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Re: перелом пластинки
Максим 13 Май 2013, 20:24
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реостеосинтез штифтом для проксимального отдела бедра
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Re: перелом проксимальной бедренной пластинки
Alexander Chelnokov 13 Май 2013, 20:34
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Уважаемые коллеги, что делать?
Удалять. Чем менее травматично, тем лучше. И закрыто штифтовать проксимальным гвоздем.
И эти пластинки больше не использовать. Ниже две свежих публикации на эту тему:
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Injury. 2013 Mar 20. pii: S0020-1383(13)00094-6. doi: 10.1016/j.injury.2013.02.020. [Epub ahead of print]
High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate.
Wirtz C, Abbassi F, Evangelopoulos DS, Kohl S, Siebenrock KA, Krüger A.
Source
Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
Abstract
INTRODUCTION:
Stable reconstruction of proximal femoral (PF) fractures is especially challenging due to the peculiarity of the injury patterns and the high load-bearing requirement. Since its introduction in 2007, the PF-locking compression plate (LCP) 4.5/5.0 has improved osteosynthesis for intertrochanteric and subtrochanteric fractures of the femur. This study reports our early results with this implant.
METHODS:
Between January 2008 and June 2010, 19 of 52 patients (12 males, 7 females; mean age 59 years, range 19-96 years) presenting with fractures of the trochanteric region were treated at the authors' level 1 trauma centre with open reduction and internal fixation using PF-LCP. Postoperatively, partial weight bearing was allowed for all 19 patients. Follow-up included a thorough clinical and radiological evaluation at 1.5, 3, 6, 12, 24, 36 and 48 months. Failure analysis was based on conventional radiological and clinical assessment regarding the type of fracture, postoperative repositioning, secondary fracture dislocation in relation to the fracture constellation and postoperative clinical function (Merle d'Aubigné score).
RESULTS:
In 18 patients surgery achieved adequate reduction and stable fixation without intra-operative complications. In one patient an ad latus displacement was observed on postoperative X-rays. At the third month follow-up four patients presented with secondary varus collapse and at the sixth month follow-up two patients had 'cut-outs' of the proximal fragment, with one patient having implant failure due to a broken proximal screw. Revision surgeries were performed in eight patients, one patient receiving a change of one screw, three patients undergoing reosteosynthesis with implantation of a condylar plate and one patient undergoing hardware removal with secondary implantation of a total hip prosthesis. Eight patients suffered from persistent trochanteric pain and three patients underwent hardware removal.
CONCLUSIONS:
Early results for PF-LCP osteosynthesis show major complications in 7 of 19 patients requiring reosteosynthesis or prosthesis implantation due to secondary loss of reduction or hardware removal. Further studies are required to evaluate the limitations of this device.
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J Orthop Trauma. 2013 Jan;27(1):22-8. doi: 10.1097/BOT.0b013e318251930d.
Mechanical failure after locking plate fixation of unstable intertrochanteric femur fractures.
Streubel PN, Moustoukas MJ, Obremskey WT.
Source
Orthopedic Trauma Service, Department of Orthopedics, Vanderbilt Medical Center, Nashville, TN 37232, USA. philipp.n.streubel@vanderbilt.edu
Abstract
OBJECTIVES:
The aim of this study was analyze modes of mechanical failure in a consecutive cohort of patients and establish possible risk factors.
DESIGN:
This was a retrospective cohort study.
SETTING:
The study was conducted at an academic level-1 trauma center.
PATIENTS:
Twenty-nine patients (mean age 56 years, range 21-92; 45% males, 41% smokers, 17% diabetic, mean body mass index 26.9, range 20-56) with 30 OTA 31A3 fractures treated between 2003 and 2007 were included.
TREATMENT:
Operative fixation using 4.5-mm locking compression plate (LCP) proximal femur plate (Synthes, Paoli, PA).
MAIN OUTCOME MEASUREMENTS:
Mechanical failure was defined as loss of alignment of at least 10° or shortening of at least 2 cm. Secondary outcomes included patient and fixation construct variables as possible predictors for mechanical failure.
RESULTS:
At 20 months of follow-up, 11 failures (37%) occurred. Mean time to failure was 18 weeks (range 2-84). Cumulative failure rates were 10%, 20%, 27%, and 33% at 1, 2, 6, and 12 months, respectively. The most frequent failure mode was varus collapse with screw cut out (5 cases). There was no statistically significant difference between groups with regards to age, body mass index, diabetes, or smoking habit. The presence of a "kickstand screw" and medial cortical reduction were not significantly different in cases with and without failure. Proximal screw number and type were similar in both groups.
CONCLUSIONS:
A high rate of mechanical failure can be expected with proximal locking plate fixation of unstable proximal femur fractures. The use of a "kickstand" screw could not be established to reduce the risk for mechanical failure.
LEVEL OF EVIDENCE:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
PMID: 22549030 [PubMed - in process]
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Re: перелом проксимальной бедренной пластинки
д-р Сидоров С.С. 13 Май 2013, 22:08
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Уважаемый Александр Николаевич! чем штифтовать: PFNa или эксперт(LFN)&
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Re: перелом проксимальной бедренной пластинки
Отправитель: maxim agalakov 13 Май 2013, 23:44
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красиво жить не запретишь, как вы это оформляете, если не секрет?
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Re: перелом проксимальной бедренной пластинки
Отправитель: Alexander Chelnokov 14 Май 2013, 07:42
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Если кость не сильно разреженная, то большой разницы нет. Важнее варус не оставлять.
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Re: перелом проксимальной бедренной пластинки
Сидоров Сергей Степанович 14 Май 2013, 09:13
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Уважаемый Максим Агалаков! Обычно пишешь служ. записку гл. врачу так мол и так для такого редкого перелома в больнице нет конструкций, но она есть у одной зарубекжной фирмы, где её можно приобрести. Закупка до 100000руб разрешена.
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Re: перелом проксимальной бедренной пластинки
Отправитель: Maxim Agalakov 14 Май 2013, 21:55
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У нас такое не проходит, так как МЭС такой имплант не покрывает
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Re: перелом проксимальной бедренной пластинки
Отправитель: Alexander Chelnokov 15 Май 2013, 00:03
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А приобретают из средств ОМС? Или какой-то другой источник?
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Re: перелом проксимальной бедренной пластинки
Отправитель: maxim agalakov 15 Май 2013, 16:40
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А у нас собственно других вариантов почти нет
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Re: перелом проксимальной бедренной пластинки
Отправитель: maxim agalakov 15 Май 2013, 18:26
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имелось ввиду, что по ОМС
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перелом проксимальной бедренной пластинки
