Difference interlocking nail & K nail

Interlocking nail K-nail

drowning hook
Control the rotation, shortening, angulation Easy to introduce
Prevent angulation and rotation of bone
Prevent upward and downward migration
of bone
Early weight bearing cause minimal blood Doesn’t need special instrument and image
loss during surgery intensifier
expensive Cheap
Source :
Bucholz RW, Brumback RJ. Fracture of the Shaft Femur, in : Rockwood &Green Fracture In
adults,4th ed. Philadelphia: Lippincott-Raven Publisher, 1996. P1827-1918

Ligament Clavicular

Source :
Atlas of Human Anatomy Professional Edition 6th Edition. Frank H. Netter, M

Triad Terrible Elbow

1. Elbow dislocation (often associated with posterolateral dislocation or LCL injury)
2. Radial head fracture
3. Coronoid fracture
Pathophysiology
Mechanism
- Fall on extended arm that results combination (valgus, axial, forces posterolateral
rotatory  posterolateral dislocation
- Structure elbow fail from lateral to medial ( LCL disrupted, anterior capsule injury,
MCL disrupted)

Poor outcomes secondary to

- Persistent instability
- Stiffness
- Arthrosis

Anatomy
1. Radial head
- Primary restraint posterolateral rotatory instability
- Secondary valgus stabilizer
2. Coronoid process
- Provide anterior and varus buttress to ulnohumeral ligament
- Resists posterior subluxation beyond 30 deg of flexion
3. MCL
- Anterior bundle (most important to stability
 restraint posteromedial rotatory instability)
- Posterior bundle
- Transverse ligament

4. LCL
- Restraint posterolateral rotatory instability
- Lateral ulnar collateral ligament
- Radial collateral ligament
- Annular ligament
- Accessory collateral ligament
Treatment
Non operative
Immobilize in 90 deg flexion 7-10 days
Indication :
- Ulnohumeral &radiocapitellar joints must be concentrically reduce
- Radial head no surgical indication
- Coronoid FX must be small
- Elbow should be stable to allow early ROM

Operative
ORIF
Indication :
- Terrible triad elbow injury
- Unstable radial head fracture
- Coronoid fracture type III
Source :
Wheeless’ Textbook of Orthopaedic. Orthopaedic references and discussion for physicians

Posterior approach humerus

Indication :
- More cosmetic compared with anterolateral approach
- Provide good exposure for middle and 1/3 distal fracture
- There is no intervenous plane in this muscle splitting approach
Landmark
Incision from 8 cm distal to the acromion to olecranon fossa
(skin incision begins at the tip of olecranon and runs proximally straight line along the
posterior midline of the arm)
indication IM nailing humerus
absolute indication :
1. open fracture
2. vascular injury
3. brachial plexus injury
relative indication :
1. pathologic fracture
2. segmental fracture
3. severe osteoporosis
4. skin compromise
5. polytrauma
Source :
AO principles of fracture management, Smith, R.M.MD,FRCS. Journal of Bone & Joint
Surgery – American Volume : 84

Cauda Equine Syndrome

defined constellation of symptom that result from terminal spinal nerve root compression in
the lumbosacral region
Key Feature
- bilateral leg pain
- bowel and bladder dysfunction
- saddle anesthesia
- lower extremity sensorimotor changes
Anatomy
- horse tail
- collection of L1-S5 peripheral nerves within the lumbar canal
- compression considered to cause lower motor neuron lesion
Conus Medullaris
- tapered, terminal end of spinal cord
- terminated at T12 or L1 vertebrae body
- injury to the sacral cord (conus) and lumbar nerve roots

Conus medullaris Cauda equina

pain Less common & less severe Pain prominent, sev ere, radiculer
location Bilateral and symmetric; in Unilateral or asymmetric; in
perineum and thigh perineum, thigh, legs or back
Sensory deficit Saddle distribution : Saddle distribution :
Bilateral, symmetric, unilateral, asymmetric, no
dissociation of sensation dissociation of sensation
Motor loss Symmetric, fasciculation Atrophy, no fasciculation
Reflex loss Ankle reflex absent Knee and ankle reflex absent
Bladder &rectal Early and marked Late and less marked
symptom
Sexual function Erection and ejaculation Less marked impairment
impaired
onset Sudden and bilateral Gradual and unilateral
Causes Many causes. Severe trauma Most common is a central herniated
to the lower back, gunshot disc
wound, fall or hard blows
Vertebrae level L1-2 L2-sacrum
Spinal level Injury of the sacral cord Injury to the lumbosacral nerve roots
segment (conus and epiconus)
and roots
How it present Suddenly and affecting both Gradually and affecting one side of
itself sides of the body the body
Pain level Mild to moderate severe
Numbness Tends to be more localized to Tends to be more localized to the
the area around the anus “saddle” area around buttock and
inner thigh
Treatment Surgery, radiation, antibiotic, Surgery, radiation, antibiotic, physical
physical therapy therapy