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Re: nonunion of femur
послал Alexander Chelnokov 09 Август 2005, 20:14
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THX for sharing the extremely difficult case. Never met nail breakage at the level. Looks like the nail was never dynamized - is that so?
If no clinical signs of infection would be found during nail removal, i would still proceed with a solid titanium nail without site opening.
Largest one we have available is 13 mm and it looks enough for most cases. Presumely you guys must be much more happy with implant choice than we here.
I would 1)use a poller wire to push the distal tip more posterior than it is now, 2)use a nail with extended options of distal locking (3-4 screws) and/or use poller screws - probably for the proximal fragment too, 3)lock it statically for 8-10 weeks, then dynamize by removal of the proximal locking screw. Good initial stabilization and no dead space in the nail must be enough to control low grade infection if any.
In case of pus in the medullary canal solution could be to perform debridement, take 10-12 mm rod, paste it over with AB cement, push through the 14 mm hole to have diameter equality, and insert it as temporary or maybe even definitive implant.
Good luck. Keep us informed.
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