To: ORT-L@www2.aaos.org
From: Nikolaj Wolfson <nswolfso@usc.edu>
Sent by: ORT-L-owner@www2.aaos.org
Date: 02/02/2007 07:02PM
Subject: Re: RE: RE: Re[2]: [ORT-L] Segmental Tibia Fx

There are so many questions to be answered:

1. How accurate our reduction is
2. Is intraoperative C arm image adequate tool to judge our reduction.
3. What is the relationship between accuracy of reduction and clinical outcome ( short and long term).

Jeff:

quantity of reduction is assessed right now with C-arm intra operatively and plain X-rays post op. There is difference between two. How much and how often this difference is is important? I do not know, but I think it likely has effect on the outcome.


Bruce:
Circular frame is nothing else but different type of distractor with easier ( for some) 3D orientation and reduction capability( for some). When I use it it is a used frame ( for which we do not pay either), and the cost is only for a wire and half pin.

I use modified circular frame and nothing is on a way. I find Alex's frame very elegantly constructed either.

As far as time is concerned it is like doing femoral nailing in a lateral vs supine position: more time to set up the case but nailing is easier and faster.

Guys: It is great in California and I am enjoying working and learning from some of my colleagues who have been here for a while.


Come to visit.

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/.../orthopaedic_surgery


----- Original Message -----
From: Bruce_Ziran@HMIS.ORG
Date: Friday, February 2, 2007 12:41 pm
Subject: RE: RE: Re[2]: [ORT-L] Segmental Tibia Fx
To: ORT-L@www2.aaos.org

> I am not sure I completely understand what benefit a circular
> frame has
> over another method, such as distractors or even small pin (3mm)
> fixatorsplaced anteriorly. I would think the rings and wires may
> get in the way and
> the epense might be prohibitive. We had a small set of used
> fixators that
> we use for small bone "distractors" and we only pay for half pins.
> I would
> be interested in the technique and the time and expense. Sounds quite
> interesting but I am not sure if I totally "get" how it is done.
>
> Bruce H. Ziran, M.D.
> Director of Orthopaedic Trauma
> St. Elizabeth Health Center
> Associate Professor of Orthopaedic Surgery
> Northeast Ohio Universities College of Medicine
>
>
>
>
> "Anglen, Jeffrey
>
> O"
>
> <janglen@iupui.ed
> To
> u> <ORT-L@www2.aaos.org>
>
> Sent by:
> cc
> ORT-L-owner@www2.
>
> aaos.org
> Subject
> RE: RE: Re[2]: [ORT-L]
> Segmental
> Tibia Fx
>
> 02/02/2007 01:12
>
> PM
>
>
>
>
>
> Please respond to
>
> ORT-L@www2.aaos.o
>
> rg
>
>
>
>
>
>
>
>
>
> Nik -
>
> Sounds like a good study, how are you going to quantitate the
> accuracy of
> reduction?
>
> UNfortunately I don't do enough acute fracture surgery these days to
> contribute any significant number of patients to such a study.
> Good luck
> with it.
>
> How is sunny southern california?
>
> Jeff
>
> ________________________________
>
> From: ORT-L-owner@www2.aaos.org on behalf of Nikolaj Wolfson
> Sent: Wed 1/31/2007 8:55 PM
> To: ORT-L@www2.aaos.org
> Subject: Re: RE: Re[2]: [ORT-L] Segmental Tibia Fx
>
>
>
> Peter, Jeff, Alex:
>
> I have been using circular frame as reduction tool prior to I.M.
> nailingfor some time. In addition to just a few wires as Alex
> elegantly does it, I
> use sometimes half pins.
> Once the acceptable reduction is achieved the Tibia is than
> reamed, ( I
> always ream), nail introduced and locked ( I always lock). So far
> there was
> no loss of reduction.
>
> We are actually considering a study where accuracy of reduction
> can be
> compared between two methods, frame assisted and frame free. If
> you are
> interested we can discuss this separately.
>
> 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/.../orthopaedic_surgery
>
>
> ----- Original Message -----
> From: Peter Trafton <Peter_Trafton@brown.edu>
> Date: Wednesday, January 31, 2007 12:53 pm
> Subject: RE: Re[2]: [ORT-L] Segmental Tibia Fx
> To: ORT-L@www2.aaos.org
>
> > Another nice conversation on the list - thanks!
> >
> > Alex - you show how a thin-wire ex fix can help with obtaining a
> > tibial fx
> > reduction during nailing. Jeff used poller screws to help with
> > obtaining the
> > reduction, and with its maintenance as well.
> >
> > I wonder if Alex has encountered problems with tibial reductions
> > "slipping"when he removes his intra-operative fixator, and if so
> > whether he uses
> > special locking screws, poller screws, or other techniques to
> > improve the
> > stability of nailed fracture.
> >
> > /pgt
> >
> >
> > ---
> > [This E-mail scanned for viruses by Declude Virus]
> >
> >
>
>
> (See attached file: winmail.dat)