Henrik Eckardt Operative Technique T2 - OTC Switzerland · fractures healed clinically and ......
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Henrik Eckardt Operative Technique T2
Transcript of Henrik Eckardt Operative Technique T2 - OTC Switzerland · fractures healed clinically and ......
Henrik Eckardt Operative Technique T2
Overview
o When shall we nail? o Patient position o Nail entry-point o Ream or not ream o Rotational control o Knee prosthesis o Poller-screw o Outcome
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When shall we nail?
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When shall we nail?
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When shall we nail?
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When shall we nail?
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Open fractures?
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Patient position
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Patient position
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Patient position
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Patient position, semi-extended, para-patellar
11 Tornetta, JOT 1995
Patient position, semi-extended, supra-patellar
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Semi-extended
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Semi-extended vs. bent knee
+ Easy to position and X-ray Better reduction by proximal Fx Better reduction by distal Fx - Increased pressure on cartilage +/- Anterior knee pain 14
Entry point lateral or medial
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Reamed nailing
Reamed: Lower risk of non-union in closed fracture (small) Reamed: Lower risk of hardware failure (small) No difference: Infection Malunion Compartment syndrome
16 JBJS 2008, SPRINT Trial Cochrane 2012
Ream or not ream
17 JBJS 2008, SPRINT Trial
Rotational control
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Knee prosthesis
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Poller screw
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Poller screw
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Outcome
Non-union closed fracture, 6-11% Non-union open fracture, 9-15% Healing time 12-24 weeks depending on soft tissue damage Infection risk open fracture 9-20%
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What to do?
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