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Re: Дефект-псевдоартрз бедра
послал Alexaander Chelnokov 11 Сентябрь 2006, 23:25
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> wide resection of infected, dead bone until you will see ' paprika
> sign ' at the live bone end.
At the moment it is very difficult to estimate the resulting defect.
From the other hand, we have two year period of tissue recovery - blood supply was restored everywhere at least partially. Distraction and tension stress can lead to further improvement of vascularization. So the approach with segmental resection should be reserved to a case of active infection.
> At the same session you can put antibiotic rod and also antibiotic
> beads.
There already have been no signs of infection for 2 year period - why use local antibiotics now?
> either clinically and also blood tests (cRP etc.) you can put a
> retrograde IM nail.
Retrograde nailing is problematic in case of knee stiffness in extension. Why not antegrade?
> With this long nail you can bone transport and also lengthen of
> the shortened thigh. 3rd session: Bone grafting of the docking site
> and interlocking of the IM nail
A viable scenario of course. Though bone transport and lengthening procedures can be performed without a nail inside. And the nail can be inserted when all the manipulations are completed. It allows not to be limited with only longitudianl traction-comression. "Lenthening then nail" allows to use a nail of proper length and diameter. It is interesting, when reaming and nail insertion have more positive influence - before or after distraction?
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