For reconstructive surgery of the knee joint, the global modular. In massive, segmental defects with loss of collateral ligamentous support and lack of bone to support the use of prosthetic augments or metaphyseal cones or sleeves, a hinged proximal tibial replacement or a socalled megaprosthesis should be available. It has been suggested that anterior bowing of the femur has an unexpected effect on implant sizing. In our experience, ct is extremely helpful in characterization of complex intraarticular fractures of the distal femur. Pdf treatment of distal femoral fractures in the elderly. Conflict of interest forms for authors and clinical. The pushthrough total femoral prosthesis offers a functional. We found the liss for treatment of distal femoral fractures of all types to. Open reduction vs distal femoral replacement arthroplasty. T2 proximal humeral nail is intended to provide temporary stabilization of various types of fractures, malunions and nonunions of the humerus. Kickstand screw designed to capture medial malleolus. Gmrs global modular replacement system distal femur technology thats. Class 2 device recall gmrs proximal femoral surgical protocol.
Uncemented megaprosthesis stem fixation using scratch fit. A guide to the placement of this mark is the linea aspera on the posterior aspect of the femur. Our biomechanical study was intended to assess the adequacy of oncologic implant pressfit stem fixation within the reamed canal of the distal femur for the stryker gmrs. Distal femoral resection 11 intramedullary alignment 12. Biarticular total femur spacer for massive femoral bone. However, the presence of a supracondylar fracture with intraarticular extension suggests that there may be an occult associated coronalplane hoffa fracture.
Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological. The use of a modular rotating hinge component in salvage revision total knee arthroplasty. Nov 30, 2017 this feature is not available right now. This publication sets forth detailed recommended procedures for using stryker orthopaedics. Class 2 device recall global modular replacement system gmrs. Downloaded from the university of groningenumcg research. Chronic osteomyelitis involving the distal femur often results in amputation or arthrodesis. Global modular replacement system one system, one vision.
The placement of an intramedullary im nail in the femur is affected by the bow of the femur. Treatment with a retrograde inserted locked intramedullary nail, journal of orthopaedic trauma, vol. Global modular replacement system proximal femoral resection for large segmental replacements, femur prosthesis surgical literature, stryker orthopaedics, mahwah, nj 07430. Distal femur fractures and its treatment with distal femur locking plate kanav padha, sandeep singh, abdul ghani, harish dang the incidence of distal femur fractures is around 37 100,000 patients per year. Gmrs distal femoral surgical protocol introduction the gmrs distal femoral components are based on over a quarter of a century of clinical history. Structural failures of the prosthesis are wellknown postoperative complications and have been reported for various prosthesis types. At the diaphysealmetaphyseal junction, the metaphysis. Mid term results of distal femoral fractures treated with a. Failures, functional results, and a comparative statistical analysis. Intraarticular fractures of distal femur present a huge surgical challenge. Patients with distal femoral fractures do not routinely require ct.
Less invasive stabilization system liss technique guide. Stryker orthopaedics has become aware that the labels on the triathlon distal. It differs from traditional stemmed prostheses because it requires only 4 to 8 cm of residual bone for. Revision distal femoral arthroplasty with the compress. Bone cement spacers loaded with antibiotic are the gold standard in septic revision. Retrograde femoral nailing of periprosthetic fractures. The incidence of primary total knee replacement tkr is increasing with a resultant rise in those patients sustaining distal femoral periprosthetic fractures around tkrs. Surgical options range from osteotomy alone, arthroplasty with intraarticular correction, or arthroplasty with extraarticular correction. Fractures of the distal femur whether supracondylar. Class 2 device recall global modular replacement system.
Monoaxial locking plate for treating distal femur fractures. Multiple acceptable options are available for the correction of distal femoral deformity associated with knee arthritis. The use of modular rotating hinge component in salvage revision total knee. Proximal tibial metaphyseal bone loss compromises the alignment and fixation of components during revision total knee arthroplasty. Distal femoral replacement in periprosthetic fracture. Proximal tibial replacement in revision knee arthroplasty for. Please vote below and help us build the most advanced adaptive learning platform in medicine. Outcome of retrograde intramedullary nailing and locking. Distal femoral fracture during primary tka is rare and associated with the use of a semiconstrained. Utilizes gmrs small axle, small bushings and mrh bumper utilizes modular rotating hinge axle, bushings, and bumper distal femur distal femur with allpoly tibial component while clinical history is the foundation for the gmrs system, our stateoftheart technology drives the systems outstanding performance. Gmrs proximal femoral surgical protocol 2 marking anterior aspect of femur a longitudinal line representing the anterior point on the femur should now be marked distal to the resection level to aid in rotational orientation of the prosthesis figure 2. Strykers gmrs represents another significant option in modular replacement systems as a solution that can help retain quality of life for patients who require radical bone resection.
System is strykers range of axially stable locking plates with locking screws designed to treat peri or intraarticular fractures. Pdf distal femoral fracture during primary total knee. The distal femur was resected through a midline skin incision and medial parapatellar arthrotomy. Pdf hip abductor moment arm a mathematical analysis for. Modular knee megaendoprotheses are commonly used devices for. The exclusion criterion to use a retrograde im nail was a type c2 or c3 fracture.
