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Re: Перипротезный перелом
Enes M. Kanlic 17 Декабрь 2008, 07:39
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Alex,
Although, there is just one view, it seems that cement is still holding well on lateral side, cup also seems to be stable, but inside is asymmetric – poly is damaged ... options:
1. "Easy": long lateral plate and anterior strut allograft w/wo bone grafting
2. "Harder" Removal of prosthesis (has to be done if it is loose in remnant of intact proof proximal femur), and new long stem, porous coated prosthesis with new cup (pt is 59years old, probable in good health – survived 6 weeks of traction… this would be my 1st option)
3. I can not imagine how any “custom” nail might work, introduced from the knee, as you have been suggesting :O !!??
Sincerely,
Enes M. Kanlic, MD, FACS
Professor
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Re: Перипротезный перелом
Alexander Chelnokov 17 Декабрь 2008, 23:28
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KE> 2. "Harder" Removal of prosthesis (has to be done if it is loose
KE> in remnant of intact proof proximal femur), and new long stem,
KE> porous coated prosthesis with new cup (pt is 59years old, probable
That would be really big surgery.
We will try to be ready to different scenarios according to intraop findings and estimation.
KE> 3. I can not imagine how any “custom” nail might work, introduced
KE> from the knee, as you have been suggesting !!??
I heard from many european colleagues about anecdotal use of old hollow Kuntscher nails for that purpose. Prof. R.Schnettler (Germany) recently told about 57 cases. I have only 2 such cases done last year, both on cementless stem. This approach is very attractive by that we achieve the same goal - "new long stem" but much less invasive.
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Re: Перипротезный перелом
Отправитель: James DeBritz 19 Декабрь 2008, 05:06
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Would love to see some post op xrays of a case where this follow nail was used. Could you oblige?
Thanks,
James DeBritz
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Re: Перипротезный перелом
Отправитель: Alexander Chelnokov 19 Декабрь 2008, 05:14
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Female, rheumatoid, THA in 2003, car accident in 2006, failed plating. Nailing in Oct 2007. The nail is solid with hollow proximal part where the stem is docked. Last images are in 1 year after
nailing.
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Re: Перипротезный перелом
Отправитель: Milton L. Routt 19 Декабрь 2008, 05:21
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Wow.
That construct is like something we’d use to patch cracked or bent fence posts on our ranch when I was a kid...but fence posts don’t walk and bleed.
I have refreshed respect for the mighty femur and it’s incredible/remarkable ability to unite, regardless of what we do to it.
Thanks for showing those films--
Chip
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Re: Перипротезный перелом
Отправитель: Alexander Chelnokov 21 Декабрь 2008, 05:57
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Dear Milton.
You wrote:
> That construct is like something we'd use to patch cracked or bent
> fence posts on our ranch when I was a kid...
Any orthopaedic fixation device is based at mechanical principles known before...
> but fence posts don't walk and bleed.
The lady walks fine and doesn't bleed ;-)
> I have refreshed respect for the mighty femur and it's
> incredible/remarkable ability to unite, regardless of what we do to it.
The femur responded by failure to Mennen plating (DePuy Bridge plate). So i would add that the ability to unite is realized in mechanically and biologically sound conditions.
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Re: Перипротезный перелом
Отправитель: Milton L. Routt 21 Декабрь 2008, 11:38
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You are so right...brilliantly said and done.
milton
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Re: Перипротезный перелом
Отправитель: James DeBritz 19 Декабрь 2008, 05:23
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Impressive. Thanks.
JND
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Re: Перипротезный перелом
naresh goyal 22 Декабрь 2008, 21:00
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sir,
remove stem,cement
do uncemented long stem with interlock screw distally, encirclage wiring to enhance fixation around isthmus.
if you feel put allograft around stem
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