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使用对侧股骨远端锁定钢板进行股骨远端骨折的内侧增强:技术说明。

Medial augmentation of distal femur fractures using the contralateral distal femur locking plate: A technical note.

作者信息

Leal Jaime Andrés

机构信息

Department of Orthopedic and Traumatology, Hospital Universitario de la Samaritana and Hospital Universitario Mayor de Méderi, Bogotá, Colombia.

出版信息

OTA Int. 2024 Sep 3;7(3):e347. doi: 10.1097/OI9.0000000000000347. eCollection 2024 Sep.

DOI:10.1097/OI9.0000000000000347
PMID:39228878
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11365623/
Abstract

INTRODUCTION

Lateral locking plates are commonly employed for the fixation of distal femur fractures. However, scenarios involving medial comminution, extremely distal fractures, periprosthetic fractures, or nonunion could necessitate medial augmentation. This study explores the possibility of using lateral distal femoral locking plate systems for medial fixation by employing the contralateral plate.

METHODS

This study presents a technical note on the application of lateral distal femur locking systems for medial augmentation in patients as indicated by current literature findings. Postoperative imaging modalities, including radiography and computed tomography (CT), were used to assess the plates' fit to the distal femur. Three cases following the specified technical note are presented.

RESULTS

The various plate systems, all comprising distal femur locking systems, demonstrated adaptability to the medial femur anatomy as confirmed by intraoperative visualization and postoperative radiographs, including two-dimensional and three-dimensional CT scans. It has also been possible to achieve at least 3 independent fixation points regardless of the size of the medial condyle.

CONCLUSIONS

Locking distal femoral plates can be a viable option for medial augmentation in indicated cases, achieving anatomical adaptation to the distal femur. This provides robust augmentation without the need for additional instruments beyond those used for the lateral cortex.

摘要

引言

外侧锁定钢板常用于股骨远端骨折的固定。然而,对于涉及内侧粉碎、极远端骨折、假体周围骨折或骨不连的情况,可能需要进行内侧增强固定。本研究探讨了通过使用对侧钢板,将股骨远端外侧锁定钢板系统用于内侧固定的可能性。

方法

本研究根据当前文献研究结果,针对患者应用股骨远端外侧锁定系统进行内侧增强固定,给出了一份技术说明。术后影像学检查方法,包括X线摄影和计算机断层扫描(CT),用于评估钢板与股骨远端的适配情况。现展示3例遵循上述特定技术说明的病例。

结果

所有不同的钢板系统均包含股骨远端锁定系统,术中可视化及术后X线片(包括二维和三维CT扫描)证实,这些系统对股骨内侧解剖结构具有适应性。无论内侧髁的大小如何,均有可能实现至少3个独立的固定点。

结论

对于特定病例,锁定股骨远端钢板可作为内侧增强固定的可行选择,能够实现与股骨远端的解剖学适配。这无需使用外侧皮质固定之外的额外器械,即可提供可靠的增强固定。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/f097d8737eec/oi9-7-e347-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/adcdce72f028/oi9-7-e347-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/e818203c1f1c/oi9-7-e347-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/693dd6512045/oi9-7-e347-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/51090fdab794/oi9-7-e347-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/f097d8737eec/oi9-7-e347-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/adcdce72f028/oi9-7-e347-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/e818203c1f1c/oi9-7-e347-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/693dd6512045/oi9-7-e347-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/51090fdab794/oi9-7-e347-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1cf/11365623/f097d8737eec/oi9-7-e347-g005.jpg

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本文引用的文献

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Injury. 2023 Oct;54(10):110936. doi: 10.1016/j.injury.2023.110936. Epub 2023 Jul 17.
2
Technical Trick: Supplemental Medial Column Screw Fixation of Distal Femur Fractures Treated With a Laterally Based Locked Plate.技术技巧:外侧锁定钢板治疗股骨远端骨折时附加内侧柱螺钉固定。
J Orthop Trauma. 2023 Apr 1;37(4):e175-e180. doi: 10.1097/BOT.0000000000002475.
3
Dual-Plating in Distal Femur Fracture: A Systematic Review and Limited Meta-analysis.
股骨远端骨折的双钢板固定:一项系统评价和有限元分析
Indian J Orthop. 2021 Aug 23;56(2):183-207. doi: 10.1007/s43465-021-00489-0. eCollection 2022 Feb.
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Early Weight Bearing after Distal Femur Fracture Fixation.股骨远端骨折固定术后早期负重
Geriatr Orthop Surg Rehabil. 2022 Jan 27;13:21514593211070128. doi: 10.1177/21514593211070128. eCollection 2022.
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Modified use of the proximal humeral internal locking system (PHILOS) plate for distal femoral nonunions.改良肱骨近端内锁定系统(PHILOS)板在股骨远端骨不连中的应用。
Eur J Orthop Surg Traumatol. 2023 Feb;33(2):425-433. doi: 10.1007/s00590-022-03203-4. Epub 2022 Jan 21.
6
Supplemental medial small fragment fixation adds stability to distal femur fixation: A biomechanical study.补充内侧小骨块固定可增加股骨远端固定的稳定性:一项生物力学研究。
Injury. 2021 Jul;52(7):1670-1672. doi: 10.1016/j.injury.2021.04.056. Epub 2021 May 1.
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Injury. 2021 Jun;52(6):1614-1620. doi: 10.1016/j.injury.2021.01.003. Epub 2021 Jan 7.
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