results of polyaxial locked-plate fixation of periarticular fractures of the knee by george...

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 TechVolume os-90(Supplement 2 Part 1):117-134

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-90:117-134


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.



Clinical photograph of patient positioning.



Bump placement directly behind the knee can accentuate hyperextension of the distal fragment.



Anterolateral incision for simple fractures at the crest of the lateral femoral trochlear flare.



Fig. 6 Lateral peripatellar arthrotomy used for more complex articular fractures.



Fig. 7 Fluoroscopic image showing articular reduction with multiple Kirschner wires and clamps, which are replaced with lag screws in the appropriate plane.



Submuscular insertion of the plate with the targeting handle assembled.



Radiographic view of a large reduction tenaculum stabilizing the plate to the distal fragment for guide-pin placement.



The distal guide-pin must be inserted exactly parallel to the joint line of the distal part of the femur.



The completed construct.



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.



Lateral radiograph demonstrating a dispersed screw pattern used for a periprosthetic fracture.



Fig. 19 Anteroposterior radiograph demonstrating multiple points of medial condyle fixation and the combination of central fixed locking and multiple peripheral polyaxial screws.



Fig. 20 Radiograph made at the time of drilling before the insertion of a polyaxial screw, demonstrating its unique advantages.



results of polyaxial locked-plate fixation of periarticular fractures of the knee by george...

Documents