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Re: Перипротезный перелом
Marco Berluconi 22 Декабрь 2008, 00:09
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Dear Sir,
the cement mantle looks good in the whole mataphyseal region so I'll consider it a Vancouver B1 fracture, so ORIF.
It will be useful to remove the free cement fragment that lays between the stem and the third fragment and perhaps the distal part of the cement in the femural shaft in order to afford the reduction of the third fragment which will give the lenght of the limb. The reduction will be hold trough 2 cerclages without degloving the periostial attachments from the third fragment. For the final fixation I prefer an hook perarticular LCP plate with 4 locking bicortical screws far from the tip of the stem, 4 monocortical locking screws in the metaphyseal
region and 2 cerclages , that mantain the third fragment, inside the plate, using the proper devices, and then cutting off the 2 provisional cerclages put before that are laying under the plate. It will be useful also add bone graft in the medial region over the third fragment in order to be faster the union.
The Reverberi's solution could also be good but it is reserved when you're sure that is a B2 fracture and you should also be aware that when you have took off all the cement the fracture will become a B3 so I'll prepare a modular long revision stem that will go far from the end of the fracture for twice the diameter of the femoral canal with the less number of cerclages I
can.
Best regards
Marco Berluconi
Trauma Unit
Istituto Clinico Humanitas
Milan Italy
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Re: Перипротезный перелом
Dino Aguilar 22 Декабрь 2008, 07:33
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ORIF with Cable ready (from Zimmer or similar) reconstruction.
Regards.
Dino Aguilar, M.D.
Managua, Nicaragua
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