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A-1211 Plates & screws
Philippe Cuenod, Switzerland
Thursday, June 14, 2018 · 9:29 a.m. · 13m 09s
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think billowing thank you michelle for inviting me i'm going to
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talk about the the plates and screws so but
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in the beginning the as we knew that cicadas for secondary
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to the a a a intimate fragmentary movement uh uh
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surgeons use to advise movement rather than immigration to treat the fracture
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but already kenya's before a jury can sharpen yeah say this
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a handsome man in germany stab eliza fracture uh with the plate
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and this technique was going oh serious into this by i don't know but uh from belgium
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perkins in the forties supplies the fractures and
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advise uh early mobility nation so it's
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in the end of uh the forty is that uh uh then is from belgium
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advice to reduce the fracture to compress at the
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side uh of uh to increase the stability
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at mobile i immediately any notice that there was no x. l. k. less but
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what he called a studio uh thursday and that is a two janus welding
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so i it said either specific physical constraints you develop the
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tools to perform the the as if it is is
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and uh the um the same that we use today and uh
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he met a a malays malay us usage and uh in fifty
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and we'll yeah with the idea of it and i guess yeah develop
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the io foundation to just study and develop the the these techniques
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of plates and screws and at the time of uh dennis e. e.
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design the crap that uh that was a kind of excel
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compress it compression device that could put the the compression of the side of the uh the
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fact aside so they they a. o. develop another
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concept without this axle a device and
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with the accounting system of all those holes with a sloping surveys
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and as a a and when you you you you put the screw inside
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there is it follows the entire surface in it put a compression
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at the fracture side because a plate is driven horizontally and this is the the
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the technique uh i don't know how to use this it's probably yes
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uh we have in you know david the current place we
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have oval holes without soaking for the the little balls
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and we just put a screw without tightening it we pull the plate
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the most we can easily then we insert another screw a a
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then the ah eccentric both of them and we can uh at an actively
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uh uh uh uh tightened them to obtain compression and then the the other
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uh uh awkward the problem all these uh these places that they wear
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very thick and we can see that they they created a uh
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uh in the crow this of the bowl so it would design a plate with uh
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uh costs of phase two would decrease the because the the contact with a bow and that
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then i may it's important big to to noted that when there is
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a single bit rate fracture that you treat with the play
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there is a release of uh opening a gap in the factory on the other
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side because of the um of the s. e. c. t. other place so
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the the one of the first possibility is to insert a
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uh like screw it's with the the the fact that plane or
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two pretty stress the the played by bending over banning it
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and then apply compression and the natural uh in s. e.
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c. t. of the playing with a plate will uh
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resists the opening of the upper to oppose it cortex and uh if there is a
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committee to fracture there is no sense to to try and uh actually reached ability
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there will be interference with about supply and fixation failure decision i is to
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breach the community's own eyeliner fragmented with a good rotation in good length
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maybe allegations some photographs and then the the the
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fragments and his uh by the surgery will
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uh he'll buy x. allocate is uh uh because of the the into fragmentary motion
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so it's important never to sacrifice the side but
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a biology another pitfall of the conventional plates
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it at the base screen to face allows drew twisting and that is if the load
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exceeds the friction force between plating bone there isn't instability and a failure and to
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correct is it would design a a locking place where the the
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screws are locking to the plate and they make a frame
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instead of uh having a separate uh screws the plate is no more
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uh against the boat but it a male uh over is the
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over is uh uh over the bowl and it's more stable and a this is a good example
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of use of these uh displayed on the basal exotic you love first made a couple
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a base fracture with a good uh functional result
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so i'll screw we use cruise every day but we don't if we have to
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define what a screw is it's not that easy actually it's a central core
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in a thick any cradles red and the rotational force of the it because i fell
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thread will convert a convert the the line you know uh the
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the forced into a line you know motion that will
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allow the the the the screw to to to move along the shaft and uh
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one of the most important part of a plate in school fixation either
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likes to the lex crew is when we we have a a
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uh reduce uh for uh i'll yeah so the basic movable the button on the yeah yeah
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yeah we we when we have reduced a longer bleak fracture a whole hell body them we
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make a a drill in uh in both got uses at the level uh the
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the diameter of the screw a you know a part and then we
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over drill the the proximal cortex then
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we want to seeing that is we we will uh increase the the length of
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the whole the the bro the breadth of the whole here to ever
