Plating the Fracture Works Every TimeAlmost-Be Careful Simon C. - - PowerPoint PPT Presentation

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Plating the Fracture Works Every TimeAlmost-Be Careful Simon C. - - PowerPoint PPT Presentation

Mar 24, 2024 383 likes •611 views

Plating the Fracture Works Every TimeAlmost-Be Careful Simon C. Mears, MD, PhD Orthopaedic Summit 2017 University of Arkansas for Medical Services Disclosure Deputy Editor: Geriatric Orthopaedic Surgery and Rehabilitation Past

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Plating the Fracture Works Every Time…Almost-Be Careful

Simon C. Mears, MD, PhD Orthopaedic Summit 2017 University of Arkansas for Medical Services

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SLIDE 2

Disclosure

  • Deputy Editor: Geriatric Orthopaedic

Surgery and Rehabilitation

  • Past President: International Geriatric

Fracture Society

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SLIDE 3

65 year old man with distal femur ppfx

Decision making for periprosthetic distal femur fractures:

  • Determine if it can be fixed

– If so use a plate – If not revise the knee replacement

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SLIDE 4

How to know if you can fix?

  • How many fracture

pieces?

  • How distal is the

fracture?

  • You need enough

bone to attach a plate

  • Consider CT scan to

help you

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SLIDE 5

Plate technique

  • Reduce the fracture with

bump or bone foam

  • Small incision laterally to

insert plate

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SLIDE 6

Plate placement

  • Carefully place the plate

distally

  • Make sure you have a true

lateral view

  • Make sure the anterior cortex

is aligned and not flexed

  • Anchor with kwires, proximal

and distal

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SLIDE 7

Reduce plate to bone

  • Multiple techniques
  • Large bone clamp
  • Small incision, pusher
  • Non locking screw to anchor plate to bone
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SLIDE 8

Reduce the plate to bone

  • Proximally, minimally invasive techniques
  • Whirlibird to drag plate to bone
  • If it is not working, open the fracture and

reduce

  • Cortical screws proximally
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SLIDE 9

Double and triple check

  • It is easy not to have a true

lateral view

  • Check this proximally and

distally

  • Be critical
  • Do this before drilling and

placing screws

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SLIDE 10

Postop

  • WBAT
  • No brace
  • Immediate knee range of motion
  • Kammerlander C, Kates SL, Wagner M, Roth T, Blauth M. Minimally invasive periprosthetic plate osteosynthesis

using the locking attachment plate. Oper Orthop Traumatol. 2013 Aug;25(4):398-408, 410. doi: 10.1007/s00064- 011-0091-1.

  • Smith WR1, Stoneback JW2, Morgan SJ1, Stahel PF3. Is immediate weight bearing safe for periprosthetic

distal femur fractures treated by locked plating? A feasibility study in 52 consecutive patients. Patient Saf

  • Surg. 2016 Dec 7;10:26. eCollection 2016.
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Outcomes

  • Knees: poor outcomes 20% mortality at

year, age was a factor in recovery

Ruder JA1, Hart GP2, Kneisl JS1, Springer BD3, Karunakar MA1. Predictors of Functional Recovery Following Periprosthetic Distal Femur Fractures. J

  • Arthroplasty. 2016 Dec 23. pii: S0883-5403(16)30898-1.
  • 1 in 5 distal femur fractures treated with

ORIF develop nonunion

Hart GP1, Kneisl JS1, Springer BD1, Patt JC1, Karunakar MA1.Open Reduction vs Distal Femoral Replacement Arthroplasty for Comminuted Distal Femur Fractures in the Patients 70 Years and Older. J Arthroplasty. 2017 Jan;32(1):202-206. doi: 10.1016/j.arth.2016.06.006. Epub 2016 Jun 23.

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Do you need to worry about the implant type?

  • NO
  • It doesn’t matter
  • Can use for a plate for both CS and PS

knees

  • Besides: us trauma docs don’t know the

difference…

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SLIDE 13

Do you need to find out how big the box is?

  • NO
  • It doesn’t matter
  • So don’t worry when the hospital that the

surgery was performed no longer exists

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SLIDE 14

Do you need to worry about flexion deformity

  • NO
  • You can put the plate where you want and

not malreduce the fracture with the nail

  • You have control to reduce the fracture
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SLIDE 15

Do you need to worry about the total hip above the fracture

  • NO
  • You can use a long

plate and overlap the femoral stem

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SLIDE 16

If you can’t fix, revise!

  • Loose implants
  • No distal bone
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SLIDE 17

Distal Femoral Replacement

  • Pluses:

– Relatively straightforward – Immediate weight bearing

  • Minuses

– Rotating hinge – Problem if this needs to be revised

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SLIDE 18

Conclusions

Use a plate! Unless you take it all out and revise Either way weight bear as tolerated and get them moving

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Conclusions

  • Avoid the nail

– Don’t worry about implant details that you can’t get anyway – Don’t worry about malreductions due to posterior starting point due the implant – Don’t worry about proximal implants

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SLIDE 20

Thank You

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References

  • Kammerlander C, Kates SL, Wagner M, Roth T, Blauth M. Minimally invasive periprosthetic plate osteosynthesis using the

locking attachment plate. Oper Orthop Traumatol. 2013 Aug;25(4):398-408, 410. doi: 10.1007/s00064-011-0091-1.

  • Smith WR1, Stoneback JW2, Morgan SJ1, Stahel PF3. Is immediate weight bearing safe for periprosthetic distal femur

fractures treated by locked plating? A feasibility study in 52 consecutive patients. Patient Saf Surg. 2016 Dec 7;10:26. eCollection 2016.

  • Hart GP1, Kneisl JS1, Springer BD1, Patt JC1, Karunakar MA1.Open Reduction vs Distal Femoral Replacement

Arthroplasty for Comminuted Distal Femur Fractures in the Patients 70 Years and Older. J Arthroplasty. 2017 Jan;32(1):202-206. doi: 10.1016/j.arth.2016.06.006. Epub 2016 Jun 23.

  • Ruder JA1, Hart GP2, Kneisl JS1, Springer BD3, Karunakar MA1. Predictors of Functional Recovery Following

Periprosthetic Distal Femur Fractures. J Arthroplasty. 2016 Dec 23. pii: S0883-5403(16)30898-1.