orthauma at hotmail
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Dec 29, 2007, 12:34 PM
Post #3 of 3
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Dear Jeff
thanks for ur thoughts, the malreduction in femur happened when i tightened the screws in the plate, but the reduction before was anatomic, i wished if LCP was available but its not..
new x-ray now /i didnt yet copy it/ there is good callus formation on the medial side of femur frx, but still in valgus!!,
for ex-fix i think i should remove it , thanks for advice
i begin physiotherapy and she is doing fine...
regards
Firas> From: janglen@iupui.edu> To: ORT-L@www2.aaos.org> Date: Thu, 27 Dec 2007 20:51:49 -0500> Subject: RE: [ORT-L] knee crush> > Ok, I'll bite on this.> > I would not worry about the lateral knee ligament instability for now. I do not think it would be very satisfying to attempt reconstruction of the lateral ligament or the posterolateral corner at this point. I would remove the medial fixator soon,as soon as the soft tissues will allow the use of a hinged brace, because pin tract infection will limit your options in dealing with the nonunion that is coming in the upper shaft area. Let the tibial plateau heal back together, get the soft tissues healed and infection free, then plan on taking out the tibial plate and doing an intramedullary nail and posterolateral bone graft.> > I am also worried about the malreduction of the distal femur. With that non-locking plate it will tend to drift into varus, which could be good since it is now in valgus, but it is unlikely to stop when it gets to anatomic, and may become a nonunion too. If it seems to be going that way, convert to a blade plate or a locking plate.> > Don't overlook the foot drop - try to prevent an equinus contracture if possible.> > Just a few thoughts -> > Jeff Anglen MD> ________________________________> From: ORT-L-owner@www2.aaos.org [ORT-L-owner@www2.aaos.org] On Behalf Of Firas . [orthauma@hotmail.com]> Sent: Thursday, December 27, 2007 5:21 PM> To: orthopod@googlegroups.com> Cc: ort-l@www2.aaos.org> Subject: [ORT-L] knee crush> > This patient-female 18y fell down from 2nd floor from about 50 day, she had open frx (G2) in distal lt femur and open comminuted tibial plateau and shaft Gustillo 3b(loss of skin 2 upper third of anteromedial tibia) + bi hemo-pneumothorax(which was drained).> There wa severe injury especially to posterolateral corner of knee,there was stretching injury to peroneal nerve and very torn TFL and LCL.> Was treated by thorough debridement and ex-fixation under tension(ligamentotaxis) and beads in ppostero lateral knee, and tension rubber bands in leg to approximate skin..> Good granulation tissue and general condition of patient after 3 weeks with normal labs(wbc-CRP) so 2nd procedure to internal fixation and skin graft was done> Distal femur frx stabilized by scews and buttress condylar plate with graft, the tibial plateau was compressed by screws and plate, and the plate was slided over tibial frx in mini incisions(I was afraid of infection from medial skin loss so I didn’t open tibial frx and didn’t grafted it) with buttressing the medial side of tibia by ex-fix> > Now….the lateral instability? What to do?and when?> Ex-fix support medially ..should I remove it?when?> Tibial midshaft frx, should I was to graft it in the 2nd operation?or wait later?> > Regards> > Firas> > ________________________________> Don't get caught with egg on your face. Play Chicktionary! Check it out!<http://club.live.com/chicktionary.aspx?icid=chick_wlhmtextlink1_dec>> ---> [This E-mail scanned for viruses by Declude Virus]>
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