[Ortho] post-nailing fracture

[Enes Kanlic]

If I may again:

1. Removal of the nail in elderly, frail lady is not a small procedure
(timing and blood loss)

2. It is hard to do "good fixation" of distal fracture through
antegrade approach.... and probably distal incision (more than just
for distal locking) would have to be made anyway (reduction, cerclage
wires...).  

3. Retrograde nail (small diameter in large bone) does not allow for
good, stable fixation (often malalignment)  and  early weight bearing
(I have seen the locking screws and nail cutting through the distal
femur into the knee joint - in osteoporotic bone, heavy persons)

4. We could treat this fracture like there is no a nail - new locking
plates allow for secure fixation.... two similar cases are attached...

5. Immediate full weight bearing after this type of fracture is in my
opinion to risky - I would suggest rather minimal.... or not at all
(just  transfers in wheelchair for about six weeks, until some healing
happens).   

 
Sincerely, 

 
Enes M. Kanlic, MD, FACS
Professor

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