Hemiarthroplasty Osteoarthritis
Advantage
Fewer complications than TSR
Simpler procedure
Fewer complications than TSR
Simpler procedure
1. RC arthropathy / > 70 / low functional demand
2. Revision TSR
3. Failed Hemiarthoplasty in proximal humerus fracture
Apophysis appears around 7 years
Ossifies age 16 years
Normal apophysis may be some distance from shaft
- rarely may be fragmented
Dislocation
Indications have narrowed
- due to success of shoulder arthroplasty
1. Chronic infections of GHJ
2. Stabilization in paralytic disorders
3. Post-traumatic brachial plexus palsy
4. Salvage of failed GHJ Arthroplasty
- may need bone graft procedures
5. Arthritic diseases unsuitable for arthroplasty / young patient
Replant
- reattachment of body part that has been completely severed
Revascularisation of incomplete Amputation
FOOSH
- axial load with a valgus force
1. Provides Valgus stability
- especially if MCL deficient
2. Longitudinal stability
- aided by interosseous membrane
3. Load Transfer
- 60% of load at elbow
2 groups
- young patient with high velocity injury
- older patient with comminuted, osteoporotic fracture
In the second group fixation can be very difficult
Hinged Joint
- trochlea axis is centre of rotation
- 40o anterior angulation in sagittal plane
10% of elbow tendonitis
Overuse injury
- poor swing in golf
- poor throwing technique
- overuse of topspin in tennis
- occupational (repetitive hammering / screwing)
Some patients also have lateral epicondylitis
Tenderness CFO
Stimulate pain
- flexion of WJ with fingers resisting
Lateral : Medial 9:1
4th & 5th decades
- M = F
- 75% dominant arm
50% of regular tennis players
- especially > 2 hrs / week
Insertion pathology / Enthesopathy
Over-extension of the elbow with supination / pronation
Lateral epicondyle
- anconeus from posterior face
- ECRB and EDC from anterior face (CEO)
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
Posterolateral Corner Reconstruction
Moulton et al. Am J Sports Med 2016
- systematic review of PCL reconstruction for chronic injuries
- 450 patients