Supracondylar distal femoral fractures may be classified as extraarticular, unicondylar, or bicondylar, and the fractures may have an intercondylar extension 1, 2. The placement of an intramedullary im nail in the femur is affected by the bow of the femur. Distal femur fractures and its treatment with distal femur. Distal femur fractures dffs are unusual and difficult to deal. This zone varies greatly in the literature, from the distal 7. 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 of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture. Limb salvage with megaprosthesis in extremity osteosarcoma. Calcaneal fracture orif with arthrex calcaneal fracture plate utilizing quickset duration. The t2 im nailing platform offers a combination of innovation, simplicity and versatility that is designed to suit your various needs.
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. Modular knee megaendoprotheses are commonly used devices for distal femur or proximal tibia replacement in tumor surgery as well as for treatment of some periprosthetic fractures around a loose or failed total knee arthroplasty. A comprehensive range of modular stems are available to be assembled with these femoral components. For bone sarcomas, patients are commonly followed at 3month intervals for 2 years, then 6month intervals for 3 years, and annually thereafter 16, 17. Gmrs uncemented pressfit stems stryker global orthopaedics methods. Downloaded from the university of groningenumcg research.
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. Ao type b distal femoral fractures, compound grade iiib and c gustilo andersons fractures and pathological fractures were excluded from the study. Mid term results of distal femoral fractures treated with. Anatomy of the distal femur cambridge orthopaedics. Tomofix medial distal femur plate surgical technique depuy synthes companies 1 2 position patient place the patient in a supine position. Stryker gmrs uncemented stems were placed, after femoral reaming, into the distal femoral canal with firm. A sterile tourniquet may be useful if treating a distal femur fracture. Visualization of the hip, knee, and ankle joint with the image intensi. After change of instruments, distal femur reconstruction was continued. Patella kinematics have been enhanced by incorporating a deepened patellar track to articulate with the duracon patellae. Fifty consecutive patients were introduction abstract in this prospective study, 50 patients with distal femur fracture were treated using distal femur locking plate. Measure the proximal femur and make a reference resection mark and a rotation mark with either methylene blue or a cautery device figure 2. A guide to the placement of this mark is the linea aspera on the posterior aspect of the femur. Uncemented megaprosthesis stem fixation using scratch fit.
Femur and tibia were prepared and a rotatinghinge global modular reconstructive system gmrs stryker inc, rutherford, nj, usa knee prosthesis was used for reconstruction figure 1b. Surgical approach surgeon may use an anterolateral or lateral parapatellar approach. An urgent product recall letter dated 172008, was sent to surgeons who are gmrs users, advising that the gmrs proximal femoral components are not compatible with alumina ceramic heads. Class 2 device recall gmrs proximal femoral surgical protocol. The imaging evaluation of distal femoral fractures is based primarily on conventional radiographs. 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. The pushthrough total femoral prosthesis offers a functional alternative to total femoral replacement.
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. Gmrs proximal femoral surgical protocol stryker meded. Prep and drape the leg circumferentially extending proximal to the hip to allow proximal extension of the surgical incision if needed. Stryker would like to thank the following surgeons for their contributions in devel oping the global modular replacement. Less invasive stabilization system liss technique guide. From a populationbased implant design, a patented screwtoplate interface, and streamlined instrumentation, our focus is on creating a welldesigned plating system, giving you more time to focus on other things. Class 2 device recall global modular replacement system. Distal femoral replacement in periprosthetic fracture. High energy distal femur fractures online ao resources. Distal femur thighbone fractures of the knee orthoinfo. Gmrs distal femoral surgical protocol introduction the gmrs distal femoral components are based on over a quarter of a century of clinical history. The aim of this report was to provide an update on the existing surgical solutions for the management of these fractures and describe. The anterior bow of the femur and its influence on femoral.
