Ortopedia Pediátrica y Cirugía Articular: Discusión entre pares / Operated twice implant failure nonunion no infection 60year male

Indian-Orthopaedic Research-Group

Amit Shrivastava

Operated twice implant failure nonunion no infection
60year male

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A 8 personas les gusta esto.
Nabard A. Zangana remove the implant ... refresh # site ...interlocking nail + B.G

Ayer a las 8:25 · Me gusta
Jerry Almeron i think it would be very hard to do interlocking nail,1st the medullary canal of the distal fragment is already obliterated and theres a lot of broken screw,my idea is to do locking plate and a lot of bone graft,of course have to freshen the fracture line thouroghly first

Ayer a las 8:35 · Me gusta · 3
Shiva Prakash S Gowda Can't nail it.. Plating will be difficult... Remove implant ...freshen edges...BG n LRS..

Ayer a las 8:39 · Me gusta · 3
Ayman Mansour There is something weird , i can see that there are two plates over each other . Any way the distal part with the broken screws seems sclerotic with a little potential for healing. And that why both plates failed think about resection of a diseased part of bone and do a vascularized graft

Ayer a las 8:40 · Me gusta · 3
Ayman Mansour Try to think of it as in tumor reconstruction

Ayer a las 8:41 · Me gusta
Ayman Mansour Or bone transport if you have the proper distraction device

Ayer a las 8:41 · Me gusta
Nabard A. Zangana dear dr. Jerry Almeron u can do reaming n recanalization of the medullary canal ... & these broken screws can easily removed ... I have x-rays of such like case I will upload it soon

Ayer a las 8:41 · Me gusta · 2
Nabard A. Zangana Rooshad Ahmad

Ayer a las 8:43 · Me gusta
Jerry Almeron thanks dr nabard zangana,ill wait for that case,i would help me a lot on how you do it,recanalization and removing the broken screws because we also see a lot of cases here in the phillipines,thanks

Ayer a las 8:49 · Me gusta
Bhavin Patel Remove implants external fixation with BG

Ayer a las 8:54 · Me gusta · 2
Yogesh Gaikwad Is there any pathology, Osteopetrosis? Need previous surgery details.

Ayer a las 9:24 · Me gusta · 2
Sandeep Bhagwat which plate is this i can see two plates, om changes may be present look at the distal medullary cavity it is showing cavity with sclerosis, as there is abundant callus formation we just need to adequately stabilize it by prox femoral locking plate or dcs, or pfn can be done if implants may be removed.

Ayer a las 9:32 · Me gusta
Shafi Bhat bone looks sclerotic,rule out sum metabolic bone disease

Ayer a las 10:12 · Me gusta · 1
Berivan Ibrahim Akraye Check for underlying cuz

Ayer a las 10:27 · Me gusta
Riad Abass Amin Abdel-Razek

Ayer a las 10:43 · Me gusta
Pishko Ali Remove plate and all screws then refresh the site finally im nailing with bone graft

Ayer a las 11:05 · Me gusta · 3
Dipak Vadodaria R/o cause and roi+nailing bg

Ayer a las 11:06 · Me gusta
Pishko Ali Also search for systemic and local causes

Ayer a las 11:11 · Me gusta
Omar Elsaid from the start why plate , nail from the first time

Ayer a las 11:44 · Me gusta
Jitender Pal longer locking plate, freshen ends, and lesser screws with construct which is less stiff

Ayer a las 11:55 · Me gusta · 1
Jitender Pal but rule out infection first of all

Ayer a las 11:56 · Me gusta · 1
Hanume Gowda S N this is hyper trophic nonunion..
needs stability...failure was due to instability...
now remove the implants
freshen the fracture site
take swabs to rule out infection...
plate or nail which ever is feasible..I will prefer nail only if I can clear all the broken svrews.
long plate with at least 5screws in each fragment...
bone graft will not be required..

Ayer a las 11:58 · Me gusta · 2
Jitender Pal in my opinion it became hypertrohic after failure of implant, so many screws close to fracture site should give a stiff construct, which probably it was. anyways it is not avascular nonunion, so a little easier to tackle by addressing biology and mechanics

Ayer a las 12:03 · Me gusta
Bikram Singla my goodness hard to belive.....

Ayer a las 12:11 · Me gusta
Ritesh Chotaliya Illizarov

Ayer a las 12:58 · Me gusta · 1
Abhishek Patil I think the second surgeon simply applied a plate on the previous one without touching the bone at all. Removing the broken screws is one hell of a task and would need special oversize drills. Even if u manage to do it there will be little space left for new ones. Treatment of course is as detailed above.be sure to have your entire trauma set and loads of patience when u operate. Of course rule out infection.

Ayer a las 14:22 · Me gusta
Rooshad Ahmad Double plating adds no benifit to the primary implant.. Sclerotic bone means bad vascularity .. So remove the implant.. Or whats possible to remove and use illizarov ring and use the principles of histeogenesis.. Do 10 days compression + 10 days distraction repeatidely for 2 months then do compression for another 2 months.. U will need no graft.. Hope u luck

Ayer a las 17:08 · Me gusta · 3
Rooshad Ahmad Nabard A. Zangana

Ayer a las 17:08 · Me gusta
Siddarth Pigilam Remove both plates. Donot waste time on removing broken screw. Freshen fracture site may need shortening a bit that bone grafting .use left side distal femur LCP in reverse manner. It's hypertrophy non union it needs good rigid fixation. If intra operative any signs of infection u can do LRS fixation, shortening than distraction from distal metaphyseal site