injury

Atlas / C1 Fractures

3 types

 

1. Posterior Arch

 

Mechanism

- axial compression with hyperextension

 

Associations

- 50% incidence other C1/2 fracture

- i.e. ondontoid fracture

 

Management

- stable

- soft / philadelphia collar

 

2. Isolated lateral mass fracture

 

Mechanism

- asymmetrical axial compression / lateral bend

Injury

Classification Leffert "OCRO"

 

I Open

 

II Closed

 

A  Supraclavicular 

- Preganglionic / Avulsion of Roots

- Postganglionic / Rupture of Trunks

 

B Infraclavicular

- cords & branches

 

C.  Post anaesthetic

 

III Radiation / Other

 

Tumour

TFCC Tears

Definition

 

Present with pain but not instability

 

Types

 

Traumatic

Degenerative

 

Different treatment algorithms for each

 

History

 

Ulna side wrist pain

- may be worse with rotation

- opening doors and jars

 

History of trauma

 

Examination

 

Local tenderness DRUJ

 

Axillary Nerve Lesions

Anatomy

 

Terminal branch of the posterior cord

- lateral to radial nerve

- behind axillary artery

- runs over inferolateral border of SSC

- enters quadrangular space

 

Quadrangular space

- SSC superiorly anterior

- T major inferior

- T minor superiorly posterior

- long head triceps and humerus

 

Divides into anterior and posterior branches

 

MCL and Posteromedial Corner

AnatomyMCL anatomy

 

1. Seebacher's 3 layers of the medial knee

 

Layer 1

- sartorius and sartorius fascia

 

Layer 2

- superficial MCL

- posterior oblique ligament

- semimembranosus

 

Layer 3

- deep MCL (meniscofemoral and meniscotibial ligament)

- posteromedial capsule 

 

2. MCL

 

Superficial MCL

Nerve Injury

Epidemiology

 

Primary THR 1%

Revision THR 3%

DDH  5%

 

Sciatic nerve 90% of nerve palsy

 

Other

- femoral nerve

- CPN

- ulna / radial nerve from positioning

 

Aetiology

 

Direct 

 

Laceration

- exposure / sciatic and superior gluteal nerve

- drill reamer / obturator nerve

- spike of cement / obturator nerve