indications

 Scapular process fractures

Types

Coracoid process

Scapula spine

Acromial fractures

Indications

Osteoarthritis

Rheumatoid arthritis

Avascular necrosis

Definition

Platelet rich plasma

Concept

2 main components

1.  Platelets

- contain PDGF, TGF, VEGF

2.  Growth factors

- ILGF

- FGF

Formed from the separation of whole blood into plasma and RBC

- separation usually achieved with centrifugation

Platelet concentration

AO Classification

Types

1. Supracondylar

2. Unicondylar

3. Intracondylar

Xrays

Supracondylar / Extra-condylar

Indications

Patient > 70

Gjertsen et al JBJS Am 2010

- 4335 patients > 70 with displaced subcapital fractures

- minimum 1 year follow up

- 1 year mortality same in each group / 25%

- 22% reoperation in ORIF v 3% in hemiarthroplasty

- more pain / higher dissatisfaction / lower quality life in ORIF group

Options

Hemiarthroplasty

- unipolar monoblock

- unipolar modular

Indications 

1. Significant functional impairment

2. PIPJ contracture

- originally thought to intervene early

- Macfarlane showed residual FFD always about 30^o

- may need to release  check rein ligaments / accessory collateral ligaments

3. MCPJ contracture >30^o

4. Trigger fingers

- must do limited fasciectomy 

History

First generation (late 70s early 80s) 

Results

Advantage

1.  Reduce implant loosening

- offset load sharing to diaphysis

- 30% if > 70 mm

2. Restore optimal alignment

Indications

1.  Using augments or bone grafting

2.  Increased constraint 

- VVS / hinge

Indications

Aseptic loosening

Infection

Instability

Wear & breakage components

Fracture

Stiffness 

Pain

Aims

Restoration of anatomical alignment

Restoration of joint line

Restoration of bone stock