jjbrooksmd at gmail
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Aug 30, 2007, 8:46 AM
Post #3 of 3
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Flavio,
Can you please elaborate on your suggestion?
Alex,
ESR of 48 concerns me, as does the amount of iatrogenic injury done
to the blood supply of that Fx at time of initial ORIF. seems like
infected nonunion to me. I'd get that hardware out and send good bone
Cxs first & foremost. Would NOT do a THA (although she may eventually
need that b/c of injury to the fem hd & 'tab cartilage).
Jeff Brooks
Stamford, CT
On Aug 30, 2007, at 11:25 AM, frg@myfastmail.com wrote:
> A Dimon a Hughston give you the medial continuity restauration and
> is a
> good and "easy" surgery in this case.
>
>
> ----- Original message -----
> From: "Alexander Chelnokov" <alex@orto.unets.ru>
> To: ORT-L@www2.aaos.org
> Date: Thu, 30 Aug 2007 19:34:04 +0600
> Subject: [ORT-L] subtrocn nonunion
>
> Dear All,
>
> A female 62 y.o. referred to our unit. In X 2006 was operated
> somewhere - open reduction and fixation of a fragmented
> subtrochanteric
> fracture. Why so strange fixation was performed - no data at the
> moment. 3 month in plaster cast. Image 1 - Apr 2007, 6 month
> after the surgery. The screw was removed some days later.
> Other images present the current situation.
>
> Wound healed uneventfully. Now there is local hyperemia at the lateral
> side of the proximal femur. WBC - 6.2, ESR - 48 m/h.
> And the patient is retired anesthesiologist.
> Maybe some tests should be added?
>
> There is a list of options. Of course any starts with hardware
> removal.
> Further:
> 1. Acute valgization and closed re-nailing by Gamma nail.
> 2. Same with blade plate.
> 3. As 1 or 2 but with gradual valgization by external fixator
> within 2-3
> weeks.
> 3. Cementless THA in one session with hardware removal
> 4. Same but cemented with antibiotics
> 5. Hardware removal, antibiotic impregnated cement spacer and THA 1-2
> month later.
> 6. Something else?
>
> What option would be optimal? THX in advance.
>
> --
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
Jeffrey J Brooks, MD
Hand & Upper Extremity Surgery
Orthopaedic Trauma Surgery
Orthopaedic Surgery & Sports medicine center
1290 Summer Street, #4400
Stamford, CT 06905
(203) 323-7331
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