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Re: Проксимальный и дистальный переломы tibia
послал Alexander Chelnokov 18 Май 2006, 21:00
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MC> From the Xrays it seems as though the proximal fracture is relatively
MC> undisplaced.
Yes.
MC> I thought that Poller screws were mostly used to prevent
MC> displacement of the fracture while the nail was being inserted.
The Poller screw here can easily lead to displacement because nail acts as a changing lever during insertion, and its angle to the shaft at initial and final postions are different. So the proximal fragment can be pushed backwards initially, then returned back - but likely with some residual displacement. So most reasonable are measures you mentioned:
MC> In this case I would think that you could hold the reduction
MC> temporarily either with a clamp, crossed K wires or a lag screw.
Or by a small plate with monocrtical screws. My preference is a small wire distractor.
MC> Then insert the nail and place a proximal blocking screw only if
MC> you need to.
If locking screws are inserted usually it is unnecessary.
MC> Will the proximal locking screws fix the proximal fragment?
Depends on nail design. I am going to make an additional hole in the proximal nail end.
MC> Are you going to fix the fibula?
No. Why?
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