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Re: Перелом вертлужной впадины, вывих и перелом бе
Chip Routt 25 Июль 2006, 09:38
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Maybe someone else can get the book for you.... try Chapters 23-26 to start.
You can access by Internet several articles which describe more problems and complications related to late presentation ORIF as with reoperation after ORIF failures...try PubMed.
For your presented patient, I'd most likely treat him with ORIF.
Chip
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Re: Перелом вертлужной впадины, вывих и перелом бе
Rahul Banerjee 25 Июль 2006, 09:39
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Letournel's book is available now. For years it was out of print, but it has been reprinted!
Rahul Banerjee
El Paso, TX
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Re: Перелом вертлужной впадины, вывих и перелом бе
Dr. V.M.Iyer 25 Июль 2006, 09:54
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Dear Alex,
I have not a big experience nor have I studied extensively on acetabular fractures. From my
theoritical knowledge and hearing others with more experience
>>> does it make sense to attempt ORIF of the acetabulum with hip reduction, or primary THA should be considered?
It makes sense to fix the acetabulum even if it is one month old. The acetabulum would be better
suited for future THA
I assume that the patient has been on skeletal traction in the past one month
Dr V M Iyer
Solapur.India
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Re: Перелом вертлужной впадины, вывих и перелом бе
Abdelsalam Eid 25 Июль 2006, 10:25
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I have just been to a meeting where we were given a lecture by a man considered to be the top authority on acetabular frx in Egypt. He said that acetabular reconstruction was worthwhile even "up to 3 months". He did not say of course that it would be something easy, but that he did it this way. Even if problems develop later in the hip, it would be a near normal anatomy, easier to reconstruct by THR if the need arises.
He also said that primary THR in such cases gave universally bad results. Of course I have no reference but you may consider this a "personal communication". ;-)
Now, to my own opinion. I believe that this is a Transverse + Posterior wall fracture type.
The transverse element does not seem so much displaced, and now after 1 month I believe it will be extremely difficult to mobilize and reduce. So I suggest you get a CT to check for incarcerated fragments, a high possibility in this unreduced dislocation. Then you open posteriorly, Kocher Langenbeck, with the patient prone, extract any incarcerated frgments, reduce the hip, fix the posterior wall by screws, and then apply a contoured reconstruction plate from the iliac wing to the ischium. This plate will hold the ransverse element, as well as buttress the posterior wall fragment(s).
Good luck and keep us posted.
Dr Abdelsalam EID M.D., AFSA (Paris V)
AO Fellow
Lecturer of Orthopedic Surgery
Faculty of Medicine, Zagazig University,
Egypt.
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