1. Aftercare of Nailed Patients and Dynamisation of Fractures КЕМЕРОВО ГкБ №3 hospital @ mail.kuzbass.net

2. 42A22

3. 12 m What is the cause of it? The nail is too thin The nail is too short Patient is a surgeon No dynamisation

4. 12 m What shall we do? Change UTN to plate Change UTN to UN Nothing

5. 12 m What shall we do? Change UTN to plate Change UTN to UN Nothing 24 m

6. 36 m What shall we do? Change UTN to plate Change UTN to UN Nothing 24 m

7. What does success of nailing depend on? When? DynamisationFull weight bearing

8. What does success of nailing depend on? Dynamisation Distal lockingProximal locking Static locking Dynamic locking

9. What does success of nailing depend on? Dynamisation Distal lockingProximal locking Static locking Dynamic locking

10. What does success of nailing depend on? Dynamisation Distal lockingProximal locking Static locking Dynamic locking

11. What does success of nailing depend on? Dynamisation Distal lockingProximal locking Static locking Dynamic locking is load transfer from nail to bone by removing proximal locking bolt from static hole

12. What does success of nailing depend on? Static locking prevents: -rotational instability -shortening of the bone segment Distal lockingProximal locking Static locking Dynamic locking In case there is no danger of bone shortening

13. What does success of nailing depend on? Dynamisation

14. What does success of nailing depend on? When? Dynamisation

15. What does success of nailing depend on? When? Dynamisation

16. What does success of nailing depend on? When? Dynamisation Primary With fractures - transverse fracture with long proximal fragment, good quality of the bone and anatomical reduction

17. What does success of nailing depend on? When? Dynamisation Primary With fractures - transverse fracture with long proximal fragment, good quality of the bone and anatomical reduction With atrophic nonunion

18. What does success of nailing depend on? When? Dynamisation Primary With fractures - transverse fracture with long proximal fragment, good quality of the bone and anatomical reduction With atrophic nonunion Full weight bearing In case of pain decreased and soft tissue healed

19. What does success of nailing depend on? When? Dynamisation Primary With fractures - transverse fracture with long proximal fragment, good quality of the bone and anatomical reduction With atrophic nonunion Full weight bearing In case of pain decreased and soft tissue healed Secondary

20. Dynamic locking Static locking Transverse fracture Spiral fracture Small-stature patient Obese patient Long proximal fragment Short proximal fragment Good quality of the bone Osteoporotic bone Clever surgeon Stupid surgeon What are timing factors of dynamisation

21. What does success of nailing depend on? When? Dynamisation Primary With fractures - transverse fracture with long proximal fragment, good quality of the bone and anatomical reduction With atrophic nonunion Full weight bearing In case of pain decreased and soft tissue healed Secondary 6 th through 8 th week 3.9 locking screws – after dynamisation 4.9 locking screws – in case of pain decreased and soft tissue healed

22. No Dynamisation ?

27. Thank you Спасибо