股骨远端骨折手术图解

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.
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.
LATERAL VIEW AP 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.
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.
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.
As additional screws are placed, better fixation of the proximal fragment is obtained.
The final radiograph demonstrating the parapatellar incision for reduction of the joint and the percutaneous incisions utilized for the placement of the screws.
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.
A percutaneous incision is used to allow for the placement of three screws through this incision. This image demonstrates the drill being introduced percutaneously into the hole and drilling through the plate into the femur.
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.
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.
LATERAL VIEW AP VIEW
LATERAL VIEW AP 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.
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The size of the plate held up against the leg after fixation.
Immediate postoperative AP radiograph
Lateral radiograph immediately postoperative, demonstrating anatomic alignment of the metaphyseal region, as well as the joint.
AP VIEW
LATERAL VIEW
AP and lateral radiographs demonstrating 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.
LATERAL VIEW AP VIEW
AP and lateral radiographs demonstrating early callus formation at six weeks.
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.
The first screw is the most proximal to seat the plate.
As the most proximal screw is placed, it pulls the femoral shaft against the plate.
As the most proximal screw is placed, it pulls the femoral shaft against the plate.