Femur, distal: extraarticular simple fracture—33-A1.2


Femur, distal: extraarticular simple fracture—33-A1.2

Reto Babst

Case description

An 87-year-old woman fell from her standing height. The patient was living independently at home. She had suffered a femoral neck fracture 3 years before which was treated with a hemiarthroplasty. The patient was walking without walking aids before the fall.

a–b Preoperative x-rays. a AP view shows a spiral fracture in severely osteoporotic bone. The cemented stem of a hemiarthroplasty lies in the proximal part of the femur. b Lateral view.

Indication for MIPO

The patient had local soft-tissue swelling with a significant hematoma and crepitus in the right thigh. Since the medullary canal was occupied proximally by a cemented implant, an extramedullary stabilization was considered using the LISS-DF with MIPO technique. A distal femoral nail was not appropriate due to the creation of a potential stress riser between the junction of prosthetic stem and the proximal end of the nail.

Preoperative planning

A hand-drawn or computer-generated preoperative plan is recommended, including the approach, the applied reduction techniques, and the selected implant ( Fig 18.3-2 ).

a–c Preoperative planning. a 1 After insertion of the plate submuscularly it is positioned on the lateral condyle 0.5–1 cm proximal to the joint line. The plate is temporarily fixed with a Schanz screw parallel to both the patellofemoral and the tibiofemoral joints. 2 Indirect reduction with MIPO distractor ( Fig 18.3-2c ). 3 Maintenance of reduction with MIPO collinear forceps. 4 Plate position is checked with image intensification in AP and lateral views. 5 Distal fixation using self-drilling, self-cutting screws. To facilitate insertion of the proximal screws, the aiming arm can now be added. 6 Proximal fixation (using bicortical and monocortical periprosthetic screws inserted through the aiming arm. b The implant is placed on the skin to check plate position, incision lines are marked. c Markings of the landmarks and the incision lines according to the length of the plate.

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Jul 2, 2020 | Posted by in ORTHOPEDIC | Comments Off on Femur, distal: extraarticular simple fracture—33-A1.2

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