technique

Advantages

Improved cosmesis

Indications

TFCC tears

SL instability

Dorsal wrist ganglion

Scaphoid fracture with percutaneous pinning

Distal radius fracture

Setup

Tourniquet

Finger Traps Index & middle

Overhead traction device

2.7 mm scope / small joint instrumentation

Position

1.  Lateral decubitus

- stabilise patient with beanbag or lateral rests

- apply skin traction to forearm

- place traction pole at foot of table opposite surgeon

- suspend arm with 10 lb weight

- abduction 60°

- forward flexion of 20°

- tilt top shoulder posteriorly 30° so that glenoid is parallel wwith bed

- mark bony landmark

- prep & free drape

Indications

Indications have narrowed

- due to success of shoulder arthroplasty

1. Chronic infections of GHJ

2. Stabilization in paralytic disorders

3. Post-traumatic brachial plexus palsy

4. Salvage of failed GHJ Arthroplasty

- may need bone graft procedures

5. Arthritic diseases unsuitable for arthroplasty / young patient

Aetiology

Post-traumatic (type III clavicle fractures)

Idiopathic

4 patterns 

1. OA with osteophytes 

-  contribute to impingement

2. Osteolysis with resorption & gross osteoporosis 

Definition

Intra-articular proximal ulna fracture

Anatomy

Articulates with trochlea

- may have a central bare area

Triceps insertion

- via broad aponeurosis which blends with anconeus and CEO

Management

Non operative Management

Undisplaced fracture

- need to ensure triceps mechanism is intact

Indications

Very few

- young labourer with severe disabling elbow pain

- trial in POP at 90^o for 6 weeks

Poor function

- adjacent joints cannot compensate for loss of function

Contraindications

RA

- high failure rate especially flail elbow with poor bone stock

Issues

Templating

Approach

Fixation

Bearing Surface

Head Size

Offset

Indications

Disabling hip pain

Severe functional impairment

Failed non operative management

Not Indicated 

Painless deformity

Indications

Severe LBP 

- most common indication

Ipsilateral knee pain

- less beneficial

Malposition

- especially abduction

Contraindications

Absent abductor mechanism

Flail

Active infection

Insufficient bone stock

Examination

LLD

Epidemiology

Average age 6 years

20% distal humeral fracture

- second most common elbow fracture after supracondylar

Mechanism

Pull Off 

- more common 

- fracture begins posterolateral metaphysis

- LCL, ECRL & ECRB attached to fragment

Push off

- varus force to extended EJ

Classification