Re[5]: [ORT-L] Segmental Tibia Fx


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Re[5]: [ORT-L] Segmental Tibia Fx

alex61 at gmail
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Feb 1, 2007, 11:07 AM

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Re[5]: [ORT-L] Segmental Tibia Fx	Can't Post

Dear Nikolaj.

Nikolaj wrote 1 февраля 2007 г., 6:55:52:

> elegantly does it, I use sometimes half pins.

Half-pins are good in acute cases. Wires are stronger. I've seen
broken half-pins in delayed cases with shortening.

> So far there was no loss of reduction.

If something goes wrong and you fight with your own reduction tool
because it was improperly positioned, and you feel that Poller wire
removal will cause slipping despite locking (what Peter asked about) a
solution is to insert Poller screw prior to poller wires removal.

> 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.

Good idea! Add my name to the list of contributors.

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

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nswolfso at usc
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Feb 1, 2007, 3:28 PM

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Re: Re[5]: [ORT-L] Segmental Tibia Fx [In reply to]	Can't Post

Alex:

My half pin is used where your anteroproximal wire is, more as a push half pin. I do use additional half pins if there is a need for the segmental reduction ( approximation). I use them intra-operatively . They do not brake.

Obviously to me ,next to the reduction , after reaming is done, comes appropriate placement of the nail, and in the proximal fractures it is inserted through the lateral entry point.

Improperly positioned reduction tool is a wrong reduction tool.

>>Good idea! Add my name to the list of contributors.
If you serious about the idea I will send you my research proposal. Just let me know.

All the best

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: alexander chelnokov <alex61@gmail.com>
Date: Thursday, February 1, 2007 3:08 pm
Subject: Re[5]: [ORT-L] Segmental Tibia Fx
To: Nikolaj Wolfson <ORT-L@www2.aaos.org>

> Dear Nikolaj.
>
> Nikolaj wrote 1 ДурЮпшО 2007 с., 6:55:52:
>
> > elegantly does it, I use sometimes half pins.
>
> Half-pins are good in acute cases. Wires are stronger. I've seen
> broken half-pins in delayed cases with shortening.
>
> > So far there was no loss of reduction.
>
> If something goes wrong and you fight with your own reduction tool
> because it was improperly positioned, and you feel that Poller wire
> removal will cause slipping despite locking (what Peter asked
> about) a
> solution is to insert Poller screw prior to poller wires removal.
>
> > 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.
>
> Good idea! Add my name to the list of contributors.
>
> --
> 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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jjbrooksmd at gmail
New User

Feb 3, 2007, 6:31 AM

Post #3 of 3 (426 views)
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Re: Re[5]: [ORT-L] Segmental Tibia Fx [In reply to]	Can't Post

Alex,

I'd love to see that presentation that you gave at the ASAMI meeting.
Is it <10mb to email off the list?

Thanks for maintaining a very interesting discussion of this topic. I
do little or no fixator-assisted nailing. I use a lot of blocking
screws, perc clamps, & manual reduction. I do use the distractor
quite often, though, but it's different as we've noted. I sometimes
have trouble maintaining alignment in 3 planes (var/valg, flex/ext,
rot) with a single pin in each fragment, thus requiring manual
pressure or additional manipulation while reaming/nailing or sliding
up the plate, despite having the distractor on (I'm mostly referring
to distal femur Fxs - my most common indication, followed by pilons
then plateaus).

I'm tempted to try your technique with tibia fxs such as the one I
showed (after learning it from someone who does it often) with the
thin wire circular frame.

Jeff

On Feb 3, 2007, at 12:13 AM, Alexander Chelnokov wrote:

> Hello Bruce,
>
> Saturday, February 3, 2007, 1:40:41 AM, you wrote:
>
> BHO> I am not sure I completely understand what benefit a circular
> frame has
> BHO> over another method, such as distractors or even small pin
> (3mm) fixators
>
> Method in general is the same - a distractor for restoration of length
> and axis and maintaning during nailing.
> Maybe there are more convenient devices - just let me know.
> Apparently the mechanics of the frame we use can be reproduced with
> different equipment. We tried a large monolateral distractor on half
> pins and gave up.
>
> To me benefits are
> 1)thin wires instead of half pins - quick, easy, stable, symmetric
> loading.
>
> 2) Multiple wires can be inserted and secured in case of articular
> involvement, rigid angular deformity
>
>
> 3) Knee support with telescoping rods allows to keep the leg steady in
> any needed knee flexion.
>
> 4)At all it is a subset of frame assisted nailing approach and
> ideology because we do many nailings after deformity correction and
> lengthening with ex-fix. So half-pins also can be used in case of
> prolonged correction, and removed before nail insertion while wires
> are maintaining reached correction.
>
> BHO> placed anteriorly. I would think the rings and wires may get
> in the way and
> BHO> the epense might be prohibitive.
>
> In general yes if apply the frame without having in mind further
> actions. And often distractor can be removed after one or two locking
> screws have been insterted.
>
> BHO> "distractors" and we only pay for half pins. I would be
> BHO> interested in the technique
>
> I presented the techinque at the last ASAMI meeting in Kyoto, Japan. I
> will upload the presentation somewhere.
>
> BHO> and the time and expense.
>
> We have in the theatre a couple of preassembled frames for any long
> bones. It takes 10-15 min. to insert and secure 2-3 wires. Of course
> we don't buy the new intra-op frame for every patient. I am aware that
> in the US any frame is a single-use device but maybe intra-op
> equipment like large AO distractor can be used many times?
>
> --
> 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]
>

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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