approach

Goal

- head that translates 50% in all directions

- allows 30^o ER with arm at side

- stable posteriorly

Pre-Op 

- antibiotics

- consider specific Propionobacterium cover

Approach

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 90^o

- minimum 7 cm skin bridge

Options

- can do trial / sham incision down to capsule

Pre-operative Planning

CT / quantify bone loss
X match 4 units
Cell saver
Anaesthetic review
Bone graft (cortical, cancellous)
Component removal gear

- extraction gear for femur / liners

- cement removers for cemented femur

- curved osteotomes for cemented cup

- X-plant for uncemented cup
Revision long stem femoral implants
Revision acetabular implants including cages

Epidemiology

Young men

Aetiology

FOOSH

- axial load, dorsiflexion and radial deviation

DISI occurs in ulna deviation

Herbert Classification

Type A    Stable acute fracture

A1 Tubercle

Anatomy

Radial bow radius

- important for rotation

Interosseous membrane

- Z pattern

- proximal radius to distal ulna

Mechanism

Direct blow

- ulna / night stick