nonoperative

 Scapular process fractures

Types

Coracoid process

Scapula spine

Acromial fractures

British Athletics Muscle Injury Classification (MRI)

Issues

Operative v Nonoperative

Levy et al Arthroscopy 2009

- systematic Review

- improved outcomes with operative management

https://pubmed.ncbi.nlm.nih.gov/19341932/

Vicenti et al. Injury 2019

- systematic review

- two studies compare operative v nonoperative

Femoral Neck Stress Fractures

Aetiology

Athletes with increase activity / distance

Women with eating disorders /  amenorrhea

Types

Compression / inferior neck

- < 50% protective weight bear

- > 50% emergent ORIF

Tension side / superior neck

- emergent ORIF

Epidemiology

Adolescent boys

Ossification

Proximal tibia / primary ossification centre

Tibial tuberosity / secondary ossification centre

- eventually merges with primary ossification centre

Ogden Classification

Type I - Tibial tuberosity ossification only

Anatomy

5 Annular pulleys

3 Cruciate pulleys

Pathology

A1 and A5 expendable

Loss of other annular pulleys can lead to bowstringing

- A2 & A4 +/- A3

Aetiology

Rock climbers

- usually when slipping

May hear or feel a pop

Develop swelling / tenderness / pain

Bowstringing

Mechanism

1. Direct lateral blow to patella

- usually with knee partly flexed and quadriceps relaxed

2.  Indirect low energy injury

Epidemiology

Most common long bone fracture

Aetiology

Young patients / sports

Elderly / simple falls

MVA - often compound

Tscherne Soft Tissue Classification

Grade 0

- nil ST injury

Grade 1

Clinical

Pain & Stiffness

- often more pain than FT tears

Bursal side tears more painful than articular

Articular side more common

May see in young patient overhead throwing

Examination

Painful arc

Impingement signs

No weakness

- function good