surgery

Technique ACDF

Anterior Cervical Discectomy and Fusion

 

ACDF C5 6

 

Position

 

Place the patient in the supine position

- small roll placed under the shoulder blades to drop the shoulders from the field

- exposes the anterior neck

- strap the shoulders at the side with minimal traction 

TSA Technique

TSR APTSR Lateral

 

Goal

- head that translates 50% in all directions

- allows 30o ER with arm at side

- stable posteriorly

 

Pre-Op 

- antibiotics

- consider specific Propionobacterium cover

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 

Management Intra-articular Fractures

Operative v Nonoperative Literature

 

1.  Buckley etal JBJS Am 2002

 

Prospective multi-centred RCT

- 309 displaced intra-articular fractures

- operative v non operative management

- 2 year follow up

 

Findings

- used patient orientated functional outcomes

- overall VAS and SF36 not significantly different between 2 groups

 

Improved Operative Outcome if

- not workers compensation

- women

- < 29

Myositis Ossificans

Definition

 

Pathological bone formation in soft tissues

 

Epidemiology

 

In elbow

- 3% of trauma

- 89% if head injury + trauma

 

Types

 

Completely different

 

1.  Myosisitis Ossificans Circumscripta

- post traumatic

- more common

- recognised as a consequence of neurological injury

 

Bipartite Patella

Ossification

 

Patella may develop from one or multiple ossification centres at 3 years

 

Failure of centres to fuse may produce bipartite or tripartite patella

- usually bilateral and painless

 

Classically superolateral

 

Classification Saupe

 

I   Inferior Pole 5%

II  Lateral 20%

Management

Non-operativePatella Instability MPFL and TTT AP

 

Results

 

90% respond 

- very important

- 6 - 12 months minimum before offering surgery

 

Physiotherapy

 

1.  Stretches

- quads stretches

- ITB

- lateral retinaculum