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Updated: Nov 22 2024

[Blocked from Release] Pangea Distal Posterolateral Fibula Plate

Images
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  • Summary
    • The plate is contoured to fit the anatomy of the distal fibula, aiding in precise placement and alignment, which is crucial for restoring normal biomechanics and reducing soft tissue irritation.
    • Typically indicated for fractures in the distal fibula, particularly comminuted or complex distal fibular fractures, fractures requiring stable fixation to restore joint alignment, and Situations where posterior and lateral stability is compromised.
    • Requires a posterolateral approach, which provides direct access to the fracture site but also necessitates careful handling of surrounding soft tissues..
  • Design & Biomechanics
    • Anatomically Contoured
      • the plate is contoured to fit the anatomy of the distal fibula, aiding in precise placement and alignment, which is crucial for restoring normal biomechanics and reducing soft tissue irritation.
    • Locking and Non-locking Screws
      • It accommodates both locking and non-locking screws, offering flexibility in fixation. Locking screws provide additional stability, especially in osteoporotic or comminuted bone, while non-locking screws allow for compression at the fracture site.
    • Low-profile Design
      • The plate has a slim profile to minimize soft tissue irritation, which is particularly beneficial for patients with limited soft tissue coverage in this area.
    • Posterolateral Placement
      • Positioned on the posterolateral aspect of the fibula, this plate is ideal for stabilizing fractures in this specific region, offering targeted support to the distal fibula and lateral malleolus.
    • Multi-planar Screw Configuration
      • this allows for optimal fixation and stability, enhancing outcomes in challenging fracture patterns.
  • Indications
    • Typically indicated for fractures in the distal fibula, particularly
      • Comminuted or complex distal fibular fractures
      • Fractures requiring stable fixation to restore joint alignment
      • Situations where posterior and lateral stability is compromised
    • Clinical Indications
      • Ankle fractures
      • Pilon fractures
  • Approach
    • Posterolateral approach
      • which provides direct access to the fracture site but also necessitates careful handling of surrounding soft tissues.
  • Placement
    • The distal portion of this plate should be placed so the 2.7mm cluster is centered over the Posterolateral metaphyseal fibula, just proximal to the peroneal groove (Confirm there is no overhang over the edge of the distal fibula)
    • When placed correctly, the distal aspect of the plate should not contact the peroneal tendons.
    • This plate sits on the edge of the fibula, at 45° posterior from the lateral side.
    • Posterolateral plate placement helps to neutralize forces for SER (supination external rotation) fracture patterns, while screw hole placement allows for fixation of these fragments
  • Fit
    • Designed with the use of SOMA: Stryker Orthopedics Modeling and Analytics1
    • SOMA includes a database with CT scans from hospitals across the world and state-of-the-art algorithms to mine the data for shape variability, bone density, and implant fit.
    • The SOMA bone database contains a collection of 5570 and growing clinical CT scans and contains over 34,600 3D bone models
    • Plate rotation allows for placement along the posterolateral shaft of the fibula while buttressing the distal fibula in spiral and oblique fracture patterns
    • The distal cluster is tapered to reduce potential of soft tissue irritation and reduce plate prominence over the distal fibula
    • The low profile 2.0mm distal end and 2.6mm shaft are designed to reduce the potential for soft tissue irritation
    • Designed for buttressing of oblique or supination external rotation ankle fractures and to treat distal fibula fractures and the syndesmosis 
    • Pangea Distal Fibula plates were found to sit closer to the bone than competitive VA LCP plates, demonstrating superior fit1 
  • Technical specifications
    • Standard plate lengths: 4-15 hole (81-235mm)
    • Thickness: 2.0mm distal, 2.6mm shaft
    • Left and right anatomic plate options
  • Screws
    • T8 Screw Platform
      • T8 Screw Platform
      • Multiaxial locking
      • 2.7
      • 8-80mm
      • Cortex
      • 2.7
      • 8-80mm
      • Washer
      • Description
    • T15 Screw Platform
      • Classification System Advanced
      • Type I
      • Description I
      • d
      • Type II
      • Description II
      • d
      • Type III
      • Description III
      • d
  • Differential
    • Differential A
      • key findings that differentiate topic from differential A
        • found with topic
          • key finding A
        • found with differential A
          • key finding A
    • Differential B
      • key findings that differentiate topic from differential B
        • found with topic
          • key finding A
        • found with differential
