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Re: Acetabular Fx Surgical Approach
послал Jeff Brooks 17 Июль 2006, 21:25
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In this erudite, and very helpful, discussion Chip has commented several times about clamping a transverse fracture.
I am familiar with all the assorted clamps, repositioning forceps, etc, available and I'm trying to picture what you describe when youention clamping "thru the notch". What type of clamp do you use most frequently (pointed reduction, offset clamp with a toothed "foot", Farabeufs or "repositioning forceps" secured to screws on either side of the Fx)? How do you clamp a transverse Fx thru the greater sciatic notch? Do you mean across it (cephalo-caudally?) Where (anatomically) do you prefer to put the teeth of the clamp?
I've used small or large "repositioning forceps" or Farabeufs in the past in fxs like this (tsvs/PW) to reduce & hold the PC Fx with temp
screws cephalad and #2 screw in the caudal seg, then manipulate & clamp these 'screw-bone-units' together with a repo/Farabeuf, palpate thru notch to assess AC reduction as well as luoroscopically, and then apply first plate near notch, then reduce & fix PW with AC screw antegrade thru second, more lateral, buttress plate for the reduced &
grafted/supported PW.
If Chip or anyone has a trick or pearl on clamping technique to reduce a tsvs Fx like this one I'd be interested in hearing it.
Thanks again to everyone for a great discussion & debate.
Jeff
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