operative_techniques_20150728215846

Question 1

What Stryker tibial nails are available?

Answer 1

8-15mm (9-11 @ BnJ)240-420mm

Question 2

How much bone do you need for 3 distal screws?

Answer 2

25mm for standard13mm for distal nail

Question 3

What is entry point for tibial nail?

Answer 3

Medial to lateral tibial spine on APAnterior articular edge on lateral

Question 4

What size is entry reamer for tibial nail?

Answer 4

12mm

Question 5

What size should canal be reamed on tibial nail?

Answer 5

1-1.5mm larger than intended nail

Question 6

In proximal humerus fracture ORIF what is the safe zone?

Answer 6

The axillary n. runs from 5cm distal to lateral acromion edge to 7cm distal. Proximal and distal to this corridor is deemed safe.

Question 7

Describe deltopectoral approach?

Answer 7

1) 12-14cm incision from coracoid process to proximal humeral shaft2) Expose deltopectoral groove and cephalic vein3) Retract cephalic vein laterally (risk of retractor damage) or medially (must cauterize branches)4) Bluntly dissect btw the deltoid and pectoralis major5) Incise the clavipectoral fascia lateral to the conjoined tendon and inferior to coracoacromial lig6) Partial release of deltoid or pec major insertions can increase exposure

Question 8

Where does the musculocutaneous n. enter the coracobrachialis?

Answer 8

2.5cm distal to tip of coracoid.

Question 9

What are some design features of the Synthes 3.5mm proximal humerus plate?

Answer 9

1) Sits 15mm distal to rotator cuff2) Shaft sits slightly anterior3) Posterior buttress for GT4) 2-14 hole plates5) 6 proximal locking holes, 2 calcar screws

Question 10

Where should the plate be positioned?

Answer 10

1) AP view: 15mm distal to cuff insertion, allow distal locking screws to be placed in calcar2) Lateral view: anterior edge of plate directly lateral to bicipital groove

Question 11

What considerations are taken for osteoporotic bone?

Answer 11

1) Just drill lateral cortex2) screws placed into subchondral bone; ~ 5-8cm from joint surface

Question 12

What size drill is used?

Answer 12

2.8mm drill for 3.5mm screwsLocking screws can be placed under power with 1.5N torque limiting attachment