“TriMed Road Show” Symposium on Periarticular Fracture Therapy (Changsha)

Time: 2019-08-14 14:00

Location: Orthepedics classroom in 7^th floor BC building in Xiangya Hospital Central South University

Host: Professor. Zhu Yong

Lecturer: Professor Robert Medoff,

Site translator： Doctor in charge Cheng Liang

“TriMed Road Show” Symposium on Periarticular Fracture Therapy(Changsha) on Aug.14.2018— the periarticular fracture specific internal fixation class was held in Xiangya Hospital Central South University.Vice director in orthopedic department of Xiangya Hospital Central South University. Professor Zhu Yong, as the host of the conference, warmly introduced Professor Robert Medoff, director of orthopedics, royal Hawaii medical center, as the guest lecturer. At the same time, he hoped that everyone could gain more new knowledge during the study and wished the conference a complete success.

Professor Zhu Yong made the opening speech.

Later, Professor Robert Medoff, who came from a long way away, shared the "complicated fixation method of distal radius fracture". First of all, Professor Robert Medoff described the particularity of the distal radius fracture. In clinical practice, there were various periarticular fractures.

Conference site

Among them, some fracture lines were located at the distal end of the radial wrist articular surface, and the bone slices were very thin and small. It was difficult to fix them with traditional plate screws and K-wires, and the fixation was easy to fail. In the early 90s, he was thinking of an improved method to improve the unstable distal radius fractures fixation. He classified the distal radius in a specific way, combined with the specific design fixation-TriMed fixation system, which was used to improve the stability of periarticular fractures when using K-wire previously. Since 1994, with the gradual popularization of clinical application, it has been included in “Campbell orthopedic surgery” and “Green hand surgery”, becoming the model of periarticular fracture treatment in the United States.

Prof.Robert Medoff was sharing the topic

Intra-articular fractures of the distal radius can be divided into 5 types according to the site: 1. styloid process of radius; 2. Margo volaris/tear drop angle 3. Free bodies joint or die punch 4. Dorsal lateral wall  5. Dorsal ulna angle. TriMed’s fixation system has hook plates, pin plates, supporting accessories, sleds and so on. It can fix the periarticular fractures in terms of various sites to restore joint surface flatness, free the joints and do early functional exercises. It is composed of pins, plates and screws to form a fixed system, which can disperse the load and avoid the problem of stress concentration at the far end of traditional internal fixator. Next, Professor Robert Medoff took the radial column fracture as an example to share the use of the radial pin plate: find the styloid process of radius in the surface, and then find the first extensor compartment. Incise the superficial fascia, separate to the distal end, turn the hand to the front, treat the volar part, do the temporary fixation, fit the plate, put the screw 2.3 in the proximal end. Drill the particular black and white K-wire 1.1mm into the small hole, screw out a little bit. Bend, cut, rotate, and impact it into the near small hole.

Case sharing in the clinical treatment by using TriMed’s fixation system

In addition, in some complex cases of distal radius fracture and dislocation, many external fixators were required. We all knew that one of the conditions for a firm external fixator was the proximity of the connecting rod to the limb. Moreover, the external fixator had many natural defects, such as the appearance was abrupt and easy to bump, inconvenient to wear and take off clothes, and easy to infect the needle path. So Professor Robert Medoff also shared a new fixation method: the TriMed bridg plate. The concept of bridg plate was first introduced from the United States in 1998. The advantage was that the operation was simple. A small incision was made at both the proximal and distal ends of the forearm, and a special handle was used to insert the proximal radial incision into the distal end of the second metacarpal bone for fixation.

Prof.Robert Medoff was showing to Prof.Zhu Yong how to use the bridge plate.

The atmosphere on site was warm. After observing and operating the bridge plate, Doctor Fu Sanqing asked: when the plate was inserted, should it be attached to bone or placed above tendon?

Professor Robert Medoff answered: it should be attached the bone under the tendon and it can be pushed in directly with the handle. In case of resistance, it can be assisted by small incision. In addition, after the placement of the bridge plate, the hand can be bent, extended and rotated, which had little impact on daily life.

The attending physician interacted with Professor Robert Medoff positively.

The next part that Professor Robert Medoff shared with us was his reflection and philosophical questions beyond the AO fixation principle of periarticular fractures. We all knew the four principles of AO: anatomical reduction, strong fixation, protection of blood supply, early active exercise. Professor Robert Medoff said that AO taught us how to put screws in and use them and how to pressurize plates. But he was disappointed when he treated periarticular fractures in the 1980s. He felt lonely and helpless like sitting on a cliff alone. He felt that the standard method was not necessarily effective for fixing periarticular fractures. Problems encountered include: arm action, screw holding force, ring stress. The lag screw played an important role in AO. Its function was to resist shearing and twisting force of bone. In order for the screw to pressurize, the contralateral cortex must penetrate to achieve stability. However, this cannot be applied in the actual fixation of small pieces of bone around the joint, so it was necessary to consider new fixation methods to eliminate the iatrogenic fracture caused by the dependence on screw holding force. How to deal with it? Tigers, for example, had long teeth that allowed them to grip their prey tightly, so he designed and invented HOOK plates. The sled plates were designed and invented based on the iron hoop on the outside of the whisky barrel, which was associated with the arch of Rome. The pin at the distal end of the radial column pin plate was small and had a very low height, but why was it powerfully supported? This was because using the suspension bridge principle. Your mind can't always be tied to the idea of AO. When encountering difficulties, you needed to try to jump out and thought it in a different way.

Attending physician Cheng Liang had a deep discussion with Prof. Robert Medoff.

In the end, Zhu Yong, said: we are very happy today to hear some different voices. We have always been taught by AO, be sure to do so, be sure to do that. But this time, it can be extended to broaden our thinking, especially when encounter some difficulties of articular fractures around, there are some other methods, instead of necessarily one way. So thank you very much, Professor Robert Medoff for today’s speech.

With the warm applause, Professor Zhu Yong presented books as a souvenir.

At this point, the conference was successfully completed. The attendees felt the new concept of specific fixation of bone blocks and a new trauma orthopedics technology. TriMed will subvert the concept of fixation of complex fractures around joints, pursuing precise medical treatment and benefiting patients!

After the conference, Professor Zhu Yong, Professor Robert Medoff and the attendees took a picture to mark the occasion.