          • key finding A
          • key finding C
  • Diagnosis
    • Made 
  • Treatment 
    • Nonoperative
      • observation +/- physical therapy
        • indications
        • techniques
        • outcomes
      • immobilization alone
        • indications
        • timing
        • modalities
        • techniques
        • outcomes
      • closed reduction and immobilization
        • indications
        • techniques
        • outcomes
    • Operative
      • emergent radical debridement and broad-spectrum IV antibiotics 
        • indications
        • antibiotics
        • techniques
      • irrigation & debridement, soft tissue management, and provisional fixation
        • indications
        • timing
        • techniques
        • outcomes
      • closed reduction and external fixation (ExFix) (+/- limited internal fixation)
        • indications
        • timing
        • techniques
        • outcomes
      • closed reduction percutaneous pinning (CRPP)
        • indications
        • timing
        • techniques
        • outcomes
      • open reduction
        • indications
        • postoperative
      • open reduction internal fixation (ORIF)
        • indications
        • timing
        • approaches
        • techniques
        • outcomes
        • postoperative
      • intramedullary nail fixation (IMN)
        • indications
        • contraindications
        • timing
        • techniques
        • outcomes
      • arthroplasty
        • indications
        • timing
        • techniques
        • outcomes
      • fragment excision 
        • indications
        • outcomes
      • limb salvage resection and chemotherapy
        • indications
        • contraindications
        • timing
        • techniques
        • outcomes
      • amputation
        • indications
      • nerve release and debridement
        • indications
        • contraindications
        • techniques
        • outcomes
  • Techniques
    • Emergency room
      • indications
      • techniques
    • Immobilization Alone with Splint & Functional Bracing
      • indications 
      • technique
      • pros/cons
      • complications
    • Closed reduction and immobilization
      • indications
      • reduction
      • immobilization
    • Chemotherapy
      • administration
    • Urgent irrigation & debridement with provisional vs. definitive fixation (I&D)
      • indications
      • techniques
    • Temporizing external fixation (ExFix)
      • indications
    • Closed reduction percutaneous pinning (CRPP)
      • indications
      • approach
      • technique
      • complications (ONLY if specific to this treatment)
    • Closed Reduction and External Fixation (ExFix)
      • indications
    • Open reduction internal fixation (ORIF)
      • indications
      • approach
      • technique
      • advanced techniques
      • complications
    • Intramedullary Nailing & Fixation (IMN)
      • indications
      • approach
      • techniques
      • complications
      • postoperative care
    • Arthroscopy
      • indication
      • approach
      • basic technique
      • advanced technique
    • Arthroplasty
      • indications
      • approach
      • technique
      • techniques - advanced
      • basic complications
      • advanced complications
    • Wide Resection
      • indications 
      • approach
      • techniques
      • complications 
    • Repair
      • indications
      • approaches
      • techniques
      • complications
    • Reconstruction
      • indications
      • approach
      • technique
      • complications
    • Arthrodesis
      • indication
      • approach
      • techniques
      • complications
    • Osteotomy
      • indications
    • Nerve Denervation, Decompression Release, and Debridement
      • open
      • arthroscop
    • Amputation
      • approach
      • technique
  • Complications
    • Postoperative Anemia, Blood Loss
      • incidence
      • risk factors
      • diagnosis
      • treatment
    • Surgical Site Infection (SSI)
      • incidence
      • risk factors
      • diagnosis
      • treatment
        • tested treatment in bold blue
          • indications
    • Nerve Injury
      • incidence
      • risk factors
      • diagnosis
      • treatment
        • tested treatment in bold blue
          • indications
            • indication A
    • Nonunion
      • incidence
      • risk factors
      • diagnosis
      • treatment
    • Recurrent Instability
      • incidence
      • risk factors
      • diagnosis 
      • treatment
    • Failure of Treatment Effect  / Persistent Pain
      • incidence
      • risk factors
      • diagnosis
      • treatment
    • Stiffness / Loss of Motion / Arthrofibrosis / Heterotopic Ossification
      • incidence
      • risk factors
      • diagnosis
      • treatment
    • Hardware Failure
      • incidence
      • risk factors
      • diagnosis
      • treatment
    • Posttraumatic Arthritis
      • incidence
      • risk factors
      • diagnosis
      • treatment
  • Prognosis
    • Natural history of disease / Prognosis without treatment
    • Prognostic variable
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