anterior

Shoulder

Approaches

 

Anterior

Anterolateral

Posterior

 

Anterior Approach / Deltopectoral

 

Indications

- shoulder stabilization

- arthroplasty

- fracture fixation

 

Approach

 

Position

- beach chair

- upper body elevated 30- 40o / reduces venous pressure and bleeding

Foot and Ankle

Approaches

 

Ankle

- anterior

- anterolateral

- posterolateral

 

Hindfoot

- lateral

- Ollier's

 

Anterior approach to Ankle

 

Concept

 

Between EHL and EDL

 

Indications 

- drainage of ankle joint

- ankle arthrodesis

- ORIF tibial plafond

- removal of loose bodies

 

Approach

 

Position 

Hip Dislocation

IncidencePosterior Hip Dislocation

 

Young men

 

Posterior / Anterior 9:1

 

Aetiology

 

High velocity injury

- head direction at impact decides direction of dislocation

 

Anterior Dislocation 

 

Externally rotated & abducted leg

- flexion = inferior dislocation

Approaches

Options

 

Anterior

- thoracotomy

- thoracoabdominal

- abdominal

 

Posterior

 

Anterior Approaches

 

C2 - T2

- anterior cervical approach

- may have to split manubrium / sternotomy for lowest levels

 

T3 - T7

- thoracotomy

- patient on side left side up to avoid veins

Monteggia

Paediatric Monteggia APPaediatric Monteggia Lateral

 

Definition

 

Fracture / plastic malformation of proximal ulna with dislocation of radial head

 

Xray

 

Radio-capitellar line disrupted

 

Sternoclavicular Dislocations

EpidemiologySCJ Anterior DIslocation

 

Extremely uncommon

Stability provided by joint capsule /costoclavicular & interclavicular ligaments 

 

Recurrent instability uncommon

 

Many apparent dislocations in adolescents may be growth plate injuries 

-will remodel without treatment

 

If OA from chronic dislocation may resect SCJ

 

Locked Glenohumeral Dislocation

Definition

 

A GH dislocation which has been missed for a significant period of time

- time period is arbitary

- > 3-6 weeks

 

Pathology

 

Humerus soft and osteoporotic

Significant soft tissue contractures

 

1.  Anterior / subcoracoid dislocation

 

Beware

- scarring to NV structures

- RC tears including SSC, especially > 40