– PreOp Planning: – knee deformities should be corrected prior to any forefoot fusions; – stability of talus in mortise is necessary for successful arthrodesis; – determine if flexibility of forefoot and hindfoot; – if foot can be reduced to a satisfactory position then an in situ type of arthrodesis may be considered; – if … Read more
– See: Operative Treatment of Posterior Malleolar Fractures – Discussion: – involves frxs of medial malleolus & fibula, along w/ frx of posterior lip of articular surface of tibia is frxed & displaced, allowing posterior & lateral displacement and external rotation w/ supination of the foot; – medial malleolus may remain intact with a tear … Read more
– Discussion: – name derives from the fact that the fracture exists in the frontal, lateral, and transverse planes; – frx tends to occur in older children and young adolescents during an 18 month window, prior to physeal closure; – lateral portion of epiphysis is the last to close leaving it vulnerable to injury; – … Read more
– origin: lateral head: superior 1/2 of post. lat. surface of humerus; long head: infraglenoid tuberosity of scapula; medial head: – inferior 2/3 on posterior surface of the humerus, beginning at the spiral … Read more
– See: Posterior Approach to the Humerus; – Discussion: – the distal triceps can be split down the middle with the dissection carried straight down to bone over the olecranon; – care is taken to mobilize full thickness fascial and periosteal flaps both medially and laterally; – the dissection … Read more
– Discussion: – see tibial non unions – OTA classification: – type I is there is loss of 50% of circumference of bone and less than 2 cm defect; – consider exchange nailing – ref: Critical-sized defect in the tibia: is it critical? Results from the SPRINT trial. – type2 if … Read more
– Bone Patellar Bone Repair: – Femoral Tunnel: – Tibial Tunnel: – Tendon Graft: – according to Noyes et. al., strength of 14 mm-wide graft of patellar tendon is approximately 175% the strength of normal Anterior Cruciate Ligament; – semitendinosus graft is approx 75%, gracilis tendon is approx 25%, … Read more
– See: Surgical Approach – Treatment Options: – No Reduction – elevation, compression, early ROM (ROWE) – Closed Reduction – Bohler: distraction/M-L – compression – Open Reduction – Palmer: lateral approach (1948) – Goals of Open Reduction: … Read more
– Non Operative Treatment: – Operative Considerations: – surgical indications: – when deformity has not been treated successfully w/ proper manipulation & serial application of casts, supported by limited operative intervention; – operative timing: – surgical goals: – goal for surgical procedures is concentric reduction of the talonavicular and calcaneocuboid joints; – deformities of the … Read more
– Discussion: – mechanism of injury: – distinguish between high velocity injuries verus low velocity injuries (as this reflects incidence of vascular and nerve injuries); – w/ low-velocity knee dislocations occurance of vascular injury is about 5% and nerve injury is about … Read more