options

Background

 total shoulder arthroplast allPoly Glenoid

 

Indications

 

RA 

OA 

AVN 

 

Contra-indications

 

Infection

Charcot

Paralysis of deltoid

Torn rotator cuff

Insufficient glenoid bone stock

 

Techniques

Osteotomy Options

 

Varus

Valgus

Extension

Flexion / Internal Rotation

Neck Lengthening

 

Varus Osteotomy / Pauwels Type I

 

Indications

 

DDH 

- improve coverage

- rarely done alone

- only if little or no acetabular dysplasia

- CE > 15 - 20o

 

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 

Sinus Tarsi Syndrome

Anatomy

 

Osseous canal between talus and calcaneum

- interosseous talo-calcaneal ligament

- cervical ligament

- joint capsule

- nerve endings / arterial anastomoses

 

Sinus Tarsi

 

Aetiology

 

Flat foot / overpronation

Inversion / sprain

 

Pathology

 

Skin Cover Options

Basic Concepts

 

Proximal tibia

- gastrocnemius local muscle flap

- gracilis free muscle flap if gastroc damaged

 

Middle tibia

- soleus local muscle flap

- gracilis free muscle flap

 

Distal tibia

- posterior tibial fasciocutaneous local flap

- gracilis free muscle flap

 

Full Thickness Tears

Surgical Options

 

1.  Open antero-lateral approach 

 

Large / Massive Cuff Tear

 

2.  Deltopectoral approach

 

Large Subscapularis tear

 

3.  Arthroscopic Assisted Mini-open

 

Indication

- Small / Moderate Cuff Tear < 3cm

- no retraction

 

Technique

- arthroscopic SAD

Osteoarthritis

EpidemiologyHeberden's Nodes

 

Male & Females > 60 years

- X-ray evidence of OA

 

Symptomatic 

- 25% females

- 15% males

 

Affected joints

 

Base thumb

PIPJ / Bouchard's nodes

DIPJ / Heberden's nodes

 

Chronic PLC Management

Issues

 

Limb alignment

 

Risk that late posterolateral corner reconstruction will fail in the setting of the varus knee

- varus knee alignment and varus thrust in stance phase

- consider osteotomy first in this setting

 

Results

 

Posterolateral Corner Reconstruction

 

Moulton et al. Am J Sports Med 2016

- systematic review of PCL reconstruction for chronic injuries

- 450 patients