Re[2]: [ORT-L] Distal tibial GSW


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Re[2]: [ORT-L] Distal tibial GSW

alex at weborto
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Apr 8, 2007, 1:23 PM

Post #1 of 4 (2577 views)
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Re[2]: [ORT-L] Distal tibial GSW	Can't Post

Hello David,

Monday, April 9, 2007, 2:10:55 AM, you wrote:

> ankle fusion by using a short locked IM nail thru the
> calcaneum across the subtalar & ankle joints into what is left of

What's wrong with the ankle & subtalar joints to consider fusion? If
tissue condition permits nailing, the distal fragment of the tibia is
long enough to allow antegrade nailing with a nail which has more than
2 locking screws.

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

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bonedocrob at bresnan
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Apr 8, 2007, 2:06 PM

Post #2 of 4 (2577 views)
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Re: Re[2]: [ORT-L] Distal tibial GSW [In reply to]	Can't Post

All What about the "old" technique of posterolateral bonegrafting
with a spanning ex fix from tibia to calcaneus. That leaves one out
of the area of trauma and in good tissue.

R Schultz
On Apr 8, 2007, at 2:23 PM, Alexander Chelnokov wrote:

> Hello David,
>
> Monday, April 9, 2007, 2:10:55 AM, you wrote:
>
>> ankle fusion by using a short locked IM nail thru the
>> calcaneum across the subtalar & ankle joints into what is left of
>
> What's wrong with the ankle & subtalar joints to consider fusion? If
> tissue condition permits nailing, the distal fragment of the tibia is
> long enough to allow antegrade nailing with a nail which has more than
> 2 locking screws.
>
> --
> 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]
>

---
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janglen at iupui
New User

Apr 9, 2007, 7:45 AM

Post #3 of 4 (2569 views)
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RE: Re[2]: [ORT-L] Distal tibial GSW [In reply to]	Can't Post

I agree with trying to save the ankle and certainly subtalar joint. A
long cloverleaf plate on the medial side and a long plate on the lateral
side and bone grafting as suggested may do it.

JOA

Jeff Anglen, MD
Professor and Chairman, Department of Orthopaedics
Indiana University School of Medicine
540 Clinical Drive, Suite 600
Indianapolis, IN 46202
317-274-7913
janglen@iupui.edu

-----Original Message-----
From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
Behalf Of Alexander Chelnokov
Sent: Sunday, April 08, 2007 4:24 PM
To: David Oloruntoba
Subject: Re[2]: [ORT-L] Distal tibial GSW

Hello David,

Monday, April 9, 2007, 2:10:55 AM, you wrote:

> ankle fusion by using a short locked IM nail thru the
> calcaneum across the subtalar & ankle joints into what is left of

What's wrong with the ankle & subtalar joints to consider fusion? If
tissue condition permits nailing, the distal fragment of the tibia is
long enough to allow antegrade nailing with a nail which has more than
2 locking screws.

--
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]

---
[This E-mail scanned for viruses by Declude Virus]

nswolfso at usc
New User

Apr 9, 2007, 9:24 AM

Post #4 of 4 (2567 views)
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Re: RE: Re[2]: [ORT-L] Distal tibial GSW [In reply to]	Can't Post

My approach is different:

Stage 1: If there is no need for the soft tissue coverage I would use small wire ( Ilizarov) ex fix after gentle I&D. Wires distally including distal tibial fragment, foot and may be calcaneus, two rings proximally with wires and half-pins.

Stage 2: based on the healing of the fracture site decide what to do next: if bone opposition reasonable: compress, if there is a bone defect treatment will be based on its size: small - bone grafting, large: bone transport.

I am treating right now similar case. The difference is low velocity vs high velocity wound ( big difference).
Good luck.

Nik

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Clinical Orthopaedics
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

----- Original Message -----
From: "Anglen, Jeffrey O" <janglen@iupui.edu>
Date: Monday, April 9, 2007 7:46 am
Subject: RE: Re[2]: [ORT-L] Distal tibial GSW
To: ORT-L@www2.aaos.org

> I agree with trying to save the ankle and certainly subtalar
> joint. A
> long cloverleaf plate on the medial side and a long plate on the
> lateralside and bone grafting as suggested may do it.
>
> JOA
>
> Jeff Anglen, MD
> Professor and Chairman, Department of Orthopaedics
> Indiana University School of Medicine
> 540 Clinical Drive, Suite 600
> Indianapolis, IN 46202
> 317-274-7913
> janglen@iupui.edu
>
>
> -----Original Message-----
> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
> Behalf Of Alexander Chelnokov
> Sent: Sunday, April 08, 2007 4:24 PM
> To: David Oloruntoba
> Subject: Re[2]: [ORT-L] Distal tibial GSW
>
> Hello David,
>
> Monday, April 9, 2007, 2:10:55 AM, you wrote:
>
> > ankle fusion by using a short locked IM nail thru the
> > calcaneum across the subtalar & ankle joints into what is left of
>
> What's wrong with the ankle & subtalar joints to consider fusion? If
> tissue condition permits nailing, the distal fragment of the tibia is
> long enough to allow antegrade nailing with a nail which has more than
> 2 locking screws.
>
> --
> 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]
>
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
>

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