Clavicle fractures
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Clavicle fractures are common injuries that can often be treated non-operatively. However, there are some cases where operative fixation is recommended, such as when there is significant shortening or angulation of the bone fragments. While non-operative treatment can have good outcomes, it carries a risk of nonunion or residual pain. Operative fixation aims to restore normal anatomy, but also risks complications from the hardware. There is variability in healing outcomes both between patients and between operative and non-operative treatment methods, and more research is still needed to determine the best approach in different situations.
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The document discusses the Sarmiento principle of functional bracing for tibial fractures developed in 1967 as an alternative to rigid immobilization. It involves early controlled movement and weight bearing to promote healing. Guidelines are provided for factors like length, rotation, valgus, and varus when applying braces. Proximal, mid-shaft, and distal tibial fractures are considered in terms of brace candidacy based on the fibula condition and soft tissue damage. The conclusion reinforces bracing for closed, axially unstable fractures with an acceptable degree of shortening and angular deformity within a few degrees of normal.
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Humeral shaft
Humeral shaft fractures can often be treated nonoperatively with a brace, though operative options include plating, flexible nailing, or locked intramedullary nailing. Plates and nails have similar union rates but nails have more complications so plates are generally preferable. Flexible nails are also an effective option. Radial nerve palsy is a risk, especially with distal fractures, and may require exploration. Most humeral shaft fractures heal well with either operative or nonoperative treatment depending on the specific situation and patient factors.
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High tibial osteotomy
High tibial osteotomy (HTO) is a surgical procedure that involves correcting angular deformities of the tibia. It has been used to treat conditions like osteoarthritis, osteochondritis dissecans, and malalignment. There are several techniques for HTO including lateral closing wedge osteotomy, medial opening wedge osteotomy, and dome osteotomy. HTO can help relieve pain from unicompartmental osteoarthritis and delay the need for knee replacement in young, active patients. Potential complications include fracture, nonunion, nerve palsy, and issues that can make later knee replacement more difficult. Precise surgical planning and fixation are important for achieving good outcomes from HTO.
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The document discusses the Sarmiento principle of functional bracing for tibial fractures developed in 1967 as an alternative to rigid immobilization. It involves early controlled movement and weight bearing to promote healing. Guidelines are provided for factors like length, rotation, valgus, and varus when applying braces. Proximal, mid-shaft, and distal tibial fractures are considered in terms of brace candidacy based on the fibula condition and soft tissue damage. The conclusion reinforces bracing for closed, axially unstable fractures with an acceptable degree of shortening and angular deformity within a few degrees of normal.
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The document discusses the Masquelet technique, a two-stage procedure for treating bone defects and non-unions. In the first stage, radical debridement is performed followed by placement of an antibiotic-loaded cement spacer to form an induced membrane. In the second stage 6-8 weeks later, the membrane is preserved while removing the spacer and filling the defect with bone graft for reconstruction. Studies reported successful outcomes using this technique for various bone defects up to 25cm in length. Key factors for success include thorough debridement, maintaining the induced membrane, adequate stabilization and soft tissue management.
Humeral shaft
Humeral shaft fractures can often be treated nonoperatively with a brace, though operative options include plating, flexible nailing, or locked intramedullary nailing. Plates and nails have similar union rates but nails have more complications so plates are generally preferable. Flexible nails are also an effective option. Radial nerve palsy is a risk, especially with distal fractures, and may require exploration. Most humeral shaft fractures heal well with either operative or nonoperative treatment depending on the specific situation and patient factors.
Osteotomies around the hip
An osteotomy around the hip is a surgical procedure used to correct biomechanical alignment and load transmission. There are various types of osteotomies of the proximal femur classified by displacement of the distal fragment, anatomical location, and indication. Common osteotomies include McMurray's displacement osteotomy, Pauwel's varus/valgus osteotomy, and Salter's innominate osteotomy. The goal of osteotomies is to improve joint congruity, relieve pain, and correct deformities around the hip joint.
High tibial osteotomy
High tibial osteotomy (HTO) is a surgical procedure that involves correcting angular deformities of the tibia. It has been used to treat conditions like osteoarthritis, osteochondritis dissecans, and malalignment. There are several techniques for HTO including lateral closing wedge osteotomy, medial opening wedge osteotomy, and dome osteotomy. HTO can help relieve pain from unicompartmental osteoarthritis and delay the need for knee replacement in young, active patients. Potential complications include fracture, nonunion, nerve palsy, and issues that can make later knee replacement more difficult. Precise surgical planning and fixation are important for achieving good outcomes from HTO.
