– Discussion: – among most frequent limb anomalies is partial or total absence of fibula; – it is most common long bone deficiency and is the most common skeletal deformity in the leg; – most often is unilateral; – paraxial fibular hemimelia is the … 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: – 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
– Measurement of Length: – its essential to plan ahead to achieve proper leg length; – w/ comminuted frx, use opposite leg to determine leg length; – one method is to obtain long cassette radiograph of opposite side w/ radiographic ruler included on the film; … Read more
– Discussion: – physeal bone bridges – methods to estimate growth potential – anatomy of distal femoral physis – distal femoral physis grows roughly at a rate of 9 mm/year (girls finish growing at age 14) – growth arrest, partial or complete, w/ progressive angulation &/or shortening ranges from 30% & 80% of pts; … Read more
– Anatomy: – arises from posterior divisions of Ventral Rami of L2, L3, L4 – see innerv. musc. lower limb; – passes inferolaterally thru psoas, & then runs between this muscle & iliacus; – it passes over Iliacus muscle to enter thigh underneath the inguinal ligament; … Read more