external fixation

Indications

Deformity correction

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

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

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

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

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