The Bone School

Technique

- extra-articular

Portals

- posterior portal very lateral so can see anterior aspect subacromial space

- port of Wilminton at anterolateral acromion to access SSC

- anterior portal in normal position, slightly more lateral so becomes working portal

Indications

Engaging Hill Sachs

Definition

Platelet rich plasma

Concept

2 main components

1.  Platelets

- contain PDGF, TGF, VEGF

2.  Growth factors

- ILGF

- FGF

Formed from the separation of whole blood into plasma and RBC

- separation usually achieved with centrifugation

Platelet concentration

AO Classification

Supracondylar

Aims

1.  Provide representative sample

- to determine whether benign or malignant

- to determine cell line

- to grade lesion

2.  Not compromise definitive treatment

Timing

Last step in evaluation / after staging

Don't perform definitive procedure immediately after biopsy unless

- pre-operative & Xray information characteristic

Anterior Cervical Discectomy and Fusion

Position

Place the patient in the supine position

- small roll placed under the shoulder blades to drop the shoulders from the field

- exposes the anterior neck

- strap the shoulders at the side with minimal traction 

Harvest site

Option 1

- lateral and medial aspect femoral trochlea

Option 2

- intercondylar notch

Option 3

- allograft

- can take larger grafts without donor site risk

Size

Goal

- head that translates 50% in all directions

- allows 30^o ER with arm at side

- stable posteriorly

Pre-Op 

- antibiotics

- consider specific Propionobacterium cover

Technique

A.  Longitudinal Cut

- plantar proximal / dorsal distally

- ends up being parallel to sole

- leave strong plantar portion of head to prevent dorsiflexion

- mark centre of head

- distally to a point 2mm prox and 3mm above the centre of the head

B.  Transverse cuts

- plantar proximal / dorsal distal

History

First generation (late 70s early 80s) 

Results