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Re: Перелом предплечья
Jeff Brooks 16 Август 2005, 09:27
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Are you going to immobilize him in a long arm cast or let him start motion?
The reductions are nice, but I'd be concerned that the fracture of the radius will move with pronation & supination encouraging nonunion (since the nail is essentially fixed to the distal radial shaft and free to move with respect to the proximal radius.
I'd lean toward 4-5 weeks in a long arm cast, giving him "credit" for the past week or so of immobilization.
Overall, very nice.
Jeff Brooks
Stamford, CT
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Re: Перелом предплечья
Shmuel Luboshitz 16 Август 2005, 09:28
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Excellent
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Re: Перелом предплечья
John Ruth 16 Август 2005, 09:30
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The reduction is excellent but I am not sure that you have rotational stability of the proximal radial fragment (no proximal locking) this could rotate with pronation and supination. If you are planning to cast then ORIF with plates is superior because casting is not necessary. I would expect these fractures to heal with callus as opposed to primary bone healing seen with plated fixation. Is healing with callus in the forearm a problem? I am not sure I know. How do these rods and locking screws compare price wise with plate and screw fixation (more expensive I would expect)? How often is hardware removal required? What was your operative time? I think these are all factors to consider when comparing a new treatment method with an established one.
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Re: Перелом предплечья
Brent Bamberger 16 Август 2005, 09:34
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Excellent
Actually plating would have been very difficult and would have added possible comlications.
Long arm cast for 2 weeks then Active ROM would be my approach. Is the elbow OK ?? radial head looks a little posterior though???
H Brent Bamberger DO
DME Grandview Hospital
Program Director Orthopedic Surgery
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Re: Перелом предплечья
Dr V. M. Iyer 16 Август 2005, 09:35
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Very good Alex
Vishu
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Re: Перелом предплечья
Rajesh 16 Август 2005, 09:36
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Good technique, but in comminuted / segmental #s like this ,isn't it better to lock statically at both ends? I would be concerned about possible rotation.I dont have any experience with closed nailing of forearm though. Is he going to be in a cast for 6 weeks?
rajesh
Mr.K.R.Rajesh,MS,DNB,FRCS,FRCS(Orth)
Consultant Upper Limb Surgeon,
Division of Upper Limb & Joint Replacement Surgery.
Cosmopolitan Hospital,
Trivandrum,Kerala,
India.
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Re: Перелом предплечья
Отправитель: Alexander Chelnokov 20 Август 2005, 16:35
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R> Good technique, but in comminuted / segmental #s like this ,isn't it better
R> to lock statically at both ends? I would be concerned about possible
R> rotation.
The nail is a bit more bent so it has also 3-point elastic fixation. Also bone ends are in contact and will allow rotation only in distraction and not in the current position.
R> Is he going to be in a cast for 6 weeks?
No.
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Re: Перелом предплечья
V. M. Iyer 16 Август 2005, 22:51
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Dear Alex,
what were the sizes of the nails? did you have to ream the bones? Regards
Vishu
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Re: Перелом предплечья
Отправитель: Alexander Chelnokov 16 Август 2005, 22:54
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DVMI> what were the sizes of the nails?
Length 200 and 240 mm, diameter 4 mm.
DVMI> did you have to ream the bones?
Yes, the radius. The set includes cannulated reamers 4 and 5 mm. Though finally our custom-made 5 mm hybrid of reamer and awl was used.
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Re: Перелом предплечья
Waldemar Kindswater 19 Август 2005, 12:53
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Perfekt!
Waldemar
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Re: Перелом предплечья
Marco Berlusconi 31 Август 2005, 08:42
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I've some questions because we have really no experience with nailing the forearm, but I think that in this case it could be a very safe option especially for the radial side.
I've learned from the AO principles that forearm fractures are like articular fractures so the reduction should be anatomic and the fixation stable. In this case the problem for a plate fixation is the radial nerve proximally but if soft tissues could be considered good there's no reason not to use a double plate. The postop xray is very nice but can we accept this reduction and this fixation as anatomical and stable? Can he move immediately the elbow and the wrist? The distal entry point is at the Lister site? which will be the result? Are they easy to remove?
I'd like to know if is there a guided device to lock the nails and the company that delivers those nails
Thanks
Marco Berlusconi
Traum Unit
Humanitas Institute
Milan Italy
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Re: Перелом предплечья
Отправитель: Alexander Chelnokov 01 Сентябрь 2005, 10:47
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mb> I've learned from the AO principles that forearm fractures are like
mb> articular fractures
Sounds like a dogmatic statement with religious rationale. Any shaft fractures definitely are not like articular ones.
mb> can we accept this reduction and this fixation as anatomical and stable?
Axis, length, radial bowing and rotation are restored. Stability is relative as in any nailing, but enough for early function.
mb> Can he move immediately the elbow and the wrist?
Sure. Though this particular patient in not very compliant
(alcoholic), and left the unit 3 days after the surgery.
mb> The distal entry point is at the Lister site?
Close to.
mb> which will be the result?
In our previus experience with non locking forearm nails usually resilts are pretty fine. Functional recovery is likely to 4 weeks.
mb> Are they easy to remove?
No experience. Since the nails have threaded canal at the end, so sliding hammer can be connected. Though i don't expect removal will be strongly needed - why touch asymptomatic implants?
mb> I'd like to know if is there a guided device to lock the nails
Yes. I attached such image with that message. See one more with the jig.
mb> and the company that delivers those nails
Nails produced by ChM (Poland) were used in this case. There are some more available on the market - Foresight (Smith & Nephew), SST (Biomet).
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