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David C. Neal - One of the best experts on this subject based on the ideXlab platform.
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Single stage bilateral flexible intramedullary fixation of periprosthetic Distal Femur fractures.
Arthroplasty today, 2019Co-Authors: David C. Neal, Varun Sambhariya, Apollo Tran, Shawn K. Rahman, Russell A. WagnerAbstract:Abstract We present a patient with bilateral Rorabeck II/Su III periprosthetic Distal Femur fractures treated successfully with bilateral single stage flexible intramedullary fixation. Flexible intramedullary fixation of Rorabeck II/Su III periprosthetic Distal Femur fractures provides the benefits of shorter operative time, lower blood loss, and preservation of bone stock compared to plate fixation and Distal Femur replacement. We suggest that for patients with similar injuries flexible intramedullary fixation can be a viable treatment option.
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Single-stage bilateral Distal Femur replacement for traumatic Distal Femur fractures
Elsevier, 2019Co-Authors: David C. Neal, Varun Sambhariya, Bs ,apollo Tran, Shawn Rahman K. Bsa, Do ,thad J. Dean, Russel A. Wagner, Md ,hugo B. SanchezAbstract:Treatment of periprosthetic Distal Femur fractures and comminuted intraarticular Distal Femur fractures with previous arthritis remains a difficult challenge for orthopedic surgeons. Previous case series have shown that Distal Femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and allow for early ambulation in both of these fracture patterns. Owing to the typical low-energy mechanism of these injuries, a bilateral injury treated with DFR is rarely encountered. We present a patient with traumatic open left Rorabeck III/Su III periprosthetic Distal Femur fracture and closed right intraarticular Distal Femur fracture (AO fcation 33-C2) with end-stage arthrosis treated with single-stage bilateral DFR. We suggest that in patients with similar injuries, single-stage bilateral DFR can provide the benefits of early mobilization and accelerated recovery. Keywords: Distal Femur fracture, Periprosthetic fracture, Revision knee arthroplasty, Distal Femur replacemen
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Single-stage bilateral Distal Femur replacement for traumatic Distal Femur fractures.
Arthroplasty today, 2018Co-Authors: David C. Neal, Varun Sambhariya, Russel A. Wagner, Apollo Tran, Shawn K. Rahman, Thad J. Dean, Hugo B. SanchezAbstract:Abstract Treatment of periprosthetic Distal Femur fractures and comminuted intraarticular Distal Femur fractures with previous arthritis remains a difficult challenge for orthopedic surgeons. Previous case series have shown that Distal Femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and allow for early ambulation in both of these fracture patterns. Owing to the typical low-energy mechanism of these injuries, a bilateral injury treated with DFR is rarely encountered. We present a patient with traumatic open left Rorabeck III/Su III periprosthetic Distal Femur fracture and closed right intraarticular Distal Femur fracture (AO fcation 33-C2) with end-stage arthrosis treated with single-stage bilateral DFR. We suggest that in patients with similar injuries, single-stage bilateral DFR can provide the benefits of early mobilization and accelerated recovery.
Oliver Kessler - One of the best experts on this subject based on the ideXlab platform.
