Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)...


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Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)...

alex at weborto
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Dec 17, 2008, 11:16 AM

Post #1 of 10 (11736 views)
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Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)...	Can't Post

Dear Enes.

You wrote Dec 17, 2008, 1:45:39:

KE> 2. "Harder" Removal of prosthesis (has to be done if it is loose
KE> in remnant of intact proof proximal femur), and new long stem,
KE> porous coated prosthesis with new cup (pt is 59years old, probable

That would be really big surgery.
We will try to be ready to different scenarios according to intraop
findings and estimation.

KE> 3. I can not imagine how any “custom” nail might work, introduced
KE> from the knee, as you have been suggesting !!??

I heard from many european colleagues about anecdotal use of old
hollow Kuntscher nails for that purpose. Prof. R.Schnettler (Germany)
recently told about 57 cases. I have only 2 such cases done last year,
both on cementless stem. This approach is very attractive by that we
achieve the same goal - "new long stem" but much less invasive.

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

---
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jamesdebritz at gmail
New User

Dec 17, 2008, 12:50 PM

Post #2 of 10 (11734 views)
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Re: Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)... [In reply to]	Can't Post

Would love to see some post op xrays of a case where this follow nail was
used. Could you oblige?

Thanks,
James DeBritz

2008/12/17 Alexander Chelnokov <alex@weborto.net>

> Dear Enes.
>
> You wrote Dec 17, 2008, 1:45:39:
>
> KE> 2. "Harder" Removal of prosthesis (has to be done if it is loose
> KE> in remnant of intact proof proximal femur), and new long stem,
> KE> porous coated prosthesis with new cup (pt is 59years old, probable
>
> That would be really big surgery.
> We will try to be ready to different scenarios according to intraop
> findings and estimation.
>
> KE> 3. I can not imagine how any "custom" nail might work, introduced
> KE> from the knee, as you have been suggesting !!??
>
> I heard from many european colleagues about anecdotal use of old
> hollow Kuntscher nails for that purpose. Prof. R.Schnettler (Germany)
> recently told about 57 cases. I have only 2 such cases done last year,
> both on cementless stem. This approach is very attractive by that we
> achieve the same goal - "new long stem" but much less invasive.
>
>
> --
> 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]
>
>

--
James N. DeBritz, M.D
Director of Orthopaedic Trauma
Washington Hospital Center
Washington, DC, USA

jamesdebritz@gmail.com
pager: 866.474.5894
fax: 202.877.3164
office: 202.877.6664
cell: 202.907.5163

alex61 at gmail
New User

Dec 18, 2008, 6:08 AM

Post #3 of 10 (11725 views)
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Re: Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)... [In reply to]	Can't Post

Hello

2008/12/18 James DeBritz <jamesdebritz@gmail.com>:
> Would love to see some post op xrays of a case where this follow nail was
> used. Could you oblige?

Attached. Female, rheumatoid, THA in 2003, car accident in 2006,
failed plating. Nailing in Oct 2007. The nail is solid with hollow
proximal part where he stem is docked Last images are in 1 year after
nailing.

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

Attachments:

get_image1.jpg (12.6 KB)

get_image2.jpg (10.7 KB)

get_image3.jpg (7.68 KB)

get_image4.jpg (7.21 KB)

get_image5.jpg (8.75 KB)

get_image6.jpg (7.88 KB)

mlroutt at u
New User

Dec 18, 2008, 7:39 AM

Post #4 of 10 (11724 views)
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Re: Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)... [In reply to]	Can't Post

Wow.

That construct is like something we'd use to patch cracked or bent fence posts on our ranch when I was a kid...but fence posts don't walk and bleed.

I have refreshed respect for the mighty femur and it's incredible/remarkable ability to unite, regardless of what we do to it.

Thanks for showing those films--

Chip

Hello

2008/12/18 James DeBritz <jamesdebritz@gmail.com>:
> Would love to see some post op xrays of a case where this follow nail was
> used. Could you oblige?

Attached. Female, rheumatoid, THA in 2003, car accident in 2006,
failed plating. Nailing in Oct 2007. The nail is solid with hollow
proximal part where he stem is docked Last images are in 1 year after
nailing.

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

jamesdebritz at gmail
New User

Dec 18, 2008, 9:43 AM

Post #5 of 10 (11719 views)
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Re: Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)... [In reply to]	Can't Post

Impressive. Thanks.

JND

On Thu, Dec 18, 2008 at 9:08 AM, Alexander Chelnokov <alex61@gmail.com>wrote:

> Hello
>
> 2008/12/18 James DeBritz <jamesdebritz@gmail.com>:
> > Would love to see some post op xrays of a case where this follow nail was
> > used. Could you oblige?
>
> Attached. Female, rheumatoid, THA in 2003, car accident in 2006,
> failed plating. Nailing in Oct 2007. The nail is solid with hollow
> proximal part where he stem is docked Last images are in 1 year after
> nailing.
>
>
> --
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia
>

--
James N. DeBritz, M.D
Director of Orthopaedic Trauma
Washington Hospital Center
Washington, DC, USA

jamesdebritz@gmail.com
pager: 866.474.5894
fax: 202.877.3164
office: 202.877.6664
cell: 202.907.5163

alex61 at gmail
New User

Dec 18, 2008, 5:29 PM

Post #6 of 10 (11683 views)
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Re: Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)... [In reply to]	Can't Post

Dear Milton.

