[Ortho] Дистальное бедро и клинковая пластина

[Jeffrey O. Anglen]

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