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Linking Proximal Femur Morphology to That of the Distal Femur
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: Samantha Wright, Tim A.e.j. Boymans, Tony Miles, Bernd Grimm, Oliver KesslerAbstract:Introduction The human body is a complex and continually adapting organism. It is theorised that the morphology of the proximal Femur is closely related to that of the Distal Femur. Patients that have abnormal anatomy in the proximal Femur, such as a high femoral neck anteversion angle, may have abnormal anatomy in the Distal Femur to overcome proximal differences. This phenomenon is of key interest when performing Total Hip Replacement (THR) or Total Knee Replacement (TKR) surgery. The current design and placement of existing hip and knee implants does not account for any correlation between the anatomical parameters of the proximal and Distal Femur, where bone anatomy may have adapted to compromise for abnormalities. A preliminary study of 21 patients has been carried out to assess the relationship between the proximal and Distal Femur. The difficulties in defining and measuring key anatomical parameters on the Femur have been widely discussed in the literature [1] due to its complex three dimensional geometry. Using CT scans of healthy octogenarians, it was possible to mark key anatomical landmarks which could be used to define various anatomical axes throughout the Femur. Correlation analyses could then be carried out on these parameters to assess the relationship between proximal and Distal Femur morphology. Methods Each Femur was initially realigned along the mechanical axis (MA); defined by joining the centre of the femoral head (FHC) to the centre of the intercondylar notch (INC) [2]. All anatomical landmarks were then identified using the Materialise Mimics v12 software (Figure 1 and 2) and exported into Microsoft Excel for analysis. Key anatomical parameters which were derived from these landmarks included the femoral neck axis (FNA), femoral neck anteversion angle (FNAA) [1–4], condylar twist angle, clinical transepicondylar axis (TEA), trochlea sulcus angle and medial and lateral trochlea twist. A correlation analysis was carried out on SPSS Statistics v20 (IBM) to assess the relationship between proximal and Distal anatomical parameters. Results The correlation analysis displayed a positive linear correlation between the FNAA and the clinical TEA (adjusted R squared = 0.471, p Discussion The morphology of the Distal Femur seems to be at least partially correlated with the proximal Femur and the relationship should be studied further to assess any potential effect on THA and TKA surgery. An extension of this study should assess an increased patient sample size and further anatomical parameters.
Michael J. Gardner - One of the best experts on this subject based on the ideXlab platform.
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Distal Femur Replacement Versus Surgical Fixation for the Treatment of Geriatric Distal Femur Fractures: A Systematic Review.
Journal of orthopaedic trauma, 2021Co-Authors: Brett P. Salazar, Aaron R. Babian, Malcolm R. Debaun, Michael Githens, Gustavo Chavez, L. Henry Goodnough, Michael J. Gardner, Julius A. BishopAbstract:OBJECTIVES The management of geriatric Distal Femur fractures is controversial, and both primary Distal Femur replacement (DFR) and surgical fixation (SF) are viable treatment options. The purpose of this study was to compare patient outcomes after these treatment strategies. DATA SOURCES PubMed, Embase, and Cochrane databases were searched for English language articles up to April 24, 2020, identifying 2129 papers. STUDY SELECTION Studies evaluating complications in elderly patients treated for Distal Femur fractures with either immediate DFR or SF were included. Studies with mean patient age
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Distal Femur replacement versus surgical fixation for the treatment of geriatric Distal Femur fractures a systematic review
Journal of Orthopaedic Trauma, 2021Co-Authors: Brett P. Salazar, Aaron R. Babian, Malcolm R. Debaun, Michael Githens, Gustavo Chavez, Michael J. Gardner, Henry L Goodnough, Julius A. BishopAbstract:OBJECTIVES The management of geriatric Distal Femur fractures is controversial, and both primary Distal Femur replacement (DFR) and surgical fixation (SF) are viable treatment options. The purpose of this study was to compare patient outcomes after these treatment strategies. DATA SOURCES PubMed, Embase, and Cochrane databases were searched for English language articles up to April 24, 2020, identifying 2129 papers. STUDY SELECTION Studies evaluating complications in elderly patients treated for Distal Femur fractures with either immediate DFR or SF were included. Studies with mean patient age <55 years, nontraumatic indications for DFR, or SF with nonlocking plates were excluded. DATA EXTRACTION Two studies provided Level II or III evidence, whereas the remaining 28 studies provided Level IV evidence. Studies were formally evaluated for methodological quality using established criteria. Treatment failure between groups was compared using an incidence rate ratio. DATA SYNTHESIS Treatment failure was defined for both SF and arthroplasty as complications requiring a major reoperation for reasons such as mechanical failure, nonunion, deep infection, aseptic loosening, or extensor mechanism disruption. There were no significant differences in complication rates or knee range of motion between SF and DFR. CONCLUSIONS SF and DFR for the treatment of geriatric Distal Femur fractures demonstrate similar overall complication rates. Given the available evidence, no strong conclusions on the comparative effectiveness between the 2 treatments can be definitively made. More rigorous prospective research comparing SF vs. DFR to treat acute geriatric Distal Femur fractures is warranted. LEVEL OF EVIDENCE Therapeutic Level IV. See instructions for authors for a complete description of levels of evidence.
