Discusión entre pares / Fresh Periprosthetic fracture. What next?

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Tabu Muri

20 de abril a la(s) 1:46

Fresh Periprosthetic fracture. What next?

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• A 6 personas les gusta esto.
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  Riyadh Nahawi Can do cross k.W s and cast

  20 de abril a la(s) 1:51 · Me gusta
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  Ali Öner Distal lateral anatomic locked plate.

  20 de abril a la(s) 1:52 · Me gusta · 3
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  Said Abdelhaleem Distal lcp mipo

  20 de abril a la(s) 2:16 · Me gusta · 1
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  Gregory Sasalos Femoral prosthesis is now loose as we can see in lat xray. KW or orif with distal lat plating won't work(except if you expect that the screws will screw on the cement). I believe it needs more radical surgery. Revision with cemented long stems. Be aware of the quality of bone. Tibia turbecle fx intraop or Q angle greater than 20 degrees and distal tube alignment????

  20 de abril a la(s) 2:20 · Me gusta · 5
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  Guevara Hamo retrograde nailing

  20 de abril a la(s) 2:39 · Me gusta
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  DrRajesh Dehariya Why # occured ?

  20 de abril a la(s) 2:54 · Me gusta
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  DrRajesh Dehariya Can this # be managed conservatively?

  20 de abril a la(s) 2:55 · Me gusta
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  Ashok Parapoyil Remove femoral component n put a stem

  20 de abril a la(s) 3:00 · Me gusta
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  Sahib Ibrahim Konservativ trt

  20 de abril a la(s) 5:13 · Me gusta
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  Amitabh Singh Always give try for conservative Rx. Others options can be tried later.

  20 de abril a la(s) 5:37 · Me gusta
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  Arunava Lala From the X ray it is evident that there is some iatrogenic tibial tuberosity avulsion. So now the question is how long back was the tkr done and what was the pre injury range of motion? If surgery was done at least 6 wks back and pt is. Having at least 90 degree range of motion then fix or else conserve

  20 de abril a la(s) 6:14 · Me gusta
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  Raviprasad Kattimani First look into the TKR implant details, there should be a space for Intra medullary supra condylar nail .positin patient in supine with knee in 20-30 degress of flexion .with surgery u can mobilise faster ..conservative will end up with stiff knee ....

  20 de abril a la(s) 6:18 · Me gusta
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  Kedar Phadke Lateral locking plate

  20 de abril a la(s) 7:17 · Me gusta · 1
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  Gregory Sasalos Conservative treatment is wrong according to books. Retrograde nail?? And the proximal screws where will they hold???????? There is no bone stock and most propably the bone above prosthesis will be cominuted

  20 de abril a la(s) 7:22 · Me gusta
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  Sanjay Sharma orif

  20 de abril a la(s) 7:28 · Me gusta
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  Raviprasad Kattimani Hi all here is the article favouring IM Supra condylar nail over LCP or other methods hope this helps , Supracondylar periprosthetic femoral fractures following total knee arthroplasty: treatment with a retrograde intramedullary nail. Int Orthop. Aug 2009; 33(4): 981–985.
  K. Chettiar, M. P. Jackson,corresponding author J. Brewin, D. Dass, and P. A. Butler-Manuel

  20 de abril a la(s) 7:34 · Editado · Me gusta · 1
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  Sunil Gupta Guevara Hamo what will be the entry point for retrograde nail and where will the screws take purchase ?

  20 de abril a la(s) 8:11 · Me gusta
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  Raviprasad Kattimani Hi the procedure will still be the same . We need to know the size of the slot in femoral component it comes with a hole to accomadate the nail. .

  20 de abril a la(s) 8:16 · Me gusta
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  Kedar Phadke Yeah there is a slot for the nail in the femoral component, but ravi sir will it help in this fracture pattern? I mean compared to a locking plate

  20 de abril a la(s) 8:22 · Me gusta
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  Raviprasad Kattimani Yes kedar ..It should not be a problem ..its easier n less traumatic procedure than LCP

  20 de abril a la(s) 8:24 · Me gusta
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  Ali Öner If you think of IM nailing, then you should know the TKR brand and model to know the width of the slot. Preoperatively make sure that femoral component slot is wide enough for IM passage. If it is narrow, IMN may get stuck prematurely.

  20 de abril a la(s) 8:31 · Me gusta
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  Raviprasad Kattimani Yes absolutely the Surgeon must now go into the operative notes of patient know the exact size n company of implant n plan pre operatively with LCP set by the side ...

  20 de abril a la(s) 8:36 · Me gusta
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  Ashutosh Chaudhari If I am not wrong this is a pfc sigma , the nail dfn is not possible , unless u have a titanium cutter , the distal lcdcp is ur only option , if u want can try a expert nail in reverse I have not tried it but have actually tried passing the dfn ( Synthes ) thru it it cannot pass but expert can be used but have no personal experience with this , also remember ur entry will be dictated by earlier surgeons decision , so u May end up with flexion extension or varus valgus at the frac over which u have no control , best of luck

  20 de abril a la(s) 10:11 · Me gusta
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  Essam Al Nagashi locked plate is implant choice if the prothesis is stabe type II rorabeck classification

  20 de abril a la(s) 10:25 · Me gusta · 1
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  Gregory Sasalos Dr Essam Al Nagashi i think it rorabeck type III at least from the lat. view. The anterior part of femoral prosthesis has no bone.

  20 de abril a la(s) 14:28 · Me gusta · 2
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  Ali Öner The only ORIF implant will be plate. It is too distal for IMN...
  
  If you don't / can't fix it, then you should have revision with distal femoral replacement option, preferably semi constrained.

  20 de abril a la(s) 14:32 · Me gusta · 1
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  Bikram Singla Two options:
  1. put cast let it unite plan revision
  2. if u can't do it better refer to ur senior surgeon try not to make a mess
  this is not the last surgery u will do in ur lifetime

  20 de abril a la(s) 14:38 · Me gusta · 1
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  Adnan Zahoor Revision with distal femoral prosthesis.....

  20 de abril a la(s) 14:54 · Me gusta
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  Robindro Pheiroijam Tabu when was the surgery done? if the prothesis is stable, no signs of loosening then i think distal femur LC-DCP will be right choice. otherwise remove the implant and cemented long stem with augmentation. good luck

  20 de abril a la(s) 17:41 · Me gusta · 2
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  Mahmoud Abouzied femoral conponent replacment by one with stem

  21 de abril a la(s) 6:37 · Me gusta
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  Gopal Goel DLFP

  21 de abril a la(s) 8:19 · Me gusta