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Discusión entre pares / If PFN is planned…how to avoid proximal fragment to displaced. Open reduction and circleage wiring?. Or to go with conventional dcs/ dhs

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Posted on mayo 15, 2014
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Indian-Orthopaedic Research-Group

Ashish Khandelwal

11 de mayo a la(s) 8:21

If PFN is planned…how to avoid proximal fragment to displaced. Open reduction and circleage wiring?. Or to go with conventional dcs/ dhs

If PFN is planned...how to avoid proximal fragment to displaced. Open reduction and circleage wiring?. Or to go with conventional dcs/ dhs

Hardik Patel Long pfn. On traction table.dont open fracture site first.only if reduction is nt adequate open it.canal looks narrow so b prepared with plate also.muscle pull will help reduction.add lateral pressure with pin or hand .

11 de mayo a la(s) 11:38 · Me gusta
Eslam Alsherif DCS is difficult as there’s a crack at its entry point.DHS is very bad option 4 this case.za ideal option for this case is proximal femoral locked platete

11 de mayo a la(s) 11:53 · Me gusta
Kapil Sangwan Dcs will be easy and perfect solution …..I don’t know why people follow intramedullay fixation in these cases…. Very difficult … Less biological…full of complication and with only so called advantage of early wt bearing.please don’t take it otherwise only health criticism

11 de mayo a la(s) 11:58 · Me gusta · 1
Kapil Sangwan Dcs is better than dhs as we don’t want any collapse in this

11 de mayo a la(s) 12:02 · Me gusta
Neeraj Singh I done same case

11 de mayo a la(s) 12:09 · Me gusta · 4
Neeraj Singh 6month post op

11 de mayo a la(s) 12:09 · Me gusta
Ahmed Rizk Can we show the lat. view dr. Ashish Khandelwal ?

11 de mayo a la(s) 12:17 · Editado · Me gusta
Ashish Khandelwal no, lat view not taken.

11 de mayo a la(s) 12:18 · Me gusta
Eslam Alsherif There is a crack reaching greater trochnter.it may shutter during insertion of dcs or pfn

11 de mayo a la(s) 12:20 · Me gusta
Bansal Ajay i can do excellent dhs(long) and will unite also

11 de mayo a la(s) 12:22 · Me gusta · 3
Ahmed Rizk Ok. Although lat. view is important , as dr Eslam Alsherif said this is an unstable intertroch. # (comminuted 3part # + reversed obliquity ) so pfn may shutter the GT. so my op. : is ORIF with DHS 6-8 holes with circulage through supine position & lat. approach ( i donno whether DCS will be harmfull or not ) i know that DHS is not suitable for such # pattern , another option is trochanteric locked plate with circulage

11 de mayo a la(s) 21:16 · Editado · Me gusta · 1
Karan Singh Unstable intertroch # , intramedullary fixation.

11 de mayo a la(s) 12:32 · Me gusta
Sharma Yuvaraj Long pfn but reaming shud b done after reduction is held with clamp.

11 de mayo a la(s) 12:48 · Me gusta · 2
Haitham Seyam Proximal femoral locked plate

11 de mayo a la(s) 13:24 · Me gusta · 1
Puneet Shah Dcs

11 de mayo a la(s) 14:05 · Me gusta
Harish Kanakpur Pfn of synthes with entry medial to tip of trochanter

11 de mayo a la(s) 20:01 · Me gusta
Suman Kumar I have done DHS in similar fracture & it had united very well. Sorry, I don’t have x-Ray to show you but You can do it. Another option here is proximal locking plate; using long incision, reduce the fracture adequately first then go for fixation & use few inter-fragmentary screws through the plate- either using DHS or locking plate. Best of Luck…

11 de mayo a la(s) 20:46 · Me gusta · 1
Somnath Chowdhury Rationale for use of DHS in this please!

11 de mayo a la(s) 20:47 · Me gusta
Sanjay Sharma long plate dhs

11 de mayo a la(s) 22:37 · Me gusta · 1
Modi Neerav wiring first and then nagotiate the long pfn

11 de mayo a la(s) 23:11 · Me gusta
Shantanu Kundgir I think u go for DHS

11 de mayo a la(s) 23:30 · Me gusta · 1
Rustom Adi Mody great case for DCS. hold reduction with 5 No. Ethibond. use a long plate.

