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Re: Перелом бедра выше пластинки
послал Myles Clough 11 Март 2002, 00:41
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Many surgeons including the AO group would argue that plates do indeed produce a stress riser at the end of the plate where the stiffer bone
reinforced by the plate joins the more flexible bone. For this reason removal of the plate has been advocated even when it is assymptomatic.
I personally cannot bring myself to do this. Cases such as yours seem to be rare. More to the point it is extremely rare to see fractures of the femur below hip fracture plates. Surely these old folk would be very vulnerable to a "plate induced" fracture if the stress riser is an important contributing factor. I have seen many contralateral fractures, where the other hip is
fractured some years after the index injury. And I have seen periprosthetic fractures so people do fall and injure the index hip. But fracture at the
distal end of a DHS (Dynamic Hip Screw) I have never seen. I would be interested to hear if this is contrary to other peoples' experience.
Incidentally the incidence of re-fracture after removal of internal fixation is reportedly quite high (5%) so it is not clear to me what the indications for this procedure in assyptomatic patients might be. A high proportion of my patients with supracondylar plates do have symptoms.
Myles Clough mylesclough@shaw.ca
Orthopaedic Surgeon, Kamloops, BC, Canada
Clinical Instructor, University of British Columbia
President, Internet Society of Orthopaedic Surgery and Trauma
http://www.isost.com
Editor, OWL (Orthopaedic Web Links) http://owl.orthogate.com
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