anterior

Options

Direct Lateral - transgluteal

Postero-lateral (AKA posterior) - release short external rotators

Direct Anterior

Results

Gait / outcomes

Meermans et al Bone Joint J 2017

- systematic review of 42 studies comparing Direct Anterior / Posterior / Lateral

Approaches

Anterior

Anterolateral

Posterior

Anterior Approach / Deltopectoral

Indications

- shoulder stabilization

- arthroplasty

- fracture fixation

Approach

Position

- beach chair

- upper body elevated 30- 40^o / reduces venous pressure and bleeding

Approaches

Anterior

Anterolateral

Lateral

Posterior

Medial

Anterior Approach / Smith Peterson

Indications

- neonatal hip sepsis

- open reduction hip DDH

Techique

Position

- supine

- sandbag under buttock

- free drape leg

Landmarks

Approaches

Ankle

- anterior

- anterolateral

- posterolateral

Hindfoot

- lateral

- Ollier's

Anterior approach to Ankle

Concept

Between EHL and EDL

Indications 

- drainage of ankle joint

- ankle arthrodesis

- ORIF tibial plafond

- removal of loose bodies

Approach

Position 

Incidence

Young men

Posterior / Anterior 9:1

Aetiology

High velocity injury

- head direction at impact decides direction of dislocation

Anterior Dislocation 

Externally rotated & abducted leg

- flexion = inferior dislocation

Options

Anterior

- thoracotomy

- thoracoabdominal

- abdominal

Posterior

Anterior Approaches

C2 - T2

- anterior cervical approach

- may have to split manubrium / sternotomy for lowest levels

T3 - T7

- thoracotomy

- patient on side left side up to avoid veins

Definition

Fracture / plastic malformation of proximal ulna with dislocation of radial head

Xray

Radio-capitellar line disrupted

Biomechanics

Able to achieve relatively high level of function after STJ fusion

- previously believed that isolated STJ fusion should not be performed

- believed that triple arthrodesis was operation of choice for hindfoot

- STJ fusion has superior result with less stress on AJ

Average loss of DF 30% / PF 10%

Position of hindfoot determines flexibility of transverse tarsal (CCJ & TNJ) joints

- imperative that fusion be positioned in ~ 5^o valgus 

Epidemiology

Extremely uncommon

Stability provided by joint capsule /costoclavicular & interclavicular ligaments 

Recurrent instability uncommon

Many apparent dislocations in adolescents may be growth plate injuries 

-will remodel without treatment

If OA from chronic dislocation may resect SCJ