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Compression hip screw fixation of intertrochanteric femoral fractures

Internal fixation is appropriate for most intertrochanteric femoral fractures. Optimal fixation is based on the stability of the fracture. The mainstay of treatment of intertrochanteric fractures is fixation with a screw-side plate device or intramedullary device. Patient positioning Place the patient on a fracture table with a perineal post. Either place the foot of the contralateral lower extremity in a boot and scissor the leg (unaffected…

Intramedullary nailing of tibial shaft fractures

Locked intramedullary nailing is currently considered the treatment of choice for most tibial shaft fractures and is especially useful for segmental and bilateral tibial fractures. Fracture table If a fracture table is used, place a calcaneal traction pin before positioning. Place the patient supine with the hip flexed 45 degrees and the knee flexed 90 degrees ( Fig. 25.1 ). Place a well-padded crossbar proximal to…

Ulnar collateral ligament reconstruction

Andrews et al. technique The goal of this procedure is to reconstruct the anterior bundle of the ulnar collateral ligament. Preoperatively, the presence or absence of the palmaris longus tendon should be documented. Alternative sources of tendon graft include the contralateral palmaris longus and gracilis tendons. Drape the arm so that the entire volar forearm to the palm is exposed. Place a tourniquet on the upper…

Biceps repair: Open approaches

Proximal biceps tendon ruptures are most common in individuals 40 to 60 years of age and often are due to impingement or chronic microtrauma on the tendon. These injuries also may occur in younger individuals during heavy weightlifting or other sports activities (e.g., football, rugby, soccer, snowboarding) or in a traumatic fall. Tenodesis techniques range from open to mini-open to all-arthroscopic. Fixation can be done with…

Treatment of shoulder instability: Capsular shift, posterior capsular shift, arthroscopic capsular shift

Capsular shift procedures are used for multidirectional shoulder instability. The principle of the procedure is to detach the capsule from the neck of the humerus and shift it to the opposite side of the calcar (inferior portion of the neck of the humerus), not only to obliterate the inferior pouch and capsular redundancy on the side of the surgical approach but also to reduce laxity on…

Treatment of shoulder instability: Bankart repair, open, and arthroscopic

The Bankart procedure is indicated when the labrum and capsule are separated from the glenoid rim or the capsule is thin; it is, however, technically difficult. Keys to the success of this procedure are: (1) maximizing healing potential by abrading the scapular neck, (2) restoring glenoid concavity, (3) securing anatomical capsular fixation at the edge of the glenoid articular surface, and (4) re-creating physiological capsular tendon…

Open repair of achilles tendon rupture

Open repair of acute Achilles tendon ruptures remains the gold standard of operative treatment, especially for athletic individuals, because of the historically low rate of reruptures, high rate of return to sports, and decreased complication rates with newer techniques. Advocates of open repair argue that Achilles tendon injuries often result in complex obliquely oriented tears that cannot be adequately apposed and repaired with percutaneous of mini-invasive…

Anterior cruciate ligament reconstruction: TRANSEPIPHYSEAL, PHYSEAL-SPARING

Transepiphyseal replacement of anterior cruciate ligament using quadruple hamstring grafts The transepiphyseal reconstruction of the anterior cruciate ligament using quadruple hamstring grafts procedure described by Anderson is indicated in patients in Tanner stage III of development. The procedure is not indicated in patients in Tanner stage IV of development, who can have conventional anterior cruciate ligament reconstruction. Preteens and patients with Tanner I or II stages…

Anterior cruciate ligament reconstruction: ANATOMICAL SINGLE-BUNDLE ENDOSCOPIC RECONSTRUCTION USING BONE–PATELLAR TENDON–BONE GRAFT

Most anterior cruciate ligament (ACL) reconstructions are currently done arthroscopically because of the advantages of smaller skin and capsular incisions, less extensor mechanism trauma, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. ■ Place the patient supine on the operating table. ■ After general endotracheal anesthesia has been administered, examine…

Facet block injections: Cervical, lumbar, sacroiliac joint

Fluoroscopically guided facet joint injections are commonly considered the gold standard for isolating or excluding the facet joint as a source of spine or extremity pain. They also may help focus treatment on a specific spinal segment and provide adequate pain relief to allow progression in therapy. Cervical medial branch block injection ■ Place the patient prone on the pain management table. Rotate the patient’s neck…