8yr m fall on ground before 1 day having # shaft femer Before 10 month he was fall & Having #on jn of u/3rd&m/3rd femer& put enders nail than aftrer 6 month removed nail again refracture on #site Put Dcp before 4 month than again # on shaft May be osteopetrosis? ??? What is the best T / t of choice opinion plz
Girish VimalWt exactly Nial sign means? S u hv 2 remove d implant opn is must, dn take a long im lock femur nail keep it just above d physial plate n lock it. Dr. Is chance o further fracturing d plated part so needs gentle hand reaming through # site retro n antigrade.Girish do it n dn tell d further story.
Jayant SharmaGirish why did you label it as osteopetrosis. Why was index surgery enders nailing in a 7 year old why not hip spica. Why did enders fail. Was plating and bone grafting done
Drgirish Gupta@dr Jayant Sharma sir I prefer enders nail at the age of 7yr union achieved but after nail removal pt fall again &refracture occur Than 2nd surgery done Dcp with out BG Union achieved but pt again fall on ground &now new#below plate
Navin Singhnon union femur in paediateic age group is a rarity. kindly post previous X rays . This DCP and screws are clearly oversized for this age. The stress riser at the end of plate made this fracture inevitable
Jayant SharmaJust to discuss out here how many of us operate a 7 yr old fracture shaft femur. I treat it in spica or a tobrruck. What is the logic for operating.
Drgirish Gupta@dr Navin Singh at present I am not having old xrays I used narrow DCP with 4.5mm cortical screw b/c Bone is osteoporotic thatswhy 3.5 screws purchase is doubtful
Nisarg Raninga BhuroI think removal of plate and long sized 4.5 mm dcp probably locking is the best option, at least 3 screw below 2 inbettwen #siteand 2 above # site
Nishikant KumarIt may be OI; LOOK FOR CAUSE, and now treatment plan is implant removal followed by longer plate;; LOCKING PLATE.; As it may be difficult to negotiate enders / TENS through earlier fracture site,Maintain working length.
Nishikant KumarLook for cause ; If OI, you will find severe osteoporosis so DCP may not hold so you shd use LOCKING PLATE.Anyway locking plate is not contraindicated in pediatric patients.
Sanjay JosephIf this is, as I suspect, osteogenesis imperfecta, then in an ideal world the treatment would be telescopic nailing. Failing this then enders nails are not a bad option.
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