Medial Plating Distal Femur Fractures: Basic Understanding

This video gives a brief overview of using the medial plate in distal femur fracture, especially regarding the principle, indications, timing, and alternatives.

[@parkaviyanr6397]

Thanks for the video...what is the approach for the medial plating and how to apply screws so proximaly in the medial plates

[@Justorthothings]

Thanks!! When a short medial plate is needed, the Swashbucker or midline approach is sufficient for proximal and distal exposure. But when long plate is needed, you can pass it through MIPO technique. An entry incision is made over medial condyle prominence and an exit incision is made proximally over the diaphysis, just in line with it under C-arm guidance, as we do in proximal locking of DFN, the vastus muscles are split and diaphysis is exposed. After that the plate can be pushed from medial condyle to anterior surface of femoral duaphysis and then rotated anteromedially using a locking sleeve. The technique is quite simple once you become familiar with it. I will try to record the steps in some surgical case and add a stepwise video.

[@hakiselaj9672]

Perfect video. Thanks

[@orthopod47]

How to approach if medial condylar split with posteromedial apex?

[@Justorthothings]

If isolated medial condyle with split then medial parapatellar approach would do. If medial condyle split with simple lateral condyle, then also medial parapatellar would do. If medial condyle and lateral condyle both split (with additional posterolateral and posteromedial apices) then dual medial+ lateral approach. This has been explained with illustrations and case examples here th-cam.com/video/-hq4E5kYyK8/w-d-xo.htmlsi=AGt-4q31Dd_YZ46z

[@chaitanyaksk90]

How do you keep proximal screws .
Can you share a video of medial plating , both short and long & mippo

[@Justorthothings]

Thanks!! When a short medial plate is needed, the Swashbucker or midline approach is sufficient for proximal and distal exposure. But when long plate is needed, you can pass it through MIPO technique. An entry incision is made over medial condyle prominence and an exit incision is made proximally over the diaphysis, just in line with it under C-arm guidance, as we do in proximal locking of DFN, the vastus muscles are split and diaphysis is exposed. After that the plate can be pushed from medial condyle to anterior surface of femoral duaphysis and then rotated anteromedially using a locking sleeve. The technique is quite simple once you become familiar with it. The proximal screws go from anteromedial to posterolateral direction and under direct vision. I will try to record the steps in some surgical case and add a stepwise video soon.

[@chaitanyaksk90]

@@Justorthothings thank you for your reply sir . What about the artery while passing in mippo . Can you share a video or image showing relation of plate and artery

[@Justorthothings]

@@chaitanyaksk90 Than ks. The plane is very much safe and is submuscular in location as we remain on the anteromedial and anterior surface of the femur when passing a long plate from distal to proximal. Otherwise in most scenarios, the plate is small and the anterior approach to distal femur is sufficient for medial plate as well. I will post the postop CT of a long medial plate case so that the plane of the long plate can be understood. I will also try to record clinical images/video when doing a long medial plate later.

[@chaitanyaksk90]

@@Justorthothings sir in the ct image you're going to upload show the relation of artery and plate so that it becomes easy

[@VijayKumar-vm5ei]

Pls do surgical video🙏🏾

[@Justorthothings]

Sure, will do it soon.