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Forum: OWL Lists: OTA:
[ORT-L] neck fx failure fixation

 
 


kolix at wp
New User

Jan 1, 2009, 2:56 AM

Post #1 of 7 (9228 views)
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[ORT-L] neck fx failure fixation Can't Post
Dear
I would like to know your opinion about this case.
Patient is my colleague ( dentist), she is 54 y.o. She was operated (ORIF +
2screws) in 21/10/2008. She's showed me this pictures week ago... last
Picture is from 16/12/2008 (7 weeks postop). Surgeon that has made this
operation recommended walking by crutches with contact. My proposal is to
reoperate this: remove this 2 screws, ORIF + anatomical reposition + ABG +
fixation by 3 cannulated screws.
How is your opinion ?
Best regards

Marek Kolasniewski
Orthopedic and Trauma Unit
Military Hospital
Poznan
Poland
Attachments: Scan00021.10.08.jpg (65.6 KB)
  Scan0007.jpg (83.4 KB)
  Scan00016.12.08.jpg (67.6 KB)
  Scan19.10.08.jpg (76.2 KB)


janglen at iupui
New User

Jan 1, 2009, 2:55 PM

Post #2 of 7 (9221 views)
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RE: [ORT-L] neck fx failure fixation [In reply to] Can't Post
In my opinion, re-reduction and refixation with bone graft is unlikely to be successful. I think the options are either intertrochanteric osteotomy, or arthoplasty. Osteotomy gives the possiblity of retaining the native hip joint, but in light of the very proximal location of the facture (very subcapital) which reduces your stability of fixation and increases your risk of persistent NU and AVN, plus the fact that there has already been a screw in the joint for a couple months scraping up the cartilage, I'd probably suggest she consider an arthoplasty - total, cementless, ceramic.

JOA
Jeff Anglen, M.D.
Professor and Chairman, Orthopaedics
Indiana University School of Medicine
541 Clinical Drive, Suite 600
Indianapolis, IN 46202
317-274-7913
janglen@iupui.edu
________________________________________
From: ORT-L-owner@www2.aaos.org [ORT-L-owner@www2.aaos.org] On Behalf Of Marek Kolasniewski [kolix@wp.pl]
Sent: Thursday, January 01, 2009 5:56 AM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] neck fx failure fixation

Dear
I would like to know your opinion about this case.
Patient is my colleague ( dentist), she is 54 y.o. She was operated (ORIF +
2screws) in 21/10/2008. She's showed me this pictures week ago... last
Picture is from 16/12/2008 (7 weeks postop). Surgeon that has made this
operation recommended walking by crutches with contact. My proposal is to
reoperate this: remove this 2 screws, ORIF + anatomical reposition + ABG +
fixation by 3 cannulated screws.
How is your opinion ?
Best regards

Marek Kolasniewski
Orthopedic and Trauma Unit
Military Hospital
Poznan
Poland
---
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kolix at wp
New User

Jan 1, 2009, 3:09 PM

Post #3 of 7 (9219 views)
Shortcut
RE: [ORT-L] neck fx failure fixation [In reply to] Can't Post
Arthroplasty is an option but I haven't considered it because of age of
patient and lack of OA sings. There is still time for this prothesis.
However osteotomy may increase chance for union. Thanks for this advice.

Marek Kolasniewski
Orthopedic and Trauma Unit
Military Hospital
Poznan
Poland

In my opinion, re-reduction and refixation with bone graft is unlikely to be
successful. I think the options are either intertrochanteric osteotomy, or
arthoplasty. Osteotomy gives the possiblity of retaining the native hip
joint, but in light of the very proximal location of the facture (very
subcapital) which reduces your stability of fixation and increases your risk
of persistent NU and AVN, plus the fact that there has already been a screw
in the joint for a couple months scraping up the cartilage, I'd probably
suggest she consider an arthoplasty - total, cementless, ceramic.

JOA
Jeff Anglen, M.D.
Professor and Chairman, Orthopaedics
Indiana University School of Medicine
541 Clinical Drive, Suite 600
Indianapolis, IN 46202
317-274-7913
janglen@iupui.edu
________________________________________
From: ORT-L-owner@www2.aaos.org [ORT-L-owner@www2.aaos.org] On Behalf Of
Marek Kolasniewski [kolix@wp.pl]
Sent: Thursday, January 01, 2009 5:56 AM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] neck fx failure fixation

Dear
I would like to know your opinion about this case.
Patient is my colleague ( dentist), she is 54 y.o. She was operated (ORIF +
2screws) in 21/10/2008. She's showed me this pictures week ago... last
Picture is from 16/12/2008 (7 weeks postop). Surgeon that has made this
operation recommended walking by crutches with contact. My proposal is to
reoperate this: remove this 2 screws, ORIF + anatomical reposition + ABG +
fixation by 3 cannulated screws.
How is your opinion ?
Best regards

Marek Kolasniewski
Orthopedic and Trauma Unit
Military Hospital
Poznan
Poland
---
[This E-mail scanned for viruses by Declude Virus]




---
[This E-mail scanned for viruses by Declude Virus]



Michael.Mazurek at med
New User

Jan 1, 2009, 8:17 PM

Post #4 of 7 (9218 views)
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Re: [ORT-L] neck fx failure fixation [In reply to] Can't Post
I would agree with Dr Anglen. THA cementless and a newer bearing surface first choice. Likely 20 year survivorship in this patinent and most predictible outcome. Distant second would be ostotomy.

