The departments electronic database was searched for all patients undergoing revision of total knee arthroplasty. Fragomen, md published outcomes of this procedure can be found at. May 10, 2015 fractures of the distal part of femur are difficult to treat, whether surgical or non surgical methods are selected. Committed to delivering a higher standard, rtis implants are used in sports medicine, general surgery, spine, orthopedic. Axle joint with rotating hinge configuration was used to represent gmrs. Current concepts in fractures of the distal femur soucasny pohled na zlomeniny dolniho konce stehenni kosti b. Radiographs of the custom nonfluted stem inserted after distal. Standard periloc radiolucent targeter instrumentation facilitates streamlined minimally invasive fixation of proximal femur fractures. Biopsy of tumors or cysts and obtaining samples for bone cultures are less common reasons for femoral surgery. 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. Short and mid term results of revision total knee arthroplasty with. 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. Nov 30, 2017 calcaneal fracture orif with arthrex calcaneal fracture plate utilizing quickset duration. 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 quadriceps muscle bellies are spared during the approach. 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. Short metaphyseal segments remaining after distal femoral tumor resection pose a unique challenge. This salvage procedure allows elderly, infirm patients to regain early ambulatory ability. Management of fractures of distal femur journal of medical. Hoffas fracture is tangential unicondylar fracture of distal femoral condyle and is a relatively rare injury. Management of distal femur fractures with modern plates and. Adaptive probabilistic approach for selecting tumour knee prosthesis. Locking plate fixation of distal femoral fractures is a. For reconstructive surgery of the knee joint, the global modular. Two patients were treated with gmrs for distal femoral nonunion, enabling. 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.
Piermatteis atlas of surgical approaches to the bones and. The distal incision was opened, then closed reduction was. Orthopaedic surgery procedure widely utilizes bone drilling in the work for. Calcaneal fracture orif with arthrex calcaneal fracture plate utilizing quickset duration. Class 2 device recall global modular replacement system. It is recommended that when selecting plate length. Gmrs distal femoral surgical protocol femoral osteotomy all remaining soft tissue at the level of transection is cleared. The system consists of a variety of different trochanter sections, anatomical in. The described surgical technique is the suggested treatment for the uncomplicated procedure.
We included people aged more than 65 years, with a diagnosis of distal femoral fracture, treated with locking plates. 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. Global modular replacement system proximal femoral resection for large segmental replacements, femur prosthesis surgical literature, stryker. The approach allows surgical exposure of the entire articular surface of the distal femur.
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. Materials and methods between 1980 and 1998, 110 consecutive patients had distal femur resection with endoprosthetic reconstruction. The surgical approach was subject to variations due to specific patient history. Distal femur allograft prosthetic composite reconstruction. Class 2 device recall global modular replacement system gmrs. This double taper configuration is intended to provide wide cortical contact, rotational. Proximal and distal femur products rti surgical holdings. The pushthrough total femoral prosthesis offers a functional. A modified anterior approach to the distal femur is presented. 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. The aim of this study is to evaluate functional outcome, fracture healing, and the complications of distal femoral intraarticular fractures using locking compression plates. Class 2 device recall gmrs proximal femoral surgical protocol. 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.
A smallsize global modular replacement system gmrs prosthesis was inserted with an. Aug 02, 2017 surgical techniques for resection of distal femur and reconstruction using megaprosthesistumor prosthesis. This edition also features six all new surgical approaches and three approaches which have been expanded to illustrate the. Using a cobb elevator, dissect the plane between the perisoteum of the femur and the vastus lateralis.
The femur is the bone most commonly associated with traumatic fractures in the dog. Rotating hinge allpoly tibial component which also articulates with the gmrs distal femur, is illustrated in. 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. Anatomy of the distal femur cambridge orthopaedics. The original system was developed by the senior author mm in conjunction with the engineers lead engineer george corsi at howmedica rutherford, nj. Distal femur resection and endoprosthetic replacemnt. The epub format uses ebook readers, which have several ease of reading. The annual number of revision total knee arthroplasty tka procedures in the united states. Lecture notes in computer science computer science and. Surgical technique distal femur cut first fourinone technique. Orthopaedics gmrs proximal femoral surgical protocol. The distal femoral template is read at the appropriate.
