RE: [ORT-L] Fwd: [Ortho] The patient with non-union of the distal femur


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RE: [ORT-L] Fwd: [Ortho] The patient with non-union of the distal femur

wdburman at frontiernet
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May 9, 2007, 2:09 PM

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RE: [ORT-L] Fwd: [Ortho] The patient with non-union of the distal femur	Can't Post

Dr. Djoldas Kuldjanov of St Louis U has a good suggestion for
operating theaters lacking locking plate options. Remember the
Schuhli nut. See Schuhli nut locked plating for failed proximal
femoral blade plate posted at weborto.net:

Preop Plan:
http://weborto.net/forum/1100327356/pics/2k411/261
Postop:
http://weborto.net/forum/1100327356/pics/2k411/263
Non-Union United:
http://weborto.net/forum/1100327356/pics/2k411/265

For a good example of how this technique can be combined with a blade
plate and applied to a distal femoral nonunion. See:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9520878&dopt=Abstract
Kassab SS,Mast JW, Mayo KA. Clin Orthop Relat Res. 1998
Feb;(347):86-92. Fig 3A_D. Patients treated for nonunions with plate
and screw fixation and adjunctive locking nuts.

Even where locking plates are available, Schuhli nuts might be useful
in case of accidental cross-threading.
http://www.hwbf.org/ota/bfc/ricc1/ft016.html

Bill Burman, MD
HWB Foundation
http://www.hwbf.org

>First, knee needs to move so loosen up the gutters and surgically
>recreate the suprapatellar pouch. A stiff knee putts too much stress on
>your fixation.
>Next, anatomic alignment [not necessarily anatomic reduction] and lots
>of compression. I would use a locking plate with non locking screws
>proximally to allow that extra compression watching to be sure not to
>create excessive valgus. I would not worry about length.
>Bone graft as needed.
>
>D Goetz
>
>-----Original Message-----
>From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
>Behalf Of Alexander Chelnokov
>Sent: Sunday, May 06, 2007 2:44 PM
>To: orthopod@googlegroups.com
>Cc: ORT-L@www2.aaos.org
>Subject: [ORT-L] Fwd: [Ortho] The patient with non-union of the distal
>femur
>
>Dear colleagues,
>
>A case from russian ortho list.
>
>THX in advance for your comments and opinions.
>
>This is a forwarded message
>From: Ruslan <orthoforum@weborto.net>
>To: ortho@weborto.net
>Date: Saturday, May 5, 2007, 1:41:47 AM
>Subject: [Ortho] The patient with non-union of the distal femur
>
>===8<==============Original message text===============
>A female with femoral nonunion,
> Trauma in 2005 - closed fracture of the distal femur, external
>fixation with Ilizarov apparatus. Non-union. In 2006 open reduction
>and external fixation with Ilizarov apparatus. In November 2006 the
>fixator was removed, after that valgus deformation developed. There
>is mobility at the site. The knee motion 0-40. We'd like to discuss
>options of internal fixation.
>
>Ruslan
>===8<===========End of original message text===========
>
>
>
>--
>Best regards,
> Alexander N. Chelnokov
>Ural Scientific Research Institute
>of Traumatology and Orthopaedics
>7, Bankovsky str. Ekaterinburg 620014 Russia
>---
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