fractures
Femoral neck stress fractures
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
Distal Femur Fractures
AO Classification
Types
1. Supracondylar
2. Unicondylar
3. Intracondylar
Xrays
Supracondylar / Extra-condylar
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
Metacarpal Fractures
Fractures
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
1. Neck of 5th Metacarpal Fracture
Non operative Management
Accept 45o angulation
- will have finger extensor lag, but will recover
Femoral Shaft Fractures
Epidemiology
Usually young patients
- 15 - 40
15% compound
Aetiology
High velocity injury
- MBA
- MVA
- pedestrian v car
- fall from height
Emergency Managment
EMST principles
- need for transfusion not uncommon
Glenoid & Scapula Fractures
Glenoid Fractures
Indications for Surgery
ORIF
- > 5mm step
- > 1/4 glenoid rim and displaced
Ideberg Classification Intra Articular Fracture
Type I
Fractures of the Glenoid rim
I A anterior
I B posterior
Differentiate from small bony Bankart
Clavicle Fractures
Mechanism
Usually a direct blow
- less commonly a fall on the outstretched hand
RTA / sporting accidents commonest causes
Can be pathological as a result of radionecrosis
- eg following radiotherapy for breast cancer.
Incidence
Fractures of the clavicle are common
Forearm Fractures
Anatomy
Radial bow radius
- important for rotation
Interosseous membrane
- Z pattern
- proximal radius to distal ulna
Mechanism
Direct blow
- ulna / night stick
Forearm Fractures
Ossification
Primary
- 8 / 52 gestation radius & ulna
Secondary
- distal radius age 1
- distal ulna age 5
Non Operative Management
Unacceptable Position
< 10: > 15o malalignment
> 10: > 10o malalignment
Postreduction Positionin / Rule of Thirds