Mike Mazurek, MD
Naval Medical Center San Diego

----- Original Message -----
From: ORT-L-owner@www2.aaos.org <ORT-L-owner@www2.aaos.org>
To: ORT-L@www2.aaos.org <ORT-L@www2.aaos.org>
Sent: Thu Jan 01 15:09:24 2009
Subject: RE: [ORT-L] neck fx failure fixation

Arthroplasty is an option but I haven't considered it because of age of
patient and lack of OA sings. There is still time for this prothesis.
However osteotomy may increase chance for union. Thanks for this advice.

Marek Kolasniewski
Orthopedic and Trauma Unit
Military Hospital
Poznan
Poland

In my opinion, re-reduction and refixation with bone graft is unlikely to be
successful. I think the options are either intertrochanteric osteotomy, or
arthoplasty. Osteotomy gives the possiblity of retaining the native hip
joint, but in light of the very proximal location of the facture (very
subcapital) which reduces your stability of fixation and increases your risk
of persistent NU and AVN, plus the fact that there has already been a screw
in the joint for a couple months scraping up the cartilage, I'd probably
suggest she consider an arthoplasty - total, cementless, ceramic.

JOA
Jeff Anglen, M.D.
Professor and Chairman, Orthopaedics
Indiana University School of Medicine
541 Clinical Drive, Suite 600
Indianapolis, IN 46202
317-274-7913
janglen@iupui.edu
________________________________________
From: ORT-L-owner@www2.aaos.org [ORT-L-owner@www2.aaos.org] On Behalf Of
Marek Kolasniewski [kolix@wp.pl]
Sent: Thursday, January 01, 2009 5:56 AM
To: ORT-L@www2.aaos.org
Subject: [ORT-L] neck fx failure fixation

Dear
I would like to know your opinion about this case.
Patient is my colleague ( dentist), she is 54 y.o. She was operated (ORIF +
2screws) in 21/10/2008. She's showed me this pictures week ago... last
Picture is from 16/12/2008 (7 weeks postop). Surgeon that has made this
operation recommended walking by crutches with contact. My proposal is to
reoperate this: remove this 2 screws, ORIF + anatomical reposition + ABG +
fixation by 3 cannulated screws.
How is your opinion ?
Best regards

Marek Kolasniewski
Orthopedic and Trauma Unit
Military Hospital
Poznan
Poland
---
[This E-mail scanned for viruses by Declude Virus]




---
[This E-mail scanned for viruses by Declude Virus]


Nfw~z %ו


george.s.thomas at gmail
New User

Jan 5, 2009, 6:52 PM

Post #5 of 7 (9187 views)
Shortcut
Re: [ORT-L] neck fx failure fixation [In reply to] Can't Post
An example of a similar sitution.

On Fri, Jan 2, 2009 at 4:39 AM, Marek Kolasniewski <kolix@wp.pl> wrote:

> Arthroplasty is an option but I haven't considered it because of age of
> patient and lack of OA sings. There is still time for this prothesis.
> However osteotomy may increase chance for union. Thanks for this advice.
>
> Marek Kolasniewski
> Orthopedic and Trauma Unit
> Military Hospital
> Poznan
> Poland
>
> In my opinion, re-reduction and refixation with bone graft is unlikely to
> be
> successful. I think the options are either intertrochanteric osteotomy, or
> arthoplasty. Osteotomy gives the possiblity of retaining the native hip
> joint, but in light of the very proximal location of the facture (very
> subcapital) which reduces your stability of fixation and increases your
> risk
> of persistent NU and AVN, plus the fact that there has already been a screw
> in the joint for a couple months scraping up the cartilage, I'd probably
> suggest she consider an arthoplasty - total, cementless, ceramic.
>
> JOA
> Jeff Anglen, M.D.
> Professor and Chairman, Orthopaedics
> Indiana University School of Medicine
> 541 Clinical Drive, Suite 600
> Indianapolis, IN 46202
> 317-274-7913
> janglen@iupui.edu
> ________________________________________
> From: ORT-L-owner@www2.aaos.org [ORT-L-owner@www2.aaos.org] On Behalf Of
> Marek Kolasniewski [kolix@wp.pl]
> Sent: Thursday, January 01, 2009 5:56 AM
> To: ORT-L@www2.aaos.org
> Subject: [ORT-L] neck fx failure fixation
>
> Dear
> I would like to know your opinion about this case.
> Patient is my colleague ( dentist), she is 54 y.o. She was operated (ORIF +
> 2screws) in 21/10/2008. She's showed me this pictures week ago... last
> Picture is from 16/12/2008 (7 weeks postop). Surgeon that has made this
> operation recommended walking by crutches with contact. My proposal is to
> reoperate this: remove this 2 screws, ORIF + anatomical reposition + ABG +
> fixation by 3 cannulated screws.
> How is your opinion ?
> Best regards
>
> Marek Kolasniewski
> Orthopedic and Trauma Unit
> Military Hospital
> Poznan
> Poland
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
>
>
>
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
>