You wrote:

> That construct is like something we'd use to patch cracked or bent
> fence posts on our ranch when I was a kid...

Any orthopaedic fixation device is based at mechanical principles
known before...

> but fence posts don't walk and bleed.

The lady walks fine and doesn't bleed ;-)

> I have refreshed respect for the mighty femur and it's
> incredible/remarkable ability to unite, regardless of what we do to it.

The femur responded by failure to Mennen plating (DePuy Bridge plate).
So i would add that the ability to unite is realized in mechanically and
biologically sound conditions.
--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia
---
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mlroutt at u
New User

Dec 18, 2008, 5:50 PM

Post #7 of 10 (11683 views)
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Re: Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)... [In reply to]	Can't Post

You are so right...brilliantly said and done.

milton

Dear Milton.

You wrote:

> That construct is like something we'd use to patch cracked or bent
> fence posts on our ranch when I was a kid...

Any orthopaedic fixation device is based at mechanical principles
known before...

> but fence posts don't walk and bleed.

The lady walks fine and doesn't bleed ;-)

> I have refreshed respect for the mighty femur and it's
> incredible/remarkable ability to unite, regardless of what we do to it.

The femur responded by failure to Mennen plating (DePuy Bridge plate).
So i would add that the ability to unite is realized in mechanically and
biologically sound conditions.
--
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]

janglen at iupui
New User

Dec 22, 2008, 6:24 AM

Post #8 of 10 (11597 views)
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RE: Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)... [In reply to]	Can't Post

Great case Alex
Reminded me of a case I did a couple years ago - 30 year old woman with juvenile rheumatoid arthritis and a nonunion below her stem. Fixed with retrograde nail which docked with the stem and a lateral locking plate. Image attached. One of the companies should come up with a stem design and nail system that anticipates this need.

Jeff Anglen, M.D.
Professor and Chairman, Orthopaedics
Indiana University School of Medicine
541 Clinical Drive, Suite 600
Indianapolis, IN 46202
317-274-7913
janglen@iupui.edu
________________________________________
From: ORT-L-owner@www2.aaos.org [ORT-L-owner@www2.aaos.org] On Behalf Of Alexander Chelnokov [alex61@gmail.com]
Sent: Thursday, December 18, 2008 9:08 AM
To: ORT-L@www2.aaos.org
Subject: Re: Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)...

Hello

2008/12/18 James DeBritz <jamesdebritz@gmail.com>:
> Would love to see some post op xrays of a case where this follow nail was
> used. Could you oblige?

Attached. Female, rheumatoid, THA in 2003, car accident in 2006,
failed plating. Nailing in Oct 2007. The nail is solid with hollow
proximal part where he stem is docked Last images are in 1 year after
nailing.

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

Attachments:

Borman 1-24-02 AP.jpg (48.6 KB)

alex61 at gmail
New User

Dec 22, 2008, 11:11 AM

Post #9 of 10 (11597 views)
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Re: Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)... [In reply to]	Can't Post

Hello dear Jeff

2008/12/22 Anglen, Jeffrey O <janglen@iupui.edu>:
> Reminded me of a case I did a couple years ago - 30 year old woman with juvenile rheumatoid arthritis and a nonunion below her stem. Fixed with retrograde nail which docked with the stem and a lateral locking plate. Image attached.

Very interesting. Never thought about the combination of both nail and
plate. And even more with bone growth stimulator.
Why didn't you use the nail only? Nail-stem interface didn't look
reliable enough to leave it alone?

> One of the companies should come up with a stem design and nail system that anticipates this need.

I haven't ever realized why every knee and hip prosthesis doesn't have
standard interface for quick coupling to a nail - socket, bayonet
mount, thread, slot, whatever else...

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

Dec 22, 2008, 12:15 PM

Post #10 of 10 (11597 views)
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RE: Re[2]: [ORT-L] Periprosthetic fracture ... options (Revision)... [In reply to]	Can't Post

Why didn't you use the nail only? Nail-stem interface didn't look

reliable enough to leave it alone?

Yes, exactly. The patient had failed a couple of plates before and was an established nonunion, and so the nail was sort of an add-on as an afterthought, not the primary fixation - it didn't overlap the stem very much and was not as tight a fit as you described your case to be. I was worried about the survival of the bone in the proximal fragment with the cemented stem in place, and a lateral plate with some cerclage - but I have follow-up from 2 years with some healing present at the fracture site and only some minor change in the plate fixation proximally. Then I moved and lost track of the patient.

jeff

Jeff Anglen, MD

Professor and Chairman, Department of Orthopaedics

Indiana University School of Medicine

541 Clinical Drive, Suite 600

Indianapolis, IN 46202

317-274-7913

janglen@iupui.edu

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