surgical approach

Approaches

Anterior

Anterolateral

Posterior

Anterior Approach / Deltopectoral

Indications

- shoulder stabilization

- arthroplasty

- fracture fixation

Approach

Position

- beach chair

- upper body elevated 30- 40^o / reduces venous pressure and bleeding

Incidence

5-15% of posterior dislocations

Aetiology

Posterior hip dislocation

Pipkin Classification

Type I - head fracture below fovea

Undisplaced

- non operative

Displaced

- excise fragment if small

- ORIF fragment if large (can contribute to instability)

Posterior Ankle Impingement

Epidemiology

Repetitive plantar flexion

- soccer players, ballet dancers

Cause

Os trigonum

FHL stenosing tenosynovitis

Soft tissue mass

Os Trigonum

Secondary centre of ossification of talus

- lateral to groove for FHL

- 2-7% of normal feet

- impinges against plafond with forced PF

DDx

Parosteal OS

- bone is not continuous with cortex in MO

Aetiology

3% incidence in elbow joint trauma to some degree

Epidemiology

Average age 6 years

20% distal humeral fracture

- second most common elbow fracture after supracondylar

Mechanism

Pull Off 

- more common 

- fracture begins posterolateral metaphysis

- LCL, ECRL & ECRB attached to fragment

Push off

- varus force to extended EJ

Classification