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1、AP view of a comminuted C3 intraarticular distal femur fracture.Lateral view demonstrating the typical extension deformity causedby the pull of the origin of the gastrocnemius muscles from theposterior distal femur.These figures demonstrate the intracondylar extension of the fractureand a free inter
2、condylar fragment(arrows).FEMORAL AXISPLANNED SCREWPOSITIONSWhen planning for the lag screw fixation,the surgeon must leave room for the lag screw of the fixed angle device or intramedullary nail.A 7-10cm lateral parapatellar incision is made which can be extended proximally into a formal lateral ap
3、proach to the femur if necessary.The intercondylar reduction is performed through this limited arthrotomy.Periarticular or standard clamps are used to manipulate and reduce the fracture which is stabilized with the templated 6.5 mm lag screws with washers.The screws are placed anterior and posterior
4、 to the planned position of the fixed angle device.Note the anatomic reduction of the articular surface.At this point,thearticular surface is reconstructed and the metaphyseal component ofthe fracture is still unfixed.AP VIEWLATERAL VIEWAP VIEWLATERAL VIEWAP and lateral radiograph demonstrating the
5、position of the lag screwas templated.Note that with traction,both the AP and lateralradiographs are manipulated such that the metaphysis is reduced.AP VIEWLATERAL VIEWThis requires a bolster underneath the metaphyseal fracture and someflexion of the knee to correct the extension deformity of the qu
6、adriceps.The dotted line represents the axis of the femur where the plate will be placed.AP radiograph demonstrating the angle at which the guidewire for the fixed angle lag screw should be placed.It should be parallel with the distal femoral articular surface,which is at approximately 95o to 98o fr
7、om the femoral shaft.95After the lag screw is placed,the appropriate sized fixed angleplate is slid subperiosteally up the femur.Notice the bolster,which is supporting the fracture in a reduced position.After the plate is advanced subperiosteally up the femur,the distal fragment is manipulated such
8、that the plating engages the lag screw.After the plate is advanced subperiosteally up the femur,the distal fragment is manipulated such that the plating engages the lag screw.AP and lateral radiographs demonstrating that the plate is against the femur and the metaphysis is generally reduced.AP VIEWL
9、ATERAL VIEWThe lateral radiograph can be used in a similar fashion to a perfect circle technique used in nailing to place the proximal screws percutaneously.A percutaneous incision is used to allow for the placement of threescrews through this incision.This image demonstrates the drillbeing introduc
10、ed percutaneously into the hole and drilling throughthe plate into the femur.The first screw is the most proximal to seat the plate.As the most proximal screw is placed,it pulls the femoral shaft against the plate.As the most proximal screw is placed,it pulls the femoral shaft against the plate.As a
11、dditional screws are placed,better fixation of the proximal fragment is obtained.The final radiograph demonstrating the parapatellar incisionfor reduction of the joint and the percutaneous incisionsutilized for the placement of the screws.The size of the plate held up against the leg after fixation.Immediate postoperative AP radiographLateral radiograph immediately postoperative,demonstratinganatomic alignment of the metaphyseal region,as well as thejoint.AP VIEWLATERAL VIEWAP and lateral radiographs demonstrating early callus formation at six weeks.