professor_eid at yahoo
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Jan 17, 2008, 12:47 PM
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[Orthopod] Re: post-nailing fracture: CHANCES
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Hello Friends
I would not like to perform an antegrade nail in this particular case however easy it may seem. Even a longer nail would not be proper in my opinion because of the mismatch between the curvature of the nail and the femur which probably caused the fracture in the first place, as the tip of the nail impinged on the anterior cortex of the distal femur weakening it over time and eventually producing the fracture.
Although I am a fan of distal femoral retrograde nails myself, I do not feel they would provide good stability in this case, unless perhaps supplemented by another method to control the coronal element of the fracture, e.g. cerclge, interfragmentary screws to the side of the nail. However, purchase of the distal locking screws in this osteoporotic bone would be extremely insecure.
So this leaves us with locked plate with sufficient bicortical screws in the proximal and distal fragments. However, first, the coronal element of the fracture needs to be controlled. I suggest interfragmentary screws rather than cerclage as screws may be inserted in a minimally invasive way and would be less insulting to the blood supply than cerclage. The plate should be done as minimally invasively as possible too.
Finally, I would caution against weight bearing for 4 weeks. Non weight bearing mobilization should be adequate until some healing can be seen.
Best regards and best of luck to the surgeon.
Dr Abdelsalam EID M.D., AFSA (Paris V)
AO Fellow
Lecturer of Orthopedic Surgery
Faculty of Medicine, Zagazig University,
Egypt.
www.doctoreid.com
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