alex at weborto
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Jan 19, 2008, 10:47 AM
Post #1 of 1
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[Orthopod] Re: post-nailing fracture: CHANCES
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Hello
Dr Eid wrote :
> 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
Fractures at this level happen without nail inside, don't they? Also
peri-implant fractures is a known problem. Force can not cause a
fracture over the nail so the bone breaks at the closest weak point.
Nail curvature in this particular case hardly ever play a role, at least
nail length is more important. A nail inserted down to the intercodylar
notch would not cause impingement of the anterior cortex or any other
stress-riser, and would protect the whole femur. The only real risk is
the neck weakness after removal of the 12 mm screw - an argument in
favour of locked plate with nail in place.
> 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.
Except direct reduction tricks like bone holders, cerclage etc, good
alignment and contact can be obtained by using of fixator-assisted
nailing and/or transmedullary (Poller) screws or wires - no need to open
fracture site.
> However, purchase of the distal locking screws in this osteoporotic bone
> would be extremely insecure./*
This is true for conventional two locking screws. There is a lot of
specially designed nail solutions to provide good grip in porotic bone
like multiple locking bolts, multiplanar holes, bolts with nuts and
washers, threaded screw holes, etc.
> */So this leaves us with locked plate with sufficient bicortical screws
To my mind every mentioned option was not criminal, and would provide
good result. The final choice will depend on availability of particulr
implants and equipment along with personal skills and preferences.
___
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia
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