Background
Indications
RA
OA
AVN
Contra-indications
Infection
Charcot
Paralysis of deltoid
Torn rotator cuff
Insufficient glenoid bone stock
RA
OA
AVN
Infection
Charcot
Paralysis of deltoid
Torn rotator cuff
Insufficient glenoid bone stock
Usually after 50-60 years of age
Primary 90% of cases
Secondary
- AVN
- trauma
- instability
Coronal plane fracture of distal femoral condyle
- intra-articular
- often only attachment is posterior capsule
Rare
Usually a severe valgus trauma
Uncommon
< 1% Primary bone tumour
Young boys
- second decade
Similar to OO
Spine 30%
- especially posterior elements
Long bones 35%
Back or limb pain
- pain less severe than OO
Fracture distal to articular surface & proximal to intertrochanteric region
On average 4 years younger than intertrochanteric fracture
One year mortality as high as 36%
Only 1/3 will return to pre-fracture living environment
3 facets
1. Posterior facet (STJ)
2. Middle facet (sustenaculum tali)
3. Anterior facet (on distal medial aspect)
Anterior process
- forms calcaneocuboid (CCJ) articulation
Thalamic portion
- under lateral process talus
Tuberosities
Posterior tuberosity
- posterior process / T Achilles attachment
5-15% of posterior dislocations
Posterior hip dislocation
Type I - head fracture below fovea
Undisplaced
- non operative
Displaced
- excise fragment if small
- ORIF fragment if large (can contribute to instability)
Primary malignancy arising from remnants of the notochord
Rare malignant tumour
Middle-aged adults (50-70)
M>F
In midline in axial skeleton
Base of skull 35%
Vertebrae 15%
- especially cervical
Sacrum 50%
Sartorius
Rectus femoris
Pelvis is a true ring
- any anterior fracture must have a posterior injury as well
- integrity of the posterior sacroiliac complex is key
2 innominate bones + sacrum
Symphysis pubis < 5mm
SI joint 2-4 mm