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leave less pressure because the area is bigger for the the head of
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uh of the school and then we can in said is true
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and you guys freely to the first got texan perches on
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the on the other one uh compressing the the fragments
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so this allows uh and early maybe decision with a good result and
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if we put lex cruel if if if the axes is perpendicular to the long axis of the bone there
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will be a maximum recently shearing forces but not enough
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compression at the level of the uh the
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factor playing so to meet both stability we can
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insert screws in the two directions or one screw perpendicular to the uh
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the the the plane and a new tradition plate that will
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and uh it diminishes the the the forces and
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there are some rules uh the the holes in goes fragments but must be
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to actual otherwise the with the loss of rejection and if the the
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the the school must be perpendicular to fracture in c. d. the centre
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of each fragment which is not that easy in small balls so
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but it is cruel is already one of the many method of
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treatment we have seen that they are matched as invasive technique
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conservative treatment exists in we have approved today and uh we have not to treat
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x. rays big uh oh make a a six inches because it's fun
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just to be tailored to the patient and not be oppose it and the conditions that must be good we have
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we need to have all the material a good operating theatre any
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major in to see fire in a surgeon aware of the
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technique and if we don't have service for because it there will be more damage to the patient and they are
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a lot of indications that most of them are unstable and underage is evil fractures
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for cobble fractures for stay for a does become the the
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more or less the the standard uh treatment in some countries who could
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they have made can also be a which is it like that
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and for the reconstruction or couple bone on union with
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or without going graph and for limited chooses
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and the main problem of uh the the plate and screwed fixation is on the proximal
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and we'll file and fractures because there is a sense to make an isn't that
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leads you allegiance if it's a a patch and that above all
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in the in the proximal phalanx bubble in the fifth finger
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there is a debatable about also the natural approach we can
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save it's personal preference because uh there is not
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real clinical difference not difficult uh can do the
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uh filings factor is unstable and could be
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treated with a with a to lex cruise or with the two wise instability the same
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the uh the screws can also be inserted a packet it nicely uh that
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better uh use uh
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screws lacks cruise only in the basal fracture or
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uh into veterinary advice compression even if we the plate we can have a good result
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it is not always possible this is the typical case intellect a couple disparate factions
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many factors it's a good indication to reduce it fixes multiple like screws
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and that they're a situation where there is a a short oblique
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and it can be treated with the uh uh uh
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lex crew through the plate it that in operating of that hospital in a different way
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now we come to they had this compression screws that um boy so told us about
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yeah actually the principle is that they ought to thread up with a different page and
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the the thread with the core speech produces more quickly than the other one
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and they are different design their their with the the um
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the the conical one and the more recent one that is with the constant that make
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to read but with the progressive it's red and the central a perforation can
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help us to to guide and it's uh it's with the standard treatment
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forced a void first devoid nonunion for book of the ham a
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which i presume and more recently pathologies or made a couple
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and that is also possible to do it like it is
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the for bennett fracture with one or two screws
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four have made it can be done petted honestly care
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must be given not to injure the the
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the no no but the results are very good even for non unions because patients normal paying
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you could work you can have a normal life and there is no more problem
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so the outcome depends upon many factors in the the type
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anatomy fractures softly she vision open factor the technique
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the surgeons scale the page in it the patience uh
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in at a i. d.s on the spot and uh the
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patient healing biology the quality of the reputation in
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the the patient's ability to cooperate because they are a lot of buttons really a lot of complications
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man union nonunion stiffness infection soft tissue isn't played using and
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it is very interesting and important to notice that
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the imprint failure is mostly of surgeon
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technical mistake before we really need to stick to do the good rule
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and have good ideas to to prevent all these problems thank you
Conference Program
A-1205 Welcome and Introduction
June 14, 2018 · 8 a.m.
A-1206 Epidemiology
Kevin Chung, USA
June 14, 2018 · 8:04 a.m.
A-1206 Epidemiology Q&A
Kevin Chung, USA
June 14, 2018 · 8:16 a.m.
A-1207 Evidence
Janos Rupnik, Hungary
June 14, 2018 · 8:19 a.m.
A-1208 Conservative
Grey Giddins , UK
June 14, 2018 · 8:31 a.m.
142 views
A-1209 K-wire & cerclage
Anuj Mishra, UK
June 14, 2018 · 8:57 a.m.
119 views
A-1209 K-wire & cerclage - Q&A
Anuj Mishra, UK
June 14, 2018 · 9:08 a.m.
A-1210 Intramedullary screws
Maurizio Calcagni, Switzerland
June 14, 2018 · 9:15 a.m.
156 views
A-1210 Intramedullary screws - Q&A
Maurizio Calcagni, Switzerland
June 14, 2018 · 9:24 a.m.
A-1211 Plates & screws
Philippe Cuenod, Switzerland
June 14, 2018 · 9:29 a.m.
154 views
A-1211 Plates & screws - Q&A
Philippe Cuenod, Switzerland
June 14, 2018 · 9:42 a.m.
A-1212 External fixation
Frédéric Schuind, Belgium
June 14, 2018 · 9:45 a.m.
126 views
A-1213 Compound fractures
Thomas Giesen, Switzerland
June 14, 2018 · 9:54 a.m.
364 views
A-1213 Compound fractures - Q&A
Thomas Giesen, Switzerland
June 14, 2018 · 10:08 a.m.
238 views