external fixation
Taylor Spatial Frame
Indications
Deformity correction
Management
Non operative
Ponseti casting
Aims of treatment
1. Correct the deformity early
2. Correct it fully
3. Hold the corrected position until foot stops growing
- AFO
- Denis Browne Boots
Timing
Start 1 - 3 weeks
- let parents settle and get used to diagnosis
- explain method and length of treatment required
Acute management
EMST / ATLS Principles
Usually polytrauma
- 10% mortality
Aims
1. Volume replacement
2. Reduce pelvic ring
3. Stop exsanguination
- external stabilisation / surgery / embolisation
Associated Local Injuries
Arterial bleeders
Femoral Shaft Fractures
Epidemiology
Usually young patients
- 15 - 40
15% compound
Aetiology
High velocity injury
- MBA
- MVA
- pedestrian v car
- fall from height
Emergency Managment
EMST principles
- need for transfusion not uncommon
Arthrodesis
Issues
Like elbow arthrodesis, knee arthrodesis is an option of last resort
Example
- cannot sit on airplane toilet with door closed
Aims
Coapt 2 coplanar cancellous surfaces under compression with rigid fixation
Indications
Septic arthritis
Salvage failed TKR / infected TKR
Tumour
Charcot Join
PFFD
Congenital pseudoarthrosis of the tibia
Definition
Anterolateral bowing
True bone dysplasia
- hamartomatous area in the tibia
- non union or potential non union through pathological fracture in this region
The defect in the bone is filled with mature, fibrous connective tissue
- not really a pseudoarthrosis
- by definition, a pseudarthrosis has a cleft lined by fibrocartilage containing fluid and bounded by a capsule
Management
Goals
1. Equal leg lengths
- goal is mild to moderate isolated discrepancy
2. Unequal leg lengths
- goal with paralysis / equinus foot
- aim 1-2 cm short for clearance
3. Level Pelvis
- should use blocks to estimate functional correction
4. Vertical LS Spine
- vertical spine more important than level pelvis
Blount's Disease
Definition
Progressive varus deformity of knees
- secondary to abnormality of medial upper tibial physis
- localised varus & internal rotation deformity
Infantile form
- onset 1-3 years / bilateral
Adolescent form