bone scan

March Fracture

 

Definition

 

Insufficiency fracture

- secondary to exceeding fatigue threshold

- usually of second or third MT shaft

 

Epidemiology

 

Onset of new and very intense / strenuous physical activity

- i.e. new army recruits / dancers

 

Women with postmenopausal osteoporosis

 

Association

 

Cavus feet

 

History

 

Paget's Disease

Definition

 

Chronic, non metabolic bone disorder

Characterised by increased bone resorption, bone formation and remodelling

 

Epidemiology

 

Rare < 40

1 – 3 % population over 60

M > F

 

Aetiology

 

Unknown

 

Paramyxovirus implicated

- measles

- RSV

- canine distemper virus

 

Electron Microscope

Accessory Navicular

Incidence

 

1 - 2 %

 

Anatomy

 

Medial Aspect of foot

- proximal to navicular

- part of T posterior tendon

 

Usually will fuse with navicular (50%)

 

Issues

 

1.  Probably not a cause of flat foot

- excising accessory navicular / rerouting / reattaching tibialis posterior

- will not help pes planus

 

2.  Pain

- may fracture

Painful TKR

Differential Diagnosis of the Painful TKA 

 

Surgical Diagnosis  

 

1.  Prosthetic loosening and failure 

2.  Infection 

3.  Patellofemoral tracking problems  

4.  Instability 

5.  Recurrent intra-articular soft-tissue impingement / Component overhang  

 

Nonsurgical Diagnoses  

 

1.  Referred pain - Hip / Back  

Management

Incidence

 

Knee > Hip

- superficial position

- limited cover of well vascularised muscle 

- watershed area of skin blood supply anterior to the skin incision 

- much increased in fully constrained prosthesis 

 

Ideal < 1%

 

Risk Factors

 

Increased with

- revision

- prior infection

- RA / Psoriatic arthropathy

- DM

Metastasis with Unknown Primary

Likely Origin / Hexagon / PBBLTKClavicle Metastasis

 

                    Thyroid     Breast      

 

Background

Aim 

 

The identification of skeletal metastasis & fixation prior to fracture

 

Incidence

 

50% of new cancer cases have metastasis

- 1% have pathological fracture

- increasing with more aggressive palliative care

 

PVNS

Definition

 

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

 

Epidemiology

 

Age: 20 - 50

Sex: M > F

 

Types

 

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully

 

Tibial Stress Fracture

EpidemiologyTibial Stress Fracture

 

Athletic / high impact exercises

 

Aetiology

 

First described in ballet dancers (Burrows 1956)

- tension side of bone / lateral side

- progression to complete fracture has been well documented in athletes

 

Signs

 

Point tenderness

- lateral aspect of tibia

 

Over time develop bony lump

 

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

 

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