jjbrooksmd at gmail
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Mar 22, 2007, 12:16 PM
Post #3 of 3
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Re: [ORT-L] Sacral Pseudoarthrosis
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Dear Josep,
Any followup on this case?
Any of our esteemed colleagues want to offer thoughts?
Some other thoughts: locking plates inserted in all-locked mode (ie,
without first lagging plate to bone to produce friction between plate
& bone) have much less rigidity than a non-locked plate & screw
construct as long as the non-locked screws have adequate insertion
tourque. We recently had a great discussion also about 1 vs 2
symphyseal plates.
Also, the initial posterior fixation in my opinion was not enough
(single cannulated IS screw with only 16mm threads).
Finally, posterior reduction, had it been more anatomic, would have
increased chances of union by virtue of more cancellous bone contact
in the R sacral ala.
Jeff
On 2/21/07, Jeff Brooks <jjbrooksmd@gmail.com> wrote:
> OK..............there's been a notable lack of response on this one so I
> guess I'll put in my two cents.
>
> The anterior locked plates shuld come out with revision anterior fixation
> first. Bone quality may not be that great so what about a longer plate
> spanning the superior rami bilat as well as cerclage.
>
> Then, flip the patient, remove the failed R IS screw, expose the nonunion
> from a posterior approach, (send Cx to be sure of sterility), fill with
> iliac crest graft obtained previously from the front, +/- BMP7, BMP2
> (although no evidence this will help), and rigid triangular osteosynthesis
> (R L5 pedicle -- Ilium -- span ilium to sacrum) as described by Chip's
> goroup in Seattle. Maybe substitute the IS screw (if no bone left) with
> transiliac bars or posterior TB plate.
>
> Tough one.
>
> I'd love to hear others' thoughts on this.
>
>
> On 2/16/07, Josep M. Muñoz Vives <jmmuvi@terra.es> wrote:
> >
> >
> > Dear list members:
> >
> > I'm sending a case on behalf of Dr. I Marimon, seeking for advice in this
> > case of sacral pseudoarthrosis.
> >
> > Dr. Josep M. Muñoz Vives
> > Hospital Universitario 'Dr. Josep Trueta'
> > Girona
> > Catalonia
> > Spain
> >
> >
> >
> >
> >
> > --
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> >
>
>
>
> --
> Jeffrey J. Brooks, MD
> Orthopaedic Surgery & Sports Medicine Center
> 1290 Summer Street, #4400
> Stamford, CT 06905
--
Jeffrey J. Brooks, MD
Orthopaedic Surgery & Sports Medicine Center
1290 Summer Street, #4400
Stamford, CT 06905
---
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