The departments electronic database was searched for all patients undergoing revision of total knee arthroplasty. Pdf treatment of distal femoral fractures in the elderly. Histopathological analysis of frozen sections and tumour specimen showed negative margins. 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. Titanium distal femur liss plates this view for left femur 422. Patella kinematics have been improved by incorporating a deepened patellar track to articulate with the duracon patellae. Outcome of retrograde intramedullary nailing and locking. Orthopaedics gmrs proximal tibial surgical protocol global modular replacement system.
Distal femoral resection 11 intramedullary alignment 12. Gmrs using clinical history to drive technology for patient satisfaction. Structural failures of the prosthesis are wellknown postoperative complications and have been reported for various prosthesis types. Modular knee megaendoprotheses are commonly used devices for. 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. Ao principles in 1958, the ao formulated four basic principles, which have become the guidelines for internal fixation. Revision distal femoral arthroplasty with the compress. 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. Chronic osteomyelitis involving the distal femur often results in amputation or arthrodesis. The use of knee megaprosthesis for the management of. Distal femur fractures that enter the the knee joint may heal with a defect in the normally smooth surface of the joint. Fracture classification according the ao ota system and the trauma mechanism radiological evaluation and complications were documented. Effect of simulated early weight bearing on micromotion and pullout strength of uncemented distal femoral stems article pdf available in orthopedics 385.
Anterior surface slopes downward from lateral to medial, lateral wall inclines 10 degrees. Surgical outcome of distal femur fracture by locking. Young as well as elderly patients can undergo a distal femur fracture by different mechanisms. Monoaxial locking plate for treating distal femur fractures. It differs from traditional stemmed prostheses because it requires only 4 to 8 cm of residual bone for. Gmrs global modular knee replacement system from stryker. The lissdf less invasive stabilization systemdistal femur is a new type of implant system for the treatment of distal femoral fractures according to the principles of minimally invasive surgery. Place the plate 2 mm proximal to the distal end of the lateral condyle fig. Introduction the supracondylar area of the femur is defined as the zone between the femoral condyles and the junction of the metaphysic with the femoral diaphysis.
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. 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. 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. The distal cortex is spared due to the pushthrough stem. Structural failure of a modern knee tumor megaendoprosthesis. Stryker orthopaedics introduced its first rotating. A guide to the placement of this mark is the linea aspera on the posterior aspect of the. Surveillance depends on both clinical examination and imaging of the. The gmrs system balances the growing demand for highperformance implants with the growing needs of the patients who live with these implants.
The proximal femoral module and distal femoral module of the gmr may be used together, or with the components of the mrs, in replacement of the total femur. 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. Despite a proposed lower incidence of aseptic loosening, uncemented distal femoral implants present challenges with the intraoperative assessment of the adequacy of stem fixation within the femoral canal. The pushthrough total femoral prosthesis offers a functional. Our biomechanical study was intended to assess the adequacy of oncologic implant pressfit stem fixation within the reamed canal of the distal femur for the stryker gmrs. Distal femoral reconstruction following failed total knee arthroplasty. Chronic osteomyelitis of the distal femur treated with. The exclusion criterion to use a retrograde im nail was a type c2 or c3 fracture. The information contained in this document is intended for. This chapter deals only with fractures that involve the supracondylar metaphyseal or intercondylar epiphyseal areas of the distal end of the femur. The global modular replacement system gmrs, stryker corporation, mahwah, nj was used in 21 70. Orthopaedics gmrs proximal femoral surgical protocol.
Straight and bowed connection piece for total femur 80mm, 90mm left and right distal femoral component, pressfit stems with titanium plasma spray and. The t2 femoral nailing system offers a universal left and right nail in addition to an antegrade or retrograde approach that may reduce inventory. The distal end of the femur traditionally encompasses the lower third of this bone. Limbsparing surgery for distal femoral and proximal. It has been suggested that anterior bowing of the femur has an unexpected effect on implant sizing. Apply gentle traction to the limb and grossly realign the femur at this time. 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. Proximal tibial replacement in revision knee arthroplasty for non. Distal femoral reconstruction following failed total knee. The annual number of revision total knee arthroplasty tka procedures in the united. Old and fresh cases and, simple or compound fractures were taken up. Orthopaedics gmrs proximal tibial surgical protocol.