techniques

Advantage

1.  Reduce implant loosening

- offset load sharing to diaphysis

- 30% if > 70 mm

2. Restore optimal alignment

Indications

1.  Using augments or bone grafting

2.  Increased constraint 

- VVS / hinge

Epidemiology

Rare

- ? dislocates in utero or post-natal period

Usually bilateral

Aetiology

Familial

Associated with Down's / Larsen's & Arthrogryposis

Pathology

Persistent lateral patella dislocation

- hypoplastic flat LFC

- aberrant lateral insertion quadriceps

- hypoplastic flat patella

Surgical Options

1.  Open antero-lateral approach 

Large / Massive Cuff Tear

2.  Deltopectoral approach

Large Subscapularis tear

3.  Arthroscopic Assisted Mini-open

Indication

- Small / Moderate Cuff Tear < 3cm

- no retraction

Technique

- arthroscopic SAD

Definition

Unacceptable position of radius post fracture

1.   Radial Shortening > 4mm at DRUJ

2.   Radial Inclination < 15°

Definition

Stenosing tenosynovitis of the first dorsal compartment of wrist

Epidemiology

Most are middle aged women

Aetiology

Repetitive thumb movements

- abduction & extension

- combined with RD & UD movements

Any mechanical irritation

- foreign body

- prominent bony surface

- restricted fascial compartment

Anatomy

Largest and most powerful rotator cuff

- arises coastal border of scapula

- superior 2/3 tendon inserts into LT

- inferior 1/3 inserts into proximal humerus

Action

- IR (with T major, P major, Lat Dorsi)

- part of force couplet depressing humeral head

Incidence

Definitions

Massive tear 

1.  > 5cm 

- retracted to humerus / glenoid margin

2.  At least 2 complete tendons

- lose SS / IS or SS / SC

Classification

Definition

Patients usually complain of subluxation rather than dislocation

- rarely requires reduction

Different entity to acute posterior dislocation usually

Epidemiology

Rare

Aetiology

1.  Ligamentous laxity > 50%

- commonly associated with MDI

- posterior only 20%

- posterior & inferior 20%

Definition

Instability in at least 2 planes

- postero-inferior

- antero-inferior

- antero-postero-inferior

Epidemiology

Recognised as a common problem 

- often misdiagnosed

Most patients athletic

Definition

Intra-articular proximal ulna fracture

Anatomy

Articulates with trochlea

- may have a central bare area

Triceps insertion

- via broad aponeurosis which blends with anconeus and CEO

Management

Non operative Management

Undisplaced fracture

- need to ensure triceps mechanism is intact