complications

Options

Microfracture

MACI

AMIC

Mosaicplasty / Osteochondral autograft

Osteochondral allografts

Treatment Algorithms

Indications

- grade 3 or 4 ICRS lesions

Niemeyer et al Arthroscopy 2011

- lesions < 4cm2 microfracture

- lesions > 4cm2 or failed microfracture ACI

Cole et al JBJS 2009

Incidence

Indications for THA

Osteoarthritis

- abnormal morphology

- loss of head neck offset

- bony impingement on acetabulum

AVN

Acetabular trauma and PTOA

Definition

Unstable injuries

Complete disruption of both the anterior and posterior ring

5 - 20% of pelvic fractures

Mechanism

Axial load

Motor vehicle accident

Fall from height

Pathology

Anterior ring

Complications

Subscapularis failure

Rotator cuff failure

Instability

Infection

Periprosthetic fracture

Aseptic loosening

Neurological injury

Parada et al. J Should Elbow Surg 2021

- 2224 aTSA complication rate 11%, revision rate 5.6%

Indications

RA 

OA 

AVN 

Contra-indications

Infection

Charcot

Paralysis of deltoid

Torn rotator cuff

Insufficient glenoid bone stock

Indications

Poor soft tissues

- prohibit ORIF

Non union

Infected non uniion

Malunion / deformity

Bone loss / bone transport / LLD

Concept

Distal Tibial Fractures

Definition

Metaphyseal

Extra-articular

Intra-articular Extension

Indications

< 60 with good bone stock and preserved joint space

Reduction

Union rates increased with anatomical reduction

Options

- closed reduction

- open reduction / if closed reduction fails

Accept

- no varus

- < 15^o valgus

- < 10^o AP plane