вверх  отправить  поиск  админ  главная  Предыдущее	Re: Огнестрельный перелом бедра в аппарате J. Tracy Watson 02 Май 2002, 00:44 We have looked at this problem of Ilizarov removal followed by secondary proceedures... immediate exchange to IM nail had the HIGHEST rate of infection even if the pin sites were pristine at time of secondary proceedure... 8 patients were treated in this fashion....7 got infected.(88%) infected nails...don't do this... for the remainder of the series 42 patients were all staged...i.e. frames removed and pin sites curretted and irrigated...post debridement cultures taken and deep culture specific antibiotics given if culture +. Secondary proceedures then followed once the pin tracts had completely healed. Secondary Plating or IM nailing was very successful. However, if the latency period was greater than one month..i.e. Ilizarov removal, pin irrigation,pin sites healed at one month THEN secondary proceedure...no infections...If the latency period was LESS than one month even with culture negative pin tracts,,, still 35% infection....If you can temporize the patient out of the frame.even if it requires traction.... then remove frame, I and D the pin sites with post debridement DEEP cultures....treat if necessary, let pin sites declare and heal themselves...THEN secondary IM nailing or plating after 1 month latency period. If pin sites never heal completely or if you culture some horrific resistant bug.. then consider extramedullary implant..or back to an ex-fix... J. Tracy Watson / Djoldas Kuldjanov	Сообщения о Ортопедия и травматология Также J. Tracy Watson Связаться с автором
	Ответить Re: Огнестрельный перелом бедра в аппарате Alexander Chelnokov 03 Май 2002, 13:02 What sort of nailing was performed in these cases? Were nails solid or cannulated? Reamed or unreamed? What kind of infection was occured? When? What measures it required and what it was resulted with? All our femoral exchanges were either before 3 weeks since ex-fix application or unintenionally later than 1 month after fixator removal. But recent months i performed 4 similar ex-fix to IM nail exchanges in tibial fractures, and two of them (with prior fixation 2 and 4 months) were done immediately on the table, and pins/wires were being removed one by one while nail was inserted. In two other cases (2 and 11 months of prior exernal fixation) fixator was removed 5 and 10 days before the surgery because of some drainage (not pus clinically) from pin sites. Unreamed solid nails (UTN) were used in all cases. All 4 proceed to uneventful healing with 4-5 days of oral ciprofloxacin. Now i think either it was incredible luck, or staphyllococci at your side are much more angry, if also solid unreamed nails were used. Any suggestions? THX in advance. [ Ответить ] ( Ответить )

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