Total Hip Arthroplasty for Acetabular Fractures
Mark Vrahas, MD
Partners Chief of Orthopaedic Trauma, Department of Orthopaedic Surgery,
Massachusetts General Hospital, Harvard Medical School
Boston, MA.
Grand Rounds presented on October 15th, 2009 at the O’Keefe Auditorium, Massachusetts General Hospital, Boston, MA.
done
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Filed under: Grand Rounds, Hip, Joint Replacement, Trauma, Videos | Tagged: acetabulam, anatomy, fractures, Grand Rounds, hip replacement, Joint Replacement, surgery, Treatment | Leave a Comment »
Diagnosis and Treatment of Peroneal Tendon Pathology
Cervical Deformity Correction
A fracture of the tibial tubercle when associated with a fracture of the tibial plateau often disrupts the extensor mechanism and can be difficult to manage. Traditionally, tibial tubercle fractures have been repaired by lagging the tubercle fragment to the posterior cortex of the tibia. However, the screws do not get adequate purchase, particularly in comminuted or osteoporotic bone. Over several years we successfully stabilized such tubercle fractures using a simple wiring technique. Here, the tibial tubercle fragment is stabilized by wiring it directly to the screws of a locking plate. Our preliminary results using this new technique have demonstrated a high rate of clinical and radiographic union, with near normal return of extensor mechanism function.
Our technique relies on the stable fixed angle construct created by the locking plate. The tibial plateau fracture and tibial tubercle fragment are exposed using a standard proximal tibia approach. Three or four 16-gauge stainless steel wires are tunneled beneath the medial soft tissues, through the medial fracture line and into the medullary canal. Care is taken to preserve as much of the soft tissue attachments to the tibial tubercle fragment as possible. The number of wires used is dependent upon the size of the fragment; for most routine cases, we generally use two or three. The plateau fracture is then reduced and stabilized using a locking plate. The lateral free ends of the wire are then looped around the visible screw shafts and brought out to the lateral side of the fracture site. The fragment is reduced and the wires are tightened to compress the fragment into place. The locking screw shafts anchor the wires and provide an overall excellent fixation.
Post-operative Care
Dr. Shapiro serves as Chief, Division of Otolaryngology in the Department of Surgery at Brigham and Women’s Hospital. She is an Associate Professor of Otology and Laryngology at Harvard Medical School. Dr Shapiro is Senior Associate Director of Graduate Medical Education for Partners HealthCare and Founding Scholar of the Academy at Harvard Medical School. She is on the faculty of the Harvard Leadership Development for Physicians and Scientists, and on the Senior Advisory Board for the Office of Women’s Careers at BWH. She has an active surgical practice treating adults with oropharyngeal dysphagia as well as general pediatric otolaryngology.
Hip Pain in the Young
Dan Pratt is Professor in the Faculty of Education and Director of Clinical Educator Fellowships in Medical Education in the Faculty of Medicine at the University of British Columbia. In 1992 he received the highest award for teaching given by the University of British Columbia – the Killam Teaching Prize. Dr. Pratt is a regular speaker at AAOS meetings and is an Instructor in AAOS Educator Courses. In 1999 his book, Five Perspectives on Teaching in Adult and Higher Education, won the Cyril O. Houle Award for most outstanding literature in adult education. In 2008 he received Canada’s most prestigious university teaching award – the 3M National Teaching Fellowship.
