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Central Cord Syndrome

Epidemiology

 

Most common pattern cord injury

 

Hyper-extension injury in middle aged man with osteoarthritic spine

 

Usually C3/4 and C4/5

 

Mechanism

 

Most common type / in older patient with pre-existing spondylosis / OPLL

- hyperextension injury

- compression of the cord

- anteriorly by osteophytes

- posteriorly by infolded ligamentum flavum

 

CRPS

Definition

 

Chronic Regional Pain Syndrome

 

CRPS 1

 

Sympathetically mediated pain syndrome

- excessive or exaggerated response of extremity to injury, surgery or disease

 

Manifested by

- intense or unduly prolonged pain

- vasomotor disturbances

- trophic changes

- delayed functional recovery

 

CRPS 2

 

Posterolateral Rotatory Instability

Definition

 

Radius rotates externally in relation to the ulna

- posterior displacement of the radial head relative to the capitellum

- in flexion

 

Posterolateral rotatory Instability

 

Anatomy LCL

 

LCL Elbow

 

MCL Insufficiency

AetiologyTommy John Surgery

 

Throwing injury

- seen in the throwing athlete

- repetitive microtrauma / valgus stress

- develop laxity

 

History

 

Initially

- lose velocity / accuracy

 

Develop medial pain

 

40% ulna nerve symptoms

 

Ankle Arthrodesis

Results 

 

90% fusion rates

 

Lose70% sagittal plane ROM

 

Disadvantages of Arthrodesis 

 

Non union rates up to 12%

Decreased gait speed

Poor mobility over uneven surfaces

Navigation

Aim

 

Attempt to reduce outliers in all 3 planes of the knee

- improve alignment

- theoretically improve survival and outcomes

 

TKR Valgus Femoral Implant Non Navigated

 

Types

 

Image based

 

Pre-op CT

- uncommon

- resource heavy

 

Patella Resurfacing

Options

 

1. Always resurface

2. Never resurface

3. Selectively resurface

 

Decision Making

 

Controversial

- literature divided on issue

 

Historically

- poor outcomes due to poor implant design

- now improved designs

- non resurfacing also improved due to better design and improved techniques in regard to tracking and rotation

 

Background

AimUKA Oxford AP

 

UKA is intended to be load sharing

- correct to neutral or slight varus

 

HTO is a load-shifting / load-sparing procedure

- over correct into valgus

 

UKA v TKR

 

Advantages UKA

 

1.  Rapid rehabilation

 

Meniscectomy

Background

 

Meniscectomy 

- resect 30%

- increases contact pressures 3.5 x

- shock absorbing capacity reduced to 20% normal

 

Results of partial & total meniscectomy are very poor in children

- meniscectomy in children is a last resort

- repair amenable tears

- treat others non-operatively

- only real indication for meniscectomy is locked knee not amenable to repair

 

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