A fixed boundary condition has been applied on the distal end of the femur and the hip contact force has been applied on the head of the femur in order to calculate the normal stresses for normal walking and standing up during this boundary condition. Femur axsos 3 titanium operative technique distal lateral femur. Distal femoral fracture during primary tka is rare and associated with the use of a semiconstrained. Nov 30, 2017 this feature is not available right now. Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate. Distal targeting system for gamma3 long nails and t2 recon nails in response to the request of surgeons around the world, stryker osteosynthesis has created a dedicated distal targeting system. Distal condylar screws are parallel to the joint surface to provide a stable support structure in the metaphyseal region multiple points of fixation increased strength optimized fit percutaneous instrumentation stable support inspired by anatomy inspired by simplicity fracturespecific solutions proximal femur.
Because the knee is the largest weightbearing joint in the body, any defect can damage the protective articular cartilage and, over time, result in arthritis. Supracondylar nailing for difficult distal femur fractures article pdf available in journal of orthopaedic surgery hong kong 112. Gmrs distal femoral surgical protocol introduction the gmrs distal femoral components are based on over a quarter of a century of clinical history. Distal femoral fracture during primary total knee arthroplasty. Chapter 53 fractures of the distal femur china quad diaries. Distal femur fractures and its treatment with distal femur. Orthopaedics gmrs proximal tibial surgical protocol table of contents introduction 2 description of the proximal tibial global modular replacement system 4 surgical protocol 7 measuring resection length 8 tibial osteotomy 9 femoral sizing 9 preparation for the mrh femoral component 10 femoral canal preparation 10 distal femoral resection 11 intramedullary alignment 12. Distal femur fractures and its treatment with distal femur locking plate kanav padha, sandeep singh, abdul ghani, harish dang the incidence of distal femur fractures is around 37 100,000 patients per year. Stryker would like to thank the following surgeons for their contributions in devel oping the global modular replacement. Orthomap express knee navigation software orthomap express knee navigation software is an intuitive, easytouse software and hardware combination that powers a simpler, less invasive approach to distal femoral resections, proximal tibial resections and femoral rotation. Distal femur plate carbofix main carbofix orthopedics. Current concepts in fractures of the distal femur soucasny pohled na zlomeniny dolniho konce stehenni kosti b. Chronic osteomyelitis of the distal femur treated with. Distal femur distal femur with allpoly tibial component while clinical history is the foundation for the gmrs system, our.
Made of continuous carbon fibers reinforced polymer. Tibia and femur axsos 3 ti distal lateral femur with targeter operative technique henderson, ce et al. Assistance at its toll free number 800 6382041 or 301 4436597 or at its internet address. Pdf chronic osteomyelitis of the distal femur treated with. Complete physeal arrest of left distal femur icd10cm diagnosis code m89. The distal femur was resected through a midline skin incision and medial parapatellar arthrotomy. Panoramic radiographs of the lower limbs bearing weight. Jan 10, 2016 operative treatment of acute distal femur fractures.
The system consists of a smiles knee, a range of shafts in 15mm increments to suit differing lengths of resections, a range of hydroxyapatite coated and uncoated collars of different diameters. Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss. Stage one involved resection of infected bone and placement of an intramedullary nail spanning the bony defect between proximal femur and tibia, with antibiotic cement. A guide to the placement of this mark is the linea aspera on the posterior aspect of the femur. In general, a longer plate allows for better mechanical advantage over a shorter plate. Dec 03, 2015 distal femur locked plates are intended for fixation of distal shaft fractures, supracondylar fractures, intrearticular fractures and periprosthetic fractures of distal femur category people. Plate system for distal femur and proximal lateral tibia. Modular megaprosthesis for distal femoral tumors request pdf. Distal femoral fractures are severe injuries which are technically challenging to treat surgically.
Locked plating for internal fixation of the adult distal. Unfortunately, neither study reported on reaming techniques or on stem diameter. Adaptive probabilistic approach for selecting tumour knee prosthesis. The global modular replacement system is intended to be used with the components of the howmedica osteonics modular replacement system, the howmedica osteonics modular rotating hinge knee system andor the howmedica osteonics kinematic rotating hinge knee system in situations where replacement of extensive bone loss in the femur andor. Femoral cadaveric specimens were thawed and cut at the distal end of the femur, at cm from the distal joint line, to e represent a distal femoral tumor resection. Despite technique suggestions from anecdotal and some early reports, knowledge about risk factors for failure, nonunion nu, and revision is limited. The proximal femoral module and distal femoral module of the gmrs may be used together, or with the components of the mrs, in replacenient of the total femur. Localize the frontal plane of the distal femur instrument 292. Stryker orthopaedics introduced its first rotating.
Stryker s gmrs represents another significant option in modular replacement systems as a solution that can help retain quality of life for patients who require radical bone resection. The medial approach to the distal femur is useful to expose a medial distal femoral fractures, a hoffatype fracture, osteochondroma, or a neoplastic lesion of bone. Open reduction and fixation is often preferred in displaced. Treatment with a retrograde inserted locked intramedullary nail, journal of orthopaedic trauma, vol. Intraarticular fractures of distal femur present a huge surgical challenge.
