TRAUMA

RECENT CONCEPTS OF FIXATIONS

DR AHMAD FADZLI SULONG IIUM KUANTAN

LOCKING VS CONVENTIONAL PLATES

PLATES

Standard cortical screw e compressing plate to surface of the bone, providing friction and stability.

Locking head screw providing angularstability and preservation of periosteal blood supply.

PLATESAngular stability? Fixed angle device?

PLATES

Benefits of locking plates

Osteoporotic bones

• Angular stability• Increase pullout strength of screws

PLATES

Angular stability especially in intraarticularfractures

PLATES

Acts as a reduction tool (comminuted/short metaphyseal segment)

PLATES

Bridging comminuted

fractures

PLATES

Confers a biological fixation

PLATES

Common fractures requiring lock plates

Comminuted distal end radius fractures

PLATES

Tibial plateau (occasionally with long metaphyseal segment)

PLATES

Comminuted distal femur

PLATES

Comminuted distal humerus fractures

PLATES

Role of lock plates in musculoskeletal infection / LRS

Option for fixing fractures immediately after removing ext fix (Eg: in open fractures)

As fracture stabilizer in damaged bone following osteomyelitis treatment

Role of lock plate in fixing distraction osteogenesis cases (consolidation phase)

PLATE

PLATE

PFN VS DHS VS PROX FEMUR PLATE

PROX FEMUR FRACTURE

Decision is mainly based on the type and configuration of fracture

PROX FEMUR FRACTURE

Any reverse obliquity/subtrochanteric fracture considered most UNSTABLE

PROX FEMUR FRACTURE

PROX FEMUR FRACTURE

STABILITY of fracture is key

Based on how intact is the posteromedial buttress and if is reverse obliquity/subtrochanteric

If stable: DHS is adequate

If unstable: PFN or Proximal Femur Lock plate

PROX FEMUR FRACTURE

DHS

PROX FEMUR FRACTURE

PFN acts as a lateral buttress for reverse obliquity fractures

PROX FEMUR FRACTURE

Shorter lever arm in PFN confers increased stability

PROX FEMUR FRACTURE

Decision for prox femur lock plate: when entry point highly comminuted – greater trochanter comminution

Or when too many fragments especially at the posteromedial buttress

Experience before: not enough screws could be placed within NOF due to its size causing instability

PROX FEMUR FRACTURE

CANNULATED SCREWS

CANNULATED SCREW

Why is it easy?

Most reductions are held by wires – as not to damage the bone

If can immediately put screw in over the said wire – easy and simple…

Hence the development of cannulted screw fixations

CANNULATED SCREW

Not all fractures can be held with enough stability with screws only – usually large single piece fractures

CANNULATED SCREW

CANNULATED SCREW

CANNULATED SCREW

Headless cannulated screws

Usually fractures that would require the screw head be exposed unto the joint surface

As the principle of fixing a fracture thru lag screw should be from small piece unto large piece

CANNULATED SCREW

WHAT IS EXPECTED OF IMPLANTS REP

WE EXPECT

Available implants and instruments Majority sizes should always be available and

updated

Especially screw sizes

Implant reps should be present whenever cases are being done Especially if involving new implants

Provide input on the surgical pearls and pitfalls of using the implants – u are exposed to more surgeons

WE EXPECT

Adequate training and experience exchange between surgeons whenever introducing new concepts or fixations

Would be good if the reps that introduce any new or upcoming breakthoughs

Implant reps should be contactable at any working times for easy enquiries

An easy and patient friendly payment process

WE EXPECT

Implant reps should be contactable at anytime during working hours for easy enquiries

An easy and patient friendly payment process

Preferably if it can be settled quickly and without hassle

WHAT WOULD BE NICE

Free implants (<RM 1000) are available readily at the hospital – including the instruments – enable quick and easy fixations even during oncall hours