Distal femoral reconstruction following failed total knee arthroplasty. Uncemented megaprosthesis stem fixation using scratch fit. 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. Subsequently, a large stryker gmrs distal femoral endoprosthesis with. The information contained in this document is intended for healthcare professionals only. Gmrs stems without derotational flutes, as well as the very similar stryker. Hip abductor moment arm a mathematical analysis for proximal femoral replacement article pdf available in journal of orthopaedic surgery and research 61. A guide to the placement of this mark is the linea aspera on the posterior aspect of the femur. Pdf is distal femur locking plate a superior implant in. Pdf distal femoral cut in total knee arthroplasty in a. Pdf chronic osteomyelitis of the distal femur treated with. Distal femur fractures that enter the the knee joint may heal with a defect in the normally smooth surface of the joint. Open reduction vs distal femoral replacement arthroplasty.
Circumference radiopaque marking outlining plate contour for positioning. Proximal femoral, distal femoral and proximal tibial modular megaprostheses have been developed for femoral and tibial juxtaarticular lesions 26 2728. Pdf distal femoral fracture during primary total knee. We would like to present an unusual case of a broken femoral. Distal femoral fractures are severe injuries which are technically challenging to treat surgically. Screw holes accommodate both locking and nonlocking screws. Pdf supracondylar nailing for difficult distal femur. Open reduction vs distal femoral replacement arthroplasty for comminuted distal femur fractures in the patients 70 years and older. Fractures of the distal femur whether supracondylar. Class 2 device recall global modular replacement system gmrs. Nov 30, 2017 this feature is not available right now. Distal femoral replacement in periprosthetic fracture.
Dec 12, 2009 nonunions of the distal femur are relatively rare but can occur with or without previous surgery. Many surgical methods have been described for the treatment of these nonunions including external fixation, intramedullary nailing, arthroplasty, and fixed. Lcp periarticular plating system the lcp periarticular plating system is capable of addressing. Class 2 device recall global modular replacement system. Distal femur thighbone fractures of the knee orthoinfo aaos.
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. Distal femoral fractures following knee arthroplasty are uncommon. 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. Free vascularized medial femoral condyle corticocancellous flap for treatment of challenging upper extremity nonunions. Locked plating for internal fixation of the adult distal femur. Despite technique suggestions from anecdotal and some early reports, knowledge about risk factors for failure, nonunion nu, and revision is limited. 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. Distal femoral fracture during primary total knee arthroplasty. Nonunions around the knee joint pubmed central pmc. 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.
Distal femoral fracture during primary tka is rare and associated with the use of a semiconstrained. Oct 01, 2016 distal femur locking plate is still the way forward for treating distal femur fractures. Locked plating for internal fixation of the adult distal. Chronic osteomyelitis of the distal femur treated with. Clinical outcomes of locked plating of distal femoral. Pdf chronic osteomyelitis involving the distal femur often results in amputation or arthrodesis.
Lcp combiholes combine a dynamic compression unit dcu hole with a locking screw hole. Chronic osteomyelitis of the distal femur treated with resection. Retrograde intramedullary nailing for the treatment of. 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. The system allows for polyaxial screw placement with subsequent screw locking for improved stability especially within osteopenic bone.
Carbofix distal femur plate is fda cleared and ce marked. Revision distal femoral arthroplasty with the compress. Distal femur distal femur with allpoly tibial component while clinical history is the foundation for the gmrs system, our. 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. In more complex fractures, ct is used to delineate intraarticular extension, degree of comminution, and fracture lines in the coronal plane. Orthopaedics gmrs proximal tibial surgical protocol. Panoramic radiographs of the lower limbs bearing weight. Global modular replacement system one system, one vision. 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. 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. Stryker would like to thank the following surgeons for their contributions in devel oping the global modular replacement. Plate system for distal femur and proximal lateral tibia.
Distal femur lecture orthopaedic trauma association. Efficacy of different revision procedures for infected. Our portfolio of lower extremities products includes a comprehensive array of intramedullary nails, locking plates, external fixation, and biologics. Download fulltext pdf what is new in distal femur periprosthetic fracture fixation. Retrograde femoral nailing of periprosthetic fractures. Open reduction and fixation is often preferred in displaced. Gmrs distal femoral surgical protocol introduction the gmrs distal femoral components are based on over a quarter of a century of clinical history. 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. If the fractures around hip are excluded, 31% femoral fractures involve distal portion 1. Proximal tibial metaphyseal bone loss compromises the alignment and fixation of components during revision total knee arthroplasty. Distal femoral fractures account for 3%6% of all fractures of the femur. Assistance at its toll free number 800 6382041 or 301 4436597 or at its internet address. Pdf core decompression of the distal femur for avascular. Unfortunately, neither study reported on reaming techniques or on stem diameter.
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. Without using the distal targeting system, the placement of the distal locking screws is done primarily by a variety of freehand techniques, using. 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. Axle joint with rotating hinge configuration was used to represent gmrs. Adaptive probabilistic approach for selecting tumour knee prosthesis. 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. Modular distal femur brochure us stanmore implants.
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. Both operative and nonoperative methods have been proposed conservative treatment used for undisplaced fractures is very demanding for patient and surgeon. Nov 27, 20 locked plating lp of distal femoral fractures has become very popular. 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. 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. Influence of the type of construct and hardware on the clinical and radiological outcomes author links open overlay panel m.
