Discusión entre pares. 65 years female who was operated by me for a supracondylar # of Rt femur 12 years back with inflatable nail...

Opciones

Shyamlal MukhiIndian Orthopaedic Research Group

65 years female who was operated by me for a supracondylar # of Rt femur 12 years back with inflatable nail as she had severe osteoporosis then and she was lost to follow up, presents with a # on the same side after a recent fall. Please opine.

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  My opinion is removal of nail and PFN
  
  
  

  26 de septiembre a la(s) 0:02 a través de móvil · Me gusta · 1
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  Pawan Ojha Remove nail and do pfn

  26 de septiembre a la(s) 2:13 a través de móvil · Me gusta
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  Ahmed Azab it was nice work

  26 de septiembre a la(s) 6:34 · Me gusta
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  Ahmed Azab removal and DHS

  26 de septiembre a la(s) 6:35 · Me gusta
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  Ahmed Azab augment the fr site by graft

  26 de septiembre a la(s) 6:36 · Me gusta
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  DrHariprasad Chowdary Munnangi Nail removal and plan fixation with recon nail

  26 de septiembre a la(s) 21:35 a través de móvil · Me gusta
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  Shyamlal Mukhi Removal not possible because of bone in growth

  26 de septiembre a la(s) 23:42 a través de móvil · Me gusta
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  DrHariprasad Chowdary Munnangi Then, extramedullary fixation is the option i feel. DHS or angled blade plate with locking screw facility

  Ayer a las 0:03 a través de móvil · Me gusta
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  Ashutosh Chaudhari Interesting ,do let us know what u do

  Ayer a las 3:52 a través de móvil · Me gusta
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  Ali Adel If the nail can not be removed..can we fix it using ilizarov ring fixator..by...doing traction to reallign the prox. Femur...applying arch in the trochanteric region...another arch in the supraacetabular region..and a ring distally..i think we can solve the problem by this

  Ayer a las 5:44 a través de móvil · Me gusta
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  Shyamlal Mukhi 67 yrs fat lady ilizarov un acceptable? Pt will not tolerate@ Ali Adel

  Ayer a las 14:56 a través de móvil · Me gusta
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  Ali Adel I was thinking as ilizarov is versatile and the pt is low demand..applying simple frame 2 arches 4 pins and a distal ring or even distal arch..it ll be just simple construct....i hope it can be solved by locked plate in some way.

  Ayer a las 15:23 a través de móvil · Me gusta
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  Mohamed Fawzy Skeletal traction and prophylactic anticoagulants

  Ayer a las 15:47 a través de móvil · Me gusta
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  Kir Pat After assesing xray 2 querry....!)I presume only antegrade nail in this case and in market? selection of this nail for s/c #?2)looking at # ,was it mal- entry hole stress riser as piriformis fossa is intact..,and antegrade thru it would have protected from this # pattern.Now after failure of this nail in hollow nonosteogenic cortical bone is more demanding ...So THR cemented will be my preference.

  Hace 21 horas · Me gusta
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  Shyamlal Mukhi Kir Pat @ Ismail Fathalla this patient was op 12 yr ago retro grade sc nail inflatable done for sc fracture now nail cannot be taken out fracture United lower one she was alright when she fell again had this inter troc fracture pl opine

  Hace 18 horas a través de móvil · Me gusta · 1
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  Shashidhar Bk Very difficult and tricky situation sir..skeleton traction xrays can help understand fracture antomy better i feel sir.this is just to help the thought process sir..drilling with metal carbide drill bit through proximal end of nail and directing a guide wire through the the neck and head for fixation in head, with fixation of GT with wiring, coverting it into PFN + DFN ...

  Hace 16 horas · Editado · Me gusta
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  Sanjeev Kumar if nail can not be removed ,open reduction and fixation with reversed opposite side distal femoral locking plate so that 2-3 screws can be inserted in the neck using miss the nail technique and all uni cortical locked screws in distal fragment.this is what i feel.

  Hace 15 horas · Me gusta · 1
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  Praveen Babu K H I think open percutanous miss a nail technique with atleast 2× 6.5 mm ccs to moblize on bed. Other option i feel if not possiable detotation boot IT #will heal

  Hace 6 horas a través de móvil · Me gusta
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  Shyamlal Mukhi @ thanks to all