Distal femur lecture orthopaedic trauma association. It offers guidance that you should heed, but, as with any. Influence of the type of construct and hardware on the clinical and radiological outcomes author links open overlay panel m. Anatomically precontoured low profile plates reduced soft tissue problems no need for plate contouring note. The management of chronic osteomyelitis of the distal femur is difficult and often results in limb loss. Pdf chronic osteomyelitis involving the distal femur often results in amputation or arthrodesis. Pdf distal femoral cut in total knee arthroplasty in a. Biomechanical analysis of the human femur bone during normal. The information contained in this document is intended for healthcare professionals only.
Pdf core decompression of the distal femur for avascular. Health, general bones care and treatment diagnosis necrosis risk factors. In massive, segmental defects with loss of collateral ligamentous support and lack of bone to support the use of prosthetic augments or metaphyseal cones or sleeves, a hinged proximal tibial replacement or a socalled megaprosthesis should be available. Patella kinematics have been improved by incorporating a deepened patellar track to articulate with the duracon patellae. The departments electronic database was searched for all patients undergoing revision of total knee arthroplasty. Orthopaedics gmrs proximal tibial surgical protocol. Class 2 device recall global modular replacement system gmrs. Distal femoral resection 11 intramedullary alignment 12.
Gmrs proximal femoral surgical protocol acknowledgements stryker would like to thank all of the surgeons for their contributions in developing the global modular replacement system gmrs. The aim of this study is to evaluate functional outcome, fracture healing, and the complications of distal femoral intraarticular fractures using locking compression plates. Proximal tibial metaphyseal bone loss compromises the alignment and fixation of components during revision total knee arthroplasty. Pdf what is new in distal femur periprosthetic fracture. The record is updated if the fda identifies a violation and classifies the action as a recall, and it is updated for a final time when the recall is terminated. Gmrs stems without derotational flutes, as well as the very similar stryker. Gmrs proximal femoral surgical protocol stryker meded. Excessive and repetitive bending is not recommended as it may weaken the plate. Distal femur thighbone fractures of the knee orthoinfo aaos. Distal femoral replacement in periprosthetic fracture.
Distal femur plate distal femur locked plate youtube. The system allows for polyaxial screw placement with subsequent screw locking for improved stability especially within osteopenic bone. Structural failure of a modern knee tumor megaendoprosthesis. Frequently, these patients have a history of fracture, and early infection progresses to chronic osteomyelitis 1, 3, 4.
Distal femur fractures, complications, surgical management. Distal femur fractures that enter the the knee joint may heal with a defect in the normally smooth surface of the joint. Nonunions around the knee joint pubmed central pmc. Simultaneous freetissue transfer and ilizarov distraction. Open reduction vs distal femoral replacement arthroplasty for comminuted distal femur fractures in the patients 70 years and older. The incidence of primary total knee replacement tkr is increasing with a resultant rise in those patients sustaining distal femoral periprosthetic fractures around tkrs. Distal femoral fractures account for 3%6% of all fractures of the femur. There was free range of motion of the right knee joint. Clinical outcomes of locked plating of distal femoral. Axle joint with rotating hinge configuration was used to represent gmrs. Locking compression plate in distal femoral intraarticular.
Lcp periarticular plating system the lcp periarticular plating system is capable of addressing. Global modular replacement system one system, one vision. Pdf is distal femur locking plate a superior implant in. To determine the ideal angle for making the distal femoral cut in total knee arthroplasty in a brazilian population. Pdf hip abductor moment arm a mathematical analysis. Proximal tibial replacement in revision knee arthroplasty.
Pdf distal femoral fracture during primary total knee. Positive results have been published by researchers with implants such as distal femur nail, dynamic condylar screw and even addition of a medial plate to a distal femur locking plate for treating distal femur fractures. Please vote below and help us build the most advanced adaptive learning platform in medicine. It is also useful to expose the neurovascular bundle when a distal femoral fracture is complicated by an arterial injury. 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. Fractures of the distal femur whether supracondylar. Locked plating for internal fixation of the adult distal femur.
Retrograde femoral nailing of periprosthetic fractures. Modular distal femur brochure us stanmore implants. It offers guidance that you should heed, but, as with any such technical guide, each surgeon must consider. Anatomy distal femur femur transitions from cylinder to condyles medial condyle extends further inferior cancellous bone trapezoidal shape what this means for fixation avoid notch and concomitant injury to cruciate ligaments avoid penetration of medial cortex with anterior screws x x deforming forces quadriceps. In more complex fractures, ct is used to delineate intraarticular extension, degree of comminution, and fracture lines in the coronal plane. Diseasedisorder overview by bulletin of the nyu hospital for joint diseases. Chronic osteomyelitis involving the distal femur often results in amputation or arthrodesis. Orthopaedics gmrs proximal tibial surgical protocol global modular replacement system. Without using the distal targeting system, the placement of the distal locking screws is done primarily by a variety of freehand techniques, using.
