Should'nt root lesions be a part of MLKI grading as it adds to the stability .

 ACL injury with medial meniscal bony root  avulsion and lateral meniscal root injury

 

arthroscopic  medail meniscal root fixation, lateral meniscal root repair and acl reconstruction 

 presented an year later with full range of movement, nil meniscal sign, stABLE ACL  and tenderness over the low profile button laterally. XRAY definitely showed medial meniscal narrowing as compared to normal knee

suggested scope and cartilage mapping while button removal

Periprosthetic fracture

54 yr old hypophosphatemia rickets with spondyloepiphyseal

 dysplasia. Periprosthetic fracture following a fall in a bowed femur . H/o multiple previous fractures Leading to sheperds crook deformity.  

 An eto foe quick explantation an correction of proximal deformity and distal locking  was planned. The distal deformity correction although was kept in mind but not corrected as it would possibly cause LLD. We got him walking at 6 weeks to get on growth  due to the capacious canal and  hypophataemia. Wonder whether a distal stress riser will cause an issue in his life time. in his life time.

 

slope neutral HTO with acl recon

2 yrs post hto with acl, recon in 52 yr old male

 

Subtrochanteric fracture post acetabular fracture sequlae

63 yr old patetient with the above fracture 5 years post both column acetabulum fracture sequlae with implant removal 5 months post op due to Klebsiella infection. now asymptomatic(infection) presented with a communited sub trochanteric fracture

 intraop frozen section, cultures and options of 2 stage and single stage were discussed with  decision to depend on frozen section taken to avoid 2 surgeries. negative frozen section  and hence THR through the trochanteric fracture (Like a flip) was done with wagner stem

 

43 years old post head injury and heterotopic ossification due to head injury.

 Had infection post attempted  HO excision on Lt hip 4 weeks ago. The surgical perspective improves with 3 D printing by infillcube at Kakanad, Kochi. The head and acetabulum appeared partly destroyed suggesting infection and hence a 2 stage THR with dual mobilty or constrained hip was planned

post op pics with cement spacer and stimulan with vacomycin and polymyxin and  postop of vac dressing to eliminate the dead space.

 

26 years post conservatively treated acetabular fracture with pain and Limp

•  Used Patients femoral head with a reverse  L cut to fill the posterior wall defect and a uncemented THR was done in 2002. the xrays below are at 18 years with no symptoms but superior linear wer is an issue and has to be followed up closely. The AML stem metal head 22 mm head with standard poly was the only available solution in 2002 in india. one had to push hard on  JNJ to bring in larger ceramic bearings  those days

 CT and Xray taken 19 years later with no symptoms. shows  predictable superior wear  with no periprosthetic lysis. the older standard polyethylene and 22.5 modular head in a very active gentleman

Painful flail lt knee post PPRP in 52 year old

52 yr old lad PPRP  had THR  rt side due to pain in a dysplastic hip 8 yrs back. followed by periprosthetic fracture 2 yeasr post op. Nov presents with pain lt knee at rest worse on wlking. cannot tolerate pain any more in the lt flail knee.  Attempted bracing to prevent the 30 degree hyperextension with no relief. Hence an RHK was done to eliminate pain and improve her gait secondarily.  In a flail limb do we do a rotaing hinge or simple hinge. the literature is a bit grey. we need a 5 degree recurvatum with a further stop ideally. We improved her gait and relieved pain for now with a link RHK with recurvatum stop

 

THR in a posterior wall fracture with damaged head

medialise the cup and got primary UN cemented cup and THR

 

HIP REPALCEMENTIN FRESH ANTERIOR COLUMN FRACTURE

 84 YR OLD ACTIVE LADY WITH AN ACUTE ANTERIOR COLUMN FRACTURE

 a ganz cage with host bone conatct and dome screws and cemented THR done to immediately mobilise the elderly and get her home without issues ASAP

Stiff Painfull knee post trauma

50 year old photographer  with a painful stiff knee 11 year post conservative treated femoral fracture

Options of fusion/ replacement with inherent risk of failure/infection and non union was discussed.  Did not expect this avulsion fracture of patella and tibial

TTO was part of exposure to correct the patella Baja

Had a delayed wound healing issues

 

12 years later walking with 0 to 70 degrees flexion. walking full wt bearing with no pain