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This document discusses the dynamic hip screw (DHS), used to treat intertrochanteric hip fractures. The DHS provides controlled collapse and dynamic action to reduce complications like screw cut-out. Key steps of the procedure include closed reduction of the fracture, guide pin and plate insertion at 135 degrees, and measuring screw length. Factors like tip-apex distance and screw position are important to prevent complications. The DHS works by creating compression as the lag screw collapses into the barrel post-operatively.
Triple arthrodesis
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Tips, tricks and pitfalls of proximal femoral nailing (PFN)
1. Proximal femoral nailing (PFN) requires thorough pre-operative planning including imaging and assessment of fracture pattern and patient comorbidities.
2. It is important to reduce the fracture before making the entry point, as the entry point will determine surgical success.
3. Factors such as varus reduction, medializing the shaft, high tip-apex distance, and penetration of the femoral head can lead to poor outcomes like nonunion.
Poller or blocking screw
Poller or blocking screws are used to stabilize fractures treated with small diameter intramedullary nails. They guide the nail like "poller" traffic devices guide vehicles. Blocking screws increase stability of distal and proximal metaphyseal fractures after nailing and can help manage malunited fractures. They work by narrowing the canal to guide the nail anteriorly and prevent sagittal plane deformity. Blocking screws are typically placed medially and laterally as close to the fracture as possible for optimal stabilization. Their placement on the concave side of deformities helps improve reduction by deflecting the nail.
Seminar k nail
Gerhard Küntscher developed intramedullary nailing during World War 2 to treat soldiers' fractures. He found that nails with elastic cross-sections like V-shapes or cloverleaves could better stabilize fractures by compressing to fill the medullary canal. Over decades, he refined nail designs and the nailing technique. Key principles were achieving stable fixation through flexible impingement in the bone and allowing weight bearing to promote healing. Factors like fracture pattern and bone anatomy determine suitability for nailing in the femur and tibia.
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Acetabular fractures
Acetabular fractures are typically caused by high-energy trauma and require careful evaluation using CT scans and plain radiographs to classify the fracture pattern according to the Letournel classification system, which describes fractures of the anterior and posterior columns. Operative treatment is indicated for displaced fractures while non-operative treatment with skeletal traction can be used for non-displaced or minimally displaced fractures.
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L03 intertrochanteric fx
Intertrochanteric hip fractures are common injuries, especially in the elderly population. They account for around 50% of all hip fractures. Treatment goals are to obtain a stable reduction and internal fixation to allow early mobility. Common classification systems include the AO/ASIF Muller system which categorizes fractures as stable or unstable. Implant options to achieve stable fixation include compression hip screws, sliding hip screws, and calcar-replacing prostheses. Post-operative rehabilitation aims to advance weight bearing as tolerated. Complications can include fixation failure, but most patients are able to regain some level of mobility.
Proximal humerus fracture Management
This document discusses the classification and anatomy of proximal humeral fractures. It provides details on:
1) Neer's classification system which categorizes fractures based on displacement of fragments into 1, 2, 3, or 4-part fractures or fracture-dislocations.
2) Important anatomical factors like the relationship between the articular head and tuberosities which impact fracture patterns.
3) Pre-operative planning involves accurate imaging like radiographs and CT scans to identify fracture characteristics to guide treatment.
Dhs principles
This document discusses the treatment of intertrochanteric hip fractures with different fixation devices. It notes that cephalomedullary devices are preferable to dynamic hip screws for fractures with posteromedial comminution or subtrochanteric extension due to their ability to provide controlled collapse and reduce bending forces. The document emphasizes the importance of pre-operative planning, proper reduction techniques, and achieving a tip-apex distance under 25mm for successful fixation with cephalomedullary devices.
Distal Clavicle Fractures
Distal clavicle fractures are classified into 5 types based on the location and involvement of ligaments. Type I fractures involve minimal displacement and are treated non-operatively. Type II fractures have greater controversy in management, with some advocating surgery for Type II fractures that have medial displacement of the distal fragment. Surgical options include plate fixation, CC ligament reconstruction, and arthroscopic techniques. While surgery aims to improve union rates, it also carries risks of complications that must be weighed against non-operative treatment. Further research is still needed to determine the optimal treatment approach for different types of distal clavicle fractures.
Thoracolumbar fractures
This document provides an overview of thoracolumbar fractures, including epidemiology, clinical evaluation, classification systems, radiographic evaluation, treatment approaches, and specific surgical techniques. It discusses the anatomy of the thoracolumbar region, mechanisms of injury, neurological assessment tools, radiographic indicators of instability, and non-operative and operative treatment options depending on the fracture classification.
Biomechanics and biology of absolute stability
The document discusses absolute stability in fracture healing. Absolute stability effectively abolishes fracture site movement, allowing direct healing through remodeling osteons instead of external callus formation. It promotes vascular ingrowth across the fracture site. Achieving absolute stability requires preserving the blood supply, anatomical reduction with no gap, and interfragmentary compression to provide mechanical stability. Clinical indications for absolute stability include articular fractures and simple diaphyseal fractures, while multifragmentary fractures are contraindications.