11 de mayo a la(s) 23:38 · Me gusta
Harnam Madan best to do intramedullary implant PFN

12 de mayo a la(s) 1:34 · Me gusta
Gopinath Duraisamy Considering narrow medullary Canal and fracture pattern, Proximal Femoral Locking plate would be a better construct.

12 de mayo a la(s) 4:31 · Me gusta
Khoi Tranchi I choice long DCS to fix fragment of large trocanter with MIPO technique

12 de mayo a la(s) 4:50 · Me gusta
Mohan Kumar Had a similar case last week

12 de mayo a la(s) 5:35 · Me gusta · 1
Mohan Kumar Did open reduction and PFN . DIDNT need cerclage….

12 de mayo a la(s) 5:36 · Me gusta · 1
Ashok Parapoyil PFN with cable wiring …

12 de mayo a la(s) 5:51 · Me gusta
Sadique Ahmed Khan Long pfn. Small rigid reamer/lateral comp with punch or at last open n hold. All these strategy should b used . Prepare for all. Dhs/dcs/pflcp will b last choice for me.

12 de mayo a la(s) 10:42 · Me gusta
Sameer Kad Dr mody , plz explain your technique of reduction using ethibond 5 . Shall I reduce the fracture with clamp and then tie with suture?… Then apply plate and remove suture or keep it

12 de mayo a la(s) 13:19 · Me gusta
Sameer Kad Dr mody , plz explain your technique of reduction using ethibond 5 . Shall I reduce the fracture with clamp and then tie with suture?… Then apply plate and remove suture or keep it

12 de mayo a la(s) 13:19 · Me gusta
Needhirajan Thenmozhi Recon nailing can be done. You need to open the proximal fragment and fix it with circelage wire. Then nail it. Will be stable with nailing.

12 de mayo a la(s) 17:06 · Me gusta
Krishna Kumar better use a DHS . it will make your life easier!

Ayer a las 10:38 · Me gusta · 1
Sanju Dhruw PFN with incirclage wiring

Ayer a las 11:05 · Me gusta
Ashish Khandelwal @mohan kumar..in this situations ..i ve also done long pfn. But in this case ..proximal comminution was also there..which was more looking in lateral view. So did a long dhs.

Hace 22 horas · Me gusta · 1
Bansal Ajay i learn from this post is that i am not only one who love in doing good dhs

Hace 22 horas · Me gusta · 2
Ashish Khandelwal Sir, as u suggest , and i m also in favour of that ..dhs or dcs always gives excellent result if done properly

Hace 21 horas · Me gusta
Bansal Ajay dhs win battle over dcs most of time

Hace 21 horas · Me gusta
Bansal Ajay

Hace 21 horas · Me gusta
Bansal Ajay did yesterday

Hace 21 horas · Me gusta
Somnath Chowdhury reverse oblique type troch # and subtroch # should not be fixed with sliding hip screw. it does not serve to unite the # across the line.

Hace 16 horas · Me gusta · 1
Bansal Ajay but sir my all cases have unite in dhs in same morphology..i will post in evening same case done today

Hace 15 horas · Me gusta
Somnath Chowdhury bansal sir, ur case is a regular trans-troch #.should unite with Sliding hip screw. its not reverse oblique.

Hace 14 horas · Me gusta
Bansal Ajay i am not talking about my case sir

Hace 14 horas · Me gusta
Somnath Chowdhury BANSAL sir, then why d u need a DHS? u may as well use a DCP or LCP. if u r not putting the sliding screw in across the fracture, u dnt need to use DHS.

Hace 14 horas · Me gusta
Bansal Ajay

Hace 13 horas · Me gusta
Bansal Ajay done today

Hace 13 horas · Me gusta
Ashish Khandelwal

Hace 13 horas · Me gusta
Ashish Khandelwal Post op..of case discussed. Used dhs instead of dcs..as after lagscrew fixation of shaft..it was pure it fracture.

