Briard Jl. How To Correct Extra Articular Deformity. Slide 41 56
-
Upload
struijs -
Category
Health & Medicine
-
view
1.089 -
download
1
Transcript of Briard Jl. How To Correct Extra Articular Deformity. Slide 41 56
Correct cutsCorrect cuts
PSPS
But medial laxityBut medial laxity
Revised with a TC3 Revised with a TC3 + lateral release+ lateral release
With still medial With still medial laxitylaxity
IA medial wedgeIA medial wedge
(to regain IA stability)(to regain IA stability)
+ Concomitant HTO+ Concomitant HTO
(to regain alignment)(to regain alignment)
Correction OsteotomyCorrection Osteotomy where ?where ? when ?when ?
at the site of the malunion :
" ideal" to correct all the components of the deformity
but : but : -long to heal at this age!-long to heal at this age!-technique may be difficult -technique may be difficult (plane oblique)(plane oblique)
-fixation: plate, locking IM rod-fixation: plate, locking IM rod-often hypocorrection-often hypocorrection
impossible
- previous infection
- age
sometimes, easier to perform sometimes, easier to perform a a metaphyseal osteotomymetaphyseal osteotomy
closing or opening wedgeclosing or opening wedge
fixation if concomitant :• with the prosthetic stem• ± staple, plate, tibial tubercle osteotomy
when you plan a when you plan a concomitant concomitant osteotomy with TKAosteotomy with TKA
for malunionfor malunionwith good collateral with good collateral ligtsligts
Plan :Plan : first intraarticular surgeryfirst intraarticular surgery (prosthesis)(prosthesis) and then perform and then perform osteotomyosteotomy
preoperative Xray planning preoperative Xray planning with templates ++ (stems)with templates ++ (stems)
Post HTOPost HTO
Watch out !Watch out !
LCLLCL
FIRSTFIRST Forget the deformityForget the deformity just think of just think of IA surgeryIA surgery and implant the and implant the
prosthesis with reference to the prosthesis with reference to the ligaments and the articular sufacesligaments and the articular sufaces
Cuts // articular surfacesCuts // articular surfaces flexion & extension gapsflexion & extension gaps knee mobile & stable knee mobile & stable but malalignedbut malaligned
elevate the tibial elevate the tibial tubercletubercle
make a proximal make a proximal tibial cut // tibial tibial cut // tibial plateauplateau
a distal tibial cut a distal tibial cut perpendicular to perpendicular to the mechanical the mechanical axis with the axis with the tibial cutting tibial cutting guideguide
//
And close the wedge
Until flush with the tibial cutting guide
• long stem• tibial tubercle,
2 screws• ± screws,
plate, staple