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This study introduces a "three-column fixation" concept for treating complex tibial plateau fractures (Schatzker Types V and VI) based on computed tomography scans. The study evaluates clinical outcomes in 29 patients treated with this column-specific fixation technique. At 2-year follow up, patients had good functional outcomes with SF-36, HSS, and lower extremity measure scores averaging 89, 90, and 87 respectively. Radiographic measurements also showed well-maintained alignment without significant malreduction. The study concludes that three-column fixation is an effective and safe method for multiplanar complex tibial plateau fractures.
principles of External fixation
explaining the principles and techniques of external fixation - done during basic ortho skills course
Posterolateral corner injuries of knee joint
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
Terrible triad - elbow
The "terrible triad" refers to an elbow dislocation with fractures of the coronoid process and radial head. This is an extremely unstable injury that often leads to recurrent instability, stiffness, and arthritis. Surgical treatment aims to address all fractures, repair ligaments, and restore stability through techniques like internal fixation, replacement, and external fixation. Postoperative rehabilitation focuses on early range of motion while protecting the repair.
Clavicle fractures-Management
This document discusses the management of clavicle fractures. It describes:
1) Non-operative and operative treatment options for middle-third clavicle fractures, including figure-of-eight bracing, slings, intramedullary fixation, and plate fixation.
2) Classification and treatment recommendations for distal-third clavicle fractures, including non-operative treatment for Types I-III and surgical options for Types IV-V.
3) Considerations for medial-third and pediatric clavicle fractures, noting most are treated non-operatively with immobilization.
4) Potential complications of treatment and techniques to minimize issues like pin migration, wound problems, and hardware failure.
Clavicle
A midshaft clavicle fracture with over 2cm of shortening was visualized on an x-ray. An incision was made over the projected inferior aspect of the clavicle after reduction. The fracture was reduced using a clamp and then fixed with a reconstruction plate placed on the inferior surface of the clavicle to avoid contouring. Postoperative x-rays confirmed successful fixation of the clavicle fracture with the plate.
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PRE OPERATIVE TEMPLATING IN TOTAL HIP ARTHROPLASTY
Templating in total hip replacement involves using preformed templates during preoperative planning to estimate implant size and position. The goals of templating include restoring hip biomechanics, predicting implant size, and recognizing potential difficulties. A standard approach involves assessing radiographs, identifying anatomical landmarks, mechanical references, and optimizing implant position. Careful templating allows surgeons to achieve successful, reproducible results while minimizing complications.
Dynamic hip screw
This document discusses the dynamic hip screw (DHS), used to treat intertrochanteric hip fractures. The DHS provides controlled collapse and dynamic action to reduce complications like screw cut-out. Key steps of the procedure include closed reduction of the fracture, guide pin and plate insertion at 135 degrees, and measuring screw length. Factors like tip-apex distance and screw position are important to prevent complications. The DHS works by creating compression as the lag screw collapses into the barrel post-operatively.
Triple arthrodesis
Triple arthrodesis is a surgical fusion of the subtalar, calcaneocuboid, and talonavicular joints to provide hindfoot stability and alignment and relieve pain. It is used to treat conditions like rheumatoid arthritis, post-traumatic arthritis, osteoarthritis, Charcot-Marie-Tooth disease, neglected clubfoot, poliomyelitis, and tarsal coalition. The Lambrinudi procedure is used for severe clubfoot and involves wedge resections of the calcaneum, talus, and navicular followed by fixation with K-wires, staples or screws. Postoperatively, the limb is immobilized for 6 weeks followed by ankle-foot orthosis use and weight bearing
Tips, tricks and pitfalls of proximal femoral nailing (PFN)
1. Proximal femoral nailing (PFN) requires thorough pre-operative planning including imaging and assessment of fracture pattern and patient comorbidities.
2. It is important to reduce the fracture before making the entry point, as the entry point will determine surgical success.
3. Factors such as varus reduction, medializing the shaft, high tip-apex distance, and penetration of the femoral head can lead to poor outcomes like nonunion.
Poller or blocking screw
Poller or blocking screws are used to stabilize fractures treated with small diameter intramedullary nails. They guide the nail like "poller" traffic devices guide vehicles. Blocking screws increase stability of distal and proximal metaphyseal fractures after nailing and can help manage malunited fractures. They work by narrowing the canal to guide the nail anteriorly and prevent sagittal plane deformity. Blocking screws are typically placed medially and laterally as close to the fracture as possible for optimal stabilization. Their placement on the concave side of deformities helps improve reduction by deflecting the nail.
