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Re: Pelvic and acetabular fracture
George Thomas 06 Июль 2009, 21:14
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Dear Dr. Routt,
It will be really helpful to me if you could post a presentation of how you put in the anterior column screw.
George Thomas,
Chief Orthopaedic Surgeon,
St. Isabel's Hospital,
Mylapore,Chennai 600004,
India.
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Re: Pelvic and acetabular fracture
Milton L. Routt 06 Июль 2009, 21:27
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Will do.
Chip
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Re: Pelvic and acetabular fracture
Milton L. Routt 06 Июль 2009, 21:36
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 ,
PPT, 769 Kb
Enclosed is a simplified presentation of one way to insert the antegrade superior ramus medullary screw...there are many other details, but here’s a start.
Chip
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Re: Pelvic and acetabular fracture
Отправитель: Jeff Brooks 06 Июль 2009, 21:44
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Chip,
That's fantastic. Thanks for sharing.
Jeff
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Re: Pelvic and acetabular fracture
Отправитель: Dr Mangal Parihar 06 Июль 2009, 21:51
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thank you dr routt for such a clear explanation. (as you said, i am sure that it is not as simple as it may seem on the presentation)
your slide number 10 - is the screw really bent or is that an artefact from the C arm.
do have any tips/thoughts on what causes and on preventing such bent images - it can be quite disconcerting at times
regards
dr mangal parihar
orthopedic surgeon, mumbai
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Re: Pelvic and acetabular fracture
Отправитель: Milton L. Routt 06 Июль 2009, 21:53
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Probably bent.
I like bent screws when the fracture is clamped...blunt 3.5mm and even most 4.5mm cortical screws tend to bounce and bend if you insert them just right...but to bounce and bend the drill must avoid eroding the cortical bone, and blunt tipped screws are used...it’s also why I use a 2.5mm drill...it seems to be quite a flexible drill, especially if used in an oscillating mode.
Bent screws almost never “straighten out” after the clamp is released, but I always check with the C-arm as I release the clamp....sometimes if you use a single 3.5mm screw, it can change and just needs to be reclamped immediately and helped out with an additional screw.
Bent screws are “not-so-good” if the surgeon is using the lag screw to reduce the fracture...an unclamped fracture reduction always loses some when the screw bends as it’s terminally tightened...for extra-articular (acetabular-sparing) ramus fractures, the resultant slight malreduction seems clinically irrelevant thus far.
Thick screws (6.5-7.0-other such big ones) don’t bend much at all.
Remember, the ramus a very bent tube of bone in several planes with a variable sized straight osseus potential pathway for a screw or 2...it’s tough shooting sometimes, but typically very efficient, comfortable, strong, and durable fixation.
Thank you-
Chip
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