Mark Clatworthy Middlemore Hospital Auckland New Zealand · Nonunion rate RIMN 1.5% cf 5.3% for LP...
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Mark Clatworthy Middlemore Hospital Auckland New Zealand
Transcript of Mark Clatworthy Middlemore Hospital Auckland New Zealand · Nonunion rate RIMN 1.5% cf 5.3% for LP...
MarkClatworthyMiddlemoreHospital
AucklandNewZealand
Incidence0.9%primary,1.7%revision–USdataPersonalseries0/2155
Riskfactors–age,osteoporosis,steroiduse,neurologicalconditions,RharthritisNotchingfemur??,Navigationpins
AllfractureideallyrequirestabilizationType1undisplacedfractureinapatientunsuitableforsurgerycantrialtractionorabrace
CRTKAmaybeamenabletoretrogradeIMnail
PositioningofthefemoralimplantimportanttodeterminepositioningoftheIMnail
Anintercondylardistanceof>1mmthenaildiameterisrequired
LockeddistalplatessuchastheLISSplateareusefulinosteoporoticbone,moredistalfractures,andsituationsinwhichthefemoralcomponentdoesnotallowpassageofanail.
LateralapproachOpenreductionoffracturePercutaneousproximalscrewplacementunderIIguidance
BiomechanicalstudyComputMethodsBiomechBiomedEngin.2011TheprobabilisticanalysisfoundthelockingplatefixationtohaveahigherprobabilityoffracturethantheIMnailfixationundertheappliedloadingconditionsLockingplate21.8%versusIMnail0.019%
HerreraetalActaOrthop2008NonunionrateRIMN1.5%cf5.3%forLPSecondaryprocedure4.6%RIMNgroupcf8.8%LP
MeneghinietalJArthroplasty2014Nonunionratetobe9%RIMNcf19%LPDespitethisdifference,theRIMNgroupshowedasignificantlyhighermalunionrate(11%vs9%forLP)
Indicationsare: Significantcomminutionandorosteoporosis Fracturetoodistaltousemultiplescrewinsertion Loosefemoralcomponent Instability
Enablesrapidrecoverywithearlymobilizationandweight‐bearing
Nounionissues
Primaryversussecondarydistalfemoralarthroplastyfortreatmentoftotalkneearthroplastyperiprostheticfemurfractures.ChenetalJArthroplasty2013
ThereweresignificantlymoresurgicalproceduresforORIFrevisiontoDFAcomparedtoprimaryDFA
PrimaryreconstructionviaORIFisbeneficialforpreservingbonestock,butprimaryDFAmaybepreferredinosteopenicpatients,orthoseathighriskfornonunion
Incidenceof0.4%‐1.7%Personalseries3/2155–0.1%‐Twopinsite#’s
Aetiology‐usuallytraumaMal‐alignmentcanleadtoastressfracturePinsitefractures
TypeA StableProsthesisTypeB UnstableProsthesis
TypeC IntraoperativeFracture
Determinedbyimplantloosening
Iflooserevisewithlongstemdistaltothefracturewithlockedplate
Ifimplantstable–lockedplate
