complications

Background

 total shoulder arthroplast allPoly Glenoid

 

Indications

 

RA 

OA 

AVN 

 

Contra-indications

 

Infection

Charcot

Paralysis of deltoid

Torn rotator cuff

Insufficient glenoid bone stock

 

Ilizarov

Ilizarov Frame Proximal Tibia Clinical Photo

 

Indications

 

Poor soft tissues

- prohibit ORIF

 

Non union

 

Infected non uniion

 

Malunion / deformity

 

Bone loss / bone transport / LLD

 

Concept

 

Displaced ORIF

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

- < 15o valgus

- < 10o AP plane

 

Displaced Arthroplasty

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

Tourniquet

DefinitionTourniquet Arm

 

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

Blood Products

Goal

 

Ultimate goal of blood management is to AVOID allogenic blood transfusion

 

Problems

 

Increased infection rate

- demonstrated in THR

- decreased killer T cells

Increased risk disease transmission

Increased risk transfusion reaction

Increased post-op fever and antibiotic requirements

Increased cost

Surgery

Indications 

 

1. Significant functional impairment

 

2. PIPJ contracture

- originally thought to intervene early

- Macfarlane showed residual FFD always about 30o

- may need to release  check rein ligaments / accessory collateral ligaments

 

3. MCPJ contracture >30o

 

4. Trigger fingers

- must do limited fasciectomy