Seminar k nail
Gerhard Küntscher developed intramedullary nailing during World War 2 to treat soldiers' fractures. He found that nails with elastic cross-sections like V-shapes or cloverleaves could better stabilize fractures by compressing to fill the medullary canal. Over decades, he refined nail designs and the nailing technique. Key principles were achieving stable fixation through flexible impingement in the bone and allowing weight bearing to promote healing. Factors like fracture pattern and bone anatomy determine suitability for nailing in the femur and tibia.
Latarjet – the panacea for traumatic anterior shoulder
The Latarjet procedure is effective for treating traumatic anterior shoulder instability, especially when there is significant bone loss. It works by increasing the effective glenoid track and addressing humeral and glenoid bone deficits. Studies show the Latarjet procedure results in excellent stability, range of motion, function, and return to sports. While it has a slightly higher risk of complications than the Bankart repair, the Latarjet procedure is superior in addressing the underlying bone pathology and has lower recurrence rates, making it the preferred option for many patients with traumatic anterior instability.
Acetabular fractures
Acetabular fractures are typically caused by high-energy trauma and require careful evaluation using CT scans and plain radiographs to classify the fracture pattern according to the Letournel classification system, which describes fractures of the anterior and posterior columns. Operative treatment is indicated for displaced fractures while non-operative treatment with skeletal traction can be used for non-displaced or minimally displaced fractures.
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This document discusses the history and applications of robotics and navigation in orthopaedics. It describes how robotic systems have evolved from early systems like ROBODOC in the 1990s to current haptic and autonomous systems. Navigation systems can be fluoroscopy-based or CT-based and provide advantages like improved accuracy and reduced radiation exposure compared to conventional surgery. Applications include joint replacement, fracture fixation, and spinal procedures. Challenges include maintaining registration accuracy, line of sight issues, and high costs.
L03 intertrochanteric fx
Intertrochanteric hip fractures are common injuries, especially in the elderly population. They account for around 50% of all hip fractures. Treatment goals are to obtain a stable reduction and internal fixation to allow early mobility. Common classification systems include the AO/ASIF Muller system which categorizes fractures as stable or unstable. Implant options to achieve stable fixation include compression hip screws, sliding hip screws, and calcar-replacing prostheses. Post-operative rehabilitation aims to advance weight bearing as tolerated. Complications can include fixation failure, but most patients are able to regain some level of mobility.
Proximal humerus fracture Management
This document discusses the classification and anatomy of proximal humeral fractures. It provides details on:
1) Neer's classification system which categorizes fractures based on displacement of fragments into 1, 2, 3, or 4-part fractures or fracture-dislocations.
2) Important anatomical factors like the relationship between the articular head and tuberosities which impact fracture patterns.
3) Pre-operative planning involves accurate imaging like radiographs and CT scans to identify fracture characteristics to guide treatment.
Dhs principles
This document discusses the treatment of intertrochanteric hip fractures with different fixation devices. It notes that cephalomedullary devices are preferable to dynamic hip screws for fractures with posteromedial comminution or subtrochanteric extension due to their ability to provide controlled collapse and reduce bending forces. The document emphasizes the importance of pre-operative planning, proper reduction techniques, and achieving a tip-apex distance under 25mm for successful fixation with cephalomedullary devices.
Distal Clavicle Fractures
Distal clavicle fractures are classified into 5 types based on the location and involvement of ligaments. Type I fractures involve minimal displacement and are treated non-operatively. Type II fractures have greater controversy in management, with some advocating surgery for Type II fractures that have medial displacement of the distal fragment. Surgical options include plate fixation, CC ligament reconstruction, and arthroscopic techniques. While surgery aims to improve union rates, it also carries risks of complications that must be weighed against non-operative treatment. Further research is still needed to determine the optimal treatment approach for different types of distal clavicle fractures.
Thoracolumbar fractures
This document provides an overview of thoracolumbar fractures, including epidemiology, clinical evaluation, classification systems, radiographic evaluation, treatment approaches, and specific surgical techniques. It discusses the anatomy of the thoracolumbar region, mechanisms of injury, neurological assessment tools, radiographic indicators of instability, and non-operative and operative treatment options depending on the fracture classification.
Biomechanics and biology of absolute stability
The document discusses absolute stability in fracture healing. Absolute stability effectively abolishes fracture site movement, allowing direct healing through remodeling osteons instead of external callus formation. It promotes vascular ingrowth across the fracture site. Achieving absolute stability requires preserving the blood supply, anatomical reduction with no gap, and interfragmentary compression to provide mechanical stability. Clinical indications for absolute stability include articular fractures and simple diaphyseal fractures, while multifragmentary fractures are contraindications.
