complications

Epidemiology

Usually young patients

- 15 - 40

15% compound

Aetiology

High velocity injury

- MBA

- MVA

- pedestrian v car

- fall from height

Emergency Managment

EMST principles

- need for transfusion not uncommon

Acute management

Resuscitation

EMST

Neurovascular assessment

Investigations - exclude Pipkin, NOF

Emergent reduction / skeletal stabilisation

Assess stability

Re-evaluate sciatic nerve

Insertion Femoral Steinman Pin

Indications

- displaced acetabular fracture

Schatzker Classification

I.  Lateral Spilt 

- seen in young patient

- lateral meniscus can be incarcerated in fracture

II.  Lateral Split Depression

- often seen in young patients with high energy injuries

- vary in severity

Issues

Complex / high energy injuries

Management of soft tissues critical

- restore length with external fixation

- await for swelling to reduce

Restoration of alignment & joint surface imperative

Outcome guarded

Definition

Fracture which extends between the trochanters of the proximal femur

- lower limit is inferior border of lesser tuberosity

Anatomy

Extra capsular / well vascularized

The key to stability is the posteromedial cortex

Incidence

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

Portals

1.  Anterolateral

Viewing portal

- 1cm lateral to patella tendon

- 1cm above joint line

- 1 cm below inferior pole patella

Problems

- too medial, in fat pad

- too high, limitation by patella, difficult to see posterior horns

- too low, damage anterior horn meniscus

Limitations

- PCL

- anterior horn LM

Advantage

Fewer complications than TSR

Simpler procedure

Intraoperative glenoid fracture

Avoid by

- careful reaming and drilling osteoporotic bone

Management

1.  Rotate metaglene

- use locking screws to stabilise glenoid

2.  PA screws

- cannulated 4.0 mm screws

- inserted percutaneously from posterior

Haematomas

Great deal of dead space is created

- always use a drain

Goal

Initial press fit

- implant geometry fits the cortical bone in the proximal femur

- good initial mechanical stability

Biological fixation for success

- good press fit

- minimal micromotion

- bony or fibrous tissue ingrowth or ongrowth