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Re: Проксимальный и дистальный переломы tibia
Alexander Chelnokov 24 Май 2006, 00:15
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MTA> to apex anterior angulation as well as valgus alignment.
This is specific for the conventional nailing technique.
MTA> Your entry point on the AP view seems to have been kept the
MTA> same.
And it could be even more medial.
MTA> How did you manage to maintain alignment? Any
MTA> intra-operative pictures of your technique?
As i mentioned a small wire distractor was used. In common upper fractures it is enough to insert 2 frontal wires to the proximal fragment - one in the upper posterior aspect of the tibia and the second anteriorly and a bit more distally. The technique allows to avoid such known tricks like more lateral entry point, semi-extended knee, extended approach, using of bone clamps, plating with monocortical screws etc.
In this particlar case 4 frontal wires were inserted in anterior and posterior aspects at both sides of proximal fracture, and fixed to a single half ring with some bend to provide compression with wire tension. Image attached.
MTA> The lateral view shows your entry point to be quite posterior and
MTA> I think this is recommended to avoid anterior angulation. Were
MTA> you concerned about intra-articular penetration?
You are absolutely right, and the entry point could be more anterior without the risk of angulation. This a bit posterior placement was caused by the proximal anterior wire. No obvious problem with the knee though.
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