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This document discusses osteotomy and unicompartmental knee replacement (UKR or "Uni Knee") for the treatment of varus malalignment and osteoarthritis in the knee. It provides details on the surgical techniques, outcomes, advantages, and contraindications of high tibial osteotomy (HTO) and UKR. Non-operative treatments for knee osteoarthritis like weight loss, exercise, and injections are also summarized.Three column fixation for complex PROXIMAL TIBIA FRACTURES
This study introduces a "three-column fixation" concept for treating complex tibial plateau fractures (Schatzker Types V and VI) based on computed tomography scans. The study evaluates clinical outcomes in 29 patients treated with this column-specific fixation technique. At 2-year follow up, patients had good functional outcomes with SF-36, HSS, and lower extremity measure scores averaging 89, 90, and 87 respectively. Radiographic measurements also showed well-maintained alignment without significant malreduction. The study concludes that three-column fixation is an effective and safe method for multiplanar complex tibial plateau fractures.
principles of External fixation
explaining the principles and techniques of external fixation - done during basic ortho skills course
Posterolateral corner injuries of knee joint
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
Terrible triad - elbow
The "terrible triad" refers to an elbow dislocation with fractures of the coronoid process and radial head. This is an extremely unstable injury that often leads to recurrent instability, stiffness, and arthritis. Surgical treatment aims to address all fractures, repair ligaments, and restore stability through techniques like internal fixation, replacement, and external fixation. Postoperative rehabilitation focuses on early range of motion while protecting the repair.
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Clavicle fractures-Management
This document discusses the management of clavicle fractures. It describes:
1) Non-operative and operative treatment options for middle-third clavicle fractures, including figure-of-eight bracing, slings, intramedullary fixation, and plate fixation.
2) Classification and treatment recommendations for distal-third clavicle fractures, including non-operative treatment for Types I-III and surgical options for Types IV-V.
3) Considerations for medial-third and pediatric clavicle fractures, noting most are treated non-operatively with immobilization.
4) Potential complications of treatment and techniques to minimize issues like pin migration, wound problems, and hardware failure.
Clavicle
A midshaft clavicle fracture with over 2cm of shortening was visualized on an x-ray. An incision was made over the projected inferior aspect of the clavicle after reduction. The fracture was reduced using a clamp and then fixed with a reconstruction plate placed on the inferior surface of the clavicle to avoid contouring. Postoperative x-rays confirmed successful fixation of the clavicle fracture with the plate.
Clavicle Fractures & ACJ Injuries
The document discusses clavicle fractures and acromioclavicular (AC) joint injuries. It begins by describing shoulder anatomy and the clavicle bone. It then discusses types of clavicle fractures, including proximal/medial, distal/lateral, and midshaft fractures. Treatment options are provided for each type, including nonsurgical and surgical methods like plating and coracoclavicular screws. Complications of clavicle fractures like nonunion are also outlined. The document concludes by reviewing the Rockwood classification system for AC joint injuries and discussing nonsurgical and surgical treatment approaches.
Clavicle fractures
The document summarizes information about clavicle fractures, including their epidemiology, anatomy, mechanisms of injury, classification systems, treatment options, and evidence for management approaches. Specifically, it finds that:
1) Clavicle fractures are among the most common fractures and midshaft fractures account for 69-80% of cases.
2) They are often caused by a direct blow to the shoulder and result in characteristic deformities from surrounding muscle and ligament forces.
3) Nonoperative treatment is usually indicated for nondisplaced fractures but recent evidence shows displaced or shortened fractures have higher risks of poor outcomes like pain, weakness and nonunion.
Fracture clavicle
1) Clavicle fractures are generally treated non-operatively as they heal well with conservative treatment. However, displaced or comminuted fractures may require surgery.
2) Indications for surgical treatment include fractures with over 2cm of displacement or shortening, multiple fracture fragments, open or impending open fractures, and associated injuries.
3) Surgical techniques include plate fixation, intramedullary pinning, and external fixation. Plate fixation provides the most stable fixation but has higher surgical morbidity.
4) Potential postoperative issues include scar sensitivity, hardware irritation, numbness, and nonunion or malunion which may require further surgery. Overall clavicle fractures have good prognosis with either non-operative or surgical treatment
Clavicle fracture
1. Fractures of the clavicle and scapula are uncommon but can result from high-energy trauma.
2. Clavicle fractures most commonly occur in the middle third and are usually treated conservatively with sling immobilization.
3. Scapula fractures involve the body, neck, glenoid, coracoid, or acromion and are often associated with life-threatening injuries requiring assessment by ATLS protocols. Most are also treated initially with sling immobilization.
