股骨远端骨折手术图解

A 7-10cm lateral parapatellar incision is made which can be extended proximally into a formal lateral approach to the femur if necessary. The intercondylar reduction is performed through this limited arthrotomy.
After the plate is advanced subperiosteally up the femur, the distal fragment is manipulated such that the plating engages the lag screw.
After the plate is advanced subperiosteally up the femur, the distal fragment is manipulated such that the plating engages the lag screw.
These figures demonstrate the intracondylar extension of the fracture and a free intercondylar fragment (arrows).
FEMORAL AXIS
PLANNED SCREW POSITIONS When planning for the lag screw fixation, the surgeon must leave room for the lag screw of the fixed angle device or intramedullary nail.
AP VIEW
LATERAL VIEW
AP andting that the plate is against the femur and the metaphysis is generally reduced.
The lateral radiograph can be used in a similar fashion to a perfect circle technique used in nailing to place the proximal screws percutaneously.
AP view of a comminuted C3 intraarticular distal femur fracture.
Lateral view demonstrating the typical extension deformity caused by the pull of the origin of the gastrocnemius muscles from the posterior distal femur.
Note the anatomic reduction of the articular surface. At this point, the articular surface is reconstructed and the metaphyseal component of the fracture is still unfixed.
Periarticular or standard clamps are used to manipulate and reduce the fracture which is stabilized with the templated 6.5 mm lag screws with washers. The screws are placed anterior and posterior to the planned position of the fixed angle device.
After the lag screw is placed, the appropriate sized fixed angle plate is slid subperiosteally up the femur. Notice the bolster, which is supporting the fracture in a reduced position.
AP VIEW
LATERAL VIEW
AP VIEW
LATERAL VIEW
AP and lateral radiograph demonstrating the position of the lag screw as templated. Note that with traction, both the AP and lateral radiographs are manipulated such that the metaphysis is reduced.
95°
AP radiograph demonstrating the angle at which the guidewire for the fixed angle lag screw should be placed. It should be parallel with the distal femoral articular surface, which is at approximately 95o to 98o from the femoral shaft.
AP VIEW
LATERAL VIEW
This requires a bolster underneath the metaphyseal fracture and some flexion of the knee to correct the extension deformity of the quadriceps. The dotted line represents the axis of the femur where the plate will be placed.