Using a Traction Table for Fracture Reduction during Minimally Invasive Plate Osteosynthesis (MIPO) of Distal Femoral Fractures Provides Anatomical Alignment

Rolfson, Ola; Ekholm, Carl; Tranberg, Roy; Rolfson, Ola; Geijer, Mats

doi:10.3390/jcm12124044

Cited by 3 publications

(2 citation statements)

References 62 publications

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“…Plate fixations are usually more invasive, and the postoperative infection rate is reported to be significantly higher than that of intramedullary nail fixation in a systematic review and meta-analysis of 936 patients with distal femur fractures in 16 studies [8]. The minimally invasive plate osteosynthesis (MIPO) technique can overcome these problems because it requires less skin and soft-tissue dissection and preserves the fracture hematoma and periosteal blood supply, resulting in undisturbed callus bone healing [12,13]. However, closed reduction in MIPO is technically demanding and may rather lead to malreduction or malalignment [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…The minimally invasive plate osteosynthesis (MIPO) technique can overcome these problems because it requires less skin and soft-tissue dissection and preserves the fracture hematoma and periosteal blood supply, resulting in undisturbed callus bone healing [12,13]. However, closed reduction in MIPO is technically demanding and may rather lead to malreduction or malalignment [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

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Intraoperative Fracture during the Insertion of Advanced Locking Screws (T2 Alpha Femur Retrograde Intramedullary Nailing System): Report of Two Cases and Identifying Causes and Prevention

Higuchi,

Taninaka,

Yoshimizu

et al. 2024

JCM

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Background: Recently, the T2 alpha nailing system (Stryker, Inc.), which has advanced locking screws that can attach a screw to a rod, has been used worldwide and is expected to improve fracture fixation. We analyzed two cases of supracondylar femoral fractures in older adult patients, in which intraoperative fractures occurred during the insertion of advanced locking screws of the T2 alpha femur retrograde intramedullary nail. Case presentation: A 93-year-old and an 82-year-old woman each underwent T2 alpha femur retrograde nail fixation for supracondylar femur fractures at separate hospitals, and advanced locking screws were used as the proximal transverse locking screws. In both patients, a fracture line was observed at the proximal screw postoperatively, and the fractures were refixed with distal cable wiring and/or femoral distal plates. The patients were subsequently discharged from the same facility with no remarkable pain. Conclusions: When inserting advanced locking screws, it is necessary to enlarge the screw hole in the near-bone cortex with a counterbore drill, which might add torque to the bone cortex that could result in fractures. If the sleeve is distant from the bone, the counterbore drill will not reach the bone, the screw hole will not expand, and the insertion of advanced locking screws will apply a strong torque to the bone cortex and may result in fracture. Moreover, it is important to confirm that the counterbore drill is securely inserted under fluoroscopy and to carefully enlarge the bony foramen manually to prevent fractures during screw insertion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intraoperative Fracture during the Insertion of Advanced Locking Screws (T2 Alpha Femur Retrograde Intramedullary Nailing System): Report of Two Cases and Identifying Causes and Prevention

Higuchi,

Taninaka,

Yoshimizu

et al. 2024

JCM

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Secondary Displacement was Common in Healing Distal Femur Fractures in a Cohort of Elderly Patients

Paulsson,

Ekholm,

Rolfson

et al. 2024

Geriatr Orthop Surg Rehabil

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Introduction Surgical treatment of distal femoral fractures (DFFs) in osteoporotic bone is challenging despite improvements in hardware and surgical techniques. The occurrence and degree of secondary displacement during healing after bridging plate fixation are still unknown. This study aimed to assess the occurrence and degree of secondary displacement in healing DFFs in elderly patients and correlate the secondary displacement to body mass index, bone density, and weight-bearing regimen. Patients and Methods The study involved 32 patients, 65 years or older, with a DFF of AO/OTA types 33 A2-3, B1-2, C1-2, and 32(c) A-C,1-3, including peri-prosthetic fractures with stable implants. Twenty-seven patients had at least 8 weeks of follow-up, and 21 patients had a complete 1-year follow-up. Minimally invasive surgery was performed using a distal anatomical femoral plate as a long bridge-plating construct. Secondary displacement was assessed with computed tomography of the entire femur postoperatively and at 8, 16, and 52 weeks. Femoral length, coronal angulation (varus/valgus), and subsidence as the change in distance between the distal joint surface and a specified locking screw were measured. Results There was a statistically significant mean femoral shortening at 52 weeks of 4.7 mm (SD 3.9, (95% CI 2.9–6.5), P < 0.001) mainly by subsidence of the distal fragment. Most patients experienced limited coronal angulation. There was no correlation between body mass index or bone density and secondary displacement. At the 1-year follow-up, no patient needed revision surgery for non-union or plate breakage. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or adverse events such as cut-outs. Conclusion Modern dynamic plate osteosynthesis could not prevent commonly occurring fracture subsidence in DFF in an elderly cohort. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or mechanical adverse events.

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A Successful Method of Attaining Traction in Above-Knee Amputation Patients With Intertrochanteric Hip Fractures

Essex,

Alaraj,

Panchbhavi

2024

Cureus

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Intertrochanteric fractures are a common occurrence in the general population; however, in patients with above-knee amputations, they are relatively rare. In this patient population, positioning on a fracture table presents a particularly difficult problem prior to the fixation of an intertrochanteric fracture. Here, we describe a 57-year-old man with extensive vasculopathy and reduced bone density who presents with an intertrochanteric fracture after a fall from standing. Adequate traction of the amputated leg was achieved via the modification of a standard fracture table and the utilization of a Bohler traction bow. Fixation of the intertrochanteric fracture was successful, and the patient suffered no postoperative complications.

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Using a Traction Table for Fracture Reduction during Minimally Invasive Plate Osteosynthesis (MIPO) of Distal Femoral Fractures Provides Anatomical Alignment

Cited by 3 publications

References 62 publications

Intraoperative Fracture during the Insertion of Advanced Locking Screws (T2 Alpha Femur Retrograde Intramedullary Nailing System): Report of Two Cases and Identifying Causes and Prevention

Intraoperative Fracture during the Insertion of Advanced Locking Screws (T2 Alpha Femur Retrograde Intramedullary Nailing System): Report of Two Cases and Identifying Causes and Prevention

Secondary Displacement was Common in Healing Distal Femur Fractures in a Cohort of Elderly Patients

A Successful Method of Attaining Traction in Above-Knee Amputation Patients With Intertrochanteric Hip Fractures

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