Discussion trimalleolar fractures involve frx of the medial and lateral malleoli along w/ a frx of the posterior lip of tibial plafond; frx fragment results from avulsion by the posterior tibiofibular ligament at its site of attachment to the tibia; clinical results triamalleolar frxs are generally worse w/ larger fragments involving a larger portion of … 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
– Discussion: – posterior horn of the medial meniscus is difficult structure to view w/ arthroscope, esp in very tight joints with little valgus laxity; – Positioning: Valgus Stress to the Slightly Flexed Knee: – valgus stress applied to slightly flexed knee (no > 10 deg) combined w/ external rotation of tibia … Read more
– Tibial Tunnel: – saftey measures: – surgeons who do not perform this operation frequently should use flouroscopy for this tunnel; – apply Jacobs chuck for a preset distance on the guidewire to make it less likely for the wire to pass … Read more
– See: Posterior Cruciate Ligament: – Discussion: – unlike the ACL, the PCL does have a capacity to heal; – references: – Chronically injured posterior cruciate ligament: Magnetic resonance imaging. – Magnetic resonance imaging of posterior cruciate ligament injuries: assessment of healing. – The natural history of … Read more
– Femoral Tunnel: – goal is to re-create the large anterolateral band of the PCL, which tightens in flexion; – see anatomy of PCL – cortical entry site: – small skin incision is made w/in Langer’s lines, which overlies the vastus medialis oblique insertion into … 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
– Discussion: – Anatomy and Function of PCL: – mechanism of injury: – fall on a flexed knee with plantar flexed ankle; – associated injuries: – ACL and collateral ligament injury (knee dislocation); – when PCL injury occurs w/ MCL … Read more
– Discussion: – dx is made when there is posterior instability on exam and a bone fragment was seen on x-ray; – MRI allows determination of the anatomy of the tear (ie femoral or tibial origin); – tibial avulsions: – tibial avulsions … Read more
– See: Posterior Approach to the Humerus; – Discussion: – considered to be the most versatile approach to the elbow; – most surgeons use straight longitudinal incision, which avoids olecranon tip, by shifting the incision slightly laterally or medially; – Variations of Posterior Approach: – Transolecranon Osteotomy … Read more