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Re: Acetabular Fx Surgical Approach
послал Bruce Ziran 16 Июль 2006, 01:02
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It seems that there are a lot of strong opinions on this matter. Just to stir it up a bit more, I will propose that using a Jackson table, lateral position, with traction, and using the peroneal post with the vertical height adjustment gets the best of both worlds. The vertical post overcomes gravity quite easily and facilitates surgical luxation of the head when longitudinal traction is added. The set up is easy, all of the vectors of forces that those who propose prone positioning can be accounted for, and if a troch osteotomy is needed (for whatever reason), it allows access to more anterior structures. I am definitely not a fan of floppy lateral with manual traction. I agree with Chip, this is absolute torture, but I have used all of the described methods and settled on what seemed easiest. Over come the vectors of deformity, eliminate human fatigue (manual traction), and its not so bad. If a T or bad transverse is tough, it is probably not going to be solved, or caused by the position, but probably justifies a sequential procedure with a second postioning and anterior approach. Acetabular and pelvic surgery seemed to bring out the dogma in us all..
Bruce H. Ziran, M.D.
Director of Orthopaedic Trauma
St. Elizabeth Health Center
Associate Professor of Orthopaedic Surgery
Northeast Ohio Universities College of Medicine
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