[ORT-L] Another stuck nail - Orthopedics Forum


	MAIN INDEX	SEARCH POSTS	WHO'S ONLINE	LOG IN

Forum: OWL Lists: OTA:
[ORT-L] Another stuck nail

felixalbers at terra
New User

Apr 28, 2008, 6:56 PM

Post #1 of 5 (3987 views)
Shortcut

[ORT-L] Another stuck nail	Can't Post

Hello All,

this 34 year old healthy man sustained a closed right femoral fracture in november 2006. Initial treatment with plating with poor technique, so early hardware failure resulted. Two months later he went to Paraguay and was treated with plate removal and femoral nailing (Synthes nail). He started weight-bearing one month later and was walking with a cane and complaining of some feeling of "instability", but working normally and without pain until january 2008. At this time he started complaining of some pain on his thigh. Some days ago he came to me with this recent x-rays showing a broken nail and a hypertrophic non-union. ESR, CRP and CBC normal, no history of fistulae. His knee has a normal range of motion.

Options are 1) removal of nail, new reaming and nailing
2) removal of nail, new plating (+ bone grafting?)
3) forget about the distal nail fragment, just remove the proximal part, new plating.

My suggestion to this patient was nail removal, leaving the distal part there, decortication, bone grafting, plating. I�m afraid there is too much osteolysis on the distal femur and fracture is too distal to achieve enough stability with a new nail.

What do you think?
Thanks for your advice.

Felix Albers
Hospital Cristo Redentor
Porto Alegre - Brazil.

Attachments:

DSC06581.JPG (28.1 KB)

DSC06585.JPG (26.8 KB)

hselhi at gmail
New User

Apr 29, 2008, 6:21 AM

Post #2 of 5 (3982 views)
Shortcut

RE: [ORT-L] Another stuck nail [In reply to]	Can't Post

Dear Dr Felix,

May I request you to send us a x-ray with knee joint so as to enable us to
see the size of distal fragment.

Regards

HArpal

From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On Behalf
Of Felix Albers
Sent: Tuesday, April 29, 2008 7:26 AM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] Another stuck nail

Hello All,

this 34 year old healthy man sustained a closed right femoral fracture in
november 2006. Initial treatment with plating with poor technique, so early
hardware failure resulted. Two months later he went to Paraguay and was
treated with plate removal and femoral nailing (Synthes nail). He started
weight-bearing one month later and was walking with a cane and complaining
of some feeling of "instability", but working normally and without pain
until january 2008. At this time he started complaining of some pain on his
thigh. Some days ago he came to me with this recent x-rays showing a broken
nail and a hypertrophic non-union. ESR, CRP and CBC normal, no history of
fistulae. His knee has a normal range of motion.

Options are 1) removal of nail, new reaming and nailing

2) removal of nail, new plating (+ bone grafting?)

3) forget about the distal nail fragment, just
remove the proximal part, new plating.

My suggestion to this patient was nail removal, leaving the distal part
there, decortication, bone grafting, plating. I�m afraid there is too much
osteolysis on the distal femur and fracture is too distal to achieve enough
stability with a new nail.

What do you think?

Thanks for your advice.

Felix Albers

Hospital Cristo Redentor

Porto Alegre - Brazil.

davyin04 at yahoo
New User

Apr 29, 2008, 8:15 AM

Post #3 of 5 (3982 views)
Shortcut

Re: [ORT-L] Another stuck nail [In reply to]	Can't Post

Hi,
The Original nail was short. would remove the proximal piece, open the fracture (you would have to open to plate anyway) ream, put in a longer nail with bone graft. Use a nail that will give you a little bit of dynamisation from the onset. If the distal piece is stuck, use the distal screw holes to form a cortical window to dislodge the nail.
David Oloruntoba.

----- Original Message ----
From: Felix Albers <felixalbers@terra.com.br>
To: ORT-L@www2.aaos.org
Sent: Tuesday, 29 April, 2008 3:56:26 AM
Subject: [ORT-L] Another stuck nail

Hello All,

this 34 year old healthy man sustained a closed right femoral fracture in november 2006. Initial treatment with plating with poor technique, so early hardware failure resulted. Two months later he went to Paraguay and was treated with plate removal and femoral nailing (Synthes nail). He started weight-bearing one month later and was walking with a cane and complaining of some feeling of "instability", but working normally and without pain until january 2008. At this time he started complaining of some pain on his thigh. Some days ago he came to me with this recent x-rays showing a broken nail and a hypertrophic non-union. ESR, CRP and CBC normal, no history of fistulae. His knee has a normal range of motion.

Options are         1) removal of nail, new reaming and nailing
                          2) removal of nail, new plating (+ bone grafting?)
                          3) forget about the distal nail fragment, just remove the proximal part, new plating.

My suggestion to this patient was nail removal, leaving the distal part there, decortication, bone grafting, plating. I´m afraid there is too much osteolysis on the distal femur and fracture is too distal to achieve enough stability with a new nail.

What do you think?
Thanks for your advice.

Felix Albers
Hospital Cristo Redentor
Porto Alegre - Brazil.

__________________________________________________________
Sent from Yahoo! Mail.
A Smarter Email http://uk.docs.yahoo.com/nowyoucan.html

alex61 at gmail
New User

Apr 29, 2008, 9:19 AM

Post #4 of 5 (3982 views)
Shortcut

Re: [ORT-L] Another stuck nail [In reply to]	Can't Post

Dear Felix

2008/4/29 Felix Albers <felixalbers@terra.com.br>:

> Options are 1) removal of nail, new reaming and nailing
>

This would be close to my choice. Since the nail is hollow it is possible to
remove the distal piece through the proximal entry point with an olive guide
wire and one or two more wires. Then i'd try to achieve stability not only
by reaming and insertion of a thicker nail but mostly by "tension stress".
Particularly here you have some degrees of varus. Insert transmedullary
(Poller) screw or wires to push the nail from the lateral wall. You will
gain not only alignment but also dramatically increased stability because of
tension of the hypertrophic nonunion.

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

sannapareddy_98 at yahoo
New User

Apr 29, 2008, 11:32 AM

Post #5 of 5 (3982 views)
Shortcut

Re: [ORT-L] Another stuck nail [In reply to]	Can't Post

Alexander Chelnokov <alex61@gmail.com> wrote: Dear Felix

2008/4/29 Felix Albers <felixalbers@terra.com.br>:
Options are 1) removal of nail, new reaming and nailing

This would be close to my choice. Since the nail is hollow it is possible to remove the distal piece through the proximal entry point with an olive guide wire and one or two more wires. Then i'd try to achieve stability not only by reaming and insertion of a thicker nail but mostly by "tension stress". Particularly here you have some degrees of varus. Insert transmedullary (Poller) screw or wires to push the nail from the lateral wall. You will gain not only alignment but also dramatically increased stability because of tension of the hypertrophic nonunion.

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia
Dear Felix,
If you are sure the non-union is an is not infected and could not deliver the distal fragment of the nail with out opening the fracture, i think you should consider making an opening in the inter condylar notch and inserting a solid rod to deliver the fragment through gentle blows from the proximal opening.
Dr.Krishna Reddy, Nellore, India.

---------------------------------
Meet people who discuss and share your passions. Join them now.

Search for (options)