Intraarticular fractures of distal femur present a huge surgical challenge. Resection length of the femur and consecutive reconstruction was. Gmrs global modular knee replacement system from stryker. A recent study reported coronal plane fracture in 38. Locking compression plate in distal femoral intraarticular. The incidence of primary total knee replacement tkr is increasing with a resultant rise in those patients sustaining distal femoral periprosthetic fractures around tkrs.
The management of chronic osteomyelitis of the distal femur is difficult and often results in limb loss. This article presents three cases of chronic osteomyelitis treated with a staged approach culminating in endoprosthetic reconstruction. 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. Patella kinematics have been enhanced by incorporating a deepened patellar track to articulate with the duracon patellae. The global modular replacement system gmrs, stryker corporation, mahwah, nj was used in 21 70. In general, a longer plate allows for better mechanical advantage over a shorter plate. Patients with osteosarcoma of the distal femur have traditionally been treated with a high aboveknee amputation. All seven oncologic patients were continuously diseasefree. Made of continuous carbon fibers reinforced polymer. Please vote below and help us build the most advanced adaptive learning platform in medicine. Gmrs proximal femoral surgical protocol stryker meded. Stryker, usa, hmrs stryker, usa, and mets stanmore implants, uk prostheses.
The departments electronic database was searched for all patients undergoing revision of total knee arthroplasty. 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. The distal femur and the proximal tibia are common sites for primary and metastatic bone tumors. Distal femoral fractures following total knee replacement. Preoperatively radiographs in two plans as well as standing entire limb radiographs have been taken. Proximal tibial replacement in revision knee arthroplasty. To determine the ideal angle for making the distal femoral cut in total knee arthroplasty in a brazilian population. Patients with failed distal femoral megaprostheses often have bone loss that limits reconstructive options and contributes to the high failure rate of revision surgery. 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. Diseasedisorder overview by bulletin of the nyu hospital for joint diseases. 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. Frequently, these patients have a history of fracture, and early infection progresses to chronic osteomyelitis 1, 3, 4.
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. Is distal femur locking plate a superior implant in distal femur fracture. Download scientific diagram radiographs of the custom nonfluted stem. Talbot, the medial femoral condyle free osteocutaneous flap for. Aseptic loosening rates in distal femoral endoprostheses. Complete physeal arrest of left distal femur icd10cm diagnosis code m89. Treatment with a retrograde inserted locked intramedullary nail, journal of orthopaedic trauma, vol. The pushthrough total femoral prosthesis offers a functional. 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. It offers guidance that you should heed, but, as with any such technical guide, each surgeon must consider. Stryker orthopaedics introduced its first rotating. Anatomically precontoured low profile plates reduced soft tissue problems no need for plate contouring note. 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.
It offers guidance that you should heed, but, as with any. Radiographs of the custom nonfluted stem inserted after distal. Supracondylar nailing for difficult distal femur fractures article pdf available in journal of orthopaedic surgery hong kong 112. 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.
Distal femur fractures, complications, surgical management. Chronic osteomyelitis involving the distal femur often results in amputation or arthrodesis. Femur axsos 3 titanium operative technique distal lateral femur. Patella kinematics have been improved by incorporating a deepened patellar track to articulate with the duracon patellae. Jan 10, 2016 operative treatment of acute distal femur fractures. Chapter 53 fractures of the distal femur china quad diaries. Simultaneous freetissue transfer and ilizarov distraction. Modular megaprosthesis for distal femoral tumors request pdf. It differs from traditional stemmed prostheses because it requires only 4 to 8 cm of residual bone for. Gmrs using clinical history to drive technology for patient satisfaction.
Health, general bones care and treatment diagnosis necrosis risk factors. The distal femur was resected through a midline skin incision and medial parapatellar arthrotomy. Excessive and repetitive bending is not recommended as it may weaken the plate. It is also useful to expose the neurovascular bundle when a distal femoral fracture is complicated by an arterial injury. It is recommended that when selecting plate length.
Current concepts in fractures of the distal femur soucasny pohled na zlomeniny dolniho konce stehenni kosti b. Straight and bowed connection piece for total femur 80mm, 90mm left and right distal femoral component, pressfit stems with titanium plasma spray and. Biomechanical analysis of the human femur bone during normal. Pdf what is new in distal femur periprosthetic fracture.
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. Distal femur plate distal femur locked plate youtube. Distal femoral resection 11 intramedullary alignment 12. Healing complications are common after locked plating for distal femurs. Tibia and femur axsos 3 ti distal lateral femur with targeter operative technique henderson, ce et al. Structural failure of a modern knee tumor megaendoprosthesis. 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. Proximal femoral replacement in contemporary revision total hip arthroplasty for severe femoral bone loss. Indications for distal femoral replacement arthroplasty in. 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.
The aim of this study is to evaluate functional outcome, fracture healing, and the complications of distal femoral intraarticular fractures using locking compression plates. Distal femur fractures and its treatment with distal femur. Distal femoral reconstruction following failed total knee. Develops, manufactures and markets specialty surgical and medical products internationally, and provides outpatient physical therapy services in the united states. Localize the frontal plane of the distal femur instrument 292. Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate.
Pdf hip abductor moment arm a mathematical analysis. 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. Fractures of the distal femur occur at an incidence of 4. The purpose of this study was to analyze the complications and clinical outcomes of lp treatment for distal femoral fractures. Orthopaedics gmrs proximal tibial surgical protocol global modular replacement system. The information contained in this document is intended for. Downloaded from the university of groningenumcg research database pure.
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