alex at weborto
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Jan 18, 2008, 10:26 PM
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[Orthopod] Re: post-nailing fracture: CHANCES... TKA... yes
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Dear Enes,
Friday, January 18, 2008, 2:14:40 AM, you wrote:
KE> EMK: On the x-rays we see severe arthritis, lateral tibial plateau
KE> defect and probable knee instability.
She is an elderly lady with multiple comorbidities.
AFAIR there was no instability. Before the last supracondylar
fracture she was able to walk, no severe pain marked. Her knee was
contractured for about 5 years.
KE> If patient is in good medical health (able to walk and leave
KE> fes more years, and the only limitation is bad knee pain and
KE> instability), with decent soft tissues (no risk of flap necrosis),
Flap recrosis after quad plasty is very likely even in young
patients with best skin conditions. This patient had scars after
previous surgeries particularly over lateral side of the knee abd
distal femur.
KE> than
KE> with one procedure we would solve her fracture, pain and probably
KE> improve the range of motion...
She'd been observed by colleagues from another unit. Even without the
last fracture they didn't plan Judet quad plasty and TKR. I only
helped with the low invasive fracture fixation.
Of course locked plating was discussed, particulary proposed by me
myself to prevent my involvement :-) But colleagues insisted on the
presented nailing because they were familiar with our results, and took
the solution as best choice.
I don't have experience of so massive interventions neither know
somebody around who would perform TKR for arthritis in extra
conditions of acute supracondylar fracture, even if there would be no
other difficulties. We'd prefer to get the fracture healed, then
proceed with joint replacement.
I'd like to learn how TKR is performed with a supracondylar fracture
except the target knee problem, even without knee extension
contracture. What type of prosthesis is to be used? THX in advance.
--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia
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