severe osteoporosis.ppt
Transcript of severe osteoporosis.ppt
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Topics
Fixation Technique
Locking Compression Plate
Blade ( Rotational or Spiral )
Tension band iring
Buttress plate
Bone Cement
Clinical application
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!ynamic Compression
An"ular Sta#ility
$C% &$ockin" Compression %late'
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$C% %late hole desi"n and screws
Compression %late (nternal Fixator
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)iomechanics Force Transmission
Conventional plate $ockin" plate
Compression
(nternal Fixator
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(mplant
(nternal Fixator
Conventional plate $ockin" plate
)iomechanics Force Transmission
Compression
Friction
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(mplant
Conventional plate $ockin" plate
)iomechanics Force Transmission
Compression
Friction
dependin" on
#one *uality
independent o+
#one *uality
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An"ular Sta#ility
Advantages of locking plate
1. Improved stability
Accurate plate contouring unnecessary
-Less disturbance of periosteal blood supply
.Less screw loosening
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An"ular Sta#ilityAn"ular Sta#ility
Advantages of locking plate
1. Improved stability
Accurate plate contouring unnecessary
-Less disturbance of periosteal blood supply
.Less screw loosening
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$ar"er area o+ resistanceSe*uential screw pullout
)endin" +orce
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%arallel direction o+screw insertion
Multi direction o+screw insertion
Pull-out strength direction of screw
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$/S%&$ockin" /umerus Spoon %late'
Comminuted+x
Osteoporotic#one
01 y, F
pseudarthrosis
2year a+ter in3
Improved stability
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!"#$ F$%%&C'$
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ust ater op$ * months ater op$
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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
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51y. Female. RA.RA. 11-A3 non-union
3 months after re-operation
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Severe Osteoporotic cases
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!istal humerus
lockin" plates$C% Metaphyseal
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An"ular Sta#ility
Advantages of locking plate
1. Improved stability
Accurate plate contouring unnecessary
-Less disturbance of periosteal blood supply
.Less screw loosening
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$%Conv %
Accurate plate contouring unnecessary
(nternal Fixator
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An"ular Sta#ility
Advantages of locking plate
1. Improved stability
Accurate plate contouring unnecessary
-Less disturbance of periosteal blood supply
.Less screw loosening
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$C%Conv %
%eriosteal #lood
distur#ance due to
plate compression
Less disturbance of periosteal blood supply
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An"ular Sta#ility
Advantages of locking plate
1. Improved stability
Accurate plate contouring unnecessary
-Less disturbance of periosteal blood supply
.Less screw loosening
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$%Conv %
$oad
Less screw loosening
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$%Conv %
Less screw loosening
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$%Conv %!ual Sin"le
Less screw loosening
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98y. Female.
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5 months after
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Asian %FNA
+nstable Trochanteric Fractures,steoporotic bone
Suitable or -sian structure
-nti&rotation ,ptimal stabilit#
,ne single element
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.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
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A562- mm A570 mm
Se"ment Se"ment
Sta#le Fixation 444 %FNA )lade
)one removal &!/S' versus #one compaction &%FNA'
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1 mm
8d"e o+ helical #lade)orderline thread
Sta#le Fixation 444 %FNA )lade
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Requirement
Bending point should be high
Lateral side edge should be
smooth circular arc
Proximal diameter should be
thin don
Asian %FNA
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(mprovement o+ Nail
$ateral cut
%rotect lateral wall
%roximal #endin" point
$ateral #endin" an"le 9
PFNA
Asian PFNA
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(mprovement o+ Nail
Bending point
Lateral bending angle
%FNA 7
Asian
%FNA
9
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(mprovement o+ Nail
Blade end
Blade end
%$*mm shorter 0 Reduce a protrusion
at the lateral cortex
%FNA
Asian %FNA
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1istal locking option
Static o#li*ue Static transverse !ynamic
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!!#$ F$ unstable Fx$
' months ater op$
o PF2-
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%34#$ F
10 w
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Tension band wiring
Good indication:
Proximal humeral fractures. Distal humeral fractures
Utilize soft tissues : Not influenced by bone quality
Fixation strength: Not so stable
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556$ Female$ C"
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Tension band iring
ust ater operation
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,ne #ear ater operation
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%%&C"4!#$ Female
Fracture&dislocation 7 greater tuberosit# racture
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1isplaced head
Reduction
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ust ater operation ,ne #ear later,ne #ear later
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!8#$ Female$ %"&-'
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First operation
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%'eeks ater the operation
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Tension band iring 9 Bone grat
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Buttress Plate
SupportSupport
-gainst the axial loading-gainst the axial loading
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%"&B%%"&B%
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-rticular surace & "$*mm scre-rticular surace & "$*mm scre
:etaph#sis & buttress plate:etaph#sis & buttress plate
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%"&B'%"&B'
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8 eeks ater operation8 eeks ater operation
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!8#; F$
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62y Male
;ust a+ter in3ury;ust a+ter in3ury ;ust a+ter op;ust a+ter op
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62y Male
7 months a+ter op7 months a+ter op
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)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$
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5*#$ F$5*#$ F$ Peri&T.- racturePeri&T.- racture
Loosening o implantLoosening o implant
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"$*mm
reconstruction plate
(double plate)
Bone cement
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% #ear ater op$% #ear ater op$
Bone union(7)Bone union(7)
Trochanteric Fractures treated b#
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#
1
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#
CC
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Stress 1istribution
From the /ie o Biomechanical aspect
Stress concentration
? Breakage o the Fixation?2e other Fractures
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5"#; Female
2on&union
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ust ater op$ust ater op$ 4months ater op$4months ater op$
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@%#$ F$ ""&-'
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@%#$ F$ ""&-' %3 1a#s ater op$
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@%#$ F$ ""&-' Re&Fixation
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