ORTHOPAEDIC VIDEO THEATER ABSTRACTS

Safe Surgical Dislocation for Femoral Head Fractures

Ashok Sunil Gavaskar Kumaresan, MS; Parthasarathy Srinivasan; Naveen Tummala, MS;
Hitesh Gopalan, MS; Bhupesh Karthik Balasubramanyan
DOI: 10.5435/JAAOS-D-17-00521
Abstract: Femoral head fractures are high-energy injuries often associated with posterior hip
dislocation. Surgical treatment is recommended in cases of incongruent or unstable hip joint after
closed reduction. Safe surgical dislocation has emerged as the approach of choice in these injuries. It
provides circumferential exposure of the femoral head and acetabulum to address fractures and
labral injuries without additional risk of osteonecrosis of the femoral head. Sound knowledge of the
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vascular supply to the femoral head, meticulous posterior soft-tissue dissection, and a precise
osteotomy technique are imperative to avoid iatrogenic injury to the femoral head blood supply. In this surgical technique
video, we explain the anatomic basis, key landmarks, and techniques in performing a safe surgical dislocation for a Pipkin
type II fracture-dislocation. Watch the video trailer: http://links.lww.com/JAAOS/A42.

Anatomy Revisited: Medial Longitudinal Foot Arch

Joris Robberecht, MD; Geoffroy Vandeputte, MD; Francis Van Glabbeek, MD; Iles Jonkers, MD;
Hannelore Boey, MD
DOI: 10.5435/JAAOS-D-17-00522
Abstract: Adult-acquired flatfoot deformity is a frequent clinical entity leading to invalidating symptoms
in middle-aged patients. In this video, we revisit the anatomy of the static stabilizing structures of the
medial longitudinal foot arch. These structures include the plantar fascia; the talocalcaneal interosseous
ligament; and the spring ligament complex, consisting of the tibionavicular portion of the superficial
deltoid ligament, the superomedial bundle of the calcaneonavicular ligament, and the inferior bundle of
the calcaneonavicular ligament. With the help of a gait simulator, we illustrate the effect of sectioning these ligaments. Based on
the anatomic characteristics, we suggest a reconstruction technique to repair the spring ligament complex. Watch the video
trailer: http://links.lww.com/JAAOS/A43.

Targeted Muscle Reinnervation and its Role in Acute Management of

Above-Elbow Amputations
Mark A. Tait, MD; John W. Bracey, MD; Bryan J. Loeffler, MD; Raymond G. Gaston, MD
DOI: 10.5435/JAAOS-D-17-00523
Abstract: Targeted muscle reinnervation (TMR) is a surgical technique that can provide patients
intuitive myoelectric prosthetic control as well as prevention of, or relief from, neuroma-associated
pain. This technique involves nerve transfers that increase the number of available surface
electromyography (EMG) targets leading to improved patient control of the myoelectric prosthesis.
Additionally, utilization of EMG pattern recognition has evolved in conjunction with TMR to further
improve prosthetic control. Early case studies seem to indicate that TMR is successful in prevention of early neuroma
formation after amputation and is a highly effective surgical intervention for the treatment of painful neuromas. The
technique of TMR in the above-elbow amputee has been well described. These advances in surgical and prosthetic
technique have led to implementation of TMR in all patients with transhumeral amputations at our facility during the initial
hospitalization following their injury as discussed by other institutions. In this video, we discuss technical aspects of TMR in
above-elbow amputees as well as the importance of a patient care team including physicians, therapists, and prosthetic
designers. We present two patients who underwent TMR after traumatic transhumeral amputation. Both patients underwent
surgical intervention shortly after initial injury. In both cases muscle reinnervation occurred, leading to reliable
EMG signals for control of a myoelectric prosthesis. The intuitive nature of TMR led to early control of the prosthesis. In
both cases, patients were able to control a myoelectric prosthesis with use of reinnervated muscles using
pattern recognition–based myoelectric prosthesis and neither has had painful neuroma formation. Watch the video
trailer: http://links.lww.com/JAAOS/A44.

© 2017 The Author(s). Published by Wolters Kluwer Health, Inc., on behalf of the American Academy of Orthopaedic Surgeons.
Video trailers that accompany these abstracts are available on www.jaaos.org.

664 September 2017, Vol 25, No 9

Copyright ª the American Academy of Orthopaedic Surgeons. Unauthorized reproduction of this article is prohibited.