[Orthopod] Re: post-nailing fracture


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[Orthopod] Re: post-nailing fracture

drgauravbhalla2003 at yahoo
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Feb 3, 2008, 5:51 PM

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[Orthopod] Re: post-nailing fracture	Can't Post

You may try to improve the reduction by removing the distal locking bolts, correcting the valgus under image intensification - using Poller screws 1 or 2 and by doing the distal locking again in the new position. All the best..

Dr.Gaurav N Bhalla
D'ortho; MS Ortho
Orthopaedic surgeon and traumatologist
++91-9935693677; ++91-9415406331

----- Original Message ----
From: Sandro Reverberi <reverberisandro@gmail.com>
To: Orthopod <orthopod@googlegroups.com>
Sent: Wednesday, 30 January, 2008 8:49:07 PM
Subject: [Orthopod] Re: post-nailing fracture

dear Gaurav,
your thinkings are exactly my opinions ; I have removed the nail and
by the same approach I have done a osteosynthesis by an anterograd
Grosse-Kenpf nail.
Minimal exposition of the fracture was necessary to remove distal
screws and so we put a Lambotte's clamp to mantain the reduction till
distal stabilization.
The reduction wasn't optimal (a little valgus) but I think it was the
best biological solution to this hard problem.
I thank you all for your suggestions,
Sandro Reverberi

On 29 Gen, 15:39, Gaurav N Bhalla Orthopaedic Surgeon Kanpur India
<drgauravbhalla2...@yahoo.co.uk> wrote:
> This is a very nice discussion. If I may comment -
> 1. I feel that the option of exchanging this nail with a similar,
> longer nail with multiplanar distal locking screws is the most
> biologic option and the removal of this nail should not be much of a
> problem.
> 2. The total time taken and the blood loss in this surgery should not
> be more than the other 2 options, in fact if all goes well it may be
> quicker as the approach is smaller and the closure will take lesser
> time.
> 3. The only compromise over the locking plate is the purchase in the
> distal fragment, but once the locking bolts are in place the purchase
> should be enough for at least wheel chair mobility and isometric and
> isotonic Quads.
> 4. The rehabilitation time and the knee stiffness should also be the
> least with this method.
> 5. Bone healing (union) should be fast as it is a long spiral
> metaphyseal-diaphyseal # and using this fixation the fracture site
> will not be opened.
> 6. The screw in the neck will prevent (prophylactic fixation) a neck
> fracture in this already osteopototic bone.
> 7. Of course medical management for osteoporosis must be initiated, I
> do not consider any need for cement.
> Thank you all.
>
> On Jan 16, 9:17 pm, "reverberi sandro" <reverberisan....@gmail.com>
> wrote:
>
>
>
> > Dear All,
> > I should like know what is your preferred treatment for this fracture at the
> > tip of a long Gamma nail (on a healed subtrocantheric fracture : see img
> > tmgn00a).
> > The patient is a 81 years old lady with osteoporosis and important knee
> > arthrosis (as you can see).
> > Do you remove the nail or not? can we obtain a stable ostheosynthesis with a
> > plate without remove the nail?
> > Do you prefer to apply a plate or an endomedullary nail (along the old way
> > of gamma nail) to preserve joint motion?
> > It is justified to apply bone cement in the bone loss ?
> > Best regards
> > Sandro Reverberi
> > Arcispedale S. Maria Nuova
> > Reggio Emilia
> > Italy
>
> > tmgn3.jpg
> > 74KViewDownload
>
> > tmgn2.jpg
> > 45KViewDownload
>
> > tmgn00a.jpg
> > 16KViewDownload- Nascondi testo tra virgolette -
>
> - Mostra testo tra virgolette -

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