Ankle arthritis and ankle fusions can be performed through open, mini-open, or arthroscopic techniques. The goals of ankle fusion surgery are to create a stable, plantigrade foot that is painless. Preoperative planning involves assessing for deformities, adjacent joint arthritis, and soft tissue contractures. During the procedure, cartilage is removed and bone surfaces are prepared to promote fusion with fixation methods like screws, plates, or external fixation. Postoperative care involves restricted weight bearing to allow fusion to occur.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
muscle pedicle grafting for delayed presentation of intra cpasular fracture neck of Femur.. a study of 65 cases in Osmania Medical College, Hyderabad, Telengana.
Management of atypical THA periprosthetic fracture RiverTsai2
There increasing cases of atypical THA periprosthetic fracture after long term anti-osteoporosis agent use,especially biphosphonates. It has special characteristics form traditional Vancouver periprosthetic fracture. The speech is delivered by Dr. Chun-Hao Tsai of China Medical University Hospital ,Taichung,Taiwan.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
muscle pedicle grafting for delayed presentation of intra cpasular fracture neck of Femur.. a study of 65 cases in Osmania Medical College, Hyderabad, Telengana.
Management of atypical THA periprosthetic fracture RiverTsai2
There increasing cases of atypical THA periprosthetic fracture after long term anti-osteoporosis agent use,especially biphosphonates. It has special characteristics form traditional Vancouver periprosthetic fracture. The speech is delivered by Dr. Chun-Hao Tsai of China Medical University Hospital ,Taichung,Taiwan.
Colorado shoulder specialist Dr. Peter Millett analyzes a case study of a 48 year-old active male with a supraspinatus tear with Grade 2 atrophy. The goal of arthroscopic rotator cuff repair is to restore the anatomy, biomechanics, shoulder function and promote healing. The advantages of arthroscopic repair is lower complication rates than RSTA and tendon transfer and overall improved functional outcomes.
Depending on the type of rotator cuff tear will help establish the reconstruction classification. In Dr. Millett's study from AAOS in 2014 there are four tear pattern recognitions: crescent, L/Reverse L, U-Shape and Massive Contracted. These pattern recognitions are required for modern arthroscopic rotator cuff repair to help facilitate anatomic restoration, optimize biomechanical properties and tendon biology, along with decrease failure rates.
For older patients, Dr. Millett conducted a study on the outcomes of rotator cuff repairs in older patients. The study found that the mean patient satisfaction was 9/10 improvement in pain affecting ADLs and ability to participate in sporting activities.
Can read freely here
https://sethiortho.blogspot.com/
DISTAL FEMUR FRACTURES
OVERVIEW
• INTRODUCTION
• EPIDEMIOLOGY
• ANATOMY AND IT’S RELEVENCE
• CLASSIFICATION
• CLINICAL PRESENTATION
• IMAGING
• MANAGEMENT
– Operative
– Approaches
– Implants
– Tips and tricks
INTRODUTION
• Fractures of the supracondylar and
intercondylar region of the femur.
• Bimodal distribution,
– Younger patients – High energy
– Elderly patients – Low energy
• A challenging fracture type to treat.
EPIDEMIOLOGY
• Less than 1% of all fractures
• 3 – 6% of femoral fractures
• Incidence – 37 per 100,000 population in USA.
• Non union rate 10 – 20% after plate fixation.
• Coon MS, Best BJ. Distal Femur Fractures. National Library of Medicine.
August 2021.
• Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review.
Injury. 2006 Aug;37(8):691-7.
ANATOMY
• Distal most 10- 15 cm of the femur. supracondylar
and condylar region.
• Medial condyle extends more distally and is more
convex than the lateral femoral condyle. This
accounts for the physiologic valgus of the femur.
• The lateral surface has a 10° inclination from the
vertical, while the medial surface has a 20–25° slope.
• Patello-femoral inclination approximately 10°
• In order to avoid joint penetration, screws should be
placed parallel to both the patellofemoral and
femorotibial joints planes.
Muscle attachments
• Shortening is due to the pull of the quadriceps
and hamstring muscles
• Varus and extension deformity is caused by
the pull of the adductors and gastrocnemius.
• Neuro-vascular bundle lie near the posterior aspect
of the distal femur.
• Vascular injuries occur in about 3% and nerve injuries
in about 1% of fractures of the distal femur.
