surgical technique

Issues

Complex / high energy injuries

Management of soft tissues critical

- restore length with external fixation

- await for swelling to reduce

Restoration of alignment & joint surface imperative

Outcome guarded

1.  Templating

Xray

AP in plane of scapula

- template glenoid 

- most inferior screw is in thick bone of scapular axillary border

AP humerus

- size and fit of diaphyseal and metaphyseal humeral components

CT

Indication

1.  Acute < 3/52

- single bundle

2.  Chronic

- double bundle

Technique Single Bundle

Set up

- knee at 90 degrees on bolster

- x-ray getting lateral of knee

Causes

Most common

- fascia lata on greater trochanter

- iliopsoas on lesser trochanter

1.  Intra-articular structures

- labrum

- ligamentum Teres

- loose bodies

- synovial chondromatosis

- osteochondoma

2.  Extra-articular structures

- fascia lata on greater trochanter (common) 

Epidemiology

Second most common  hindfoot after calcaneal fractures

Aetiology

Aviators Astragalus

Fall from height

- hyper-dorsiflexion injury

- neck of talus strikes the anterior tibia

Anatomy

More than half surface covered by articular cartilage

- medial articular wall straight

- lateral articular wall curves posteriorly

Definition

Fibrous proliferative lesion in plantar fascia

Epidemiology

Male, white, middle age

May arise in isolation

Association Dupuytren's Diathesis

- aka Lederhosen disease

Pathology

Proliferative Fibroblastic lesion

- May resemble fibrosarcoma histologically

Indications

1.  Persistent instability despite ORIF and LCL repair

2.  Gross acute instability, not suitable for surgery

3.  Delayed treatment > 4 weeks

Aetiology

S. aureus / Strept

- usually a history of trauma

Non operative Management

Indications

< 20^o sagittal

< 30^o coronal

< 3 cm of shortening

Options

Definition

Injury to ulnar collateral ligament of thumb MCPJ

Aetiology

Initial description

- chronic laxity of British gamekeeper's thumb's 

- no specific trauma

- secondary to breaking pheasant's neck

Acute trauma

- snow ski

- ball games

Valgus / forced abduction

Anatomy

UCL