74 year karate instructor with osteoarthritis hip

Issues of full ROM and wear were the issues discussed with the patient, He had to continue with his Karate. His bone looked good being in a physically active  person.

 Dual mobility with ceramic head was selected.

 Size 12 Evolutis stem, largest available in India was found to to stable on axial and torsional loading intraop  and -3 head and Dual mobilty was used due to his extreme ROM requirement

He starts doing karate kicks 3 rd day in ward before discharge and sinks by 2 cm and  now painless and short limped lurch. may be one should have cemented taking the risk of cementation in elderly. his canal was not stove pipe and felt good. Size 12 limitation may be an an indication for cement.

 a cemented DUAl mobility like below would be the solution in soft bone. Collared corail stem might hold some value but could swing instead of sinking

type 3 acromioclavicular dislocation in a rt handed policeman

options

1. conservative. the results of conservative equal surgical

In type 3. 4 , 5 ,6 surgical might have better results

 Patient was advised surgery elsewhere and had a relative with symptomatic ?acjt subluxation with symptoms  and was pushing for surgery. Not sure the indication that pt wants surgery as an indication is  acecptable. Was given independant literature and time to rethink. Came back saying surgery is what he wants.

 So plan was for stabilisation with implants (dog bone) and  semitendinosis graft for Conoid, Trapezoid and anterior and superior acjt lig reconstruction. 5 mm excision of lateral end of clavicle was done to avoid acjt symptoms lateral. there are reports of leaving the joint alone and also removing only the acjt disc. only the conoid was drilled thru clvicle as was worried about 3 drill holes in clavice and fracture seen in another pt. A small superior  subscap flap tear was seen on scopy which was missed on MRI

 

 The 2 red circles are where the graft was knotted and reinforced with fibre wire sutures

Few questions remain if surgical tt is planned

Do we tighten the dog bone first or the graft

Excision of acjt- was it necessary

Weaver and Dunn procedure is abandoned

 

SNAC wrist Stage 3(Vender)

28 YEAR RT HAND MECHANICAL ENGINEER PRESENTED WITH PAIN 4 YEAR Rt WRIST WITH DIFFICULTY IN LIFTING OR GRIPPING HEAVY OBJECTS 

Dorsiflexion - 22 deg (R) / 40 deg (L)

Palmar flexion - 18 deg (R) / 70 deg (L)
Radial deviation - 15 deg (R) / 30 deg (L)
Ulnar deviation - 17 deg (R) / 40 deg (L)

GRIP STRENGTH (avg of 3 values)
(R) - 64.5 lbs
(L) - 72.4 lbs

 

Scopy confirmed severe radioscaphoud OA more on the 

 styloid and early lunatocapitate OA

Scaphoidectomy and 4 corner fusion was done and. At 3 months he has 50 percent reduction in palmar flexion more or less same grip strength and satisfaction of 6/10. Awaiting 6 month review for better function

Good Times- when passion sans politics worked

The core of the first team I worked with  in Kerala, Amrita institute where most of us in the  team above worked with passion (Orthopedic I meant)  to put Kerala Orthopedics on the cutting edge. Thanks to the support of the management, the staff and the young team where we worked  with critical review every morning of what we did, achieved a lot and pushed for a lot of changes without compromise in the Orthopedic field in our country.  

 

Another way to treat mucinous cyst and ganglions in ACL

Options for painful cystic degeneration in  acl include

Excision and reconstruction of ACL

Multiple punctures  with needles and shaver for healing respone

Multiple punctures and intraligamentous  microfracture done below show quicker healing

Pics left to right preop, 2 weeks and 6 months post op

Back at sports