– See: – TKR Menu – Flexion Contracture of TKR – Flexion Gap / Extension Gap – Joint Line Position – Valgus Deformity / Varus Deformity – Discussion: – first: Malalignment should always be corrected first; – second: soft tissue adjustments which … Read more
– See: TKR Menu – Discussion: – soft tissue component is most frequently a result of of contracture of posterior capsule, but gastrocnemius, hamstrings, and PCL are also frequently involved; – references: – Flexion Contracture Following Primary Total Knee Arthroplasty: Risk Factors and Outcomes – Preoperative Considerations: … Read more
– Discussion: – results from a defect is somatic mutation in the gene coding for alpha subunit of Gs, the G protein that stimulates cAMP formation; – overproduction of cAMP, causes overexpression of c-fos, which regulates proliferation and differentiation of osteoblasts and osteoclasts; – results in … Read more
– See: TKR Menu / Supracondylar Femur Frx – Discussion: – known risk factors include notching of the femur, osteoporosis, and excessive polyethylene wear (w/ subsequent osteolytic defect) – other risk factors include osteonecrosis of the femur; – ref: Morphologic analysis of periprosthetic fractures after hip resurfacing arthroplasty. – Radiographs: – often oblique radiographs are needs … Read more
– Discussion: – advantages of femoral shaft reaming: – avoids potential mis-sizing of nail diameter (which can occur when non-reamed nails are inserted); – reaming may carry bone graft particulate into the fracture site; – faster union may be achieved in … Read more
– Discussion: – general discussion of non union / infected femoral nails – femoral shaft that has not healed in 26 wks signals a delayed union; – may be more common in segmental fractures and in winquest type IV fractures; – most common iatrogenic risk factor is failure to … Read more
– Discussion: – the two incision (“backdoor”) approach has remained the gold standard for ACL reconstruction, because it is the only technique which can reliably position the femoral tunnel at the 10 o’clock (or 2 o’clock) position (which is necessary for anatomic reconstruction); … Read more
– Discussion: – most common error is non isometric anterior tunnel placement within intercondylar notch rather than at its normal posterior insertion; – ACL graft should pull up into tibial tunnel by about 2mm with extension when fixed on femoral side; – this represents the closest reconstitution of … Read more
– Discussion: – External Fixation – ref: External fixation of pediatric femoral fractures. – IM Nailing: (flexible vs rigid) – avascular necrosis is a reported complication in young adolescents; – consider IM entry point anterior to piriformis fossa; – children w/ coxa … Read more
– Discussion: – child abuse: 30% of femoral frx in children < 4 yrs are 2nd to child abuse; – Over-riding of Fracture Fragments: – in children between the ages of 2-10 yrs, overgrowth averages 0.9 cm; – in kids between 2 & 10 yrs, side to side apposition … Read more