supracondylar femoral fracture theerachai apivatthakakul 17 march 2011
TRANSCRIPT
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SUPRACONDYLAR FEMO RAL FRACTURE THEERACHAI APIVATTHAKAKUL17 March 2011
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Supracondylar Fractures Supracondylar Fractures
“ zone between femoral condyle “ zone between femoral condyle
and junction of metaphysis and junction of metaphysis
~9 cm.from articular surface” aaaaaaaaa aaaaaaaa9
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DEFORMING MUSCLE
QUADRICEPS
HAMSTRINGS
GASTROCNEMIUS
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Stewart MJ etal. JBJS 1966;48A Stewart MJ etal. JBJS 1966;48A
“ Additional trauma of surgery“ Additional trauma of surgery
and the proximity of metallic and the proximity of metallic
aa aaaaaa aa aaa aaaaa aaaaaaaaaa implants to the joint predispose
to excessive reaction and to excessive reaction and
subsequent adhesion lead to joint stiffness” subsequent adhesion lead to joint stiffness”
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19746Schatzker et al. INJURY ; 1979SchatzkerandLambertCORR 19746Schatzker et al. INJURY ; a a a a1979
• - 7175% good to excellent result• - 7175% good to excellent result
•a aaaaaaa aaaaaa aaaa aaaaaaaaa• Accurate anatomical reduction
•aaaaaa aaaaaaaa aaaaaaaa• Stable internal fixation
•aaaaa a aaaaaaaaaaa• Early mobilization
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ANATOMYANATOMYANATOMYANATOMY
• Surgical anatomy• Surgical anatomy
• Mechanical axis• Mechanical axis
• Anatomical axis• Anatomical axis
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LATERAL VIEW LATERAL VIEW
• Anterior half• Anterior half
Blade position Blade position
• Posterior half• Posterior half
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CROSS SECTION CROSS SECTION
• Trapezoid shape• Trapezoid shape
• aaaaaaaa a aaaaaaaaa>• Width anterior > posterior
• Medial ,lateral wall inclination• Medial ,lateral wall inclination
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ANATOMY
LATERALVIEW
CROSS SECTION
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ClassificationClassification
• severity of injury• severity of injury
• treatment• treatment
• prognosis• prognosis
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AO CLASSIFICATION
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CONSERVATIVE TREATMENT CONSERVATIVE TREATMENT
• Difficult articular reduction• Difficult articular reduction
• Posterior displacement• Posterior displacement
•aaaaa aaaaaaaaa• Joint stiffness
• Muscle atrophy• Muscle atrophy
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CONSERVATIVE TREATMENT
- SINGLE PIN -DOUBLE PIN
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OPERATIVE TREATMENT OPERATIVE TREATMENT
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INDICATION FOR ORIF INDICATION FOR ORIF
•a aaaaaaaa aaaaa-aaaaaaaaaa aa.• - Displaced intra artricular Fx.
• aaaaaaaaaaaaaaaaaaaa aaaaaaaa,• Multiple injuries,ipsilateral injuries
• Most open fractures• Most open fractures
• Associated vascular injuries Associated vascular injuries• Associated vascular injuries Associated vascular injuries
•a aaaaaaaaaaa aaaaaaaa• Pathological fracture
• Irreducible fracture• Irreducible fracture
•un reducible fracture•un reducible fracture
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-CONTRA INDICATION-CONTRA INDICATION
• Active infection• Active infection
• Severely contaminated open Fx.• Severely contaminated open Fx.
• Severe osteopenia• Severe osteopenia
• Inadequate facilities• Inadequate facilities
• Inexperienced surgeons• Inexperienced surgeons
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LATERAL APPROACH TIBIAL TUBERCLEOSTEOTOMY
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Tibial tubercle osteotomy Tibial tubercle osteotomy
• Complete articular exposure• Complete articular exposure
• - Pre drill tibial tubercle• - Pre drill tibial tubercle
• Fix to posterior cortex• Fix to posterior cortex
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Tibial tubercle osteotomy
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CONDYLAR BUTRESS PLATE
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THANK YOU THANK YOU
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SUPRACONDYLAR FEMO RAL FRACTURE THEERACHAI APIVATTHAKAKUL -AO BASIC COURSE 24 2
6 1998AUG,
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What is your purpose for presentation in your practice?
• Lectures
• Podium presentation
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Davos 2006
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Davos 2008