complications

Definition

Unstable injuries

Complete disruption of both the anterior and posterior ring

5 - 20% of pelvic fractures

Mechanism

Axial load

Motor vehicle accident

Fall from height

Pathology

Anterior ring

Complications

Subscapularis failure

Rotator cuff failure

Instability

Infection

Periprosthetic fracture

Aseptic loosening

Neurological injury

Parada et al. J Should Elbow Surg 2021

- 2224 aTSA complication rate 11%, revision rate 5.6%

Indications

RA 

OA 

AVN 

Contra-indications

Infection

Charcot

Paralysis of deltoid

Torn rotator cuff

Insufficient glenoid bone stock

Indications

Poor soft tissues

- prohibit ORIF

Non union

Infected non uniion

Malunion / deformity

Bone loss / bone transport / LLD

Concept

Distal Tibial Fractures

Definition

Metaphyseal

Extra-articular

Intra-articular Extension

Indications

< 60 with good bone stock and preserved joint space

Reduction

Union rates increased with anatomical reduction

Options

- closed reduction

- open reduction / if closed reduction fails

Accept

- no varus

- < 15^o valgus

- < 10^o AP plane

Definition

Garden 1 / 2

Algorithm

ORIF

- ~ 15% displacement rate with non operative management

- increased risk of non union

- reduced hospital in patient stays

Options

Cannulated screws

DHS + derotation screw

3 cannulated screws

Indications

Patient > 70

Gjertsen et al JBJS Am 2010

- 4335 patients > 70 with displaced subcapital fractures

- minimum 1 year follow up

- 1 year mortality same in each group / 25%

- 22% reoperation in ORIF v 3% in hemiarthroplasty

- more pain / higher dissatisfaction / lower quality life in ORIF group

Options

Hemiarthroplasty

- unipolar monoblock

- unipolar modular

General

- haemarthrosis

- DVT

- infection

Septic Arthritis

Incidence

Definition

Device that encircles a limb to occlude the vascular supply

Aim is to provide bloodless field

Contra-Indications

Local

- poor skin

- PVD

- DVT

- vascular bypass surgery

General

- sickle cell anaemia