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Distal Femur locking plates fit poorly before and after total knee arthroplasty
Journal of Orthopaedic Trauma, 2019Co-Authors: Sean T Campbell, Julius A. Bishop, Liam C Bosch, Steven T Swinford, Derek F Amanatullah, Michael J. GardnerAbstract:Objective:To evaluate the fit of Distal Femur locking plates. Secondarily, we sought to compare plate fit among patients with and without a total knee arthroplasty (TKA).Design:Retrospective.Setting:University hospital.Intervention:Standard length precontoured Distal Femur locking plates from 4 manu
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Dynamic Locked Plating of Distal Femur Fractures.
Journal of orthopaedic trauma, 2015Co-Authors: Michael S. Linn, Christopher M. Mcandrew, Beth Prusaczyk, Olubusola Brimmo, William M. Ricci, Michael J. GardnerAbstract:Objectives:Nonunion after locked bridge plating of comminuted Distal Femur fractures is not uncommon. “Dynamic” locked plating may create an improved mechanical environment, thereby achieving higher union rates than standard locked plating constructs.Setting:Academic Level 1 Trauma Center.Patients/P
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Pitfalls in the application of Distal Femur plates for fractures.
Journal of orthopaedic trauma, 2011Co-Authors: Cory A. Collinge, Michael J. Gardner, Brett D. CristAbstract:Despite design features intended to aid the surgeon in restoring proper alignment, malunion and implant-related problems are relatively common after a Distal Femur fracture treated with plate fixation. This article presents case examples of these problems followed by a discussion of the relevant Distal femoral anatomy, design features of modern locked Distal Femur plating systems, and technical points necessary to avoid malunion and implant-related problems when using these devices.
Julius A. Bishop - One of the best experts on this subject based on the ideXlab platform.
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Distal Femur Replacement Versus Surgical Fixation for the Treatment of Geriatric Distal Femur Fractures: A Systematic Review.
Journal of orthopaedic trauma, 2021Co-Authors: Brett P. Salazar, Aaron R. Babian, Malcolm R. Debaun, Michael Githens, Gustavo Chavez, L. Henry Goodnough, Michael J. Gardner, Julius A. BishopAbstract:OBJECTIVES The management of geriatric Distal Femur fractures is controversial, and both primary Distal Femur replacement (DFR) and surgical fixation (SF) are viable treatment options. The purpose of this study was to compare patient outcomes after these treatment strategies. DATA SOURCES PubMed, Embase, and Cochrane databases were searched for English language articles up to April 24, 2020, identifying 2129 papers. STUDY SELECTION Studies evaluating complications in elderly patients treated for Distal Femur fractures with either immediate DFR or SF were included. Studies with mean patient age
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Distal Femur replacement versus surgical fixation for the treatment of geriatric Distal Femur fractures a systematic review
Journal of Orthopaedic Trauma, 2021Co-Authors: Brett P. Salazar, Aaron R. Babian, Malcolm R. Debaun, Michael Githens, Gustavo Chavez, Michael J. Gardner, Henry L Goodnough, Julius A. BishopAbstract:OBJECTIVES The management of geriatric Distal Femur fractures is controversial, and both primary Distal Femur replacement (DFR) and surgical fixation (SF) are viable treatment options. The purpose of this study was to compare patient outcomes after these treatment strategies. DATA SOURCES PubMed, Embase, and Cochrane databases were searched for English language articles up to April 24, 2020, identifying 2129 papers. STUDY SELECTION Studies evaluating complications in elderly patients treated for Distal Femur fractures with either immediate DFR or SF were included. Studies with mean patient age <55 years, nontraumatic indications for DFR, or SF with nonlocking plates were excluded. DATA EXTRACTION Two studies provided Level II or III evidence, whereas the remaining 28 studies provided Level IV evidence. Studies were formally evaluated for methodological quality using established criteria. Treatment failure between groups was compared using an incidence rate ratio. DATA SYNTHESIS Treatment failure was defined for both SF and arthroplasty as complications requiring a major reoperation for reasons such as mechanical failure, nonunion, deep infection, aseptic loosening, or extensor mechanism disruption. There were no significant differences in complication rates or knee range of motion between SF and DFR. CONCLUSIONS SF and DFR for the treatment of geriatric Distal Femur fractures demonstrate similar overall complication rates. Given the available evidence, no strong conclusions on the comparative effectiveness between the 2 treatments can be definitively made. More rigorous prospective research comparing SF vs. DFR to treat acute geriatric Distal Femur fractures is warranted. LEVEL OF EVIDENCE Therapeutic Level IV. See instructions for authors for a complete description of levels of evidence.
