Buttress PlatingButtress plate - A plate employed to support the fractured bone in the area of the metaphysis, usually used in conjunction with lag screwsAntiglide plate - A plate used to reduce an oblique fracture indirectly through interference between the plate and the undisplaced main fragment
Mangled Extremity: LEAP Study- Scoring systems are not helpful.- Initial sensation is not a reliable indicator offuture sensation.- Results poor at 2 years, whether amputated orsalvaged.- Results even worse at 7 years.- Most risk factors for poor results are beyondsurgeon s control.- Poor results related to socioeconomic status
IM Nailing after Ex Fix?- Best done early (within 2weeks)- Pin sites must be clean.- Patient must be stable.- Infection risk higher than infemur.
ORIF after Ex Fix?- Can be delayed.- Pin sites should be clean.- Skin must be healthy.- Can be minimallyinvasive.
Techniques for Proximal Fractures:- Obtain reduction.- Provisional plating (unicortical).- Blocking screws.- Multiple interlocking screws.- Interest in suprapatellar approach.
Techniques for Distal Fractures:- Plate fibula if fractureddistally.- Steinman pins as joysticks.- Blocking screws.- Multiple interlocking screws
Wire FixatorsBeing replaced by locking plates.
Summary of Current Concepts- Indications have not changed.- Reamed intramedullary nailing is the mainstay oftreatment.- Remember ATLS, Damage Control.- Don t be in a hurry to amputate.- Consider delayed ORIF after Ex Fix.- Obtain and Maintain reduction of proximal anddistal fractures.- New technologies have not yet withstoodscrutiny.