Enhanced fixation option 2: Locking Attachment Washer
The Locking Attachment Washer ( LAW ) can be regarded as the most important initiation of the RFN-A System. This fresh fixation option is expected to significantly improve retrograde pinpoint of native and periprosthetic distal femoral fractures by optimizing distal plant anchorage ( Fig 8 ). The LAW concept allows to connect an anatomically shaped 6-hole plate ( the lock in attachment washer ) at the lateral femoral epicondyle to the regress collar in an angular stable manner. This is accomplished by placing two 5 mm variable angle ( VA ) interlocking screws through the LAW and the two LM breeze through holes. In addition, four 3.5 millimeter VA screws can be inserted in the remaining law holes thereby enhancing complete anchorage in the distal femur .
Surgeons already use smash and plate combinations in clinical practice to improve distal femoral fracture obsession. however, current implants used for this alleged double fixation proficiency are not specifically designed for the purpose of connecting a plate and a nail down. In this regard the LAW concept pioneers fracture obsession. It offers the advantages of breeze through and plating in one arrested development construct .
LAW design

The law is made of stainless sword. It is pre-contoured and offered in 5° and 10° blueprint versions to close match the anatomy of the lateral femoral epicondyle when paired with the retrograde nail of the comparable crouch ( Fig 9 ). The law contains etch details to provide data on the LAW type, left- or right-side function american samoa well as predilection. The positions of the buttocks 3.5 millimeter VA locking screw holes are different between the left and correct locking attachment washers because this accounts for the derive oblique screw trajectories when the cosmopolitan RFN-A is used in the leave or right field femur. In certain patients, it might be preferred to pair the 5° police with the 10° flex nail down to achieve better law fit. For the same reason, the 10° jurisprudence might be used in combination with the 5° bend nail. The 10° law has a larger out-of-plane offset between the two 5.0 mm VA screw holes compared with the 5° law. This could be beneficial for the transition from the lateral femoral epicondyle if the proximal LM sleep together is located more superior due to patient anatomy, nail interpolation astuteness, or the presence of a entire stifle arthroplasty femoral part ( Fig 8 ). OPTILINK 5.0 millimeter VA Locking Screws are used to connect the stainless steel law to the titanium debase nail. These stainless steel steel screws have undergo carbonize, a moo temperature hotness treatment in an environment enriched with carbon atoms to allow safe pairing with titanium implants.

The jurisprudence increases the fixation density of the nail down in the distal femur, which is specially utilitarian to stabilize short distal bone segments .
Based on a compression screen in a standardized distal femoral foam model the RFN-A with a in full instrument LAW provided a 42 % higher load to failure and a 30.5 % higher axile severity than the RFN-A without LAW. In both constructs two distal nail interlocking screws were used to analyze the sole benefit of the LAW .
The improved nail anchorage distally contributes indirectly to the stability at the fracture locate although the law does not bridge the fracture.

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