[Orthopod] Re: post-nailing fracture: CHANCES... TKA... yes: Distal Fem. Replacement, Literature


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[Orthopod] Re: post-nailing fracture: CHANCES... TKA... yes: Distal Fem. Replacement, Literature

alex at weborto
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Jan 20, 2008, 3:01 AM

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[Orthopod] Re: post-nailing fracture: CHANCES... TKA... yes: Distal Fem. Replacement, Literature	Can't Post

Dear Enes

> could be summarized AS: *it is** indicated for elderly patient with
> (complex) fractures and accompanying severe knee arthritic changes,
> using distal femoral replacement constrained type of prosthesis.

THX a lot. Very interesting. Never thought about this. As I menioned,
the approach is not (yet?) adopted in our institution or somewhere
around. Will kick our prosthetic gurus to learn about the tactics. Maybe
it will be accepted sooner or later. If sooner - because of your input.

> I have attached similar case (knee periprosthetic fractures in
> rheumatoid patient ... it fits good for both discussed topics this "time
> around"...:

To restore the patient to his "yesterday" level of activity when knee
prosthesis becomes unstable as a result of a fracture we are forced to
solve both problems simultaneously. We can not separate the steps.

But if a patient with knee problem survived without knee prosthesis for
5-10 years, and now just fractured the femur, it is not a big tragedy
for him just to return to his yesterday level. And wait some month for
fracture union, and then finally do routine TKR.

So what is optimal - either do "extended" TKR for both problems, or two
less invasive procedures separately within few month, what both variants
mean for future revisions? The answer will strongly depend on local
settings, traditions, superstitions...

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

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