However, the management of massive bone defects constitutes a surgical challenge, requiring the use of different nails, expensive long stems, or cementcoated tumor prostheses for preparing the spacer. We describe a novel technique for preparing a biarticular. Modular knee megaendoprotheses are commonly used devices for distal femur or proximal tibia replacement in tumor surgery as well as for treatment of some periprosthetic fractures around a loose or failed total knee arthroplasty. The system consists of distal femoral components, extension. Distal femoral fracture during primary total knee arthroplasty. Pdf hip abductor moment arm a mathematical analysis. Despite a proposed lower incidence of aseptic loosening, uncemented distal femoral implants present challenges with the intraoperative assessment of the adequacy of stem fixation within the femoral canal. Chronic osteomyelitis of the distal femur treated with. Stryker sent urgent product recall notification letters and product accountability forms via fedex on 12212007, return receipt requested. The compress compliant prestress cps implant can reconstruct the femur even when there is little remaining bone. Effect of simulated early weight bearing on micromotion and pullout strength of uncemented distal femoral stems article pdf available in orthopedics 385.
The annual number of revision total knee arthroplasty tka procedures in the united. An urgent product recall letter dated 172008, was sent to surgeons who are gmrs users, advising that the gmrs proximal femoral components are not compatible with alumina ceramic heads. Femoral cadaveric specimens were thawed and cut at the distal end of the femur, at cm from the distal joint line, to e represent a distal femoral tumor resection. The polyax locked plating system is indicated for the treatment of distal femur and proximal tibia fractures. Structural failure of a modern knee tumor megaendoprosthesis. Gmrs proximal femoral surgical protocol acknowledgements stryker would like to thank all of the surgeons for their contributions in developing the global modular replacement system gmrs. The system is intended for use in open or percutaneous fracture fixation cases requiring open reduction internal fixation orif of closed and open fractures of the distal femur and proximal tibia, including repair of non. Total knee arthroplasty in patients with extraarticular. Treatment of distal femoral fractures in the elderly using a lessinvasive plating technique. Distal femur distal femur with allpoly tibial component while clinical history is the foundation for the gmrs system, our. Class 2 device recall triathlon femoral distal fixation peg. Gmrs distal femoral components are marketed in the united states for use with. Survival and complications in hinged knee reconstruction.
The femoral head is then impacted and the hip joint is reduced. Strykers gmrs represents another significant option in. Babst department of trauma surgery, cantonal hospital lucerne, lucerne, switzerland summary this paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. Proximal tibial replacement in revision knee arthroplasty for non. Reconstruction of distal femoral fractures with fixedangled. Stryker gmrs uncemented stems were placed, after femoral reaming, into the distal femoral canal with firm, hand pressure applied via a customized, springbased insertion. The treatment modality should be chosen based on the extent of deformity and attention to preservation of the collateral ligaments. The departments electronic database was searched for all patients undergoing revision of total knee arthroplasty. The distal portion of the femoral prosthesis is first linked to the tibial component. A guide to the placement of this mark is the linea aspera on the posterior aspect of the. The information presented is intended to demonstrate the breadth of stryker product offerings. The consecutive multicentre study cohort consists of all distal femoral fractures treated with the ncb distal femur plate zimmer, warsaw, usa and a minimum followup of twelve months.
The collar is not an optional item and must be used. Patella kinematics have been improved by incorporating a deepened patellar track to articulate with the duracon patellae. If you need help accessing information in different file formats, see instructions for downloading viewers and players. Open reduction vs distal femoral replacement arthroplasty for comminuted distal femur fractures in the patients 70 years and older. Patella kinematics have been enhanced by incorporating a deepened patellar track to articulate with the duracon patellae. The aim of this study is to evaluate functional outcome, fracture healing, and the complications of distal femoral intraarticular fractures using locking compression plates.
Rockwood and wilkins fractures in children 9th edition pdf. Knee society score kss was calculated and range of motion rom was. The stryker gmrs endoprosthesis provided the longest moment arm in singleleg stance. Secure the total femur coupler trial to the diaphyseal. Distal femoral varus osteotomy may be used to treat valgus knee malalignment or to protect a knee.
The anteroposterior and lateral xrays of the knee with distal femur were performed. Stage one involved resection of infected bone and placement of an intramedullary nail spanning the bony defect between proximal femur and tibia, with antibiotic cement. The t2 femoral nailing system offers a universal left and right nail in addition to an antegrade or retrograde approach that may reduce inventory. The t2 im nailing platform offers a combination of innovation, simplicity and versatility that is designed to suit your various needs. Gmrs proximal femoral surgical protocol stryker meded. The conventional sps small and basic fragment sets are standard plating systems which offer a broad range of. If well aligned and fixed, the original tibial component was left in place. Femur axsos 3 titanium operative technique distal lateral femur. Consult strykers entire gmrs catalogue on medicalexpo. Proximal tibial replacement in revision knee arthroplasty.
