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
- Posted by victor valdes
- Posted on mayo 15, 2014
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- Comentarios desactivados en 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

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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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 .
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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
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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
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Eslam Alsherif There is a crack reaching greater trochnter.it may shutter during insertion of dcs or pfn
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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
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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…
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Gopinath Duraisamy Considering narrow medullary Canal and fracture pattern, Proximal Femoral Locking plate would be a better construct.
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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.
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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
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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
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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.
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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.
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Ashish Khandelwal Sir, as u suggest , and i m also in favour of that ..dhs or dcs always gives excellent result if done properly
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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.
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Bansal Ajay but sir my all cases have unite in dhs in same morphology..i will post in evening same case done today
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Somnath Chowdhury bansal sir, ur case is a regular trans-troch #.should unite with Sliding hip screw. its not reverse oblique.
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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.
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Ashish Khandelwal Post op..of case discussed. Used dhs instead of dcs..as after lagscrew fixation of shaft..it was pure it fracture.
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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.
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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.
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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.
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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 .
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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
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Trimbak Patel A pressure from lateral surface during incertion of instruments, & nail will help to prevent lateral fragment seperation.
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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.
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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 .
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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
-
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
-
-
-
-
-
-
Eslam Alsherif There is a crack reaching greater trochnter.it may shutter during insertion of dcs or pfn
-
-
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
-
-
-
-
-
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…
-
-
-
-
-
-
-
Gopinath Duraisamy Considering narrow medullary Canal and fracture pattern, Proximal Femoral Locking plate would be a better construct.
-
-
-
-
-
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.
-
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
-
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
-
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.
-
-
-
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.
-
-
Ashish Khandelwal Sir, as u suggest , and i m also in favour of that ..dhs or dcs always gives excellent result if done properly
-
-
-
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.
-
Bansal Ajay but sir my all cases have unite in dhs in same morphology..i will post in evening same case done today
-
Somnath Chowdhury bansal sir, ur case is a regular trans-troch #.should unite with Sliding hip screw. its not reverse oblique.
-
-
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.
-
-
Ashish Khandelwal Post op..of case discussed. Used dhs instead of dcs..as after lagscrew fixation of shaft..it was pure it fracture.
-
-
-
-
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.
Médico Especialista y Subespecialista
CERTIFICADO POR EL CONSEJO MEXICANO DE ORTOPEDIA Y TRAUMATOLOGIA AC, MIEMBRO DE LA SOCIEDAD MEXICANA DE ORTOPEDIA PEDIATRICA INR, UNAM
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