[Ortho] Политравма

[Aharon Liberson]

3-D reconstruction would help to decide whether the calcaneum would be good
enough to keep (heel pad is important, but I am not sure from current photo
it is viable). Everything on Ilizarov or pantalar nail. Symes needs the
same pad. Bk needs a proper gastroc flap. You can concider forefoot as a
donor site(I published something lije this this year). Tough case-
goodluck. Liberson
24 п■п╣п╨ 2015 пЁ. 6:58 п©п╬п╩я▄п╥п╬п╡п╟я┌п╣п╩я▄ "п⌡п╣п╬п╫п╦п╢ п÷п╟п╨" <orthoforum на weborto.net>
п╫п╟п©п╦я│п╟п╩:

> п÷п╟я├п╦п╣п╫я┌п╨п╟ 68 п╩п╣я┌. п÷п╬п╩п╦я┌я─п╟п╡п╪п╟.
> пёп╡п╟п╤п╟п╣п╪я▀п╣ п╨п╬п╩п╩п╣пЁп╦ п©я─п╦п╡п╣я┌я│я┌п╡я┐я▌! п▓я│п╣я┘ я│ п╫п╟я│я┌я┐п©п╟я▌я┴п╦п╪ п²п╬п╡я▀п╪ п⌠п╬п╢п╬п╪! п°п╦я─п╟! п■п╬п╠я─п╟!
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> п▓ п╬я┌п╢п╣п╩п╣п╫п╦п╦ п╫п╟ п╩п╣я┤п╣п╫п╦п╦ п╫п╟я┘п╬п╢п╦я┌я│я▐ п©п╟я├п╦п╣п╫я┌п╨п╟ 68 п╩п╣я┌. п╒я─п╟п╡п╪п╟ п╡ я─п╣п╥я┐п╩я▄я┌п╟я┌п╣ п■п╒п÷
> п╡ п╨п╬п╫я├п╣ п╬п╨я┌я▐п╠я─я▐ 2015 пЁп╬п╢п╟. п÷п╣я─п╦п©я─п╬я┌п╣п╥п╫я▀п╧ п©п╣я─п╣п╩п╬п╪ п©я─п╟п╡п╬пЁп╬ п╠п╣п╢я─п╟,
> п©п╣я─п╦п©я─п╬я┌п╣п╥п╫я▀п╧ п©п╣я─п╣п╩п╬п╪ п╩п╣п╡п╬пЁп╬ п╠п╣п╢я─п╟. п≈п╟п╨я─я▀я┌я▀п╧ п©п╣я─п╣п╩п╬п╪ п©п╦п╩п╬п╫п╟ п╩п╣п╡п╬п╧ пЁп╬п╩п╣п╫п╦.
> п≈п╟п╨я─я▀я┌я▀п╧ п©п╣я─п╣п╩п╬п╪ п╢п╦я│я┌п╟п╩я▄п╫п╬пЁп╬ п╪п╣я┌п╟я█п©п╦я└п╦п╥п╟ п╬п╠п╣п╦я┘ п╨п╬я│я┌п╣п╧ п©я─п╟п╡п╬пЁп╬ п©я─п╣п╢п©п╩п╣я┤я▄я▐.
> п·я┌п╨я─я▀я┌я▀п╧ п©п╣я─п╣п╩п╬п╪ п©п╦п╩п╬п╫п╟ п©я─п╟п╡п╬п╧ пЁп╬п╩п╣п╫п╦, п©я▐я┌п╬я┤п╫п╬п╧ п╨п╬я│я┌п╦ п©я─п╟п╡п╬п╧ я│я┌п╬п©я▀
> п╬я┌п╨я─я▀я┌я▀п╧ п©п╬п╢я┌п╟я─п╟п╫п╫я▀п╧ п╡я▀п╡п╦я┘ п©я─п╟п╡п╬п╧ я│я┌п╬п©я▀, п╬я┌п╨я─я▀я┌я▀п╧ п©п╣я─п╣п╩п╬п╪п╬п╡я▀п╡п╦я┘ п╨п╬я│я┌п╣п╧
> я│я┌п╬п©я▀ п╡ я│я┐я│я┌п╟п╡п╣ п╗п╬п©п╟я─п╟.
> п÷я─п╦ п©п╬я│я┌я┐п©п╩п╣п╫п╦п╦ п░п▓п╓ я│я┌п╣я─п╤п╫п╣п╡я▀п╣ п╫п╟ п╫/п╨п╬п╫п╣я┤п╫п╬я│я┌п╦. п÷п╣я─п╦п©я─п╬я┌п╣п╥п╫я▀п╣ п©п╣я─п╣п╩п╬п╪я▀
> п╬п©п╣я─п╦я─п╬п╡п╟п╫я▀ п©п╬я│п╩п╣ я│я┌п╟п╠п╦п╩п╦п╥п╟я├п╦п╦ я│п╬я│я┌п╬я▐п╫п╦я▐ п╫п╟ 8 я│я┐я┌п╨п╦ п©п╬я│п╩п╣ п©п╬я│я┌я┐п©п╩п╣п╫п╦я▐.
