inter prosthetic fracture in a 67 year rheumatoid pt

 The fracture was non healing for 3 months of conservative care elsewhere

To maintain her mobility the options of fixation and femoral replacement was considered as the hip was painful too due to the migration . A THR  link total femur was linked to the previous RHK tibia which was asymptotic

 

superior capsular reconstruction

rt handed 60 year old lady with 4 cm retraction gautlier grade 3

post op 3 months thanks to physio Sreejith's efforts post op

painful dislocated rt shoulder in a 76 year old lady

Mri showed chronic cuff tear grade 3 gautilier

 with subscap tear 

 The issue  of  reverse shoulder was easy as she has pain and was unstable due to cuff tear arthropathy with thrice weekly dislocation during sleep. Before the arrival of Grammonts prosthesis,  fusion could have been the only option

superior capsular reconstruction  have come recently from Dr. Mihata, however as there is already cuff arthropathy, pain at rest may not relieved.  Capsular reconstruction would improve movement but not increase strength and in this case the instability sealed  the solution.

The next problem whether a constrained liner was needed  or a subscap repair was mandatory or desirable. In this case as subs cap was retracted  further to try repair a constrained liner was use  and the result  is below