surgical options

Definition

Coronal plane fracture of distal femoral condyle

- intra-articular

- often only attachment is posterior capsule

Epidemiology

Rare

Mechanism

Usually a severe valgus trauma

Xray

Non-Operative

Education regarding shoe wear

- extra wide / large toe box

Insoles

- longitudinal arch support

- pre MT dome for metatarsalgia

- podiatry to attend to callosities

Toe spacers

Analgesia

Operative

Indications

1.  Continued pain and discomfort

2.  Difficulties with shoe wear

Non-operative Management

Natural history

Return to Sport

Shelbourne et al. Am J Sports Med 1999

- 133 patients with isolated PCL injuries followed for mean of 5 years

- 1/2 returned to sport at same level of play

- 1/3 returned to sport at lower level of play

https://pubmed.ncbi.nlm.nih.gov/10352760/

Agolley et al. Bone Joint J 2017

Definition

Fracture below lesser trochanter / proximal 5 cm femur

Aetiology

Young patients / high velocity injuries

Old patients / osteoporosis

Background

The coronoid is the most important portion of ulno-humeral articulation

Reasons

1.  Provides anterior buttress

2.  Anterior capsule and brachialis attach to coronoid

2.  Anterior band of the MCL attaches to it

- distally and medially on sublime tubercle

Definitions

Massive tear 

1.  > 5cm 

- retracted to humerus / glenoid margin

2.  At least 2 complete tendons

- lose SS / IS or SS / SC

Classification

Rheumatoid Arthritis Diagnostic Criteria

1987 American College of Rheumatology 

Need 4/7 (MAX RANS)

1. Morning Stiffness

2. Arthritis of 3 areas > 6/52

3. Xray changes

4. Rh factor

5. Arthritis of Hand > 6/52

6. Nodules

7. Symmetric Arthritis > 6/52

NHx

Natural History of ACL deficient knee is variable

- functional instability 15% - 90%

- progression to OA is variable

Depends on level of patient demands / activity

1.  Late meniscal injury in ACL deficient knee

15-25%

2.  Function

Daniels Am J Sports Med 1994

- 292 ACL defecients knees

Definition

Crushing osteochondritis of metatarsal head

Epidemiology

Usually 2nd metatarsal (80%)

- occasionally third

- can occur in any

Age 10-15 years

- peak 15 year old girls

- F:M = 3:1

- occurs during the growth spurt at puberty

Bilateral in 6%

Aetiology

Definition

Spinal cord dysfunction
- extrinsic compression of the cord or its vascular supply
- caused by degenerative disease of spine

Epidemiology

Most common spinal cord dysfunction in patients > 55 years old
 

C5/6 commonest level