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Re: ANKLE FRACTURE
послал Enes M. Kanlic 13 Сентябрь 2004, 00:39
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Alex,
As I mentioned before (down), in Dr. Salvi's case, I am for temporary fixation, sparing even the talus (not to get wire as possible vehicle for contamination) and than early fusion.
Fixing the fibula, will provide some stability to the ankle and through the incision relatively far from the major zone of injury (antero-medial), and if we do want to restore the anatomy (if feasible), that is the first step - as T. Rüedi told us a long time ago.
Your (or Dr. Lazarev) case is nice but a quite different. The stability is obviously provided by very well placed nail, and "soft and bent" wire does provide just some weak reinforcement to the construct - I would prefer the plate if tissues are good, or "real" nail, like Rush - non locked,
percutaneous large cannulated screw, or even locked (Biomet SST fibular nail)... (examples some other time, I have work to do...)
There are different ways to skin the cat, but I guess, we agreed that is good to fix the fibula in distal nailed tibia fractures, aren't we!?
Enes M. Kanlic, MD, PhD
Associate Professor
Department of Orthopaedics
TTUHSC in El Paso, Texas
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