Able to achieve relatively high level of function after STJ fusion
- previously believed that isolated STJ fusion should not be performed
- believed that triple arthrodesis was operation of choice for hindfoot
- STJ fusion has superior result with less stress on AJ
Average loss of DF 30% / PF 10%
Position of hindfoot determines flexibility of transverse tarsal (CCJ & TNJ) joints
- imperative that fusion be positioned in ~ 5o valgus
Extremely uncommon
Stability provided by joint capsule /costoclavicular & interclavicular ligaments
Recurrent instability uncommon
Many apparent dislocations in adolescents may be growth plate injuries
-will remodel without treatment
If OA from chronic dislocation may resect SCJ
Patients usually complain of subluxation rather than dislocation
- rarely requires reduction
Different entity to acute posterior dislocation usually
Rare
1. Ligamentous laxity > 50%
- commonly associated with MDI
- posterior only 20%
- posterior & inferior 20%
A GH dislocation which has been missed for a significant period of time
- time period is arbitary
- > 3-6 weeks
Humerus soft and osteoporotic
Significant soft tissue contractures
1. Anterior / subcoracoid dislocation
Beware
- scarring to NV structures
- RC tears including SSC, especially > 40
Diagnostic
Pain / Stiffness / Locking
Instability
- exclude OCD
Assess syndesmosis
Therapeutic
Synovitis
Osseous lesions / Tibiotalar impingement spurs
Osteochondral defects