Data Trace Editor See: Surgical Approach Tension Band Theory Discussion transverse frx involving less than 50% of proximal sigmoid notch are suited to stable internal fixation by tension band; Weber modification provides improved frx rigidity; may also use T.B.W. along with a 6.5 mm cancellous screw, 7.0 mm screws, or 7.3 mm screw; surgical consent: patient should understand, … Read more
– See: Orthopaedic Trauma Implants: Know Your Implants (from Synthes web site) – Discussion: – Bone Healing w/ Plates – Characteristics of Metal Implants – concepts: – tension side of the fracture: – when plating a fracture the plate should be applied to tension … Read more
See: Total Hip Replacement Menu: revision arthroplasty menu Femoral Revision exposure of femur it is essential that prior to attempted femoral component removal, that there is a clear retrograde path for stem removal; this means that any trochanteric overhang is removed, either with a high speed bur or with an trochanteric osteotomy: some recommend routine … Read more
Rule Out Infection » probably every revision joint procedure should have frozen sections sent prior to insertion of the components in order to determine whether acute inflammation is present (indicating infection); references: Failed total hip replacement: assessment by plain radiographs, arthrograms, and aspiration of the hip joint. The value of aspiration of the hip joint before … Read more
Discussion removal of broken femoral stems: removal of cementless stems: removal of cemented femoral stems: as noted by Peters, et al. (1997), at the time of acetabular component revision, evidence supports leaving a well fixed cemented component in place; in femoral components inserted w/ first generation cementing techniques, the rate of mechanical failure was 22% … Read more
(See also: Total Hip Replacement Menu) Discussion evaluation of the painful THR indications for revision evaluation for loosening outcomes: references: Why revision total hip arthroplasty fails. Revision Hip Arthroplasty: Infection is the Most Common Cause of Failure Examination examination for loosening: previoius incisions; contracture of the flexors and adductors (adds to complexity of the case); … Read more
– TKR Menu: AP cutting guide – Determine Appropriate AP Component Size: – most instrument systems incorporate cutting block that is placed on end of femur & rotated to appropriate orientation; – prior to inserting the AP sizing guide, remove any prominent meniscal remnants so that the posterior “fins” of the … Read more
– See: Femoral Component – Resection of the Distal Femur: – cushing rongeur is used to remove osteophytes in medial & lateral aspects of the femoral condyles as well as the intercondylar space; – this avoids, possible mis-sizing of the femoral component; – femoral IM alignment rod: (discussion) … Read more
– Discussion: – femoral cutting guide is set for the appropriate right or left valgus angulation of +5 to 7 deg (in the tall thin patient try +5 deg, & in short obese patient try 7 or even +9 deg); – in lateral plane, this cut is perpendicular to anatomic axis … Read more
– Discussion: – see: – tibial component – extra-medullary cutting guide; – preparation for proximal tibial cut – posterior slope – this cut is made at right angles to anatomical axis … Read more