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Re: Humeral pseudoarthrosis
Castro 06 Июль 2005, 19:56
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Hi Dr. Josep,
Have a nice day,
This hypertrophic nonunion have to be treated by Ilizarov principles of close distraction-compression osteosynthesis.
By my opinion, if the nail is not broken, don▓t remove it, and apply Ex. Fix, with 2-3 pins in each part, then distraction for 7mm-10mm., followed by compression over nail, without any refreshment or opening of the fracture site > If the nail is broken, you can remove the proximal part of the nail only, by this way, you▓ll get a nice healing after 12 weeks approximately.
Yours Dr. Castro
Jordan
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Re: Humeral pseudoarthrosis
George Thomas 07 Июль 2005, 14:15
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I would vote for removal of the nail and reosteosynthesis with a long plate (10 holes) leaving the screw holes near the fracture site empty. I would probably use 3 screws in each fragment, but could go up to 4. I would also use cancellous bone graft.
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Re: Humeral pseudoarthrosis
Отправитель: Jeff Brooks 07 Июль 2005, 14:18
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I also vote for nail removal, ORIF with long (10-12 hole) plate - maybe a "wave plate" configuration, with autologous iliac crest graft underneath.
Also, ultrasound or e-stim postop will be of benefit.
There may also be a role, depending on availability and financial resources, for OP-1 (BMP 7).
Good luck. Please let us know what you do.
Jeff Brooks
Stamford, CT
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Re: Humeral pseudoarthrosis
Отправитель: Bill Burman 07 Июль 2005, 14:27
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>I also vote for nail removal, ORIF with long (10-12 hole) plate - maybe a
>"wave plate" configuration, with autologous iliac crest graft underneath.
For "wave plate" example - see Lawrence Webb's OTA BFC Lecture
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