surgical technique

Patella Baja

Patella Baja

 

Aetiology

 

Congenital

 

Acquired

- trauma

- post ACL reconstruction / TKR

- chronic quadriceps rupture

 

Issues

 

Decreases ROM

Associated with early OA of the PFJ

 

Diagnosis

 

Blackburne-Peel ratio at 30 degrees flexion

 

Displaced ORIF

Indications

 

< 60 with good bone stock and preserved joint space

 

Reduction

 

Union rates increased with anatomical reduction

 

Options

- closed reduction

- open reduction / if closed reduction fails

 

Accept

- no varus

- < 15o valgus

- < 10o AP plane

 

Lumbar Discectomy Techniques

Disectomy Technique for Posterolateral L4/5 disc 

 

Anatomy

 

L4/5 disc at level of facet joints

 

Interlaminar space is below disc

- have to take inferior aspect of superior lamina

 

Pedicle and transverse process at same level

 

Disc usually on one side

- hemilaminotomy

- no need to remove spinous process

- this preserves stability

 

Morton's Neuroma

Definition

 

Benign enlargement of the common digital branch

- usually 3rd webspace

 

Mortons Neuroma Common Site

 

Anatomy

 

Found at level of or just distal to MT heads

- deep to the deep transverse MT ligament

 

Epidemiology

 

Classically women between 40 and 60

Management

Non Operative

 

Options

 

Metatarsalgia

- preMT dome

 

Claw toes

- wide deep toe box

 

Foot drop

- AFO

 

Insensate foot

- custom orthosis

 

Varus

- lateral heel wedge

- AFO (flexible)

- medial iron with lateral T strap

 

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

Surgical Technique

ApproachRevision TKR Tibial Lysis

 

Incision

 

Always use the most lateral scar

- blood supply comes from medial aspect

- want to avoid a large lateral flap of dubious quality

- cross transverse scars at 90o

- minimum 7 cm skin bridge

 

Options

- can do trial / sham incision down to capsule