Ответить
|
Re: Peri-prosthetic femoral fracture
Alexaander Chelnokov 21 Ноябрь 2006, 13:43
|
MTA> 2). There is rather limited room between the condyles in an IB2 knee for
MTA> a retrograde nail.
Go antegrade if you have an approriate implant available. Attached is a result of a similar fracture.
|
[
Ответить ]
|
Re: Peri-prosthetic femoral fracture
Dr Andrea Salvi 21 Ноябрь 2006, 13:46
|
Dear colleague,
I would suggest the use of an external fixation on both the condyles, with a single fiche on the internal condylus (stabilizing antirotatory function), two fiches on the external condyles and three fiches on the dyaphisis.
Best regards,
Andrea E. Salvi - MD
Orthopaedic and Traumatism Department
Mellino Mellini Hospital Trust
Civil Hospital of Iseo (Brescia), Italy
|
[
Ответить ]
|
Re: Peri-prosthetic femoral fracture
Myles Clough 21 Ноябрь 2006, 13:47
|
The implication from Mr Asumu's original message is that if a retrograde nail was possible he would do it. If it is truly impossible then I would agree with Alex' suggestion; perhaps use a hacksaw to shorten the nail a little. If it's just "difficult" to do a retrograde nail and you have proved (on the bench) that you can get nail up past the implant, then I would try that and revert to antegrade if on the day it is "impossible".
Another thought - spanning external fixator holding the fracture reduced until healing then whatever procedures are necessary to recover range and acceptable function once the fracture has healed. This might mean a revision TKR but one with a reasonable chance of success and you might get away with no major procedures.
Myles Clough
Consultant Orthopaedic Surgeon (Retired), Kamloops, BC, Canada
Clinical Instructor, University of British Columbia
|
[
Ответить ]
|
Re: Peri-prosthetic femoral fracture
Отправитель: george therthanath 21 Ноябрь 2006, 14:19
|
Myles,
The external fixator very close to the knee prosthesis till such time that we get good union!
Isn't there a high risk of infection to the prosthesis in this procedure?
Or, are there any tricks to minimise infection from a pin tract that will be very close to the prosthesis?
Dr. T. I. George,
Senior Orthopaedic Surgeon
And Head of Orthopaedics Unit-III,
Little Flower Hospital and research Centre,
Angamaly, Kerala State,
India.
|
[
Ответить ]
|
|
Re: Peri-prosthetic femoral fracture
Niraj L Vora 21 Ноябрь 2006, 14:16
|
How about a LISS or similar implant? Or am I missing a trick here??
Niraj
Niraj L Vora
Orthopaedic Surgeon
Prescot, UK
|
[
Ответить ]
|
Re: Peri-prosthetic femoral fracture
Отправитель: Alexander Chelnokov 21 Ноябрь 2006, 14:24
|
Of course, locked plates can be suitable. Though antegrade nail would be less invasive.
|
[
Ответить ]
|
|
Re: Peri-prosthetic femoral fracture
katsevman haim 21 Ноябрь 2006, 18:12
|
if the prosthesis is stable i advise to fixate this frx with retrograde nail if possible that will be more stable than anterograde or internal fix devise like l-plate, 90 degree DHS or LCP ...if the prosthesis is loosed - revision will be done ...
|
[
Ответить ]
|
Re: Peri-prosthetic femoral fracture
Dr Abdelsalam Eid 22 Ноябрь 2006, 00:01
|
Dear Mr Asumu
I think LISS plate would be a very good solution to this problem. Antegrade nailing in this type
of fracture requires a nail with many locking possibilities distally. Even then, I would still
worry about the stability of fixation od the ability to mobilize early. I would strongly advise
against external fixation near a TKR. The potential complications may be disasterous.
Best of luck
Dr Abdelsalam EID M.D., AFSA (Paris V)
AO Fellow
Lecturer of Orthopedic Surgery
Faculty of Medicine, Zagazig University,
Egypt.
|
[
Ответить ]
|
Re: Peri-prosthetic femoral fracture
Mr Theophilus Asumu 22 Ноябрь 2006, 17:41
|
My preference would be to rigidly fix the fracture internally. I just feel that it may not be possible given the very porotic nature of the bone distal to the fracture (I am re-sending the lateral x-ray which really concerns me).
I doubt if I could lock a nail (either antegrade or retrograde) distal to the fracture which extends virtually to the implant. I have similar concerns about plate fixation. Has anyone got a reasonable volume of experience with this type of fracture?
I would be very nervous about infection with an external fixator close to the TKR. A spanning fixator is an idea but the knee will surely be incredibly stiff at the end of treatment. How easy is it for a lady in her 70s to mobilise in a spanning fixator?
Many Thanks.
Mr Theophilus Asumu FRCS (Tr & Orth)
Consultant Orthopaedic Surgeon
Oldham
United Kingdom
|
[
Ответить ]
|
Re: Peri-prosthetic femoral fracture
Отправитель: Lou Nunez 22 Ноябрь 2006, 17:45
|
I have seen a number of fractures of this type. I believe that due to fact that this fracture is mainly metaphyseal, excellent healing potential is present. I don't believe that a spanning exfix would be a good choice due to the fact that you might not get the motion that you want. I believe
that a percutaneous Lis plate may be the way to go. You should be able to get some screws across the metaphysis and get decent alignment. I know that others have mentioned the Lis plate, but I don't think anyone has suggested a percutaneous approach. This approach would not disturb the callus which is probably already forming by now.
This is not an easy problem!
Good luck,
Lou Nunez, MD, Fishkill, NY
|
[
Ответить ]
|
|
Re: Peri-prosthetic femoral fracture
Каминский Андрей 29 Ноябрь 2006, 19:48
|
Прошу прощения за Русский. Мы бы делали ппаратом Илизарова, с поксимальной стержневой базой и дистальной кольцевой на дисьальном отломке с фиксацией коленного сустава в аппарате на 3 - 4 недели.
С уважением, Каминский А.В.
|
[
Ответить ]
|
( Ответить )
|
Peri-prosthetic femoral fracture
