posterior

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

Medial Parapatellar

Medial

Lateral

Posterior

Modified Posterior

Medial Parapatellar Approach

Indications

Synovectomy 

Patellectomy 

TKR

Technique

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

DDx

Baker's Cyst

Popliteal Anerysm

Soft tissue sarcoma

Osteosarcoma / Parosteal OS

Hemangioma / AVM

Note:

Always do xray for calcification

A Bakers cyst / aneurysm can be calcified

1.  Arthroscopic Posterior Bankart Repair +/- Capsular Plication

Technique

Posterior Portal

- make slightly inferior and lateral compare to normal

- inspect joint

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