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Re: Acetabular Fx Surgical Approach
послал Jeff Brooks 15 Июль 2006, 23:06
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Thanks to all who have commented. This case has generated a very nice set of 'pearls'. (In part,by posting this case I wanted to generate a discussion of when to approach any acetab fx thru 2 approaches but it has expanded nicely into a great overall advice session!)
a couple more discussion points:
1) from the back thru KL, if the ant column is off rotationally as assessed by palpation thru the GS notch and fluoro, I'd try a pin and t-handle in the ischium to derotate, then AC antegrade screw. Any other tricks for AC reduction thru the KL approach?
2) also, has anyone had experience with ilioinguinal approach thru a previously-operated belly (with scars all over the place and probable
adhesions nearby where you're working along the brim??)
3) If hospital has no Judet table (but something close that doesn't rotate or allow boot-attachment for flexion of the knee to relax the nerve while DF pin is in traction), does one still go prone, say, on the radiolucent board with +/- femoral distractor from ilium to femur (although wrong Tx vector) or prone with a strong assistant to pull (along with, of course, the appropriate reduction/distraction clamps)?
Thanks for everyone's comments, and thanks Chip for sending those great case examples.
Jeff
Jeffrey J. Brooks, MD
Stamford, CT
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