– See: Anterior Approach to the Humerus Axillary Approach: Posterior Approach Posterior Approach to Humerus Surgical Approach for Proximal Humeral Fractures Positioning and Draping: supine or beach chair; small soft bolster is placed beneath the shoulder blades to protract the shoulder; head is stabilized to prevent hyperextension and subsequent brachial plexus palsy; place patient in … Read more
– PreOp Planning: – consider NG tube and foley catheter; – have proper sized C-collar available for post operative care; – position: supine w/ halter cervical traction (3-5 lbs) w/ head turned slightly to the right; – consider placing a rolled towel between the … Read more
– Discussion: – varus deformity of the ankle may follow distal tibial fracture or distal tibial epiphyseal frx; – deformities due to distal tibial epiphyeal injuries are often progressive; – deformities due to tibial plafond injuries are usually static (from malreduction at the … Read more
– Discussion: – w/ an “isolated fibular frx,” the paramount indication of an unstable frx is lateral talar shift (which indicates deltoid ligament injury); – this is manifested radiographically as an increase in the medial clear space; – normally the medial clear space (between talus & medial … Read more
– See: Antiglide Plate – Discussion: – position of plate is dependent on level of frx, condition of overlying soft tissues, and the extent of comminution; – Posteriorly Positioned Plate: – see antiglide plate: – allows use of a thicker, stronger plate; – less risk of wound slough; … Read more
– See: Refereneces for Ankle Fractures: The Segmental Rectus Abdominis Free Flap for Ankle and Foot Reconstruction. The deltoid ligament. An evaluation of need for surgical repair. Salvage procedures for complications of total ankle arthroplasty. Diagnostic and operative arthroscopy of the ankle. An experimental approach. Acute rupture of the peroneal retinaculum. Guidelines for selective radiological … Read more
– Discussion: – select appropriately sized 6.5 mm or 7.0 mm canulated screw (threads must cross the frx site); – consider direction of maximal deformity and displacment; – guide wire insertion (for cannulated screw insertion); – K wire is inserted from deep w/ in sinus … Read more
– See: Equinovarus: – Discussion: – most common problem; – in those w/ diplegia, it is bilateral & almost always flexible in child under three years; – diff dx: toe walking – Exam: – it is essential that the ankle and hindfoot be held in varus while … Read more
– Treatment Considerations: – it is essential to reduce the dislocation in the ER, so as to avoid tenting of the skin over the anterior tibia; – w/ a trimalleolar frx-dislocation, consider a posterior approach using an antiglide plate and fixation of the posterior malleolar fragment (which can be accomplished through … Read more
– Discussion: – some recommend early motion after operative treatment of ankle fractures; – however, there is little differnece in range of motion between ankles that are treated with early motion and those that are immobilized; – similarly, wt-bearing affects does not appear to affect recovery; – Non Operative … Read more