Clavicle fracture
1. The clavicle is the only long bone that lies horizontally in the body and connects the thorax to the shoulder girdle.
2. Clavicle fractures are classified based on their location as medial, middle, or lateral thirds. Common causes are falls on an outstretched hand or lateral shoulder.
3. Treatment depends on the fracture type and patient factors, ranging from sling immobilization to surgical fixation with plates or screws.
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The document summarizes a study on the mini-open Latarjet procedure for patients with failed arthroscopic Bankart repair for recurrent shoulder instability. 24 patients underwent the mini-open Latarjet procedure and were followed for a minimum of 2 years. Results found satisfactory range of motion, functional outcomes, and low recurrence rates. Complications were minor. The study concludes the mini-open Latarjet is an effective option for challenging cases of recurrent instability after failed soft tissue repair due to significant bone loss.
Ac dislocation
1) Mathew, a 55-year-old male, presented with pain and swelling in his left shoulder following a road traffic accident 1 week ago. On examination, he was found to have a bony prominence over the lateral end of his left clavicle and difficulty raising his left arm, consistent with an acromioclavicular joint dislocation.
2) He underwent open reduction of the dislocated joint and fixation of the clavicle to the base of the coracoid using K-wires.
3) Acromioclavicular joint dislocations are commonly caused by direct trauma and account for about 9% of shoulder injuries, usually affecting males aged 20-30 years old.
MANAGEMENT_OF_CLAVICLE_FRACTURE_AND_ACROMIOCLAVICULAR_INJURY 2.pptx
This document summarizes the presentation on clavicle fractures by Dr. K Maneesh Chandra. It discusses the mechanisms of injury, physical exam findings, imaging modalities, anatomy, treatment options and management of complications for clavicle fractures in infants, children and adults. Surgical treatment involves open reduction and internal fixation with plates or screws while non-surgical treatment uses sling immobilization. Complications are addressed and factors influencing treatment choice are outlined.
U01 clavicle ac_sc_joints1
The document describes the anatomy and classification of injuries to the clavicle, acromioclavicular joint, and sternoclavicular joint. It discusses the clavicle bone, its joints, ligaments, muscle attachments, mechanisms of injury, physical exam, radiographic evaluation, classification of fractures, and treatment options for fractures and dislocations which can include nonoperative treatment, plate fixation, intramedullary fixation, coracoclavicular screw fixation, and distal clavicle excision.
Shoulder instability
The document discusses shoulder instability, including its definition, causes, clinical presentation, evaluation, and treatment options. Static factors like bony anatomy and ligaments contribute to stability, while dynamic factors include muscle forces. Pathologies include labral tears and capsular injuries. Treatment depends on factors like age, activity level, and pathology. Non-operative options include immobilization, while surgery repairs tissues like the labrum or tightens the capsule. Rehabilitation progresses from rest to strengthening and sport-specific training.
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Clavicle fractures are common injuries, especially in young active individuals. The majority occur in the midshaft region due to its thin bone and lack of muscle protection. Treatment depends on the location and degree of displacement/shortening. Nondisplaced fractures are usually treated nonsurgically with slings or strapping. Displaced fractures may require plate fixation, intramedullary nails, or coracoclavicular ligament repair/reconstruction to achieve union and restore function. Complications can include nonunion, malunion, hardware irritation, and neurovascular injury.
Case discussion 10
A 30-year-old man presented with a progressively painful mass around his left knee for 5 months. X-rays showed periosteal reaction and disrupted cortex of the distal femur. This is most likely osteosarcoma, which will be further investigated with MRI, biopsy, and staging. The principles of open biopsy aim to obtain a representative sample without compromising treatment. After diagnosis and staging, treatment options include neoadjuvant chemotherapy, wide surgical excision, and adjuvant chemotherapy. Prognostic indicators include tumor stage, grade, size, location, and response to neoadjuvant chemotherapy.
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Femur Fracture power point gagahagwhagahahaha
1) The document discusses distal femur fractures, providing information on classification, treatment options, surgical approaches, and fixation methods.
2) Distal femur fractures account for 7% of femur fractures and can be either high-energy injuries in younger patients or low-energy fractures in elderly patients.
3) Treatment has shifted from skeletal traction to operative fixation with plates or nails, with the goal of anatomic reduction and stable fixation to allow early range of motion.
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This document discusses diagnosis and treatment of acromioclavicular (AC) joint injuries. It describes the anatomy of the AC joint and classifications of injuries. For type I and II injuries, conservative treatment with slings or harnesses is recommended. Types IV, V and VI generally require surgical treatment to reduce and reconstruct injured ligaments. Recent techniques focus on arthroscopic reconstruction of the coracoclavicular ligaments and stabilization of the AC joint with suture anchors, tightropes or tendon grafts. Arthroscopy allows better visualization and less invasive reconstruction of the ligaments compared to open surgery.