Patients with failed distal femoral megaprostheses often have bone loss that limits reconstructive options and contributes to the high failure rate of revision surgery. The global modular replacement system gmrs, stryker corporation, mahwah, nj was used in 21 70. If the fractures around hip are excluded, 31% femoral fractures involve distal portion 1. Healing complications are common after locked plating for distal femurs. Uncemented megaprosthesis stem fixation using scratch fit. The introduction of chemotherapy, the advances in surgical and diagnostic techniques, and the multidisciplinary approach allowed limb salvage procedures for sarcoma with no obvious detectable differences in oncologic or functional results compared with amputation 25, 8. Resection length of the femur and consecutive reconstruction was. Fractures of the distal femur occur at an incidence of 4. Revision distal femoral arthroplasty with the compress. Distal femoral fractures following knee arthroplasty are uncommon. We would like to present an unusual case of a broken femoral. It differs from traditional stemmed prostheses because it requires only 4 to 8 cm of residual bone for. The distal femur and the proximal tibia are common sites for primary and metastatic bone tumors. Stryker, usa, hmrs stryker, usa, and mets stanmore implants, uk prostheses.
Carbofix distal femur plate is fda cleared and ce marked. Subsequently, a large stryker gmrs distal femoral endoprosthesis with. Gmrs using clinical history to drive technology for patient satisfaction. Pdf supracondylar nailing for difficult distal femur. Retrograde intramedullary nailing for the treatment of. Screw holes accommodate both locking and nonlocking screws. Chronic osteomyelitis of the distal femur treated with resection. Distal femoral resection with endoprosthetic reconstruction martin malawer overview the distal femur figure 30. Both operative and nonoperative methods have been proposed conservative treatment used for undisplaced fractures is very demanding for patient and surgeon. All seven oncologic patients were continuously diseasefree. Class 2 device recall global modular replacement system.
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. Oct 01, 2016 distal femur locking plate is still the way forward for treating distal femur fractures. Download fulltext pdf what is new in distal femur periprosthetic fracture fixation. Talbot, the medial femoral condyle free osteocutaneous flap for. Proximal femoral, distal femoral and proximal tibial modular megaprostheses have been developed for femoral and tibial juxtaarticular lesions 26 2728. The mets distal femoral replacement system is designed as a modular system that can be used to replace diseased or deficient bone in the distal femur. Efficacy of different revision procedures for infected.
Many surgical methods have been described for the treatment of these nonunions including external fixation, intramedullary nailing, arthroplasty, and fixed. Preoperatively radiographs in two plans as well as standing entire limb radiographs have been taken. Dec 12, 2009 nonunions of the distal femur are relatively rare but can occur with or without previous surgery. The information contained in this document is intended for.
Open reduction vs distal femoral replacement arthroplasty. Free vascularized medial femoral condyle corticocancellous flap for treatment of challenging upper extremity nonunions. Distal femoral reconstruction following failed total knee arthroplasty. Hip abductor moment arm a mathematical analysis for proximal femoral replacement article pdf available in journal of orthopaedic surgery and research 61. Our portfolio of lower extremities products includes a comprehensive array of intramedullary nails, locking plates, external fixation, and biologics. In the largest series of cemented distal femoral stems, implant survival was only 67% using aseptic loosening as the failure criteria with almost 10% of stems removed for aseptic loosening. This article presents three cases of chronic osteomyelitis treated with a staged approach culminating in endoprosthetic reconstruction. Downloaded from the university of groningenumcg research database pure. 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. Aseptic loosening rates in distal femoral endoprostheses.
The pushthrough total femoral prosthesis offers a functional. Nov 27, 20 locked plating lp of distal femoral fractures has become very popular. Circumference radiopaque marking outlining plate contour for positioning. Indications for distal femoral replacement arthroplasty in. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with the tibia and kneecap forming the knee joint. A typical tumour prosthesis set for distal femur tumour knee reconstruction contains femoral. Is distal femur locking plate a superior implant in distal femur fracture. The purpose of this study was to analyze the complications and clinical outcomes of lp treatment for distal femoral fractures. Radiographs of the custom nonfluted stem inserted after distal.
Gmrs global modular knee replacement system from stryker. Download scientific diagram radiographs of the custom nonfluted stem. A recent study reported coronal plane fracture in 38. Patients with osteosarcoma of the distal femur have traditionally been treated with a high aboveknee amputation. It is recommended that when selecting plate length. Patella kinematics have been enhanced by incorporating a deepened patellar track to articulate with the duracon patellae. Straight and bowed connection piece for total femur 80mm, 90mm left and right distal femoral component, pressfit stems with titanium plasma spray and. Develops, manufactures and markets specialty surgical and medical products internationally, and provides outpatient physical therapy services in the united states. Lcp combiholes combine a dynamic compression unit dcu hole with a locking screw hole.
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