Hace 12 horas · Me gusta
Bansal Ajay excellent

Hace 12 horas · Me gusta
Bansal Ajay why proximal part of plate is empty

Hace 12 horas · Me gusta
Bansal Ajay dear Ashish Khandelwal interfragmentry was not mandatory in your case

Hace 12 horas · Me gusta
Ashish Khandelwal As the shaft was well reduced with 2lag screws. And didnt used some proximal screw because i was afraid of splitting of medial cortex, because of shearing force of screw.

Hace 12 horas · Me gusta · 1

Manjunath Ds Dcs

11 de mayo a la(s) 8:26 · Me gusta
Sudhir Khursade DCS

11 de mayo a la(s) 8:38 · Me gusta
Alok Shrivastava Subtroch # DCS is the best option

11 de mayo a la(s) 8:39 · Me gusta
Chaitanya Kumar U can go with dcs.. With circlage wire

11 de mayo a la(s) 8:45 · Me gusta
Kir Pat PFN with cerclage ,probably IL screw will be at distal level

11 de mayo a la(s) 8:55 · Me gusta
Emam Mohamed pf locked plate i think with 2 interfragmentory screws

11 de mayo a la(s) 9:04 · Me gusta
Ahmed Elsayed Biological prox fem locked plate

11 de mayo a la(s) 9:06 · Me gusta
Shashi Bhushan Long plate dhs

11 de mayo a la(s) 9:06 · Me gusta
Syed Kashif U hv all the options doc .as mentioned earlier.PFN I hv the experience, even on this geometry u can get away with it.no need circulate, bad thing.just choose longer length and u can do it with PFN , one from synthes.

11 de mayo a la(s) 9:08 · Me gusta
Sameer Kad ORIF withDCS … NO NEED OF CIRCLAGE wire … It will unite….

11 de mayo a la(s) 9:19 · Me gusta
Mohan Kumar PFN no need for cerclage….

11 de mayo a la(s) 9:28 · Me gusta
Aymen Elbatran Pfn

11 de mayo a la(s) 9:35 · Me gusta
Mohammed Ali u can augment ur fixation with submuscular unicortical locked plate small DC..

11 de mayo a la(s) 9:38 · Me gusta
Somnath Chowdhury u can do widout cerclage; do proximal reaming after entry with awl/guide pin. don’t ream distally. introduce stout hand reamer and reduce over it. Synthes provides a stout slotted cannulated device which is used to this effect very effectively. if adequate sized nail is used, no need for cerclage.

11 de mayo a la(s) 9:49 · Me gusta · 1
Ali Rawanduzy DHS

11 de mayo a la(s) 9:54 · Me gusta · 1
Ashish Khandelwal Basically dcs will give a beautiful xray postop. Previously had good results with Long dcs in this type of fracture,except in one case where dcs broken..but probably i have bent it little ,from where it broken .

11 de mayo a la(s) 9:55 · Me gusta · 1
Ashraf Goda locked proximal femoral plate with lag screws through it may give excellent result

11 de mayo a la(s) 10:04 · Me gusta · 3
Abhijit Lonari Long pfn in lateral position
Open reduction

11 de mayo a la(s) 10:07 · Me gusta
Nimish Agarwal the main problem is that it will reduce in abduction making life difficult for pfn hence I agree with dr somnath’s method I have good exerience with rigid reaming in reverse oblique fr and use it to reduce

11 de mayo a la(s) 10:26 · Me gusta
Nimish Agarwal recon nail is better option

11 de mayo a la(s) 10:27 · Me gusta
Nishint Gupta open reduction,,,hold reduction and long pfn

11 de mayo a la(s) 10:34 · Me gusta · 3
Trimbak Patel A pressure from lateral surface during incertion of instruments, & nail will help to prevent lateral fragment seperation.

11 de mayo a la(s) 10:36 · Me gusta · 1
Syed Kashif Dr nimish PFN from synthis is Better construct.it has a proximal interlocking blade instead of bolt or a screw.it has a proven better record than recon nail.