--
George Thomas,
Chief Orthopaedic Surgeon,
St. Isabel's Hospital,
Mylapore,Chennai 600004,
India.
Phone +91-44-24991081/82/83
Editor, Indian Journal of Medical Ethics,
www.issuesinmedicalethics.org
www.ijme.in
Attachments: pre 1.jpg (20.4 KB)
  post ap.jpg (26.0 KB)
  post lat.jpg (19.1 KB)
  fail ap.jpg (20.8 KB)
  fail lat.jpg (20.5 KB)
  osteo ap.jpg (24.7 KB)
  osteo lat.jpg (26.4 KB)


janglen at iupui
New User

Jan 6, 2009, 10:03 AM

Post #6 of 7 (9183 views)
Shortcut
RE: [ORT-L] neck fx failure fixation [In reply to] Can't Post
Similar, but more distal fracture site and no screw in the joint, so osteotomy is more likely to give a good functinal hip.

Jeff Anglen, M.D.
Professor and Chairman, Orthopaedics
Indiana University School of Medicine
541 Clinical Drive, Suite 600
Indianapolis, IN 46202
317-274-7913
janglen@iupui.edu
________________________________
From: ORT-L-owner@www2.aaos.org [ORT-L-owner@www2.aaos.org] On Behalf Of George Thomas [george.s.thomas@gmail.com]
Sent: Monday, January 05, 2009 9:52 PM
To: ORT-L@www2.aaos.org
Subject: Re: [ORT-L] neck fx failure fixation

An example of a similar sitution.

On Fri, Jan 2, 2009 at 4:39 AM, Marek Kolasniewski <kolix@wp.pl> wrote:
Arthroplasty is an option but I haven't considered it because of age of
patient and lack of OA sings. There is still time for this prothesis.
However osteotomy may increase chance for union. Thanks for this advice.

Marek Kolasniewski
Orthopedic and Trauma Unit
Military Hospital
Poznan
Poland

In my opinion, re-reduction and refixation with bone graft is unlikely to be
successful. I think the options are either intertrochanteric osteotomy, or
arthoplasty. Osteotomy gives the possiblity of retaining the native hip
joint, but in light of the very proximal location of the facture (very
subcapital) which reduces your stability of fixation and increases your risk
of persistent NU and AVN, plus the fact that there has already been a screw
in the joint for a couple months scraping up the cartilage, I'd probably
suggest she consider an arthoplasty - total, cementless, ceramic.

JOA
Jeff Anglen, M.D.
Professor and Chairman, Orthopaedics
Indiana University School of Medicine
541 Clinical Drive, Suite 600
Indianapolis, IN 46202
317-274-7913
janglen@iupui.edu<mailto:janglen@iupui.edu>
________________________________________
From: ORT-L-owner@www2.aaos.org<mailto:ORT-L-owner@www2.aaos.org> [ORT-L-owner@www2.aaos.org<mailto:ORT-L-owner@www2.aaos.org>] On Behalf Of
Marek Kolasniewski [kolix@wp.pl]
Sent: Thursday, January 01, 2009 5:56 AM
To: ORT-L@www2.aaos.org<mailto:ORT-L@www2.aaos.org>
Subject: [ORT-L] neck fx failure fixation

Dear
I would like to know your opinion about this case.
Patient is my colleague ( dentist), she is 54 y.o. She was operated (ORIF +
2screws) in 21/10/2008. She's showed me this pictures week ago... last
Picture is from 16/12/2008 (7 weeks postop). Surgeon that has made this
operation recommended walking by crutches with contact. My proposal is to
reoperate this: remove this 2 screws, ORIF + anatomical reposition + ABG +
fixation by 3 cannulated screws.
How is your opinion ?
Best regards

Marek Kolasniewski
Orthopedic and Trauma Unit
Military Hospital
Poznan
Poland
---
[This E-mail scanned for viruses by Declude Virus]




---
[This E-mail scanned for viruses by Declude Virus]




--
George Thomas,
Chief Orthopaedic Surgeon,
St. Isabel's Hospital,
Mylapore,Chennai 600004,
India.
Phone +91-44-24991081/82/83
Editor, Indian Journal of Medical Ethics,
www.issuesinmedicalethics.org<http://www.issuesinmedicalethics.org>
www.ijme.in<http://www.ijme.in>


george.s.thomas at gmail
New User

Jan 6, 2009, 6:45 PM

Post #7 of 7 (9182 views)
Shortcut
Re: [ORT-L] neck fx failure fixation [In reply to] Can't Post
I agree about the screw in the hip.
The fracture line is almost vertical - subcapital supero-laterally and basal
infero-medially. Almost pure shear.

