Dr Franz Birkholtz (Pretoria, South Africa)

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Teaching other surgeons from all over in our viewing room

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Unitas is the largest private hospital in SA and has 500 beds.

It is owned and run by Netcare. Our practice is a completely separate entity and we are not employed by the hospital.

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The woundcare room in our office. This is normally where adjustments take place.

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Wow Dr. Birkholtz, these photos are amazing. You're doing God's work!

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Tx Arche. It is indeed a calling.

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Thank you dr. Franz for pictures.

Picture does speak thousand words !

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looks ace those pictures, some of the setup reminds me of the hospital standards in my country so I am very happy with this.

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Quote from: Franz on March 30, 2014, 04:01:51 PMHi TRS,

subsidence in the region of 5-10mm. Only a problem with externals only. With LATP it can be prevented with meticulous surgical technique.

Rgds,

FFB

Wow...i cant believe this, is subsidence common? i mean is there nothing one can do to prevent it when doing externals only? It would mean that i would likely have to lengthen 5 cm to get 4 cm in the end, and thats not counting the pin bending i will have to make up for..

It sounds terrible and really there should be some kind of way to prevent it..im really worried now. Especially when doing small ammounts 4 cm, losing 10 mm would be catastrophic.

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That is my concern too only with external. Because of that i am thinking in LON.
i think you should make mínimum 4,5cm, because you will lose some milimetres.

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Quote from: paco1 on March 30, 2014, 07:48:01 PMThat is my concern too only with external. Because of that i am thinking in LON.
i think you should make mínimum 4,5cm, because you will lose some milimetres.

Logically it would seem that Subsidence occurs because of removing the frames to early, the bone might be solid enough to hold the body weight but still not completely solid. If you have the frames on long enough for the bone to become as hard as it can, it should not be able to compress and removing a few pins with the frame removal should not have any effect on the new calles that solidified between the pin sites.

But i dont know of course and would appreciate if Dr. Franz could offer a deeper insight to subsidence and why it happens and what can be done to prevent it.