– 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
Current Concepts Review. Treatment of Unstable Fractures of the Shaft of the Tibia. Current Concepts Review. Timing of Operative Treatment of Fractures in Patients Who Have Multiple Injuries. Pelvic and Lower Extremity Trauma–Symposium: Intramedullary Devices for Tibial Fracture Stabilization. The use of a tourniquet when plating tibial fractures. Conservative management or closed nailing for tibial shaft fractures. … Read more
– Considerations: – consider applying an arthroscopy post to the table inorder to assist w/ reduction; – w/ the post in place, 3 point pressure can be applied; – fracture should be reduced as much as possible prior to application of external fixator; – … Read more
– Discussion: – main goal is to prevent THR dislocation but also to maintain optimal offset; – prior to reducing the hip, ensure that center of femoral head is approximately at level of the greater trochanter; – once trial reduction has been completed, the trial acetabular liner is removed, the … Read more
– Landmarks: – posterior superior iliac spine: forms the superior landmark; – incision starts at the posterior 1/3 of the greater trochanter and extends proximally for 10 cm toward a point 2 fingerbreadths below the PSIS; – this will bring the incision directly over the sciatic notch and will also … Read more
– See: THR dislocation: – Checklist: – need complete muscular relaxation; – irrigate any debris from acetabulum; – Difficult Reduction: – capsule might have to be further released, esp if head and neck segment was short preoperatively; – if reduction is not possible & leg is lengthened, … Read more
– Discussion: – anesthesia considerations: – note that with spinal anesthesia, the table will be tilted reverse trendelenburg inorder to prevent high spinal (this will have the effect of predisposing for vertical cup position if note remedied; – note that leg lengthening is more common with spinal vs general; … Read more
– See: – operative considerations for hip dyplasia – reaming technique: – component insertion: – component position: – screw placement: – acetabular component revision: – bone grafting for acetabular defects: – … Read more
– Discussion: – easiest method to measure leg lengths is the measure the distance from the ASIS and a marked point on the knee; – measurement is made using the cautery cord; – the thigh must be in the exact same position each time the length is measured; – steinman pin method: – separate posterior … Read more
– See: Total Hip Replacement Menu – Discussion: – most common complication in total hip arthroplasty and most common cause of component failure; – osteolysis is a time dependent process which arises from inflammatory reaction against polyethylene particulate debris; – patho-biology: – osteolysis is … Read more