Medial Tibial Stress Syndrome
- pain along the tibial origin of tibialis posterior or soleus
Pain anterior aspect of shin
- running
- soccer
- basketball
Compartment Syndrome
Stress fracture of tibia
Usually 2° to changes in activity
- increase in mileage
1. Neck of 5th Metacarpal
2. Metacarpal Shaft
3. Metacarpal Head
4. Base of Metacarpal Fracture Dislocations
5. Base of Thumb Fractures / Bennett's / Rolanda
Non operative Management
Accept 45o angulation
- will have finger extensor lag, but will recover
High energy usually
Occasionally osteoporotic fracture in elderly
Other
- radiotherapy
- fatigue fracture in children
Don't present as isolated injury
- associated with pelvic fracture
Zone 1
- lateral to foramina
- neurologic injury from proximal migration & compression of L5 nerve root
Minimal trauma fracture
- secondary to osteoporosis
- wedge fractures
F > M
More common in elderly patients
Uncommon in men < 75
- look for alternative diagnosis
Renal failure
Malignancy - metastasis
Infection
Can present with pain
Non-union
- arrest of progression to union at fracture site
- > 6-9 /12
- no visible progressive signs of healing for at least three consecutive months
- individualise for each fracture
- when the surgeon believes the fracture has little or no chance to heal
Delayed union
- failure of fracture to unite within expected time
- still may spontaneously unite
Neurological pain in arm after injury in sport
- usually due to brachial plexus injury
Contact sports
- ice hockey
- rugby
- american football
- basketball
Brachial plexus injury
Cervical nerve root injury
Traction injury
- hit onto shoulder
Infection of skin and subcutaneous tissue
- spreads across fascial planes
- many microbes can be responsible
Type 1 Polymicrobial
Type 2 Monomicrobial
Group A Beta Hemolytic Strep (S. pyogenes)
- most common cause monomicrobial
S. Aureus / MRSA
Vibrio
Chronic Regional Pain Syndrome
CRPS 1
Sympathetically mediated pain syndrome
- excessive or exaggerated response of extremity to injury, surgery or disease
Manifested by
- intense or unduly prolonged pain
- vasomotor disturbances
- trophic changes
- delayed functional recovery
CRPS 2
HIV
Risk seroconversion
- 1 in 250
- 50% less with gloves & blunt needle
US Public Health Service Guidelines
- recommend 2 drug therapy for 4 weeks post exposure (AZT and 3TC)
- consider if patient's virus is resistant, and change medications accordingly
Hepatitis C
Seroconversion risk varied reports
Hereditary bleeding disorder due to defective and/or deficient factor VIII molecule
Inherited X-linked recessive disorder
- occurs almost solely in males
- female carriers usually asymptomatic
- 30% have no family history
FVIII deficiency
X-linked disorder
- 1:10 000
- all ethnic groups