?? NON UNION FEMUR AND TIBIA

[CHERRY KOVOOR]

Dear Friends

I am putting up this case for an experienced opinion

31 yr old BSF jawan while on leave involved in a road accident on 7^th August 2009 and had liver injury and # femur and tibia which was open , Treated initially in one of the medical colleges.[ as per intial hosp reccords]. Tibia fixed with V nail and femur with plate and screws .

At present tibial # is mobile with varus deformity [ with V nail inside]. Femur # when compare with initial x-rays shows increasing gap. He has been advised to wait for another 2 months by the previous treating doctor.

Pt is concerned about his leave and if needed would like to have both surgeries at one go. My plan is Ilizarov / interlocking for the tibial non union . concerning the femur am I justified in going ahed with plate removal and interlocking considering that as compared to initial x-rays the femur # site gap is increasing ?

Attaching x-rays

Awaiting your opinions

 

DR C CHERIAN KOVOOR

KOCHI

INDIA

 

[CHERRY KOVOOR]

Attaching tibia x-rays

[Dino Aguilar]

1.       Rule out infection in both femur and tibia.

a.       Where surgery was done (In my country, I know about some hospital because the rate of infection), CPR, ESR, CBC.  Wound Clinic

b.      If all is ok, I will keep  that always in mind

2.       Femur has 12 – 14 weeks, I hate plates in femur but is done.  Femoral Non union is after 24 weeks, why don’t proceed with femur bone graft, and take cultures thinking about infection.  Change the plate for IM Road is perfect but I think too early.

3.       Tibia, I hate ex fix.  I use it, but Only if I can not use a IM Road (personal choice) why don’t change the Nail, thicker and reaming.  I use Ilizarov bur for reconstruction, it’s not easy to carry  an Ilizarov, but is a perfect choice. Leaving the nail and exfix for compression.  Good.

Regards.

 

 

Dino Aguilar

Mobile 505-888-32132

Office 505-2255-6898

Hospital Metropolitano

Suite #306

dagu...@cablenet.com.ni

Blackberry PIN 208150D8

PO Box 2261

Managua, Nicaragua

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[Dr Saleh Alharby]

1- Femur
Femur x ray showed periosteal reaction??!!!
If callus this means unstable fixation, but it could be due to low grade infection.Too early to interfere. Do CBC,ESR CRP. If you feel it is infection wait for this periosteal reaction to mature and remove the plate plus debride the femur. If infected and you interfere now you may make it worse and enter into the dilemma of infected nonunion and your choices of fixation at the time will be limited and difficult.So follow up x ray after two months and hope you will have mature callus.
2- Tibia
It is deformed and one has to remove this implant and replace or put Ilizarov to gradually correct and compress simultaneously.
good luck

On Sat, Dec 19, 2009 at 4:43 PM, CHERRY KOVOOR <kovo...@gmail.com> wrote:

Attaching tibia x-rays

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--
Dr SALEH WASLALLAH ALHARBY (FRCS)
Consultant and Associate Professor in Orthopaedics,
Department of Orthopaedic Surgery ,
Division of Sports Medicine and Reconstructive Surgery
King Khalid University Hospital and College of Medicine
King Saud University.
P.O.Box 87996, Riyadh 11652, Saudi Arabia.
E- mail alha...@yahoo.com

http://faculty.ksu.edu.sa/DrSalehAlharby/default.aspx

Management is doing things right, Leadership is doing the right things.

[Alexander Chelnokov]

Hello

2009/12/19 CHERRY KOVOOR <kovo...@gmail.com>:

> Tibia fixed with V nail and femur with plate and screws .

I'd remove the plate and use a locked nail. And exchange the tibial
nail to a locked one. In case of infection beads should be put into
the wound after plate removal and AB cement coated nails used.

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

[CHERRY KOVOOR]

Hi alex

THANKS FOR OPINION

Long time no see

CHERRY