OKOJ

OKOJ, Volume 8, No. 9


Proximal Tibial Nailing Using the Semiextended Technique

Intramedullary nailing of proximal tibia fractures has been associated with a high incidence of malalignment following osteosynthesis. Valgus malalignment has been attributed to poor endosteal fit of the implant in the widened tibial diaphysis as well as a laterally directed nail insertion angle from a medially placed starting portal. Anterior angulation has been attributed to the pull of the patellar tendon on the proximal fracture fragment when the knee is flexed during conventional tibial nailing. In this paper, we describe the use of the semiextended position, which eliminates the malalignment problems associated with conventional nailing and minimizes the risk of infection by using a relatively small incision while leaving the musculature around the fracture untouched.

    • Keywords:
    • intramedullary nailing

    • intramedullary nail fixation

    • proximal third tibial shaft fractures

    • proximal third tibia fractures

    • extra-articular proximal tibia fractures

    • nonarticular proximal tibia fractures

    • semiextended position

    • Subspecialty:
    • Trauma

Shoulder Resurfacing Arthroplasty: Current Concepts

Humeral head resurfacing arthroplasty has been shown to be an effective, bone-preserving alternative to traditional shoulder replacement in the treatment of a variety of arthritic conditions of the shoulder. Advantages of humeral resurfacing arthroplasty over standard shoulder replacement using stemmed implants are numerous. In addition to preserving bone stock and cartilage, resurfacing arthroplasty can be done quicker, with less blood loss, and with fewer postoperative complications. Normal anatomy is maintained and no changes in inclination, version, or offset are required. Resurfacing arthroplasty also allows for a straightforward revision to a conventional total shoulder replacement if necessary. The ideal patient is young, with isolated humeral head chondrosis and an intact glenoid. Contraindications include inadequate bone stock and infection, and the joint as a whole must be relatively free of arthritis.

    • Keywords:
    • shoulder replacement

    • shoulder resurfacing

    • resurfacing arthroplasty

    • humeral resurfacing arthroplasty

    • Humeral head resurfacing

    • humeral head resurfacing arthroplasty

    • surface replacement arthroplasty

    • cementless surface replacement arthroplasty

    • hemi-resurfacing arthroplasty of the shoulder

    • resurfacing arthroplasty of the humerus

    • Subspecialty:
    • Shoulder and Elbow

Surgical Technique Utilizing Porous Metal Augments for Acetabular Deficiencies

Dr. Berend and his team perform a revision total hip replacement in a 72-year-old woman who had undergone primary total hip arthroplasty for osteoarthritis. She had experienced multiple dislocations and was treated with combinations of closed reductions and revision of the acetabulum. She later developed a loose cup with superior migration that was causing her pain. This particular patient's condition was further complicated by the presence of Staphylococcus aureus in her hip. The goals of the surgery were to restore the anatomic hip center, achieve cup stability, and decrease the risk of postsurgical dislocation by the utilization of a large femoral head. Dr. Berend describes his surgical approach and demonstrates acetabular preparation, trialing of the cup and acetabular augment, positioning of the augment, bone grafting, "unitization" of the augment and cup; final cup insertion and fixation; and trialing of the reconstruction.

    • Keywords:
    • Revision total hip arthroplasty

    • revision total hip replacement

    • acetabular deficiency

    • porous metal acetabular augment

    • Subspecialty:
    • Adult Reconstruction

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