results of polyaxial locked-plate fixation of periarticular fractures of the knee by george...
TRANSCRIPT
![Page 1: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/1.jpg)
Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee
by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz, and Bruce Levy
JBJS Essent Surg TechVolume os-90(Supplement 2 Part 1):117-134
March 1, 2008
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 2: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/2.jpg)
Fig. 1 Close-up view of the POLYAX plate (DePuy Trauma, Warsaw, Indiana) demonstrating the large blue 8.0-mm fixed-angle central locking screw and the peripheral green polyaxial locking
screws.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 3: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/3.jpg)
Fig. 2 Close-up view of the head of the plate, demonstrating the central fixed threaded hole and the peripheral holes containing locking bushings to allow angulation prior to locking.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 4: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/4.jpg)
Clinical photograph of patient positioning.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 5: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/5.jpg)
Bump placement directly behind the knee can accentuate hyperextension of the distal fragment.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 6: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/6.jpg)
Anterolateral incision for simple fractures at the crest of the lateral femoral trochlear flare.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 7: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/7.jpg)
Fig. 6 Lateral peripatellar arthrotomy used for more complex articular fractures.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 8: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/8.jpg)
Fig. 7 Fluoroscopic image showing articular reduction with multiple Kirschner wires and clamps, which are replaced with lag screws in the appropriate plane.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 9: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/9.jpg)
Submuscular insertion of the plate with the targeting handle assembled.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 10: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/10.jpg)
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 11: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/11.jpg)
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 12: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/12.jpg)
Radiographic view of a large reduction tenaculum stabilizing the plate to the distal fragment for guide-pin placement.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 13: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/13.jpg)
The distal guide-pin must be inserted exactly parallel to the joint line of the distal part of the femur.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 14: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/14.jpg)
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 15: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/15.jpg)
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 16: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/16.jpg)
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 17: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/17.jpg)
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 18: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/18.jpg)
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 19: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/19.jpg)
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 20: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/20.jpg)
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 21: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/21.jpg)
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 22: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/22.jpg)
The completed construct.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 23: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/23.jpg)
A combination of distal polyaxial (green) and fixed locking (blue) screws used to fix a periprosthetic fracture proximal to the site of a total knee arthroplasty.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 24: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/24.jpg)
Lateral radiograph demonstrating a dispersed screw pattern used for a periprosthetic fracture.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 25: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/25.jpg)
Fig. 19 Anteroposterior radiograph demonstrating multiple points of medial condyle fixation and the combination of central fixed locking and multiple peripheral polyaxial screws.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.
![Page 26: Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee by George Haidukewych, Stephen A. Sems, David Huebner, Daniel Horwitz,](https://reader035.vdocuments.net/reader035/viewer/2022070403/56649f2c5503460f94c46e33/html5/thumbnails/26.jpg)
Fig. 20 Radiograph made at the time of drilling before the insertion of a polyaxial screw, demonstrating its unique advantages.
George Haidukewych et al. J Bone Joint Surg Am 2008;os-90:117-134
©2008 by The Journal of Bone and Joint Surgery, Inc.