– Debridement: – all foreign material must be removed from the knee; – retained frags of cement can act as nidus for residual infection; – infected granulation tissue & scar tissue should be excised to provide healthy vascularized soft tissue surrounding the knee. – number of debridements needed before wound closure depends … Read more
– IM Nailing Technique – Open Femur Frx – Radiographs: – look for evidence of a pathologic lesion on x-ray, noting that it would be disasterous if a nail were driven through an occult osteosarcoma or chondroscaroma; – AP pelvis: (rule out concomitant injuries) – Hip Dislocation … Read more
– Evaluate Proximal Stem: – decide whether trochanteric osteotomy is required; – it is essential to avoid a proximal femoral frx while extracting the stem; – direct extraction of a femoral stem can be blocked by excessive cement or proximal bony overgrowth medial to the greater trochanter; … Read more
– Discussion: – this stage is both preclinical and preradiographic; – dx is suspected in one hip when other has definite disease, because it is known that there is high incidence of bilateral involvement; – this is the stage of the truly silent hip
– Discussion: – for HTN; – Alpha blocker with some direct smooth muscle relaxation: – Dosing: – Initial: 1mg PO bid to tid (watch out for syncope); – Maintenance dose: 6-15 mg/day given in 2-3 divided doses; – Maximun daily dose: 20 mg/day; – Precautions: – syncope may occur w/ dose > 2 mg; – … Read more
– See: – Biomechanics of TKR – Joint Line Position – PCL Retaining TKR – Discussion: – cruciate ligaments are needed for running atheletes, but are not as important to resist forces in thesagittal plane in reconstructed arthritic knee; – theoretically, PCL-substituting TKR allow exposure & ligament correction of PCL-sacrificing prosthesis while reproducing kinematic effects of PCL; … Read more
– See: PIN – Inciting causes: – radiocapitellar joint ganglions and synovitis – congenital tightness of ligamentous arcade of Frohse; – include poorly placed screws for fracture fixation – PIN is vulnerable during ORIF of proximal radius; – in 25% … Read more
– See: – Malgaigne Fracture – Sacral Fractures – Sacroiliac Fracture Dislocations – cresent fracture – Evaluation of Stability: – as noted by Kellam, et al. (1987), a stable injury is one that can withstand normal physiologic forces w/o excessive deformation; – it … Read more
– Discussion: – diagnosis: limb is shortened, internally rotated, and adducted; – Thompson and Epstein Classification: – Type I: w/ or w/o a minor fracture – Type II: w/ large single frx of post. acetabular rim; … Read more
– Graft Selection: – bone patella bone allograft or achilles tendon allograft; – if achilles tendon is used, the free end is secured w/ a locked whip stitch (Krackow stitch); – in the report by Fanelli et al. 1996, there was no disadvantage … Read more