股骨远端骨折手术图解.ppt

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1、APviewofacomminutedC3intraarticulardistalfemurfracture.Lateralviewdemonstratingthetypicalextensiondeformitycausedbythepulloftheoriginofthegastrocnemiusmusclesfromtheposteriordistalfemur.Thesefiguresdemonstratetheintracondylarextensionofthefractureanda

2、freeintercondylarfragment(arrows).FEMORALAXISPLANNEDSCREWPOSITIONSWhenplanningforthelagscrewfixation,thesurgeonmustleaveroomforthelagscrewofthefixedangledeviceorintramedullarynail.A7-10cmlateralparapatellarincisionismadewhichcanbeextendedproximallyint

3、oaformallateralapproachtothefemurifnecessary.Theintercondylarreductionisperformedthroughthislimitedarthrotomy.Periarticularorstandardclampsareusedtomanipulateandreducethefracturewhichisstabilizedwiththetemplated6.5mmlagscrewswithwashers.Thescrewsarepl

4、acedanteriorandposteriortotheplannedpositionofthefixedangledevice.Notetheanatomicreductionofthearticularsurface.Atthispoint,thearticularsurfaceisreconstructedandthemetaphysealcomponentofthefractureisstillunfixed.APVIEWLATERALVIEWAPVIEWLATERALVIEWAPand

5、lateralradiographdemonstratingthepositionofthelagscrewastemplated.Notethatwithtraction,boththeAPandlateralradiographsaremanipulatedsuchthatthemetaphysisisreduced.APVIEWLATERALVIEWThisrequiresabolsterunderneaththemetaphysealfractureandsomeflexionofthek

6、neetocorrecttheextensiondeformityofthequadriceps.Thedottedlinerepresentstheaxisofthefemurwheretheplatewillbeplaced.APradiographdemonstratingtheangleatwhichtheguidewireforthefixedanglelagscrewshouldbeplaced.Itshouldbeparallelwiththedistalfemoralarticul

7、arsurface,whichisatapproximately95oto98ofromthefemoralshaft.95°Afterthelagscrewisplaced,theappropriatesizedfixedangleplateisslidsubperiosteallyupthefemur.Noticethebolster,whichissupportingthefractureinareducedposition.Aftertheplateisadvancedsubperiost

8、eallyupthefemur,thedistalfragmentismanipulatedsuchthattheplatingengagesthelagscrew.Aftertheplateisadvancedsubperiosteallyupthefemur,thedistalfragmentismanipulatedsuchthattheplatingengagesthelagscrew.APandlateralradiographsdemonstratingthatthep