Arthroscopic shoulder stabilisation.

Is it the standard of care? Shoulder surgery has grown much in the last decade. Even in the presence of engaging Hill Sach's , soft tissue reconstruction, bony procedures, arthroscopy has a major role.

 

Identifying the precise pathology whether it is ALPSA, HAGL, RHAGL. Bony bankart's, engaging Hill sach's, pathology specific management is the Standard of care. Puttiplatt's surgery is definitely history(arthritis after stabilisation as the tight anterior structure predispose to posterior wear of the glenoid., the role of Bristow's procedure is controversial. Latarjets modified both arthroscopic and open is advised to increase the arc of glenoid extrarticularly in engaging Hillsach's and has the best results to date.

Timing of surgery is more controversial. Do we intervene for the young first time dislocator with a bankarts or immobilise first in external rotation. multiple recurances can give rise to plastic deformation of both the anterior and posterior capsule leading to various techniques to tighten in both directions and centering the head.on nthe glenoid.

Ankylosed knee with patellar fracture - by Sreenath for opinion

54 yr male with trauma history of ankylosis same knee following septic arthritis at 16 yrs of age,diabetes controlled by dietnot willing for tkr as he had thought about it becos of ankylosis earlier and firm on that decision,no pain previously,office job
Questions for academic interest

Should patella be fixed?

Timing of tkr whether now or when?What all Technical difficultis during surg?How is outlook after tkr?

OATS

28 year old male with a focal cartilage defect(10 mm) in the medial femoral condyle. Picked up on a cartigram with a 1.5 tesla MRI. I year postop cartigram showing the articular cartilage of MFC after OATS

Similar defect in the lateral femoral condyle covered by a bioscaphold( Trufit) in a 40 year old man with equally good short term result-18 months

MRI with a D-gemeric software makes diagnosis of cartilage injuries accurate.

arthroscopic decompression of Spinoglenoid ganglion

25 yr old male, Pain ,weakness -7 months insiduous onset
No history of injury. Conservative treatment for 6 months elsewhere
external rotation weakness (rt) shoulder, Wasting of infraspinatus

MRI Confirms an spinoglenoid ganglion. Options include open excision, ultrasound guided aspiration, arthroscopy to adddress labral lesion and ganglion. We Elected to do an arthroscopic ganglion decompression with immediate relief of pain. Surprisingly no labral tears were found and the ganglion alone was decompressed.

We has since then done another similar case where in a large type 2 b labral tear which was repaired.

Infra spinatus wasting

Options of management include

Spontaneous resolution of the ganglion piatt et al j.of shoulder and elbow surgery,2002 (2 pts )
IMAGE GUIDED ASPIRATION OF THE CYSTS (mixed results)
recurrence common , Tung et al j.of roentgenology 2000 ¾ recurrence in 4 months
Open excision deltoid splitting/detachment
intraarticular pathology undiagnosed
Arthroscopic
Snyder et al ,j.of arthroscopy,2006
Iannotti et al,j.of arthroscopy 1996
chen et al j. of arthroscopy,2003

Type 3 b infected open fracture distal femur and proximal tibia

25 year old male with type 3 b open fracture of distal femur and proximal tibia and lateral facet of patella presented I week after the injury with infected ( wound was contaminated with mud and leaves found 1 week after the injury when the patient presented to us).

Repeated debridement daily under epidural 5 times in 6 days followed primary grafting with iliac crest HAP granules soaked in polymyxcin which was sensitive for gram negative enterocooci and E. coli.

The free flaps for the wound failed twice and was finally closed with negative pressure suction and skin grafting
At 6 months with no evidence of infection and the fracture show tricortical bridging. He is mobilised with a single crutch. The range of movement is 0 to 60 degrees with quads tightness.

I believe the local delivery of antibiotics with HAP granules with slow leaching of antibiotics and osteoconduction helped as achieve union without infection by 6 months.