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Re: Acetabular Fx Surgical Approach
послал Chip Routt 16 Июль 2006, 00:37
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You can do whatever approach that you choose..my comments reflect what I've learned the hard way, and I'm trying to help others avoid the same path... simple as that.
The lateral position is cumbersome (for everyone) and gravity impacts the limb causing displacement of the caudal transverse segment along with the limb. It turns an operation into a wrestling match...and gravity and the limb will defeat the surgeon most times. If you like malreductions and frustrating fixations, you'll get them.
The osteotomy adds just one more level of complexity and another opportunity for situations to occur which you'd rather not have occur... non-union, symptomatic implants, resultant pain, limp, AVN...and on and on.
These additional and unnecessary operative steps complicate an otherwise very routine operation.
Reducing a transverse accurately and safely is extremely difficult with the patient positioned laterally, regardless of the selected exposure... it can be done, and we've all had mentors teach us what we feel and hope to be "excellent" exposures and we dutifully follow that educational stream regardless of its foundation... me too and I'm very grateful... but we can also make progress beyond and build onto that learning platform.
The prone position truly makes it an uneventful operation as long as the surgeon knows how to work thru the greater sciatic notch to access the quadrilateral surface, has adequate clamps, knows appropriate fixation techniques, and understands acetabular/pelvic intraop imaging with the C-arm.
That's why-
Chip
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