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Apr 30, 2008, 12:54 AM
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»Ø¸´£º [ORT-L] Another stuck nail
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The biomechanical unstable is the main cause to nonunion , so my suggestion to this patient is the removal of proximal nail through the original incision, and then open the knee joint and remove the distal nail, next step is to use the retrograde intramedullary nail to fix the fracture.
Li Ning
the third hospital of Shijiazhuang ,China
Felix Albers <felixalbers@terra.com.br> дµÀ£º
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.
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