FRACTURES ABOUT A TOTAL KNEE · 11/19/2018 1 florida orthopaedic institute fractures about a total...

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FLORIDA ORTHOPAEDIC INSTITUTEFLORIDA ORTHOPAEDIC INSTITUTE

FRACTURES ABOUTA TOTAL KNEE

FRACTURES ABOUTA TOTAL KNEE

FLORIDA ORTHOPAEDIC INSTITUTEFLORIDA ORTHOPAEDIC INSTITUTE

DISCLOSUREDISCLOSURE

DESIGNER & RECEIVE ROYALTIES:

A.L.P.S. SYSTEM - ZIMMER - BIOMET

POLYAXIAL PLATES - ZIMMER - BIOMET

SONIC PIN - STRYKER

TRIGEN NAILS - SMITH & NEPHEW

INTERTAN NAIL - SMITH & NEPHEW

JET-X EX FIX - SMITH & NEPHEW

BIONX SCREWS - CONMED/LINVATEC

FIBULA/ULNA NAIL - ACUMED

A.L.P.S. SYSTEM - ZIMMER - BIOMET

POLYAXIAL PLATES - ZIMMER - BIOMET

SONIC PIN - STRYKER

TRIGEN NAILS - SMITH & NEPHEW

INTERTAN NAIL - SMITH & NEPHEW

JET-X EX FIX - SMITH & NEPHEW

BIONX SCREWS - CONMED/LINVATEC

FIBULA/ULNA NAIL - ACUMED

UNIVERSITY of SOUTH FLORIDA / FLORIDA ORTHOPAEDIC INSTITUTE DEPARTMENT OF ORTHOPAEDIC SURGERY

FLORIDA ORTHOPAEDIC INSTITUTEFLORIDA ORTHOPAEDIC INSTITUTE

AND I RECEIVE

ROYALTIES

IN MY ROLE AS

EDITOR‐IN‐CHIEF

AND I RECEIVE

ROYALTIES

IN MY ROLE AS

EDITOR‐IN‐CHIEF

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2012, Vol. 43pp. 1084 - 89

PLATES:69% HEALED (25/36)

22% DELAYED / N-U

2012, Vol.27pp. 809 - 813

PLATES:26% FIXATION FAILED

11% DELAYED / N-U

BENEFITS OF A RIMN

USES PREVIOUS INCISION

EARLY WEIGHTBEARING

LOAD SHARING !!!!

IMMEDIATE ROM

USES PREVIOUS INCISION

EARLY WEIGHTBEARING

LOAD SHARING !!!!

IMMEDIATE ROM

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2006, Vol # 23, pp. 405 - 408

REVISION ARTHROPLASTY

LOCKEDPLATE

RETROGRADEIM NAIL

LOCKED PLATEvs. RIMN

CASE1

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SIX (6) OPERATIONS POST TKA TO FIX STRESS FRACTURE. HAS NOT WALKED IN 5 YEARS

RETROGRADE FEMORAL NAILING

RETROGRADE FEMORAL NAILING

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RETROGRADE FEMORAL NAILING

RETROGRADE FEMORAL NAILING

1 WEEKPOST- OP1 WEEK

POST- OP

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16 WEEKSHEALED

FRACTURE

16 WEEKSHEALED

FRACTURE

CASE2

SUTYPE I

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LOADSHARING

EARLYWEIGHTBEARING

FULL ROM

CASE3

M, 89 y.otransferred fromanother hospital

in immobilizer

PAIN IN KNEEFELL 2 DAYS AGO

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IMMOBILIZER TAKEN OFF

TRANSLATED

EXTENSION

?PLANNED

TOSHORTEN

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2005, Vol. 19pp. 164 - 170

EXCELLENT RESULTS @ 24 mos.

