[Ortho] Перелом бедра, через неделю после эндопротезир

[Tim Bray]

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