eastln at yahoo
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Dec 1, 2007, 6:57 AM
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»Ø¸´£º [ORT-L] Distal femur non union
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Dear Carel
This is a tough case .The poor kid have experienced many surgery and the site of femoral fracture must have bad blood supply. A s a orthopedist , how to fix the fracture is a problem that faced with us . The purpose of re-operation is realization of rigid internal fixation and less aggressive to blood supply.
I prefer the larger intermedullary locking nail with bone graft as my first choice, my reason is as followed. IM can place in closed condition and consider the centered fixation is more rigider than eccentric fixation of plate in the biological mechanism. Whatever to pick out the kind of fixation, bone graft is necessary to this patient.
The wire track infection of external fixation is common and don¡¯t realize the rigid fixation, so I gave up it. LC-DCP is capable of compressing the fracture, but it need the wilder strip of soft tissue.Maybe LISS is the another choice, but it also don¡¯t compress the facture effectively.
Best regards,
Li Ning
The third hospital of Shijiazhuang, Hebei province, China.. zip code: 050011
"J.C. Goslings" <j.c.goslings@amc.uva.nl> дµÀ£º A question for the list members.
16 yr old boy, high energy motorcycle trauma trauma in July 2005 with:
- hip dislocation + acetabular fracture L
- distal femoral fracture L
- tibial shaft fracture L
- metatarsal fractures L
Treatment:
july 05: LISS femur, LCP plate tibia, double recon. plate post. acetabulum
oct 05: cancellous bone graft femur
aug 06: blade plate + bone graft
nov 06: revision blade plate
feb 07: retrograde nail + bone graft + BMP
may 07: dynamisation nail
sept 07: locking screw removal (max. dynamisation reached)
nov 07: persistant non-union distal femur; other fractures healed uneventfully.
All with gradual/partial weightbearing etc. Currently 50-100% weight bearing, no pain.
Soft tissues are intact. No smoking or diabetes.
CRP <2
What would you do?
Kind regards,
Carel Goslings
Trauma Unit AMC
Amsterdam, NL
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