On Tue, Jan 6, 2009 at 11:33 PM, Anglen, Jeffrey O <janglen@iupui.edu>wrote:

> Similar, but more distal fracture site and no screw in the joint, so
> osteotomy is more likely to give a good functinal hip.
>
> Jeff Anglen, M.D.
> Professor and Chairman, Orthopaedics
> Indiana University School of Medicine
> 541 Clinical Drive, Suite 600
> Indianapolis, IN 46202
> 317-274-7913
> janglen@iupui.edu
> ------------------------------
> *From:* ORT-L-owner@www2.aaos.org [ORT-L-owner@www2.aaos.org] On Behalf Of
> George Thomas [george.s.thomas@gmail.com]
> *Sent:* Monday, January 05, 2009 9:52 PM
> *To:* ORT-L@www2.aaos.org
> *Subject:* Re: [ORT-L] neck fx failure fixation
>
> An example of a similar sitution.
>
> On Fri, Jan 2, 2009 at 4:39 AM, Marek Kolasniewski <kolix@wp.pl> wrote:
>
>> Arthroplasty is an option but I haven't considered it because of age of
>> patient and lack of OA sings. There is still time for this prothesis.
>> However osteotomy may increase chance for union. Thanks for this advice.
>>
>> Marek Kolasniewski
>> Orthopedic and Trauma Unit
>> Military Hospital
>> Poznan
>> Poland
>>
>> In my opinion, re-reduction and refixation with bone graft is unlikely to
>> be
>> successful. I think the options are either intertrochanteric osteotomy,
>> or
>> arthoplasty. Osteotomy gives the possiblity of retaining the native hip
>> joint, but in light of the very proximal location of the facture (very
>> subcapital) which reduces your stability of fixation and increases your
>> risk
>> of persistent NU and AVN, plus the fact that there has already been a
>> screw
>> in the joint for a couple months scraping up the cartilage, I'd probably
>> suggest she consider an arthoplasty - total, cementless, ceramic.
>>
>> JOA
>> Jeff Anglen, M.D.
>> Professor and Chairman, Orthopaedics
>> Indiana University School of Medicine
>> 541 Clinical Drive, Suite 600
>> Indianapolis, IN 46202
>> 317-274-7913
>> janglen@iupui.edu
>> ________________________________________
>> From: ORT-L-owner@www2.aaos.org [ORT-L-owner@www2.aaos.org] On Behalf Of
>> Marek Kolasniewski [kolix@wp.pl]
>> Sent: Thursday, January 01, 2009 5:56 AM
>> To: ORT-L@www2.aaos.org
>> Subject: [ORT-L] neck fx failure fixation
>>
>> Dear
>> I would like to know your opinion about this case.
>> Patient is my colleague ( dentist), she is 54 y.o. She was operated (ORIF
>> +
>> 2screws) in 21/10/2008. She's showed me this pictures week ago... last
>> Picture is from 16/12/2008 (7 weeks postop). Surgeon that has made this
>> operation recommended walking by crutches with contact. My proposal is to
>> reoperate this: remove this 2 screws, ORIF + anatomical reposition + ABG +
>> fixation by 3 cannulated screws.
>> How is your opinion ?
>> Best regards
>>
>> Marek Kolasniewski
>> Orthopedic and Trauma Unit
>> Military Hospital
>> Poznan
>> Poland
>> ---
>> [This E-mail scanned for viruses by Declude Virus]
>>
>>
>>
>>
>> ---
>> [This E-mail scanned for viruses by Declude Virus]
>>
>>
>
>
> --
> George Thomas,
> Chief Orthopaedic Surgeon,
> St. Isabel's Hospital,
> Mylapore,Chennai 600004,
> India.
> Phone +91-44-24991081/82/83
> Editor, Indian Journal of Medical Ethics,
> www.issuesinmedicalethics.org
> www.ijme.in
>



--
George Thomas,
Chief Orthopaedic Surgeon,
St. Isabel's Hospital,
Mylapore,Chennai 600004,
India.
Phone +91-44-24991081/82/83
Editor, Indian Journal of Medical Ethics,
www.issuesinmedicalethics.org
www.ijme.in

 
 
 


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