jjbrooksmd at gmail
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Feb 6, 2007, 4:25 AM
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Re: Re[2]: [ORT-L] Distal Femur Fx - to nail or?..
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Hi Alex,
The distal metaphysis is pretty comminuted and the Fx is rather distal.
I personally don't trust my IM nailing skills to serve me well with a
Fx like that. Maybe with the Stryker distal femoral nail, but I'd
prefer the following:
I'd apply an external fixator (2 pins in the femoral shaft about
5-10cm above fx) and 2 pins in the tibia, pull, adjust var/valg and
flex-ext with ex fix/bolsters then a lateral LISS plate. I'd put 1-2
screws across the joint and look at it via a lateral arthrotomy to
make sure the joint is congruent then slide up the LISS and position it.
The lags across joint placed first need to be out of the way of the
LISS plate's future location. Fine tune varus/valgus with the push
pull tool.
I get plain x rays before leaving the OR after LISS plating b/c as
Nik points out it's hard to 'trust' the c-arm images as parallax
(sp?) can throw you off. Some authors have cited a high incidence of
malreduction using the LISS, however, so one needs to be absolutely
sure of the reduction before placing the titanium interlocks thru the
guide into the plate.
What will/did you do?
Jeff
On Feb 4, 2007, at 2:44 PM, alexander chelnokov wrote:
> Dear Brent, Joseph.
>
> Brent wrote 4 февраля 2007 г., 23:36:44:
>
>> This is probably too distal to try and nail although i have done it
>> before. The comminution distally concerns me. Stryker has a SCN
>> nail that has 45 degree cross locks plus 2 others screws distally
>
> Yes, i should check whether it is available here. But for this case I
> presume antegrade nailing.
>
>> careful with the non-displaced fx lines extending into the joint.
>
> I suppose some k-wires for provisional stabilization.
>
>> if it were my case i would use a locked plate . you should be able
>> to maintain great alignment at the joint and the long term result
>> should be just fine.
>
> We use locked plates for plateau/pilon fratures, but for the distal
> femur nails are first choice in our unit...
>
>> keep him non-weightbearing long enough because of the open
>> nature/smoker etc.
>
> Yes, only ROM exercises for initial period.
>
>> curious to know why you have waited for a couple weeks to fix it?
>
> He was referred to our unit 2 weeks after the injury.
>
>> is he in anything right now, fixator i assume since you asked
>> about fixator assisted nailing.
>
> No, on traction.
>
>> get back to me with the final x-rays,
>
> Certainly. THX for your comments.
>
> --
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia
>
> ---
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>
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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