alex,
That must have been one hell of a dog.......! :-)
I would consider gradual correction by distraction, and when the fragments are well aligned, compress the fracture.
There are two fractures of the fibula. One the obvious one, and the second just above the syndesmosis. I would try to have a wire transfixing the lower tibial and fibular fragments.
(As you well know) The exfix would allow me to continue "adding" compression to the fracture site as needed, which I think is quite likely.
I know that you are a big fan of this combination (fixator for deformity correction followed by nailing) - in your experience, do most of your cases heal uneventfully after the nailing or is there a significant requirement for things like dynamisation or bone grafting.....
Also, how many other cases have you done with a long duration of nonunion (2 years as in this case)
Mangal
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Re: Еще несращение distal tibia
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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Re: Еще несращение distal tibia
Отправитель: Mangal Parihar 15 Апрель 2005, 21:35
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Alex,
From your reply I get the idea that the procedure you are suggesting is actually similar to lenghtening over a nail, where the nail is used to protect the regenerate, and shorten the fixator time.
i.e. you use the fixator to do a gradual distraction and stimulate regenerate, followed by nailing to protect the regenerate; rather than fixator to achieve closed reduction and nailing to achieve fixation and union
It may sound like nit-picking but I suspect that it could have a bearing on outcome.
Is that right or am I misunderstanding it
Mangal Parihar
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Re: Еще несращение distal tibia
Отправитель: Alexander Chelnokov 15 Апрель 2005, 21:37
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DMP> From your reply I get the idea that the procedure you are suggesting is
DMP> actually similar to lenghtening over a nail, where the nail is used to
DMP> protect the regenerate, and shorten the fixator time.
Yes, though i wouldn't call it similar to lengthening over nail (LON).
Lengthening then nail (LTN) is much more convenient and comprehensive.
DMP> i.e. you use the fixator to do a gradual distraction and stimulate
DMP> regenerate, followed by nailing to protect the regenerate;
Exactly. And dynamize the nail if necessary.
DMP> rather than fixator to achieve closed reduction and nailing to
DMP> achieve fixation and union
This appoach we use for acute fractures and in acute angular corrections after perQ osteotomy, where even in case of ex-fix as definitive fixation we would prefer acute correction rather than open wedge regenerate.
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Re: Еще несращение distal tibia
Отправитель: Mangal Parihar 15 Апрель 2005, 22:35
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DMP> i.e. you use the fixator to do a gradual distraction and stimulate
DMP> regenerate, followed by nailing to protect the regenerate;
AC>Exactly. And dynamize the nail if necessary.
That's an interesting approach...
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