Forum Replies Created
September 30, 2019 at 2:09 pm in reply to: Exfix or bridge plate open distal radius fractures? #95471
I’ve used this technique increasingly frequently and it has essentially replaced an external fixator in my practice.
I am currently using a LCP plate but am interested to see that a number of manufacturers are bringing out low profile bridging plates that are pre-countoured to sit across the wrist.
Other areas where I have found Avance fits into my practice is for nerve gap reconstruction during limb or digit replantation where there doubt over the survival of the extremity makes alternatives to autograft attractive.
A concern over how well the larger diameter allografts vascularise has lead me to think about using cables of allograft of a smaller diameter instead, as one would do for an autograft reconstruction.
I have noticed that regeneration across a segment of Avance takes much longer, possibly twice as long, as one would expect for a similar length of autograft. I’d be interested to hear other surgeons experiences.
I’d agree that an end neuroma presents a challenging problem.
I have some experience of submuscular or interosseous implantation with varied results. ALternatives include centro-central neurorrhaphy, an end to side neurorrhaphy or a long to relocate the regenerating stump.
Lately there has been increasing attention upon targeted muscle reinnervation (TMR), particularly in the context of an end neuroma within an amputation stump.
Nerve capping is an old technique which showed some promise before falling out of favour. It seems to be seeing a re-emergence with novel materials that may avoid some of the historical problems with the technique. I’m looking forward to the results of the Protect Neuro trial, having used the device in select cases.