ACL INJURIES
This document provides an overview of anterior cruciate ligament (ACL) injuries, including:
1) The anatomy, functions, and mechanisms of ACL injury. Common symptoms include the knee popping out and difficulty walking. Physical exams include the anterior drawer test and Lachman's test.
2) MRI is the best imaging method, showing primary signs like an absent ACL or secondary signs like bone bruises.
3) Treatment options include non-operative management for mild injuries or reconstruction using autografts like the patellar tendon or hamstring tendons. Proper technique and rehabilitation are important for success.
4) Complications can include limited motion, pain, and failure, which may be due to
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Anular repair after lumbar discectomy surgery may decrease reherniation rates and improve patient outcomes by restricting nucleus material from re-extruding through the anular defect. Clinical studies have found that anular repair reduces reoperation rates by 47-64% compared to discectomy without repair. Repairing the anulus fibrosus during lumbar microdiscectomy can successfully be accomplished in over 90% of cases and may result in fewer additional surgeries for patients.
Updated PCL, PLC and Knee Dislocation for Postgraduate Orthopaedic Course in ...
Updated PCL, PLC and Knee Dislocation for Postgraduate Orthopaedic Course in ...Professor Deiary Kader
The document discusses the posterior cruciate ligament (PCL) and posterolateral corner (PLC) of the knee. It provides details on the anatomy, mechanisms of injury, clinical assessment, treatment, and complications for injuries to these structures. For PCL injuries, the strongest ligament in the knee, treatment involves conservative management for isolated acute injuries or reconstruction for chronic symptomatic injuries. For PLC injuries, addressing all injured ligaments is important as isolated treatment can fail. Reconstruction of the lateral collateral ligament, popliteus tendon, and popliteofibular ligament is recommended for chronic complete injuries.Clavicular fracture & acj injury
The document summarizes the anatomy, classification, treatment and complications of clavicle fractures and acromioclavicular (AC) joint injuries. Key points:
- Clavicle fractures are classified using the Allman or Neer system, with most (80%) occurring in the middle third.
- Treatment depends on fracture type and displacement, with non-displaced fractures typically treated non-operatively and displaced/unstable fractures often requiring surgery.
- AC joint injuries use the Rockwood classification, with Types I-III usually treated non-operatively and Types IV-VI requiring surgery.
- Surgical options include plate fixation, CC screw fixation, hook plates or ligament reconstruction,
Hip anatomy, approaches & AVN
This document provides an overview of hip anatomy, approaches to the hip joint, and the treatment of avascular necrosis (AVN) of the hip. It discusses various surgical approaches to the hip including anterior, anterolateral, lateral, posterior, and medial. It also describes the classification systems for AVN and reviews nonsurgical and surgical treatment options such as core decompression, bone grafting, osteotomies, and hip replacement. The goal of hip preserving surgeries is to redistribute weight bearing while total hip arthroplasty is recommended for late-stage AVN.
Hip Joint anatomy, surgical approches & AVN review
This document provides an overview of hip anatomy, approaches to the hip, and the treatment of avascular necrosis (AVN) of the hip. It describes various surgical approaches to the hip including anterior, anterolateral, lateral, posterior, and medial. It also discusses the causes of AVN and classifications including Ficat & Arlet and ARCO. Surgical management of AVN including core decompression with and without bone grafting, vascularized grafts, and osteotomies are explained.
Clavicle Fracture
Clavicle fractures are common injuries, especially in young active individuals participating in sports. The majority occur in the midshaft of the bone from direct blows or falls. Nonoperative treatment is usually sufficient but displaced fractures may require surgery. Physical exam and x-rays can diagnose and classify the fracture. Most heal with rest, but operatively fixing displaced fractures can improve outcomes.
Anotomic-Biological Reconstruction of Acromio-Clavicular Joint Injuries-Dr. U...
This study evaluated 11 patients who underwent an anatomic reconstruction of the acromio-clavicular joint using a semitendinosus graft. At a minimum follow-up of 6 months, 8 patients had excellent outcomes, 2 had good outcomes, and 1 had a satisfactory outcome based on Constant and ASES scores. Complications included minimal loss of reduction in 1 patient and wound edge necrosis in another. The technique aims to anatomically reconstruct the coracoclavicular and acromioclavicular ligaments. The authors concluded the technique provides stable reconstruction with low complication rates. However, they noted limitations including the small sample size and need for longer-term studies.
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Results of Mini-Open Latarjet Procedure in Failed in Arthroscopic Bankart Rep...
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Meniscus Transplant
The document discusses meniscus transplants, including:
1) Meniscus transplantation can help reduce pain and improve function by restoring a biomechanically favorable environment in the knee.