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Distal Femur locking plates fit poorly before and after total knee arthroplasty
Journal of Orthopaedic Trauma, 2019Co-Authors: Sean T Campbell, Julius A. Bishop, Liam C Bosch, Steven T Swinford, Derek F Amanatullah, Michael J. GardnerAbstract:Objective:To evaluate the fit of Distal Femur locking plates. Secondarily, we sought to compare plate fit among patients with and without a total knee arthroplasty (TKA).Design:Retrospective.Setting:University hospital.Intervention:Standard length precontoured Distal Femur locking plates from 4 manu
Varun Sambhariya - One of the best experts on this subject based on the ideXlab platform.
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Single stage bilateral flexible intramedullary fixation of periprosthetic Distal Femur fractures.
Arthroplasty today, 2019Co-Authors: David C. Neal, Varun Sambhariya, Apollo Tran, Shawn K. Rahman, Russell A. WagnerAbstract:Abstract We present a patient with bilateral Rorabeck II/Su III periprosthetic Distal Femur fractures treated successfully with bilateral single stage flexible intramedullary fixation. Flexible intramedullary fixation of Rorabeck II/Su III periprosthetic Distal Femur fractures provides the benefits of shorter operative time, lower blood loss, and preservation of bone stock compared to plate fixation and Distal Femur replacement. We suggest that for patients with similar injuries flexible intramedullary fixation can be a viable treatment option.
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Single-stage bilateral Distal Femur replacement for traumatic Distal Femur fractures
Elsevier, 2019Co-Authors: David C. Neal, Varun Sambhariya, Bs ,apollo Tran, Shawn Rahman K. Bsa, Do ,thad J. Dean, Russel A. Wagner, Md ,hugo B. SanchezAbstract:Treatment of periprosthetic Distal Femur fractures and comminuted intraarticular Distal Femur fractures with previous arthritis remains a difficult challenge for orthopedic surgeons. Previous case series have shown that Distal Femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and allow for early ambulation in both of these fracture patterns. Owing to the typical low-energy mechanism of these injuries, a bilateral injury treated with DFR is rarely encountered. We present a patient with traumatic open left Rorabeck III/Su III periprosthetic Distal Femur fracture and closed right intraarticular Distal Femur fracture (AO fcation 33-C2) with end-stage arthrosis treated with single-stage bilateral DFR. We suggest that in patients with similar injuries, single-stage bilateral DFR can provide the benefits of early mobilization and accelerated recovery. Keywords: Distal Femur fracture, Periprosthetic fracture, Revision knee arthroplasty, Distal Femur replacemen
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Single-stage bilateral Distal Femur replacement for traumatic Distal Femur fractures.
Arthroplasty today, 2018Co-Authors: David C. Neal, Varun Sambhariya, Russel A. Wagner, Apollo Tran, Shawn K. Rahman, Thad J. Dean, Hugo B. SanchezAbstract:Abstract Treatment of periprosthetic Distal Femur fractures and comminuted intraarticular Distal Femur fractures with previous arthritis remains a difficult challenge for orthopedic surgeons. Previous case series have shown that Distal Femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and allow for early ambulation in both of these fracture patterns. Owing to the typical low-energy mechanism of these injuries, a bilateral injury treated with DFR is rarely encountered. We present a patient with traumatic open left Rorabeck III/Su III periprosthetic Distal Femur fracture and closed right intraarticular Distal Femur fracture (AO fcation 33-C2) with end-stage arthrosis treated with single-stage bilateral DFR. We suggest that in patients with similar injuries, single-stage bilateral DFR can provide the benefits of early mobilization and accelerated recovery.