Björn-Christian Link1, Theerachai Apivatthakakul2, Brian W Hill3, Peter A Cole3, Reto Babst1. 1. Department of Trauma Surgery, Cantonal Hospital Lucerne, Spitalstrasse 15, CH 6000 Lucerne, Switzerland. 2. Department of Orthopedics, Chiang Mai University, Chiang Mai 50200, Thailand. 3. Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, 640 Jackson Street, Mailstop 11503L, St. Paul, MN 55101. E-mail address for P.A. Cole: Peter.A.Cole@HealthPartners.com.
Abstract
INTRODUCTION: We describe percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO) for periprosthetic femoral shaft fractures. STEP 1 PREOPERATIVE PLANNING AND ASSESSMENT OF THE LENGTH ALIGNMENT AND ROTATION OF THE EXTREMITY: A well-developed preoperative plan and assessment of the length, alignment, and rotation of the extremity are critical. STEP 2 PREPARE THE TUNNEL: After making the appropriate incision, use the tunneling device anterior and posterior to the femur to create a soft-tissue tunnel. STEP 3 INSERT AND CONNECT THE CERCLAGE PASSER: Insert the cerclage passer carefully by keeping it in close contact with the bone. STEP 4 INSERT THE CERCLAGE WIRE AND REMOVE THE WIRE PASSER: The cerclage wire may be incrementally inserted according to the direction on the passer to prevent kinking. STEP 5 PLACE AND FIX THE SUBMUSCULAR PLATE: Verify the alignment and length of the plate with intraoperative images and precontour the plate to fit the lateral aspect of the femur as necessary. STEP 6 CLOSURE AND POSTOPERATIVE REHABILITATION: Encourage an immediate range of motion to aid in postoperative recovery. RESULTS: In our original study, ten patients with a Vancouver type-B1 periprosthetic femoral shaft fracture (mean age, seventy-four years; range, forty-seven to eighty-four years) were treated with the described percutaneous cerclage wire and MIPO techniques.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: We describe percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO) for periprosthetic femoral shaft fractures. STEP 1 PREOPERATIVE PLANNING AND ASSESSMENT OF THE LENGTH ALIGNMENT AND ROTATION OF THE EXTREMITY: A well-developed preoperative plan and assessment of the length, alignment, and rotation of the extremity are critical. STEP 2 PREPARE THE TUNNEL: After making the appropriate incision, use the tunneling device anterior and posterior to the femur to create a soft-tissue tunnel. STEP 3 INSERT AND CONNECT THE CERCLAGE PASSER: Insert the cerclage passer carefully by keeping it in close contact with the bone. STEP 4 INSERT THE CERCLAGE WIRE AND REMOVE THE WIRE PASSER: The cerclage wire may be incrementally inserted according to the direction on the passer to prevent kinking. STEP 5 PLACE AND FIX THE SUBMUSCULAR PLATE: Verify the alignment and length of the plate with intraoperative images and precontour the plate to fit the lateral aspect of the femur as necessary. STEP 6 CLOSURE AND POSTOPERATIVE REHABILITATION: Encourage an immediate range of motion to aid in postoperative recovery. RESULTS: In our original study, ten patients with a Vancouver type-B1 periprosthetic femoral shaft fracture (mean age, seventy-four years; range, forty-seven to eighty-four years) were treated with the described percutaneous cerclage wire and MIPO techniques.IndicationsContraindicationsPitfalls & Challenges.
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