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Re: Несросшийся перелом большеберцовой кости
James Carr 24 Октябрь 2002, 17:50
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There is no doubt that the Ilizarov is a versatile tool for this problem. Much less invasive than other methods. However, it is surgeon and patient labor intensive, and requires long rx- 7.5 months in the poster (on a tough group of patients).
In the states, it is an expensive implant. The UTN will likely work if the stability is good enough, but track record of reamed nail is better if infection is avoided. I would have performed a compression plating- simple, quick, cost effective, no immobilization, and early functional aftercare. No bonegraft. Results in published reports are good, and mirrors my experience. Patient acceptance excellent- much preferred to ex fix. Aftercare simple. So if its my leg, I'll take the more invasive initially for the later benefits. Jim Carr
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Re: Несросшийся перелом большеберцовой кости
Alexander Chelnokov 24 Октябрь 2002, 17:52
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DMP> I agree. The non-union looks like a 'stiff hypertrophix non-union'. So,
DMP> leave the nail in-situ. Remove the distal inter-locking screws.
I've just placed the nail and screws into the tibia...
DMP> Apply an Ilizarov frame and initially distract and later
DMP> compress. Luckily, the fibula has not united.
:-) It was osteotomized this week.
DMP> Please refer to: www.aaos.org/wordhtml/anmt2002/poster/p441.htm
THX for the abstract. It is very exciting that the technique is being distributed over the world. Distraction of hypertophic pseudarthroses with the Ilizarov apparatus had been studied in xUSSR in 1960-70s. About 30 years the approach is used here as "gold standard". But since closed interlocked nailing recently reached my environment it is so interesting to use the new toy :-)
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Re: Несросшийся перелом большеберцовой кости
Bill Burman 25 Октябрь 2002, 20:08
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Re case: http://www.hwbf.org/hwb/conf/alex39/tibnu.htm
Dr. Patel
>initially distract and later compress
Thank you for the interesting ex-fix distraction osteogenesis nonunion rx reference and images. There was a time when distraction secondary to ex-fix caused it to have a reputation as a "nonunion machine" and distracting a fracture over a nail was not well regarded. Maybe 2 wrongs make a right.
Why add compression? According to Hart et al JBJS 67A:598,
http://www.hwbf.org/hwb/conf/alex39/exfixcom.htm
ex-fix compression has no osteogenic benefit.
Bill Burman, MD
HWB Foundation
http://www.hwbf.org
P.S. Please provide some annotation for the images 1-4:
(http://www.hwbf.org/hwb/conf/alex39/tibnu.htm#patel). I am not sure if they are in the right order or right-side-up.
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