Distal femur resection with endoprosthetic reconstruction. Patella kinematics have been improved by incorporating a deepened patellar track to articulate with the duracon patellae. Another issue is periprosthetic fractures of the distal femur after total knee arthroplasty. Intraarticular fractures of distal femur present a huge surgical challenge. 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.
Patella kinematics have been enhanced by incorporating a deepened patellar track to articulate with the duracon patellae. The technique for the gmrs proximal tibia which also articulates with the distal femoral. Distal femoral replacement in periprosthetic fracture around. In general, a longer plate allows for better mechanical advantage over a shorter plate. The knee approach was usually midline or anteromedial. In addition, with the use of locking caps the screws can be locked and made angularly stable. Novel mr imaging method mavric for metal artifact suppression after joint. Swashbuckler approach and surgical technique in severely. Initially, with the use of custom adapters, the gmrs system was used in concert. It involves a midlateral skin incision, incision of the iliotibial tract and atraumatic elevation of the vastus lateralis from the intermuscular septum fig 5a.
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. 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. Fractures of the distal part of femur are difficult to treat, whether surgical or nonsurgical methods are selected. Gmrs distal femoral surgical protocol introduction the gmrs distal femoral components are based on over a quarter of a century of clinical history. Insert the plate underneath the vastus and above the.
One stem showed moderate resorption in the medial distal femur at the stem tip. This system can replace the proximal femur, distal femur, total femur, or proximal humerus. The screws were taken unlocked first to bring the plate on the bone. 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. 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. Lengthening of the femur with a remotecontrolled magnetic. Femur prosthesis surgical literature product code jdi. Gmrs proximal femoral surgical protocol stryker meded. A series of patients with apc reconstruction were evaluated to determine functional and radiologic. 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. Comminuted distal femur fractures ao type c3 in patients with ao type c3 distal femoral fractures, dual plating offers a more stable construct.
The osteotomy, perpendicular to the femoral shaft, is performed after the posterior and medial structures have been protected and retracted figure 3. Anterior surface slopes downward from lateral to medial, lateral wall inclines 10 degrees. The diversity of surgical options for the management of distal femoral fractures reflects the challenges inherent in these injuries. This system, now known as the global mrs system, is manufactured by. On the lateral view the shaft is aligned with the anterior half of the lateral condyle. In a large study of 247 gmrs prostheses, pala et al.
Make a small incision 2cm over the distal femur fig. Limb sparing options include a short stemmed modular prosthesis, total endoprosthetic replacement, crosspin fixation to a custom implant, and allograft prosthetic composite reconstruction apc. Conservative treatment often leads to knee stiffness, quadriceps wasting, fracture angulation, knee joint incongruity and displacement within the cast. Elevate the vastus lateralis and expose the distal end of the femur. Surgical techniques for resection of distal femur and reconstruction using megaprosthesistumor prosthesis. Locking compression plate in distal femoral intraarticular. At biomet, we strive to view our work through the eyes of. Distal femur ao type 33 b surgical options, results and. Submuscular locked plate for fixation of pediatric fracture. The preparation of the distal femur was made in accordance with the surgical technique. Intraarticular distal femoral fractures are challenging both in osteoporotic bone and normal bone. Structural failure of a modern knee tumor megaendoprosthesis. The distal femoral template can be used to guide the resection to a level that can be reproduced by the available implants. 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.
Because of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture. The gmrs system balances the growing demand for highperformance implants with the growing needs of the patients who live with these implants daybyday. The surgeon noted a 10cm uncontained segmental defect of the proximal medial tibia with an intact tibial tubercle. Small incisions proximal and distal to the fracture with proper contouring of the plate before insertion.
The system also allows the conversion of the proximal and distal femoral systems into a total femur using a link shaft. A guide to the placement of this mark is the linea aspera on the posterior aspect of the. 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. Surgical techniques lengthening of the femur with a remotecontrolled magnetic intramedullary nail antegrade technique s. A guide to the placement of this mark is the linea aspera on the posterior aspect of the femur. Global modular replacement system proximal femoral resection for large segmental replacements, femur prosthesis surgical literature, stryker orthopaedics, mahwah, nj 07430. The femur is composed of three separate regions figure 612 74. 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. Proximal tibial replacement in revision knee arthroplasty for non. Surgical repair of femoral injuries may be divided into surgery of the proximal, diaphyseal, and distal femur. The information contained in this document is intended for. Tomofix medial distal femur plate surgical technique depuy synthes companies 1 2 position patient place the patient in a supine position.