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11/19/2018
1
FLORIDA ORTHOPAEDIC INSTITUTEFLORIDA ORTHOPAEDIC INSTITUTE
FRACTURES ABOUTA TOTAL KNEE
FRACTURES ABOUTA TOTAL KNEE
FLORIDA ORTHOPAEDIC INSTITUTEFLORIDA ORTHOPAEDIC INSTITUTE
DISCLOSUREDISCLOSURE
DESIGNER & RECEIVE ROYALTIES:
A.L.P.S. SYSTEM - ZIMMER - BIOMET
POLYAXIAL PLATES - ZIMMER - BIOMET
SONIC PIN - STRYKER
TRIGEN NAILS - SMITH & NEPHEW
INTERTAN NAIL - SMITH & NEPHEW
JET-X EX FIX - SMITH & NEPHEW
BIONX SCREWS - CONMED/LINVATEC
FIBULA/ULNA NAIL - ACUMED
A.L.P.S. SYSTEM - ZIMMER - BIOMET
POLYAXIAL PLATES - ZIMMER - BIOMET
SONIC PIN - STRYKER
TRIGEN NAILS - SMITH & NEPHEW
INTERTAN NAIL - SMITH & NEPHEW
JET-X EX FIX - SMITH & NEPHEW
BIONX SCREWS - CONMED/LINVATEC
FIBULA/ULNA NAIL - ACUMED
UNIVERSITY of SOUTH FLORIDA / FLORIDA ORTHOPAEDIC INSTITUTE DEPARTMENT OF ORTHOPAEDIC SURGERY
FLORIDA ORTHOPAEDIC INSTITUTEFLORIDA ORTHOPAEDIC INSTITUTE
AND I RECEIVE
ROYALTIES
IN MY ROLE AS
EDITOR‐IN‐CHIEF
AND I RECEIVE
ROYALTIES
IN MY ROLE AS
EDITOR‐IN‐CHIEF
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2012, Vol. 43pp. 1084 - 89
PLATES:69% HEALED (25/36)
22% DELAYED / N-U
2012, Vol.27pp. 809 - 813
PLATES:26% FIXATION FAILED
11% DELAYED / N-U
BENEFITS OF A RIMN
USES PREVIOUS INCISION
EARLY WEIGHTBEARING
LOAD SHARING !!!!
IMMEDIATE ROM
USES PREVIOUS INCISION
EARLY WEIGHTBEARING
LOAD SHARING !!!!
IMMEDIATE ROM
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2006, Vol # 23, pp. 405 - 408
REVISION ARTHROPLASTY
LOCKEDPLATE
RETROGRADEIM NAIL
LOCKED PLATEvs. RIMN
CASE1
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SIX (6) OPERATIONS POST TKA TO FIX STRESS FRACTURE. HAS NOT WALKED IN 5 YEARS
RETROGRADE FEMORAL NAILING
RETROGRADE FEMORAL NAILING
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RETROGRADE FEMORAL NAILING
RETROGRADE FEMORAL NAILING
1 WEEKPOST- OP1 WEEK
POST- OP
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16 WEEKSHEALED
FRACTURE
16 WEEKSHEALED
FRACTURE
CASE2
SUTYPE I
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LOADSHARING
EARLYWEIGHTBEARING
FULL ROM
CASE3
M, 89 y.otransferred fromanother hospital
in immobilizer
PAIN IN KNEEFELL 2 DAYS AGO
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IMMOBILIZER TAKEN OFF
TRANSLATED
EXTENSION
?PLANNED
TOSHORTEN
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2005, Vol. 19pp. 164 - 170
EXCELLENT RESULTS @ 24 mos.
