The epub format uses ebook readers, which have several ease of reading. Multiplanar severely comminuted type c3 distal femoral fractures present many challenges in terms of surgical approach and technique of fixation, which eventually reflect on the final. A series of patients with apc reconstruction were evaluated to determine functional and radiologic. Comminuted distal femur fractures ao type c3 in patients with ao type c3 distal femoral fractures, dual plating offers a more stable construct. Two patients were treated with gmrs for distal femoral nonunion, enabling. Tomofix medial distal femur plate surgical technique depuy synthes companies 1 2 position patient place the patient in a supine position. Biopsy of tumors or cysts and obtaining samples for bone cultures are less common reasons for femoral surgery. Adaptive probabilistic approach for selecting tumour knee prosthesis. Gmrs proximal femoral surgical protocol 2 marking anterior aspect of femur a longitudinal line representing the anterior point on the femur should now be marked distal to the resection level to aid in rotational orientation of the prosthesis figure 2.
In general, a longer plate allows for better mechanical advantage over a shorter plate. The quadriceps muscle bellies are spared during the approach. Proximal tibial replacement in revision knee arthroplasty for non. Intraarticular distal femoral fractures are challenging both in osteoporotic bone and normal bone. We included people aged more than 65 years, with a diagnosis of distal femoral fracture, treated with locking plates. The departments electronic database was searched for all patients undergoing revision of total knee arthroplasty. Lecture notes in computer science computer science and. The system consists of a variety of different trochanter sections, anatomical in. This system, now known as the global mrs system, is manufactured by. Distal femur distal femur with allpoly tibial component while clinical history is the foundation for the gmrs system, our stateoftheart technology drives the systems outstanding performance.
Gmrs distal femoral surgical protocol introduction the gmrs distal femoral components are based on over a quarter of a century of clinical history. Piermatteis atlas of surgical approaches to the bones and. This system can replace the proximal femur, distal femur, total femur, or proximal humerus. The surgical options for treating distal femur fractures include intramedullary nailing and fixedangle plates with a combination of nonlocking and locking screws ehlinger et al.
Novel mr imaging method mavric for metal artifact suppression after joint. Total femur coupler 10cm or 30cm 7cm modular segmental distal femur the replacement value of each component is added together to achieve the total femoral constructs overall length. Rotating hinge allpoly tibial component which also articulates with the gmrs distal femur, is illustrated in. The information contained in this document is intended for. May 10, 2015 fractures of the distal part of femur are difficult to treat, whether surgical or non surgical methods are selected. Visualization of the hip, knee, and ankle joint with the image intensi. Short and mid term results of revision total knee arthroplasty with. Yet despite their proven track record and benefits over older implants, technical errors are common and must be overcome with proper preoperative planning and intraoperative attention to detail. At biomet, we strive to view our work through the eyes of. The knee approach was usually midline or anteromedial. Make a small incision 2cm over the distal femur fig. Class 2 device recall global modular replacement system.
The system also allows the conversion of the proximal and distal femoral systems into a total femur using a link shaft. A smallsize global modular replacement system gmrs prosthesis was inserted with an. Radiolucent targeter available for percutaneous technique2 compatible with the accord cable system to treat periprosthetic fractures beveled tip to assist with submuscular insertion available in 2, 4, 6, 9, 12, 15 and 18 hole configurations 99396mm distal femur radiolucent targeter available for percutaneous technique2. The surgeon noted a 10cm uncontained segmental defect of the proximal medial tibia with an intact tibial tubercle. The aim of this study is to evaluate functional outcome, fracture healing, and the complications of distal femoral intraarticular fractures using locking compression plates. This is an increasingly clinical situation because of the large amount of total knee replacements that are done and is expected to increase in the near. The described surgical technique is the suggested treatment for the uncomplicated procedure. The pushthrough total femoral prosthesis offers a functional. Distal femur ao type 33 b fractures consists partial articular fractures subdivided into 3 types namely sagittal lateral condyle fracture, medial condyle fracture and coronal split fracture. On the lateral view the shaft is aligned with the anterior half of the lateral condyle.
Femur prosthesis surgical literature product code jdi. The femur is the bone most commonly associated with traumatic fractures in the dog. The aim of this report was to provide an update on the existing surgical solutions for the management of these fractures and describe details of the surgical technique applicable to these injuries. The diversity of surgical options for the management of distal femoral fractures reflects the challenges inherent in these injuries. Distal femur resection with endoprosthetic reconstruction. Fragomen, md published outcomes of this procedure can be found at. The gmrs system balances the growing demand for highperformance implants with the growing needs of the patients who live with these implants daybyday. The annual number of revision total knee arthroplasty tka procedures in the united states. The distal femoral template is read at the appropriate. Surgical techniques for resection of distal femur and reconstruction using megaprosthesistumor prosthesis.
As in prior editions, piermatteis atlas of surgical approaches to the bones and joints of the dog and cat, 5th edition is teeming with highly detailed drawings that illustrate a wide range of surgical approaches. Orthopaedics gmrs proximal femoral surgical protocol. These fractures are frequently comminuted and intraarticular, and they often involve osteoporotic bone, which makes it difficult to reduce and hold them while maintaining joint function and overall limb alignment. The screws were taken unlocked first to bring the plate on the bone. Patella kinematics have been enhanced by incorporating a deepened patellar track to articulate with the duracon patellae. The distal femoral template is placed on the bone so that the silhouette of the template coincides with the distal condyles of the femur figure 1a. Locking plate fixation of distal femoral fractures is a. Swashbuckler approach and surgical technique in severely. Management of fractures of distal femur journal of medical. The femur is composed of three separate regions figure 612 74. Intraarticular fractures of distal femur present a huge surgical challenge. Structural failure of a modern knee tumor megaendoprosthesis.
