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Re: Перелом бедра, через неделю после эндопротезир
послал Tim Bray 18 Август 2007, 11:39
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In our aging population we are, unfortunately, seeing more of these; Use the fracture table supine, traditional lateral approach; we like the Stryker cable plate, most any modern design will do; first reduce the fracture with reduction clamps then cable the reduction with the metal clamps anterior so they don't interfere with the lateral plate application. Remove the clamps,
check the reduction and then apply a 12-14 hole plate from the tip of the trochanter to below the tip of the prosthesis to allow 6- 8 cortices of
distal screw fixation. Cemented stems are actually better for fixation as you may be able to angle proximal screws through the cement mantel for increased proximal fixation stability. Two additional cables around the bone/plate construct in addition to the two reduction cables with the
proximal screws should be adequate fixation. There is data now to suggest allograft struts are not as frequently indicated, possibly due to better fixation options. We have used BMP sponges (Infuse) applied medially along the fracture site prior to closing the wound without a drain. Non weight bearing for 10- 12 weeks, DVT prophylaxis 21 days, good diet, no smoking.
Good Luck,
Tim Bray, Pete Althausen, Tim O'Mara-
Reno Ortho Clinic Fracture Service
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