operative

 Scapular process fractures

Types

Coracoid process

Scapula spine

Acromial fractures

LC-1:  pubic rami fracture with sacral fracture

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

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

Definition

Rockerbottom foot / Persian Slipper Foot

Epidemiology

Uncommon

50% bilateral

Doesn't delay walking

- may present in toddler with callus under talus head

Associations

Congenital anomalies

- CNS disorders

- spina bifida & diastematomyelia ~10%

- arthrogryposis

- neurofibromatosis 

Mechanism

1. Direct lateral blow to patella

- usually with knee partly flexed and quadriceps relaxed

2.  Indirect low energy injury

Definitions

Massive tear 

1.  > 5cm 

- retracted to humerus / glenoid margin

2.  At least 2 complete tendons

- lose SS / IS or SS / SC

Classification

Epidemiology

Dominant arm of middle aged men

- between 40 and 60

Aetiology

Sudden dramatic event

- sporting / weightlifting injury

- resisting heavy extension load

Pathology

Degenerative changes seen on histology

Types

Complete

- retracted / rupture of lacertus fibrosis

- minimally retracted

Epidemiology

Average age 6 years

20% distal humeral fracture

- second most common elbow fracture after supracondylar

Mechanism

Pull Off 

- more common 

- fracture begins posterolateral metaphysis

- LCL, ECRL & ECRB attached to fragment

Push off

- varus force to extended EJ

Classification