Elevate the vastus lateralis and expose the distal end of the femur. This salvage procedure allows elderly, infirm patients to regain early ambulatory ability. Materials and methods between 1980 and 1998, 110 consecutive patients had distal femur resection with endoprosthetic reconstruction. Fractures of the distal part of femur are difficult to treat, whether surgical or nonsurgical methods are selected. Because of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture. In a large study of 247 gmrs prostheses, pala et al. The distal incision was opened, then closed reduction was. Gmrs proximal femoral surgical protocol stryker meded. Class 2 device recall global modular replacement system gmrs. Surgical repair of femoral injuries may be divided into surgery of the proximal, diaphyseal, and distal femur. Anatomy of the distal femur cambridge orthopaedics.
Radiographs of the custom nonfluted stem inserted after distal. Calcaneal fracture orif with arthrex calcaneal fracture plate utilizing quickset duration. Aug 02, 2017 surgical techniques for resection of distal femur and reconstruction using megaprosthesistumor prosthesis. Another issue is periprosthetic fractures of the distal femur after total knee arthroplasty. The approach allows surgical exposure of the entire articular surface of the distal femur. Surgical technique distal femur cut first fourinone technique. A modified anterior approach to the distal femur is presented. Current concepts in fractures of the distal femur soucasny pohled na zlomeniny dolniho konce stehenni kosti b. The original system was developed by the senior author mm in conjunction with the engineers lead engineer george corsi at howmedica rutherford, nj.
Small incisions proximal and distal to the fracture with proper contouring of the plate before insertion. Conservative treatment often leads to knee stiffness, quadriceps wasting, fracture angulation, knee joint incongruity and displacement within the cast. Standard periloc radiolucent targeter instrumentation facilitates streamlined minimally invasive fixation of proximal femur fractures. The proximal femoral module and distal femoral module of the gmr may be used together, or with the components of the mrs, in replacement of the total femur. One stem showed moderate resorption in the medial distal femur at the stem tip. Locking compression plate in distal femoral intraarticular.
Insert the plate underneath the vastus and above the. Management of distal femur fractures with modern plates and. Patella kinematics have been improved by incorporating a deepened patellar track to articulate with the duracon patellae. This edition also features six all new surgical approaches and three approaches which have been expanded to illustrate the. Gmrs distal femoral surgical protocol femoral osteotomy all remaining soft tissue at the level of transection is cleared.
Utilizes gmrs small axle, small bushings and mrh bumper utilizes modular rotating hinge axle, bushings, and bumper distal femur distal femur with allpoly tibial component while clinical history is the foundation for the gmrs system, our stateoftheart technology drives the systems outstanding performance. Using a cobb elevator, dissect the plane between the perisoteum of the femur and the vastus lateralis. The technique for the gmrs proximal tibia which also articulates with the distal femoral. Distal femoral replacement in periprosthetic fracture around. The osteotomy, perpendicular to the femoral shaft, is performed after the posterior and medial structures have been protected and retracted figure 3. In addition, with the use of locking caps the screws can be locked and made angularly stable. Initially, with the use of custom adapters, the gmrs system was used in concert. Hoffas fracture is tangential unicondylar fracture of distal femoral condyle and is a relatively rare injury.
A guide to the placement of this mark is the linea aspera on the posterior aspect of the femur. Distal femur allograft prosthetic composite reconstruction. May 04, 2016 surgical approach the lateral approach to the distal femur is the standard surgical approach for the fixation of type a distal femur fractures. The surgical approach was subject to variations due to specific patient history. Class 2 device recall gmrs proximal femoral surgical protocol. From these, all patients having distal femoral replacement for periprosthetic fracture around the distal femoral component using the stryker global modular replacement system gmrs implant were filtered. Anterior surface slopes downward from lateral to medial, lateral wall inclines 10 degrees. It is recommended that when selecting plate length. Babst department of trauma surgery, cantonal hospital lucerne, lucerne, switzerland summary this paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. Committed to delivering a higher standard, rtis implants are used in sports medicine, general surgery, spine, orthopedic. The preparation of the distal femur was made in accordance with the surgical technique. Surgical technique the profemurz is a femoral implant designed with a rectangular cross section and a conical profile characterised by a constant increase in volume from the distal tip to the proximal area.
Global modular replacement system proximal femoral resection for large segmental replacements, femur prosthesis surgical literature, stryker orthopaedics, mahwah, nj 07430. Global modular replacement system proximal femoral resection for large segmental replacements, femur prosthesis surgical literature, stryker. Limb sparing options include a short stemmed modular prosthesis, total endoprosthetic replacement, crosspin fixation to a custom implant, and allograft prosthetic composite reconstruction apc. Orthopaedic surgery procedure widely utilizes bone drilling in the work for. Orthopaedic oncology revision surgery trauma gmrs using clinical. For reconstructive surgery of the knee joint, the global modular. Submuscular locked plate for fixation of pediatric fracture. Distal femur ao type 33 b surgical options, results and. It involves a midlateral skin incision, incision of the iliotibial tract and atraumatic elevation of the vastus lateralis from the intermuscular septum fig 5a. Axle joint with rotating hinge configuration was used to represent gmrs. Surgical techniques lengthening of the femur with a remotecontrolled magnetic intramedullary nail antegrade technique s. Distal femur resection and endoprosthetic replacemnt. Short metaphyseal segments remaining after distal femoral tumor resection pose a unique challenge.
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