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 Non union femur - osteogenisis imperfecta |
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 Отправлено Cherian Kovoor 22 Январь 2007, 00:34
Dear All
Requesting your opinions
51 yr old short statured male. Case of osteogenisis imperfecta - his daughter was treated by me for the same condition. Very poor financial condition. bilateral femoral bowing.
Had a # femur [R] 1 year ago- treated by a senior surgeon by plating which has gone into a non union.
Now what can be done-
the classical procedure would be Kebab ostoeotmies and nailing but is there any alternative?
what I was thinking was flexible bundle nailing, webber wiring and bone grafting.
Requesting opinions . attaching xrays and clin pic
thanking you
DR C CHERIAN KOVOOR
KOCHI
INDIA
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Re: Non union femur - osteogenisis imperfecta
Alexaander Chelnokov 22 Январь 2007, 00:40
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> the classical procedure would be Kebab ostoeotmies and nailing but
> is there any alternative?
Why seek for alterative? I would try to remove screws percutaneously under image intenisfier, ream, then start closed nail insertion performing perQ osteotomies (two must be enough), immediately pushing quide wire and the nail down the osteotomy line. Then lock the nail and voila.
Of course the same final result but with more long or invasive way can be reached by ex-fix with hinges (as definitive fixation after alignment or converted to a nail) or by a long plate.
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Re: Non union femur - osteogenisis imperfecta
Отправитель: Anton Kovalenko 25 Январь 2007, 23:12
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Dear Alex
>performing perQ osteotomies (two must be enough), immediately pushing
>quide wire and the nail down the osteotomy line.
Do you think that lengthening and changing axis of thigh after doudle osteotomy will be insignificant?
Best regards, Kovalenko A.N.
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Re: Non union femur - osteogenisis imperfecta
Отправитель: Alexander Chelnokov 25 Январь 2007, 23:28
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The surgery requires thorough preop planning for estimation of all angles and gained length. The plan also depends on the status of the opposite leg, and further intenions of its correction later. In case of extra length the problem can be addressed during the surgery.
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Re: Non union femur - osteogenisis imperfecta
Mark Eidelman 22 Январь 2007, 01:45
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Dear Cherian,this is very challenging case.
I think that plating was wrong option for OI.I certainly agree that she need IMN , but not flexible( they not stable enough).In your case you have double Coras, therefore 2 osteotomies will be OK.She does not need BG, just stable IM locking nail.I did some Cora drawing, may be it will help you.
Good luck.
Mark .
OI.ppt
45KB (46592 bytes)
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Re: Non union femur - osteogenisis imperfecta
Castro 24 Январь 2007, 04:11
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Dear Dr. Cherian Kovoor,
It's nice to do it by ex.fix.- Ilizarov type, with wedges, you can correct it better than, if you use nailing.
yours Dr. Castro
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