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Re: Interesting case - what would you do? Knee val
послал Mangal Parihar 30 Апрель 2007, 17:18
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I opened it up from the lateral aspect.
Freed up the non-union site with minimal disturbance to the posterior and lateral soft tissue attachments on the lateral condyle fragment.
Applied a distractor between femoral shaft and tibia, to create a space on the lateral aspect.
This brought the lateral condylar fragment into a position that seemed to be reasonably well aligned, but showed up a bone gap.
This was fixed temporarily, bone grafted with tricortical struts, and fixed by two cancellous screws. The fragment was not large enough to afford any fixation to a plate or such implant, and the screws held it compressed well to the rest of the distal femur.
Post-op - limb is well aligned, rom 0-30, but I am not pushing that right now, for the next two or three weeks.
Further plan - hope that the screws hold the fragment appropriately till union, but if the stability on table is anything to judge by, that should not be a problem.
Quadricepsplasty after a year or so, to restore flexion.
Pictures attached.
Mangal Parihar
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