11 de mayo a la(s) 10:38 · Me gusta
Vinod Pawar Dcs

11 de mayo a la(s) 11:35 · Me gusta · 2
Hardik Patel Long pfn. On traction table.dont open fracture site first.only if reduction is nt adequate open it.canal looks narrow so b prepared with plate also.muscle pull will help reduction.add lateral pressure with pin or hand .

11 de mayo a la(s) 11:38 · Me gusta
Eslam Alsherif DCS is difficult as there’s a crack at its entry point.DHS is very bad option 4 this case.za ideal option for this case is proximal femoral locked platete

11 de mayo a la(s) 11:53 · Me gusta
Kapil Sangwan Dcs will be easy and perfect solution …..I don’t know why people follow intramedullay fixation in these cases…. Very difficult … Less biological…full of complication and with only so called advantage of early wt bearing.please don’t take it otherwise only health criticism

11 de mayo a la(s) 11:58 · Me gusta · 1
Kapil Sangwan Dcs is better than dhs as we don’t want any collapse in this

11 de mayo a la(s) 12:02 · Me gusta
Neeraj Singh I done same case

11 de mayo a la(s) 12:09 · Me gusta · 4
Neeraj Singh 6month post op

11 de mayo a la(s) 12:09 · Me gusta
Ahmed Rizk Can we show the lat. view dr. Ashish Khandelwal ?

11 de mayo a la(s) 12:17 · Editado · Me gusta
Ashish Khandelwal no, lat view not taken.

11 de mayo a la(s) 12:18 · Me gusta
Eslam Alsherif There is a crack reaching greater trochnter.it may shutter during insertion of dcs or pfn

11 de mayo a la(s) 12:20 · Me gusta
Bansal Ajay i can do excellent dhs(long) and will unite also

11 de mayo a la(s) 12:22 · Me gusta · 3
Ahmed Rizk Ok. Although lat. view is important , as dr Eslam Alsherif said this is an unstable intertroch. # (comminuted 3part # + reversed obliquity ) so pfn may shutter the GT. so my op. : is ORIF with DHS 6-8 holes with circulage through supine position & lat. approach ( i donno whether DCS will be harmfull or not ) i know that DHS is not suitable for such # pattern , another option is trochanteric locked plate with circulage

11 de mayo a la(s) 21:16 · Editado · Me gusta · 1
Karan Singh Unstable intertroch # , intramedullary fixation.

11 de mayo a la(s) 12:32 · Me gusta
Sharma Yuvaraj Long pfn but reaming shud b done after reduction is held with clamp.

11 de mayo a la(s) 12:48 · Me gusta · 2
Haitham Seyam Proximal femoral locked plate

11 de mayo a la(s) 13:24 · Me gusta · 1
Puneet Shah Dcs

11 de mayo a la(s) 14:05 · Me gusta
Harish Kanakpur Pfn of synthes with entry medial to tip of trochanter

11 de mayo a la(s) 20:01 · Me gusta
Suman Kumar I have done DHS in similar fracture & it had united very well. Sorry, I don’t have x-Ray to show you but You can do it. Another option here is proximal locking plate; using long incision, reduce the fracture adequately first then go for fixation & use few inter-fragmentary screws through the plate- either using DHS or locking plate. Best of Luck…

11 de mayo a la(s) 20:46 · Me gusta · 1
Somnath Chowdhury Rationale for use of DHS in this please!

11 de mayo a la(s) 20:47 · Me gusta
Sanjay Sharma long plate dhs

11 de mayo a la(s) 22:37 · Me gusta · 1
Modi Neerav wiring first and then nagotiate the long pfn

11 de mayo a la(s) 23:11 · Me gusta
Shantanu Kundgir I think u go for DHS

11 de mayo a la(s) 23:30 · Me gusta · 1
Rustom Adi Mody great case for DCS. hold reduction with 5 No. Ethibond. use a long plate.

11 de mayo a la(s) 23:38 · Me gusta
Harnam Madan best to do intramedullary implant PFN

12 de mayo a la(s) 1:34 · Me gusta
Gopinath Duraisamy Considering narrow medullary Canal and fracture pattern, Proximal Femoral Locking plate would be a better construct.

