– Discussion: – 60% of plataue frxs involve lateral plateau. – this probably is result of valgus alignment of lower extremity and fact that most injuring forces are directed laterally to medially; – frxs of medial plateau make up 15% & bicondylar lesions 25% of plateau frx; – bicondylar frxs combine any of unicondylar … Read more
– Post Op Care: – consider keeping the knee in 45-60 deg flexion; – for the first 5 postop days, the pts leg is maintained in a CPM machine, and the ROM is increased to a range of 15 to 70 deg; – POD #3: active assisted ROM exercises … Read more
– Discussion: – Lateral plateau: Incision: – Medial Plateau: Incision: – Tibial Osteotomy: – osteotominizing tibial tubercle to incr exposure can lead to difficulty in certain frx, because tubercle may be only component of a Bicondylar Fracture left intact; – Elevation of Fracture Frag: … Read more
– Discussion: – tibial component fixation requires a stem to prevent sinking of the implant due to compressive failure of prox tibial cancellous bone, & shear stresses are high enough in knee to require fixation of tibial tray with peripheral pegs; – tibial stem reduces shear forces at the prosthesis bone interface, as well as … Read more
– See: – Tibial Plateau Frx Menu, Rim fractures: – Discussion: – frx dislocations of tibial plateau will have assoc: – knee dislocations, and ligamentous injuries; – meniscal injuries, which are usually not repairable; – N/V injuries, increasing from 2% for type … Read more
– See Technique of IM Nailing – Indications: – tibial shaft fractures within 4 cm distal to the tibial tuberosity to 4 cm proximal to the ankle may be treated with interlocking techniques; – Soft Tissue Injury: – open tibial frx (Gustillo classification): – reconstruction for leg defects: – Frx … Read more
– See: Innerv. Musc. Lower Limb: – Anatomy: – tibial nerve is derived from L4, L5, S1, S2, S3; – the anterior component, supplies muscles of posterior thigh (except short head of biceps whch is supplied by peroneal nerve); – in popliteal space it gives off branches that supply … Read more
– Discussion: (w/ assistance and narration by Dr Kyle Dickson MD) – term pilon (hammer) fracture was introduced to describe these compression injuries by Destot in 1911; – ref: High-energy tibial pilon fractures: an instructional review. – frx components: – combination of ankle frx & distal tibial metaphyseal frx, usually w/ intra articular comminution; – frx … Read more
– Considerations: – pin care: – tissue motion impairs tissue resistance to infection; – excess motion at pin skin interface can be reduced by wrapping sterile gauze between the pin clamp and skin; – surgical sponges around pins … Read more
– See: Preparation for Proximal Tibial Cut: – Discussion: – intrameduallary & extrameduallary systems are available for aligning the proximal tibial cut; – IM system is less accurate, particularly when tibia has varus bow and may lead to excessive cement column; – ref: Extramedullary … Read more