– Implant Selection: Osteonics – PreOp Planning: – Patient Positioning: – Anterior Longitudinal Midline Approach: – Synovectomy (if appropriate): – Medial and Lateral Capsular Exposure: – Patellar Eversion: – Articular Exposure: – IM Alignment Rod: – drill is used to enter femoral IM canal just … Read more
– Incision: – although the closed reduction may require external rotation of the hip, the initial incision is facilitated w/ slight internal rotation of the leg; – make straight lateral incision two finger breadths below the vastus ridge to a point 5-7 cm distally; – typically the … Read more
– Discussion: – when viewed in cross section, shape of distal femur resembles trapezoid w/ medial side inclinded about 25 deg & lateral side about 10 deg; – both the seating chisel and the subsequent blade plate should be 1 cm to 2 cm short of medial cortex … Read more
– See: – Discussion: – consider 90 deg of flexion in splint for 4 days, then begin CPM; – need to start early motion; – look for late varus collapse of knee; – attempt to ambulate at 2-4 days, & consider FWB at 3-6 months; … Read more
– See: – Distal Femoral Shaft Fractures – Distal Femoral Phyeal Frx – Supracondylar Fractures following TKR – Discussion: – work up for femur fracture – mechanism: axial load to a flexed knee; – Bimodal distribution: – low energy fractures involving older females (often have severe osteoporosis); – high energy fractures involving younger males; – associated … Read more
– See: proximal femoral shaft fractures / – Discussion: – definition: – between lesser trochanter and 5 cm distal, even as far as center of isthmus of the femoral shaft; – technically starts below the lesser tuberosity; – medial and posteromedial cortex is a site of high compressive forces, while lateral cortex experiences high tensile stresses (forces … Read more
– See: Bone Healing w/ Plates – Discussion: – useful in subtrochanteric frxs since it permits insertion of at least two cortical screws into proximal fragment (calcar); – having multiple points of fixation above and below the fracture prevents varus or rotational migration; … Read more
Anatomy axis of femoral neck forms angle of approx 135 deg w/ femoral shaft, and is anteverted from the frontal plane by variable amount (- 4 to 36 deg, average 10 to 20 deg in Caucasians); distinct cortex surrounds the cancellous bone of the neck, the center of which becomes progressively empty with age (Ward’s triangle); center of … Read more
– Discussion: – arises from ascending cervical arteries – epiphyseal arterial branches form at subsynovial intra articular ring, and go on to enter the head of the femur; – disruption of this arterial ring occurs from high femoral neck frx; – these pts … Read more
– Discussion: – classifaction and fracture stability – frx stability is based on presence or absence of posteromedial butress; – farther down shaft of femur primary frx is located, greater incidence of delayed union and implant failure; – forces acting on hip joint … Read more