nail plate devise

An out line on the design and rationale of the nail plate device for stabilising a periprosthetic fracture of distal femur in total knee replacement-       Dr. Jacob Varughese

 Displaced supracondylar fractures (type 2) needs to be properly aligned and stabilized for an optimal outcome. Stabilization using intramedullary nails, locking plates, external fixators have been described.  The small porotic distal fragment precludes stable fixation with either plate or nail  to commence immediate mobilisation. 

Design of a nail plate  device

In 2009 following difficulty in stabilising these distal femoral fractures  combination of a separate  Intra medullary nail  and a locking  plate  was used to stabilise and mobilise the elderly  above mentioned osteoporotic fracture. This was  repeated in  bilateral case where in the nail was removed  to pass the distal locking screws  from the plate resulting in translation of the distal fragment ref  pic 4  below.  Both the fractures healed in 3 months and the patient was mobilised weigth bearing

Procedure

Knee replacement incision.

A supracondylar nail 9 mm in diameter was passed through the distal fragment  and using this to reduce the fragment and pass it retrograde into the proximal fragment. This avoids soft tissue stripping and quick reduction of the fracture in anterior-posterior and medial lateral planes  with out soft tissue stripping associated with reduction with a plate device. This nail devise could be locked proximally and distally if possible or at this stage a locking plate is passed through a MIPPO technique on the lateral side and locking screws can be applied distally though the incision and percutaneous screws can be applied proximally. In the case  in picture 3 on the right knee the nail was removed after the plate was applied distally to facilitate  screw insertion resulting in translation in the medio-lateral plane. Therefore it was decided to use both nail and plate in 3 further cases where in we obtained stable reduction to facilitate immediate mobilisation.

 With these results we attempted to design a new implant ( nail plate device) to improve the technique and rigidity of  fixation