ONLY 10 PATIENTS

2017, Vol. 103pp. 257 - 262

TRENDS TOWARDS

HIGHER RATES OF N-U

WITH LOCKED PLATES

FLORIDA ORTHOPAEDIC INSTITUTEFLORIDA ORTHOPAEDIC INSTITUTE

LIMITATIONS - IM NAILINGLIMITATIONS - IM NAILING

REQUIRES 12 mm. INTERCONDYLAR REGIONREQUIRES 12 mm. INTERCONDYLAR REGION

CONTRA-INDICATED IFCLOSED BOXCONTRA-INDICATED IFCLOSED BOX

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2016, Vol 47pp. 460 - 464

RETROGRADE FEMORAL INTRAMEDULLARY NAILS USED.

Manufacturer Model Diameter (mm)

Biomet Phoenix retrograde nail 10.5DePuy ACE retrograde femoral nail  10Smith & Nephew  Trigen retrograde femoral nail 10Stryker  T2 supracondylar femoral nail 10

2015, Vol. 29pp. 380 - 384

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A = ant cortex to Blumenstadt’s line B = widest AP diameter condyle

A/B = Starting Point Ratio

(SPR)

X = ant flange to plug (ant position of box)

Y = widest AP diameterX/Y = Femoral Cond. Ratio

(FCR)

SPR = 0.392 FCR = 0.416

FCR = 0.444 cruciate retaining

FCR = 0.393 post stabilized

SPR = 0.399 MEN

SPR = 0.386 WOMEN

~ 6 mm difference

2014, Vol. 29pp. 1639 - 41

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2013, Vol. 27pp. 158 - 161

ISOLATED HYPEREXTENSION WITH RIMN (30 pts)NOT A PROBLEM

@ ~ 6 YEARS

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2014, Vol. 28pp. 307 - 312

LOCKED PLATES & RIMNBETTER THAN

COMPRESSION PLATING

LP NONUNIONSRIMN MALUNIONS

CASE4

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SUTYPEI - II

CENTER-CENTER

FEAR OF VARUS

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1999

Journal of Orthopaedic TraumaVol. 13, no. 8, pp 523 - 527© 1999 Lippincott Williams & Wilkins Inc.

The Mechanical Effect Of Blocking Screws In Stabilizing Tibia Fractures With Short Proximal Or Distal Fragments After Insertion Of Small‐Diameter Intramedullary Nails.

Krettek, C.

POLLERSCREW

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2014, Vol. 21pp. 224 -231

LP RIMN LP +RIMN

NAILor

PLATE?

LAG SCREW MAYBE…

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BIOMXTHIS MAKES

SENSE

BUT WILL IT STRESS SHIELDTHE LATERALFEMUR SHAFT

?

CONCLUSIONS

BENEFITS OF A RIMN

USES PREVIOUS INCISION

EARLY WEIGHTBEARING

LOAD SHARING !!!!

IMMEDIATE ROM

USES PREVIOUS INCISION

EARLY WEIGHTBEARING

LOAD SHARING !!!!

IMMEDIATE ROM

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LOCKEDPLATE

RETROGRADEIM NAIL

LOCKED PLATEvs. RIMN

REVISION ARTHROPLASTY

CLOSED BOX & NARROW

CRUCIATE RETAINING TKA

MALUNION IN METAPHYSIS

LIMITATIONS OF A RIMN

CLOSED BOX & NARROW

CRUCIATE RETAINING TKA

MALUNION IN METAPHYSIS(extension & valgus)

FLORIDA ORTHOPAEDIC INSTITUTEFLORIDA ORTHOPAEDIC INSTITUTE

LIMITATIONS - IM NAILINGLIMITATIONS - IM NAILING

REQUIRES 12 mm. INTERCONDYLAR REGIONREQUIRES 12 mm. INTERCONDYLAR REGION

CONTRA-INDICATED IFCLOSED BOXCONTRA-INDICATED IFCLOSED BOX

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UNIVERSITY of SOUTH FLORIDA / FLORIDA ORTHOPAEDIC INSTITUTE DEPARTMENT OF ORTHOPAEDIC SURGERY