This article presents three cases of chronic osteomyelitis treated with a staged approach culminating in endoprosthetic reconstruction. Once the appropriate size is determined, the final prosthesis is placed. Sep 22, 2015 patients with failed distal femoral megaprostheses often have bone loss that limits reconstructive options and contributes to the high failure rate of revision surgery. Distal femur fractures and its treatment with distal femur.
Distal cutting guide standard femoral cutting block small femoral cutting block drill guide 2. Chapter 53 fractures of the distal femur china quad diaries. In these cases, a distal femur locking compression plate osteosynthesis was performed. Pdf chronic osteomyelitis of the distal femur treated with. Gmrs proximal tibial surgical protocol description of the proximal tibial modular replacement system the gmrs system was developed to meet the unique needs of patients who require reconstruction of large segmental defects for tumors, failed previous arthroplasty, or trauma. A retrospective analysis of the patient notes was performed to examine the patient.
It is also useful to expose the neurovascular bundle when a distal femoral fracture is complicated by an arterial injury. The gmrs system is the evolution of its predecessors, the krh, mrh. Overall, the seventh edition of rockwood and greens fractures in adults rockwood and wilkins fractures in children is an outstanding body of work presenting the most comprehensive and current treatment of musculoskeletal trauma possible. Surgical techniques can be performed with a lateral openingwedge or medial closingwedge correction of the deformity.
Orthopaedics gmrs proximal tibial surgical protocol. Orthopaedics gmrs proximal tibial surgical protocol table of contents introduction 2 description of the proximal tibial global modular replacement system 4 surgical protocol 7 measuring resection length 8 tibial osteotomy 9 femoral sizing 9 preparation for the mrh femoral component 10 femoral canal preparation 10 distal femoral resection 11 intramedullary alignment 12. Titanium distal femur liss plates this view for left femur 422. Fracture classification according the ao ota system and the trauma mechanism radiological evaluation and complications were documented. Distal femoral reconstruction following failed total knee arthroplasty.
Failure to do so may result in excessive subsidence of the prosthesis. It offers guidance that you should heed, but, as with any. Stryker s gmrs represents another significant option in modular replacement systems as a solution that can help retain quality of life for patients who require radical bone resection. Stryker orthopaedics has a long tradition of understanding surgeons clinical requirements and the growing needs of the patients. From these, all patients having distal femoral replacement for periprosthetic fracture around the distal femoral component using the stryker global modular replacement system gmrs implant were filtered. It offers guidance that you should heed, but, as with any such technical guide, each surgeon must consider. These distal femoral fixation pegs are an accessory to the triathlon femoral component and are optional for use. This increases the length of the patello femoral moment arm, which maximizes quadriceps efficiency and allows the patient to achieve full extension with less effort. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in surgery. The information contained in this document is intended for. Positive results have been published by researchers with implants such as distal femur nail, dynamic condylar screw and even addition of a medial plate to a distal femur locking plate for treating distal femur fractures. The medial approach to the distal femur is useful to expose a medial distal femoral fractures, a hoffatype fracture, osteochondroma, or a neoplastic lesion of bone. Orthopaedics gmrs proximal tibial surgical protocol global modular replacement system.
From a populationbased implant design, a patented screwtoplate interface, and streamlined instrumentation, our focus is on creating a welldesigned plating system, giving you more time to focus on other things. Our portfolio of lower extremities products includes a comprehensive array of intramedullary nails, locking plates, external fixation, and biologics. The global modular replacement system gmrs, stryker. Tomofix medial distal femur plate surgical technique depuy synthes companies 1 warning. Oct 01, 2016 distal femur locking plate is still the way forward for treating distal femur fractures. Orthopaedics gmrs proximal femoral surgical protocol. In the elderly, distal femoral fractures are a mirror image of its more prevalent, proximal sibling, the fracture of the neck of femur or hip fracture. Current concepts in fractures of the distal femur soucasny pohled na zlomeniny dolniho konce stehenni kosti b. The anterior bow of the femur and its influence on femoral. The global modular replacement system is intended to be used with the components of the howmedica osteonics modular replacement system, the howmedica osteonics modular rotating hinge knee system andor the howmedica osteonics kinematic rotating hinge knee system in situations where replacement of extensive bone loss in the femur andor. Locking compression plate in distal femoral intraarticular. Distal femoral varus osteotomy is a wellestablished procedure for the treatment of lateral compartment cartilage lesions and degenerative disease, correcting limb alignment and decreasing the progression of the pathology.
Download rockwood and wilkins fractures in children text. Gmrs global modular knee replacement system from stryker. The pushthrough total femoral prosthesis offers a functional alternative to total femoral replacement. A femoral trial is built using modular segments to optimize leg length and soft tissue tension. These pegs are designed to provide rotational stability and to aid the surgeon in the placement of the femoral component on the prepared distal femur. Although fractures of the neck of femur have a much higher incidence, one may consider both, two ends of a spectrum of the same condition, as they are in close proximity. Lcp periarticular plating system the lcp periarticular plating system is capable of addressing. Hinged proximal tibia reconstruction prostheses entail more infection than distal femur prostheses, with mean incidence of 16. Pdf chronic osteomyelitis involving the distal femur often results in. A plain collar is provided if hydroxyapatite coating is not required.