Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,

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Presentation transcript:

Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz, and Bruce Levy JBJS Essent Surg Tech Volume os-90(Supplement 2 Part 1): March 1, 2008 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1 Close-up view of the POLYAX plate (DePuy Trauma, Warsaw, Indiana) demonstrating the large blue 8.0-mm fixed-angle central locking screw and the peripheral green polyaxial locking screws. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2 Close-up view of the head of the plate, demonstrating the central fixed threaded hole and the peripheral holes containing locking bushings to allow angulation prior to locking. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Clinical photograph of patient positioning. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Bump placement directly behind the knee can accentuate hyperextension of the distal fragment. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Anterolateral incision for simple fractures at the crest of the lateral femoral trochlear flare. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6 Lateral peripatellar arthrotomy used for more complex articular fractures. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7 Fluoroscopic image showing articular reduction with multiple Kirschner wires and clamps, which are replaced with lag screws in the appropriate plane. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Submuscular insertion of the plate with the targeting handle assembled. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Radiographic view of a large reduction tenaculum stabilizing the plate to the distal fragment for guide-pin placement. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

The distal guide-pin must be inserted exactly parallel to the joint line of the distal part of the femur. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

The completed construct. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

A combination of distal polyaxial (green) and fixed locking (blue) screws used to fix a periprosthetic fracture proximal to the site of a total knee arthroplasty. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Lateral radiograph demonstrating a dispersed screw pattern used for a periprosthetic fracture. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Fig. 19 Anteroposterior radiograph demonstrating multiple points of medial condyle fixation and the combination of central fixed locking and multiple peripheral polyaxial screws. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Fig. 20 Radiograph made at the time of drilling before the insertion of a polyaxial screw, demonstrating its unique advantages. George Haidukewych et al. J Bone Joint Surg Am 2008;os- 90: ©2008 by The Journal of Bone and Joint Surgery, Inc.