ONLY 10 PATIENTS
2017, Vol. 103pp. 257 - 262
TRENDS TOWARDS
HIGHER RATES OF N-U
WITH LOCKED PLATES
FLORIDA ORTHOPAEDIC INSTITUTEFLORIDA ORTHOPAEDIC INSTITUTE
LIMITATIONS - IM NAILINGLIMITATIONS - IM NAILING
REQUIRES 12 mm. INTERCONDYLAR REGIONREQUIRES 12 mm. INTERCONDYLAR REGION
CONTRA-INDICATED IFCLOSED BOXCONTRA-INDICATED IFCLOSED BOX
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2016, Vol 47pp. 460 - 464
RETROGRADE FEMORAL INTRAMEDULLARY NAILS USED.
Manufacturer Model Diameter (mm)
Biomet Phoenix retrograde nail 10.5DePuy ACE retrograde femoral nail 10Smith & Nephew Trigen retrograde femoral nail 10Stryker T2 supracondylar femoral nail 10
2015, Vol. 29pp. 380 - 384
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A = ant cortex to Blumenstadt’s line B = widest AP diameter condyle
A/B = Starting Point Ratio
(SPR)
X = ant flange to plug (ant position of box)
Y = widest AP diameterX/Y = Femoral Cond. Ratio
(FCR)
SPR = 0.392 FCR = 0.416
FCR = 0.444 cruciate retaining
FCR = 0.393 post stabilized
SPR = 0.399 MEN
SPR = 0.386 WOMEN
~ 6 mm difference
2014, Vol. 29pp. 1639 - 41
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2013, Vol. 27pp. 158 - 161
ISOLATED HYPEREXTENSION WITH RIMN (30 pts)NOT A PROBLEM
@ ~ 6 YEARS
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2014, Vol. 28pp. 307 - 312
LOCKED PLATES & RIMNBETTER THAN
COMPRESSION PLATING
LP NONUNIONSRIMN MALUNIONS
CASE4
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SUTYPEI - II
CENTER-CENTER
FEAR OF VARUS
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1999
Journal of Orthopaedic TraumaVol. 13, no. 8, pp 523 - 527© 1999 Lippincott Williams & Wilkins Inc.
The Mechanical Effect Of Blocking Screws In Stabilizing Tibia Fractures With Short Proximal Or Distal Fragments After Insertion Of Small‐Diameter Intramedullary Nails.
Krettek, C.
POLLERSCREW
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2014, Vol. 21pp. 224 -231
LP RIMN LP +RIMN
NAILor
PLATE?
LAG SCREW MAYBE…
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BIOMXTHIS MAKES
SENSE
BUT WILL IT STRESS SHIELDTHE LATERALFEMUR SHAFT
?
CONCLUSIONS
BENEFITS OF A RIMN
USES PREVIOUS INCISION
EARLY WEIGHTBEARING
LOAD SHARING !!!!
IMMEDIATE ROM
USES PREVIOUS INCISION
EARLY WEIGHTBEARING
LOAD SHARING !!!!
IMMEDIATE ROM
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LOCKEDPLATE
RETROGRADEIM NAIL
LOCKED PLATEvs. RIMN
REVISION ARTHROPLASTY
CLOSED BOX & NARROW
CRUCIATE RETAINING TKA
MALUNION IN METAPHYSIS
LIMITATIONS OF A RIMN
CLOSED BOX & NARROW
CRUCIATE RETAINING TKA
MALUNION IN METAPHYSIS(extension & valgus)
FLORIDA ORTHOPAEDIC INSTITUTEFLORIDA ORTHOPAEDIC INSTITUTE
LIMITATIONS - IM NAILINGLIMITATIONS - IM NAILING
REQUIRES 12 mm. INTERCONDYLAR REGIONREQUIRES 12 mm. INTERCONDYLAR REGION
CONTRA-INDICATED IFCLOSED BOXCONTRA-INDICATED IFCLOSED BOX
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UNIVERSITY of SOUTH FLORIDA / FLORIDA ORTHOPAEDIC INSTITUTE DEPARTMENT OF ORTHOPAEDIC SURGERY