12 de mayo a la(s) 4:31 · Me gusta
Khoi Tranchi I choice long DCS to fix fragment of large trocanter with MIPO technique

12 de mayo a la(s) 4:50 · Me gusta
Mohan Kumar Had a similar case last week

12 de mayo a la(s) 5:35 · Me gusta · 1
Mohan Kumar Did open reduction and PFN . DIDNT need cerclage….

12 de mayo a la(s) 5:36 · Me gusta · 1
Ashok Parapoyil PFN with cable wiring …

12 de mayo a la(s) 5:51 · Me gusta
Sadique Ahmed Khan Long pfn. Small rigid reamer/lateral comp with punch or at last open n hold. All these strategy should b used . Prepare for all. Dhs/dcs/pflcp will b last choice for me.

12 de mayo a la(s) 10:42 · Me gusta
Sameer Kad Dr mody , plz explain your technique of reduction using ethibond 5 . Shall I reduce the fracture with clamp and then tie with suture?… Then apply plate and remove suture or keep it

12 de mayo a la(s) 13:19 · Me gusta
Sameer Kad Dr mody , plz explain your technique of reduction using ethibond 5 . Shall I reduce the fracture with clamp and then tie with suture?… Then apply plate and remove suture or keep it

12 de mayo a la(s) 13:19 · Me gusta
Needhirajan Thenmozhi Recon nailing can be done. You need to open the proximal fragment and fix it with circelage wire. Then nail it. Will be stable with nailing.

12 de mayo a la(s) 17:06 · Me gusta
Krishna Kumar better use a DHS . it will make your life easier!

Ayer a las 10:38 · Me gusta · 1
Sanju Dhruw PFN with incirclage wiring

Ayer a las 11:05 · Me gusta
Ashish Khandelwal @mohan kumar..in this situations ..i ve also done long pfn. But in this case ..proximal comminution was also there..which was more looking in lateral view. So did a long dhs.

Hace 22 horas · Me gusta · 1
Bansal Ajay i learn from this post is that i am not only one who love in doing good dhs

Hace 22 horas · Me gusta · 2
Ashish Khandelwal Sir, as u suggest , and i m also in favour of that ..dhs or dcs always gives excellent result if done properly

Hace 21 horas · Me gusta
Bansal Ajay dhs win battle over dcs most of time

Hace 21 horas · Me gusta
Bansal Ajay

Hace 21 horas · Me gusta
Bansal Ajay did yesterday

Hace 21 horas · Me gusta
Somnath Chowdhury reverse oblique type troch # and subtroch # should not be fixed with sliding hip screw. it does not serve to unite the # across the line.

Hace 16 horas · Me gusta · 1
Bansal Ajay but sir my all cases have unite in dhs in same morphology..i will post in evening same case done today

Hace 15 horas · Me gusta
Somnath Chowdhury bansal sir, ur case is a regular trans-troch #.should unite with Sliding hip screw. its not reverse oblique.

Hace 14 horas · Me gusta
Bansal Ajay i am not talking about my case sir

Hace 14 horas · Me gusta
Somnath Chowdhury BANSAL sir, then why d u need a DHS? u may as well use a DCP or LCP. if u r not putting the sliding screw in across the fracture, u dnt need to use DHS.

Hace 14 horas · Me gusta
Bansal Ajay

Hace 13 horas · Me gusta
Bansal Ajay done today

Hace 13 horas · Me gusta
Ashish Khandelwal

Hace 13 horas · Me gusta
Ashish Khandelwal Post op..of case discussed. Used dhs instead of dcs..as after lagscrew fixation of shaft..it was pure it fracture.

Hace 12 horas · Me gusta
Bansal Ajay excellent

Hace 12 horas · Me gusta
Bansal Ajay why proximal part of plate is empty

Hace 12 horas · Me gusta
Bansal Ajay dear Ashish Khandelwal interfragmentry was not mandatory in your case

Hace 12 horas · Me gusta
Ashish Khandelwal As the shaft was well reduced with 2lag screws. And didnt used some proximal screw because i was afraid of splitting of medial cortex, because of shearing force of screw.

Hace 12 horas · Me gusta · 1

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