Ortho Oracle - orthopaedic operative atlas

Timing of Surgery in Orthopaedic Patients with Brain Injury

– see: anesthesia menu – Discussion:     – assessment of perfusion: damage control orthopaedics     – the most common situation is how to manage the femur fracture in the brain injured patient;         – some authors have expressed concern that intraoperative hypoxia and hypotension may commonly occur w/ early IM nail stabilization; … Read more

Synthes IM Femoral Nail Insertion Technique

– See: (Synthes Product Menu)       – Reaming and Nailing Maneuver       – Intramedullary Nailing       – Miss A Nail Technique       – Spiral Blade – Incision and Entry into Meduallary Canal     – Proximal Inter-Locking – Distal Interlocking

Surgical Instruments for Revision THR

– Company Specific Products:      – Innomed Products:      – Biomet® Flexible Osteotome System  – Screw Drivers:      – manufacturer specific screw drivers are necessary to remove the acetabular screws; – High-Speed Drills:      – disadvantage: these drills remove bone more easily than they do harder cement;      – may be needed to remove distal … Read more

Supracondylar Femoral Fractures

– See: – Distal Femoral Shaft Fractures – Distal Femoral Phyeal Frx – Supracondylar Fractures following TKR – Discussion: – work up for femur fracture – mechanism: axial load to a flexed knee; – Bimodal distribution: – low energy fractures involving older females (often have severe osteoporosis); – high energy fractures involving younger males; – associated … Read more

Subtrochanteric Fractures

  – See:  proximal femoral shaft fractures / – Discussion: – definition: – between lesser trochanter and 5 cm distal, even as far as center of isthmus of the femoral shaft; – technically starts below the lesser tuberosity; – medial and posteromedial cortex is a site of high compressive forces, while lateral cortex experiences high tensile stresses (forces … Read more

Subtrochanteric Frx: Anatomy and Factors in Bone Healing

Anatomy axis of femoral neck forms angle of approx 135 deg w/ femoral shaft, and is anteverted from the frontal plane by variable amount (- 4 to 36 deg, average 10 to 20 deg in Caucasians); distinct cortex surrounds the cancellous bone of the neck, the center of which becomes progressively empty with age (Ward’s triangle); center of … Read more

Subtrochanteric Fracture Stability

– Discussion:     – classifaction and fracture stability     – frx stability is based on presence or absence of posteromedial butress;     – farther down shaft of femur primary frx is located, greater incidence of delayed union and implant failure;     – forces acting on hip joint           … Read more

Stable Frx

– See: Radiographic Findings – stable intertroch frx is one that when reduced has cortical contact w/o gap medially and posteriorly;      – this contact will prevent frx displacement into varus or retro-version when forces are applied to proximal femur; – medial cortices are not comminuted & there is no displaced frx of lesser trochanter

SROM Hip System

– See: – PreOperative Planning:     – preoperative leg length:     – acetabulum:          – evaluation of cup position:          – acetablar component loosening          – use a wax pen to mark the tear drop and the superior aspect of the acetabulum, and overlie … Read more