posterior

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

Knee

ApproachesPosterior approach knee

 

Medial Parapatellar

Medial

Lateral

Posterior

Modified Posterior

 

Medial Parapatellar Approach

 

Indications

 

Synovectomy 

Patellectomy 

TKR

 

Technique

 

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

Mass Behind Knee

DDxPosterior knee mass

 

Baker's Cyst

Popliteal Anerysm

Soft tissue sarcoma

Osteosarcoma / Parosteal OS

Hemangioma / AVM

 

Note:

 

Always do xray for calcification

A Bakers cyst / aneurysm can be calcified

 

 

 

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

 

Posterior Instability

Definition

 

Patients usually complain of subluxation rather than dislocation

- rarely requires reduction

 

Different entity to acute posterior dislocation usually

 

Epidemiology

 

Rare

 

Aetiology

 

1.  Ligamentous laxity > 50%

- commonly associated with MDI

- posterior only 20%

- posterior & inferior 20%

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