complications

Definition

Unstable injuries

Complete disruption of both the anterior and posterior ring

Complications

Subscapularis failure

Rotator cuff failure

Instability

Infection

Periprosthetic fracture

Aseptic loosening

Neurological injury

Incidence

Parada et al. J Should Elbow Surg 2021

- 2224 aTSA complication rate 11%, revision rate 5.6%

Indications

Osteoarthritis

Rheumatoid arthritis

Avascular necrosis

Indications

Poor soft tissues

- prohibit ORIF

Non union

Infected non uniion

Malunion / deformity

Bone loss / bone transport / LLD

Concept

Distal Tibial Fractures

Definition

Metaphyseal

Extra-articular

Intra-articular Extension

Epidemiology

Adolescent boys

Ossification

Proximal tibia / primary ossification centre

Tibial tuberosity / secondary ossification centre

- eventually merges with primary ossification centre

Ogden Classification

Type I - Tibial tuberosity ossification only

Indications

< 60 with good bone stock and preserved joint space

Reduction

Union rates increased with anatomical reduction

Options

- closed reduction

- open reduction / if closed reduction fails

Accept

- no varus

- < 15^o valgus

- < 10^o AP plane

Definition

Garden 1 / 2

Algorithm

ORIF

- ~ 15% displacement rate with non operative management

- increased risk of non union

- reduced hospital in patient stays

Options

Cannulated screws

DHS + derotation screw

3 cannulated screws

Indications

Patient > 70

Gjertsen et al JBJS Am 2010

- 4335 patients > 70 with displaced subcapital fractures

- minimum 1 year follow up

- 1 year mortality same in each group / 25%

- 22% reoperation in ORIF v 3% in hemiarthroplasty

- more pain / higher dissatisfaction / lower quality life in ORIF group

Options

Hemiarthroplasty

- unipolar monoblock

- unipolar modular