2) A long-term study of 119 meniscus transplant cases found a 79% success rate, with the main factors affecting survival being increased age and number of previous surgeries.
3) Case studies demonstrate that meniscus transplantation, combined with cartilage repair procedures, can provide long-term benefits for patients with meniscus injuries and cartilage damage.
Biologic Knee Replacement Presentation
Biologic Knee Replacement (BKR) is our approach to treating knee injuries, from trauma to arthritis, and is designed to help people delay, or even avoid, artificial knee replacement. BKR is a scientifically-proven collection of our out-patient surgical techniques and procedures and consists of any combination of meniscus transplantation, articular cartilage paste grafting, ligament replacement as explained in further detail below. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using Biologic Knee Replacement.
Meniscus Transplant and Replacement
By replacing all or a portion of the meniscus with donor cartilage, the patient can regain the natural “shock absorber” in the knee and experience many additional years of activity, even in the presence of arthritis. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using meniscus transplant alone or in combination with any of the Biologic Knee Replacement procedures.
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This document outlines the rehabilitation goals and protocol following meniscal allograft transplantation surgery. The goals are for patients to regain function and mobility, with the long term aim of being fitter, faster and stronger than before surgery. The rehabilitation involves an initial protective phase focusing on reducing pain and swelling, followed by a moderate protective phase adding range of motion and strengthening exercises. Later phases progress to functional exercises and a gradual return to normal activities and sports. Close monitoring during rehabilitation is important to correct any compensatory movement patterns and ensure the best surgical outcomes.
Osteochondritis dissecans
1) The document describes a technique called articular cartilage paste grafting to treat large cartilage lesions in the knee that have failed previous repairs.
2) The technique involves morselizing the damaged cartilage into a paste and grafting it into the lesion. Two patient cases are described where this technique successfully treated large OCD lesions.
3) Preliminary studies show that the paste contains viable cells that are capable of proliferating and expressing cartilage genes, suggesting the paste contains cells that could aid in cartilage repair.
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The document discusses various types of ankle injuries and treatments. It focuses on ankle arthritis, cartilage defects, and ligament injuries. For cartilage defects, it recommends treating the worst lesion with cartilage grafting from the tibia. Rehabilitation for cartilage grafting involves initial non-weight bearing, continuous passive motion therapy, and a early emphasis on regaining full range of motion. Rehabilitation for ankle injuries generally should provide protection, improve joint mechanics and gait, enhance proprioception, and restore patient function.
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The Stone Clinic is a sports medicine clinic in San Francisco, California, offering orthopaedic surgery and medical care, physical therapy and rehabilitation, and radiology imaging services. The Stone Clinic was founded by Kevin R. Stone, M.D., an orthopaedic surgeon, combining himself with a team of nurses, physical therapists, imaging specialists, and patient coordinators, in 1988 to focus on caring for injured athletes and people experiencing arthritis pain.
The Stone Clinic is founded on the goal of rehabilitating all patients to an operating level higher than before they were injured. The Stone Clinic specializes in sports medicine and injury treatment of knee, shoulder, and ankle joints. Stone has lectured and is recognized internationally as an authority on cartilage and meniscal growth, replacement, and repair. Stone and the Stone Clinic are known for the development of the paste grafting surgical technique in 1991, combined with meniscus replacement, which are biologic joint replacement procedures for the regeneration of the knee joint. Surgical procedures were subjected to rigorous outcomes analysis with the results reported in peer reviewed journals. The surgical techniques have been taught to surgeons in the US and worldwide, through lectures and videos.
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Clavicle fractures
- 1. CLAVICLE FRACTURES Kevin R. Stone, M.D. The Stone Clinic, San Francisco, CA
- 9. OPERATIVE TECHNIQUE Intra-medullary fixation
- 10. OPERATIVE TECHNIQUE Intra-medullary fixation
- 11. OPERATIVE TECHNIQUE Intra-medullary fixation
- 12. OPERATIVE TECHNIQUE Intra-medullary fixation
- 13. OPERATIVE TECHNIQUE Intra-medullary fixation
- 19. CLAVICLE FRACTURES Patient Example: JC Pre-op x-ray
- 20. CLAVICLE FRACTURES Patient Example: JC Post-op x-ray Open reduction and internal fixation Problem - Proud Screw
- 21. Patient Example: JC 2 Mo. Post-op x-ray Hardware Removal 8 Mo. Post-op
- 23. CLAVICLE FRACTURES Patient Example: MM X-ray Immediately Post Trauma Non-operative care or operative fixation??? AP Oblique
- 24. CLAVICLE FRACTURES Patient Example: MM 1 Mo. Post Trauma X-ray Non-operative care Oblique AP
- 26. Thank you