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Re: Дистальное бедро и клинковая пластина
послал Jeffrey O. Anglen 05 Сентябрь 2007, 12:34
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It appears to me as if someone has already tried to "Mold" or contour this plate - there seems to be an extra angle in it. This plate should not be contoured, since the shape of it (the 95 degree angle) is what allows it to be used , when inserted correctly, to re-establish the relationship between the joint and shaft axes.
I think the primary problem is "simply" a translational one and not a major angular deformity. I wonder if the shortening is more related to contracture than loss of bone. I would obtain long alignment films (hip- knee-ankle), and perhaps a scanogram, or at least separate bilateral femur films, to try and sort these issues out.
I think I would favor treatment to healing in this position, with aggressive PT and then re-evaluate the extent of disability. Nutritional and medical optimization and a bone stimulator may be worth considering. The presence of a cerclage wire in an area of comminution is often forensic evidence of bone murder. I am not optimistic that a retrograde nail would lead to secure healing and would worry about taking it all apart at this stage.
Jeff Anglen
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