> п⌡п╣п╡я▀п╧ п©п╦п╩п╬п╫ - п╫п╟ п п╒ п╡п╥я─я▀п╡п╫п╬п╧ я┘п╟я─п╟п╨я┌п╣я─ п©п╣я─п╣п╩п╬п╪п╟ - п©я─п╦п╫я▐я┌п╬ я─п╣я┬п╣п╫п╦п╣ п╡я▀п©п╬п╩п╫п╦я┌я▄
> п╟я─я┌я─п╬п╢п╣п╥. п▓я▀п©п╬п╩п╫п╣п╫ п©п╬я│п╩п╣ я│п©п╟п╢п╣п╫п╦я▐ п╬я┌п╣п╨п╟ я│я┌п╣я─п╤п╫п╣п╪ Multiloя│.
> п÷я─п╣п╢п©п╩п╣я┤я▄п╣ - VCP + T п╬п╠я─п╟п╥п╫п╟я▐.
> п÷я─п╟п╡п╟я▐ пЁп╬п╩п╣п╫я▄ - я│я┌п╬п©п╟. п÷п╬я│п╩п╣ п÷п╔п·, я┐я│я┌я─п╟п╫п╣п╫п╦я▐ п╡я▀п╡п╦я┘п╟ п╡ п©п╬п╢я┌п╟я─п╟п╫п╫п╬п╪ я│я┐я│я┌п╟п╡п╣
> п╦ п░п▓п╓ я│я┌п╟п╠п╦п╩п╦п╥п╟я├п╦п╦ п©я─п╦ п©п╬я│я┌я┐п©п╩п╣п╫п╦п╦ я─п╟п╫п╟ п╡п╣п╩п╟я│я▄ п╬я┌п╨я─я▀я┌п╬. п▓я┌п╬я─п╦я┤п╫п╟я▐
> я┘п╦я─я┐я─пЁп╦я┤п╣я│п╨п╟я▐ п╬п╠я─п╟п╠п╬я┌п╨п╟ - я│п╣п╨п╡п╣я│я┌я─п╫п╣п╨я─я█я┌п╬п╪п╦я▐. п·я│я┌п╣п╬я│п╦п╫я┌п╣п╥ п©п╣я─п╣п╩п╬п╪п╟
> п╪/п╠п╣я─я├п╬п╡п╬п╧, п╠/п╠п╣я─я├п╬п╡п╬п╧ п╨п╬я│я┌п╣п╧ п©п╩п╟я│я┌п╦п╫п╟п╪п╦, VAC п╢я─п╣п╫п╦я─п╬п╡п╟п╫п╦п╣. п≈п╟ п╡я─п╣п╪я▐
> п╩п╣я┤п╣п╫п╦я▐ п╣я┴п╣ 3 я─п╟п╥п╟ п▓п╔п·. п²п╟ я│п╣пЁп╬п╢п╫я▐я┬п╫п╦п╧ п╢п╣п╫я▄ п╩п╬п╨п╟п╩я▄п╫п╟я▐ п╨п╟я─я┌п╦п╫п╟ п╫п╟ я└п╬я┌п╬.
> п·я┌п╢п╣п╩я▐п╣п╪п╬п╣ я│п╣я─п╬п╥п╫п╬п╣, я▐п╡п╫п╬пЁп╬ пЁп╫п╬я▐ п╫п╣я┌. R-пЁя─ п╦ п╩п╬п╨п╟п╩я▄п╫п╬ - п©я─п╟п╨я┌п╦я┤п╣я│п╨п╦
> п╬я┌я│я┐я┌я│я┌п╡я┐п╣я┌ я│я─п╣п╢п╫п╦п╧ п╬я┌п╢п╣п╩ я│я┌п╬п©я▀: 1/2 я┌п╟я─п╟п╫п╫п╬п╧ п╨п╬я│я┌п╦, 1/2 п©я▐я┌п╬я┤п╫п╬п╧ п╨п╬я│я┌п╦,
> п©я─п╣п╢п©п╩я▌я│п╫п╟ п╬я┌я│я┐я┌я│я┌п╡я┐п╣я┌ п©я─п╟п╨я┌п╦я┤п╣я│п╨п╦ п©п╬п╩п╫п╬я│я┌я▄я▌.
> п п╬п╪п╪п╣п╫я┌п╟я─п╦п╦ п©п╬ я│п╢п╣п╩п╟п╫п╫п╬п╪я┐ п©я─п╦п╡п╣я┌я│я┌п╡я┐я▌я┌я│я▐!
> п≤ п╡п╬п©я─п╬я│ п╨ п╨п╬п╩п╩п╣пЁп╟п╪ - п╣я│я┌я▄ п╩п╦ я│п╪я▀я│п╩ п╠п╬я─п╬я┌я▄я│я▐ п╥п╟ я│я┌п╬п©я┐?
> п∙я│п╩п╦ п╟п╪п©я┐я┌п╟я├п╦я▐ я┌п╬ п╨п╟п╨п╬п╧ я┐я─п╬п╡п╣п╫я▄ п©я─п╣п╢п©п╬я┤я┌п╦я┌п╣п╩я▄п╫п╣п╧?
> п║я┌п╬п╦я┌ п╩п╦ я─п╟я│я│п╪п╟я┌я─п╦п╡п╟я┌я▄ п╟п╪п©я┐я┌п╟я├п╦я▌ п©п╬ я┌п╦п©я┐ п÷п╦я─п╬пЁп╬п╡п╟ я│ п╬п╢п╫п╬п╡я─п╣п╪п╣п╫п╫я▀п╪
> п╟я─я┌я─п╬п╢п╣п╥п╦я─п╬п╡п╟п╫п╦п╣п╪ пЁ/я│я┌п╬п©п╫п╬пЁп╬ я│я┐я│я┌п╟п╡п╟?
> п║ я┐п╡п╟п╤п╣п╫п╦п╣п╪ п⌡п╣п╬п╫п╦п╢ п÷п╟п╨
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