Periprosthetic fracture in a Octagenerian

Atrial fibrillation and aortic stenosis

 narrow canal 10.5. bowed femur 

Absence of curved 10 inch 10.5 mm dia porocoat stem made us use this cemented long exeter stem 10 mm dia and 240 mm and wired proxmally without cement. In the past a porocoat stem was cemented distally after removing the porocoat intraop with a burr only distally to cement and  the proximal uncemented stem was wired  to the periprosthetic fracture to facilitate  e ingrowth or fracture healing and immediate mobilisation . It make for a quick surgwry in these unfit pts and can mobilise full wt bearing stwt.

Patella dislocation with osteochondral fracture of medial facet

14 yr old male with genu valgum open physis and grade 3 b troclea and osteochondral fracture patella underwent medial epiphysidesis by paeds team, fixqtion on oc peice with suture tape and biopins and teochleplasty and mpfl repqir rather than recon. div class="separator" style="clear: both;">

Hypointense ACL

we still do not have a a clear cut correlation between clinical and radialogical data to make an informed decision for return to sport like in fracture union

Ulnar plus with TFCC tear

ulnocarpal impingement with triquetrql wear and large central tear of TFCC treated arthroscopic wafer procedure

 

Intraop fracture in a porotic RA pt with 2 yr okd fracture treated by interfragmentary screws only

stem and wedge back up done but unfortnately during trial reduction the femoral condyle fractures and screw hold for fixation was poor and therefore a distal femur replacement with Link Rhk was done a few days later. Having a distal femoral replacement inplant on table is advisable as a policy

Distal femoral fracture in a 80 CRF patient on dialysis and major cardiac issues

A distal femoral replacement was decided by the team to mobilse the patient immediately though with difficulty. The risks were explaned and a 5 cm poly distal femur replacement and a link RHK knee was done

Rising numbers of elderly parents living alone need an aggreesive metabolic management of osteoporosis. we are seeing an epidemic of insufficiency and periprosthetic fractures thsi fortnight. Better methods other than BMD measurements are needed to control bone and muscle loss. Do we need to routinely use bone resorption markers as the BMDs dont match the porosis when do the Bone cuts in TKR. Quick stable fixations as seen above are needed in these patients to get them back on there feet soon div class="separator" style="clear: both;">

Meniscal Transplant -Post menisectomy medial in a 24 yr old

Dislocation in a post stroke patient one montg postop

posterior impingement and anterior disloccation wad the cause. as he was a post strone one month, a constained luner or dual mobikty was the choice. A constrained option was chosen after discussion with the family. was pleasant surprised to see ingrowth in cup at 6 weeks. /a>

Does sagital alignment have a role

Dislocation in Thr post fracture neck of femur

Dislocation post THR in elderly is an issue which can be avoided by using larger head diameter, Tighter soft tissue with correct verical and horizontal offset. Good soft tissue repair is possible and may be avoid southern approaches The case below had stem sinkage causing lax soft tissue and retroverted acetabulum. A cemented stem to correct the vertical and horizontal offset and constriained liner was used as the posterior soft tissue were deficienct and patient was elderly.

Proximal bone loss in distal loading stem rt srom was revised due metal ions going up after 14 years. rt side was coc

one stage bil thr in ddh

lt hip had an abductor lurch 3 month postbil THR . Both were done with a hardinge approach, COC bearings with cone prosthesis as 2 offset options were available. The lurch on the lt persisited, pt has history or surgery on lt side for ddh as an infant and now has trochnateric overgrowth. . Should I consider distalising the trochanter to reduce jt forces

THR is stiff spine - Stuck Sitting

Case of stiff spine in an outlet view  suggesting a stuck sitting position. To avoid anterior dislocation a neutral version and closed cup with a nonmodular dual mobilty cup was chosen

 

popliteomeniscal fascicle repair

patient felt a lateral pop. Figure of four test was -ve. felt unstable with lachmanb1A and negative pivot shift. Lateral meniscus had a small bucket handle tear and lax anterior meniscopopliteal fascicle. could subluxe lateral meniscus by 50 percent at the anterior part of pop hiatus and less posteriorly