CLASSIFICATION
• AO/OTA
CLINICAL PRESENTATION
• High energy trauma
• Older patients – low energy
• Swelling , Deformity
• Open fractures
• Neuro-vascular complications not uncommon
IMAGING
• Plain radiography
– AP
– Lateral
• CT
– Intra-articular fracture assessment
– Pre-op planning
– Identify osteochondral fragments
• Angiography
– ABI < 0.9
MANAGEMENT
• Non operative
– Non-displaced type A fractures
– Non- ambulatory / Inoperable
– Splint care / knee immobilizer / hinged knee brace
• Operative
– Any displacement / malalignment
– Intra-articular involvement
SURGICAL MANAGEMENT
• ORIF
• Retrograde IM nail
• External fixation
• Arthroplasty
Open Reduction & Internal Fixation
• Indications
– Intra-articular fractures
– Low Type A fractures
– Metaphyseal comminution
– Non-union
– Osteoporotic bones
Pre – operative Planning
‘Failing to plan is planning to fail’
• Implants
• Anatomical lateral locking plate
• Condylar variable angle locking
compression plate (VA-LCP)
• 95° angled blade plate
• 95° dynamic condylar screws
• lag screws / headless screws
• Other plates for adjunctive fixation
Pre – operative Planning
• Other devices and instruments
– Image intensifier
– Femoral distractor
– Reduction clamps
• Pointed clamps
• Collinear clamp
– Schanz pins
– K wi
Objectives:
-Recognize the anatomy of the proximal tibia
-Describe initial evaluation and management
-Identify common fracture patterns
-Apply treatment principles and strategies for Partial articular fractures and Complete articular fractures
-Discuss rehabilitation and complications
-Learn Management in selected tibial plateau case scenarios
Intramedullary nailing of fractures.dr mohamed ashraf.HOD.govt TD medical co...drashraf369
presentation of biology,biomechanics and practice of intramedullary nailing of long bone fractures by dr mohamed ashraf,govt TD medical college,alleppey,kerala,india
This is a comprehensive guide to the Ream and Run procedure, a variation of shoulder replacement for younger patients with shoulder arthritis or those who wish to have no restrictions after surgery
Total Hip replacement for Ankylosing Spondylitis: Planning & Execution Vaibhav Bagaria
Performing Total Hip replacement in Ankylosing Spondylitis requires a well thought of strategy. Preoperative planning, Inventory ordering, positioning, cup and stem orientation all play a role.
1. Ankle Arthritis & Fusion:
Open, Mini, Arthroscopic
Selene G. Parekh, MD, MBA
Associate Professor of Surgery
Partner, North Carolina Orthopaedic Clinic
Department of Orthopaedic Surgery
Adjunct Faculty Fuqua Business School
Duke University
Durham, NC
919.471.9622
http://seleneparekhmd.com
Twitter: @seleneparekhmd
2. Ankle Arthritis
• Ankle is more commonly injured than any other joint
in the body
• Subject to more WB force per cm2 than any other
joint
• Prevalence of ankle arthritis is 9 x’s lower than at
the hip or knee
• Trauma is the most common cause
• Ankle sprains, ankle fx, pilon fx …
3. Indications
• Arthrosis
• Pain
• Deformity
• Failed TAR
• Charcot ankle
• Degenerative Arthritis
• Rheumatoid Arthritis
• Post Traumatic/
Acquired Deformity
• Instability from
Paralytic Disorders
• Neuropathic Joint
• Failed Total Ankle
Replacement
13. Surgical Principles
• Create broad, congruent cancellous surfaces
• Remove all cartilage
• Feather and penetrate into subchondral bone
• Use bone graft or substitutes to fill defects
• Stabilize w/ rigid fixation
• Appropriate alignment to create a plantigrade
foot
18. Open: Lateral
• Position: supine
• Incision
• 10cm prox to tip of
fibula base of 4th MT
• Structure at risk
• Anterior branch sural n.
• Peroneals
19. Open: Lateral
• Full thickness flaps
• Periosteum of fibula stripped anteriorly and
posteriorly
• Protect peroneals
20. Open: Lateral
• Fibular osteotomy 2cm
proximal to level of joint
• Proximal-lateral
• Distal-medial
29. Open: Anterior
• Enter joint
• Prepare joint
• Position and fixation
with screws or plates
30. • Position: supine
• Extended scope portals
• Use lamina spreaders
• Debride joint
• Only do if no deformity
• Minimally invasive and
good results
Mini-Open
32. Mini-Open
• Place laminar spreader in one wound and
prepare from the other
• Posterior 1/3 ankle difficult to visualize
• Prepare joint
• Position and fixation with screws
33. Mini-Open Results
• Early radiographic evidence on healing @ 6wks
Paremain, 1996.
• Clinical fusion = 100%
44. Ankle Arthrodeses: Open vs.
SAA
• SAA
– Less morbidity
– Decreased time to fusion
• 4 – 8 wks less
• Open
– Can address deformities
45. Ankle Arthrodeses: Open
• Alignment & fixation
• Ant aspect of talus aligns ant cortex of tibia
• Screws
• W/in sinus tarsi, above lat process
• Aim screws medially & as proximal as possible
• Ensure all threads are in proximal piece
55. • Solid arthrodesis 12 weeks (no BG), 14 wks
(BG)
• AOFAS from 37 to 68.
• 93% were satisfied. No complications .
• CONCLUSION: The anterior double plating
system: Reliable method to achieve solid
tibiotalar arthrodesis, even with loss of bone ,
e.g. failed TAA
Anterior double plating for rigid fixation of isolated tibiotalar
arthrodesis.
Plaass C, Knupp M, Barg A, Hintermann B.
Foot Ankle Int. 2009 Jul;30(7):631-9.
60. External Fixation
• Advantages
• Avoid metal in infected
bone
• Better control in poor
quality bone
• May lengthen and fuse
at some time - Ilizarov
• Disadvantage
• Pin tract infections
• Patient acceptance of
fixator
• Pin breakage