severe osteoporosis.ppt

7/24/2019 severe osteoporosis.ppt

1/75


2/75

Topics

Fixation Technique

Locking Compression Plate

Blade ( Rotational or Spiral )

Tension band iring

Buttress plate

Bone Cement

Clinical application


3/75

!ynamic Compression

An"ular Sta#ility

$C% &$ockin" Compression %late'


4/75

$C% %late hole desi"n and screws

Compression %late (nternal Fixator


5/75

)iomechanics Force Transmission

Conventional plate $ockin" plate

Compression

(nternal Fixator


6/75

(mplant

(nternal Fixator



Compression

Friction


7/75

(mplant



Compression

Friction

dependin" on

#one *uality

independent o+

#one *uality


8/75

An"ular Sta#ility

Advantages of locking plate

1. Improved stability

Accurate plate contouring unnecessary

-Less disturbance of periosteal blood supply

.Less screw loosening


9/75

An"ular Sta#ilityAn"ular Sta#ility







10/75

$ar"er area o+ resistanceSe*uential screw pullout

)endin" +orce


11/75

%arallel direction o+screw insertion

Multi direction o+screw insertion

Pull-out strength direction of screw


12/75

$/S%&$ockin" /umerus Spoon %late'

Comminuted+x

Osteoporotic#one

01 y, F

pseudarthrosis

2year a+ter in3

Improved stability


13/75

!"#$ F$%%&C'$


14/75

ust ater op$ * months ater op$


15/75

22 months after inj.22 months after inj. LHSPLHSP Bone graft 4 weeks laterBone graft 4 weeks later

51y. Female. RA. 11-A351y. Female. RA. 11-A3 non-unionnon-union


16/75

51y. Female. RA.RA. 11-A3 non-union

3 months after re-operation


17/75

Severe Osteoporotic cases


18/75

!istal humerus

lockin" plates$C% Metaphyseal


19/75


20/75

An"ular Sta#ility







21/75

$%Conv %


(nternal Fixator


22/75

An"ular Sta#ility







23/75

$C%Conv %

%eriosteal #lood

distur#ance due to

plate compression

Less disturbance of periosteal blood supply


24/75

An"ular Sta#ility







25/75

$%Conv %

$oad

Less screw loosening


26/75

$%Conv %



27/75

$%Conv %!ual Sin"le



28/75

98y. Female.


29/75

5 months after


30/75

Asian %FNA

+nstable Trochanteric Fractures,steoporotic bone

Suitable or -sian structure

-nti&rotation ,ptimal stabilit#

,ne single element


31/75

.xcellent it through bone compaction

.xcellent it through bone compaction

Less bone remo/al compared to a screLess bone remo/al compared to a scre

Sta#le Fixation 444 %FNA )lade


32/75

A562- mm A570 mm

Se"ment Se"ment


)one removal &!/S' versus #one compaction &%FNA'


33/75

1 mm

8d"e o+ helical #lade)orderline thread



34/75

Requirement

Bending point should be high

Lateral side edge should be

smooth circular arc

Proximal diameter should be

thin don

Asian %FNA


35/75

(mprovement o+ Nail

$ateral cut

%rotect lateral wall

%roximal #endin" point

$ateral #endin" an"le 9

PFNA

Asian PFNA


36/75

(mprovement o+ Nail

Bending point

Lateral bending angle

%FNA 7

Asian

%FNA

9


37/75

(mprovement o+ Nail

Blade end

Blade end

%$*mm shorter 0 Reduce a protrusion

at the lateral cortex

%FNA

Asian %FNA


38/75

1istal locking option

Static o#li*ue Static transverse !ynamic


39/75

!!#$ F$ unstable Fx$

' months ater op$

o PF2-


40/75

%34#$ F

10 w


41/75

Tension band wiring

Good indication:

Proximal humeral fractures. Distal humeral fractures

Utilize soft tissues : Not influenced by bone quality

Fixation strength: Not so stable


42/75

556$ Female$ C"


43/75

Tension band iring

ust ater operation


44/75

,ne #ear ater operation


45/75

%%&C"4!#$ Female

Fracture&dislocation 7 greater tuberosit# racture


46/75

1isplaced head

Reduction


47/75

ust ater operation ,ne #ear later,ne #ear later


48/75

!8#$ Female$ %"&-'


49/75

First operation


50/75

%'eeks ater the operation


51/75

Tension band iring 9 Bone grat


52/75

Buttress Plate

SupportSupport

-gainst the axial loading-gainst the axial loading


53/75

%"&B%%"&B%


54/75

-rticular surace & "$*mm scre-rticular surace & "$*mm scre

:etaph#sis & buttress plate:etaph#sis & buttress plate


55/75

%"&B'%"&B'


56/75

8 eeks ater operation8 eeks ater operation


57/75


58/75

!8#; F$


59/75

62y Male

;ust a+ter in3ury;ust a+ter in3ury ;ust a+ter op;ust a+ter op


60/75

62y Male

7 months a+ter op7 months a+ter op


61/75


62/75


63/75

)one Cement +or Screw Fixation

.nhanced plate ixation strength to the bone

1on=t use racture site

-ter drilling and tapping; in>ect the bone cement

Beore hardening the cement; insert scres$


64/75

5*#$ F$5*#$ F$ Peri&T.- racturePeri&T.- racture

Loosening o implantLoosening o implant


65/75

"$*mm

reconstruction plate

(double plate)

Bone cement


66/75

% #ear ater op$% #ear ater op$

Bone union(7)Bone union(7)

Trochanteric Fractures treated b#


67/75

#

1


68/75

#

CC


69/75

Stress 1istribution

From the /ie o Biomechanical aspect

Stress concentration

? Breakage o the Fixation?2e other Fractures


70/75

5"#; Female

2on&union


71/75

ust ater op$ust ater op$ 4months ater op$4months ater op$


72/75

@%#$ F$ ""&-'


73/75

@%#$ F$ ""&-' %3 1a#s ater op$


74/75

@%#$ F$ ""&-' Re&Fixation


75/75

severe osteoporosis.ppt

Documents

Transcript of severe osteoporosis.ppt