Discusión entre pares / 2 months old ILN femur + circlage wiring done some where

2 months old ILN femur + circlage wiring done some where. Will fracture unite or need removal of static screw. Im thinking dat already nail is longer if i remove static screw nail may palpate at proximal. sugetions plz
  • Mohit Kumar Leave it as such under close observation
  • Salman Mhamed Sadek Remove the px secr. to keep the nail in dynamic state
  • King Sudheer If i remove proximal screw already nail is proximal..any impingement problem?
    3 horas · Me gusta · 1
  • Shahab Ud Din Exchange ILN bigger dia,appropiate lengath so noimpingement problem. (Exchange nailing vl help in union)
    3 horas · Editado · Me gusta · 2
  • Manish Budhia Don’t take out proximal screw bc there is only one static screw proximally.so if u remove that screw ,rotation will be at fracture site and leads to nu.distal screws are broken so nail is already dynamized.wait for one more month
    3 horas · Me gusta · 1
  • Salman Mhamed Sadek In this picture. You have impg. So the state will not change but when you rmove the scr.we will get more acceleration for healing
  • Salman Mhamed Sadek I think both up and down scr.when you remove the nail will go to dynamic State
  • Hardayal Singh Ghuman Remove proximal screw
  • Sushil Vijay You should not remove screw as both distal screws are already bent…. It will break in dynamization. Better do exchange nailing as still no significant callus visible.
    3 horas · Me gusta · 2
  • Satish Kumar Wait for 2 month
  • Vijay Kumar Agarwal Fracture is already dynamised…….don’t hurry…… Give fracture time to heal….. Avoid wt bearing
  • Bhupesh Mahawar Wait n watch for 1 month. Distal screws seems to b broken, i.e. already dynamized. It will unite. Don’t remove prox screws as it may lead to rotational instability.
    2 horas · Me gusta · 1
  • Shrikrishna Dhone Remove screws distal one dynamize,more chances of union as # is transverse ,telescopy will act as compression at # site give functional brace for femur
  • Mahmoud Mohamed Distal screws are already broken.wait and see
  • Mohamed Mamdouh For follow up
  • Shrikrishna Dhone Although srews are broken/bent there is gap at # site hence removal is better
  • Prashant Yadav Removing prox screw ll worse the situation by making fracture rotationally unstable and distal screws are already broken so nail is already in auto-dynamisation state.
    Do exchange nailing with larger diameter nail
    1 hora · Me gusta · 2
  • Vijay Kumar Agarwal fracture is already in process of union ……there is well visible callus posteriorly !
  • Lalith Mohan I agree with dr vijay kumar.you have to just wait for at least another 2 months.
  • Nitish Bhan Both the screws have broken and there is no distal hold.. the nail is wobbling and there is no rotational control..better leave it ..if u r lucky it may unite.a better option is to redo nailing with an appropriate diametre nail.removing nail will not help..it will make it more unstable and u might have hypertrophic non union..
  • Kir Pat Any minor intervention like dynamizing, will lead nail penetration and protrusion ,instability,malunio and nondunion uncertainity and delayed rehab and broken screw removal ,by any shortcuts ,same procedural incision in exchange nailing by shorter ,may be same dia will solve all future impending and will make you and pt feel secure about results

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