– General Discussion of IM Nails – PreOp Planning – positioning – note rotational alignment of the opposite non injured side. – cautions: – proximal tibial fractures (high complication rate w/ IM nailing) – distal tibia fracture – IM nailing of open tibial fractures – segmental tibia fractures: / treatment methods for tibial … Read more
– Discussion: – based on available data, the results of external fixation is comparable to IM nailing when the frx ends can be keyed together (maximal bone loading), in which case there will be minimal loss of reduction and minimal frx site motion w/ wt bearing; – proximal tibial frx: (see IM … 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
– See: – Enhancement of Fixator Stability – Ilizarov Menu – Ring characteristics – Safe Zone of Pin Insertion – Foot Inclusion – Synthes Hybrid Fixator – Wire Insertion Technique – Discussion: – in the report by Paley D and Maar DC (2000), … Read more
– Discussion: – mangled extremity severity score: – main controversy is whether tibial defect reconstruction and soft tissue reconstruction are indicated; – indications: – high velocity open tibia frx, w/ concomitant nerve, artery, &/or massive soft tissue disruption; – types IIIB … 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: Total Hip Replacement Menu) – PreOp: – Theory and Background: – Checklist for THR and Radiographs: – Initial Exposure: – positioning, prepping and antibiotics: – posterolateral skin incision: – incise thru iliotibial band: – split gluteus maximus: – The course of the superior gluteal nerve in the lateral approach to the hip; – identify the … Read more
– positioning and prepping – posterolateral skin incision – incise thru iliotibial band – split gluteus maximus – peel back the trochanteric bursa: – divide trochanteric bursa and sweep it posteriorly to expose vastus lateralis, short external rotators and posterior border of gluteus medius; … 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: Neurologic Injuries in THR: – Discussion: – sciatic nerve is palpated by rolling it under surgeon’s finger as it crosses ischial projection from posteroinferior aspect of the acetabulum; – palpate sciatic nerve as it passes superficial to obturator internus & gemelli; – sciatic … Read more