AVN

Displaced ORIF

Indications

 

< 60 with good bone stock and preserved joint space

 

Reduction

 

Union rates increased with anatomical reduction

 

Options

- closed reduction

- open reduction / if closed reduction fails

 

Accept

- no varus

- < 15o valgus

- < 10o AP plane

 

Management

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

Hip Dislocation

IncidencePosterior Hip Dislocation

 

Young men

 

Posterior / Anterior 9:1

 

Aetiology

 

High velocity injury

- head direction at impact decides direction of dislocation

 

Anterior Dislocation 

 

Externally rotated & abducted leg

Management

Management Summary

 

Stage 0

 

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

 

Stage 1 / Normal X-ray, abnormal MRI

 

Forage: 80% G/E

Bisphosphonates

 

Stage 2 / Abnormal X-ray with cysts and sclerosis

 

A:  As for Stage I

Background

Bilateral Hip AVN Xray

 

Definition

 

Non-traumatic or traumatic condition of femoral head with bone death

 

Epidemiology

 

20 - 50 yo (average 38)

- M: F 4:1

 

NHx  

 

70-80% with AVN will progress within 1 year

 

Talar Neck Complications

AVN  

 

Largely related to degree of displacement

 

Incidence

 

Hawkins Type I

- 0% to 13% 

 

Talus AVN Hawkins 1

 

Hawkins Type II 

- 20% to 50% 

- usually only patchy and not a problem (rarely collapses)

Kienbock's Disease

Definition 

 

Avascular necrosis & subsequent disintegration of lunate

 

Aetiology

 

50-75% history of trauma

 

Occasionally seen in sickle cell / steroid use

 

Pathogenesis

 

Vascular Theory

 

Trauma disrupting vascularity

- single incident with disruption of blood supply

AVN Shoulder

Shoulder AVN

 

Epidemiology

 

Much less common than hip OA

- usually presents late

 

Aetiology

 

Similar causes as hip (AS IT GRIPS 3C)

 

Alcohol / Steroid / Trauma / Idiopathic

 

Gauchers

 

RA / RTx

 

Sickle Cell 

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