marco.berlusconi at fastwebnet
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Jun 28, 2008, 2:08 PM
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[Orthopod] consiglio suggestion
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Dear Sirs,
I've this case of a young woman 26 ys old with an open book fracture of the pelvic ring with a posterior instability (C type because she has also a posterior ligament injury with a fracture also of the VL process)and a bilateral fracture of the anterior wall of the acetabulum who has been fixed with a posterior SI screw and a double anterior plating.
Actually, she has a perfect mobility of the hip joint but she has a right sciatalgia with complete integrity of the muscles but a lasegue at 30°, also perfect skin sensibility for VL and S1. She can stay sit but pain while standing up. This Lasegue began the day after surgery.
Do you think will be good to remove the posterior SI screw?
And while removing the screw do you suggest to open the first window of the ilioinguinal approach in order to look at the nerves while removing the screw and eventually fix the SI with a doble plate o leave nothing posterior, be aware that she'll not walk for at least two months for the bilateral acetabular fractures?
Cari colleghi,
vi chiedo un consiglio su qs ragazza 26 anni operata x una frattura dell'anello pelvico con frattura bilaterale della parete ant dell'acetabolo con doppia placca ant e vite SI destra. Attualmente anche mobili, ma sciatalgia destra con integritą di tutta la muscolatura e sensibilita' L5 e S1, ma Lasegue + a 30° a destra.
Come si puo' vedere alla TC la vite post passa ant alla SI destra e io ho paura che possa irritare la radice (strano che abbia solo un lasegue, ma vi disturbo x qs). Siamo a 7gg dall'intervento e io pensavo di rimuovere la vite tra 7gg. A qs punto la domanda iniziale č se siete d'accordo sul programma. La seconda domanda č se sia mglio fare la prima finestra dell'ileoinguinale onde vedere la radice mentre sfilo la vite ed a qs punto se valga la pena mettere una o 2 placche sulla SI x stabilizzare post, tenendo conto che la pz starą sicuramente in scarico x altri 2 mesi x la fr bil acetabolo.
Thanks in advance
marco berlusconi
Trauma Unit
Istituto Clinico Humanitas
Milan Italy
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