Rheumatoid Arthritis
Issues
Rotator cuff
- often deficient
Bone stock
- often deficient
Glenoid
- often posterior version
Management
Options
1. TSR
Indications
- cuff intact
Rotator cuff
- often deficient
Bone stock
- often deficient
Glenoid
- often posterior version
1. TSR
Indications
- cuff intact
Parosteal OS
- bone is not continuous with cortex in MO
3% incidence in elbow joint trauma to some degree
Adolescents & young adults
Usually between 12 - 21 years
Throwing athletes / gymnasts
Little Leaguer's Elbow
- combination of capitellar OCD and MCL injury
- a repetitive throwing injury / seen in pitchers
1. Trauma & Overuse
Common throwing sports / gymnastics
Relatively rare
Average age 50
Men 4:1 Women
Usually dominant arm
Primary
- associated with strenuous manual labour
Secondary
- trauma
- OCD
- synovial chondromatosis
- valgus extension overload / MCL insufficiency
Reproduce the normal anatomical centre of rotation
Restore femoral offset
Maintain equal leg lengths
Usually template off normal hip
1. LLD
2. Offset
3. Femoral component
4. Acetabular component
5. Osteotomy / femoral seating
The perpendicular distance from the centre of the femoral head to the long axis of the femur
Harris 1992
- aim for supra-physiologic offset
- avoid making offset less than original at all costs & makes longer if possible
Soft tissue balancing equals restoring femoral offset
1. Abductor lurch / Trendelenburg gait
Type I: Undisplaced avulsion fracture
Type II: Anterior portion displaced & hinged
Type IIIA: Displaced
Type IIIB: Displaced & Rotated
Uncommon
- 4% OS
Females more common
- similar to GCT
Less aggressive locally
- less metastasis
- size / location & duration of symptoms don't correlate with outcome
Arise from cortex of bone / periosteum
- parosteal
- periosteal
- high grade juxtacortical
It was described in 1983 by Dr. Nora, and is sometimes called Nora's disease or Nora's lesion
Bizarre parosteal osteochondromatous proliferation
Rare lesion
- occurs most commonly in the hands and feet
Adults in their 20's and 30's
Males = Females
Bone island
Hamartomatous lesion
- island of mature cortical bone found in the midst of normal cancellous bone
>10
M=F
Asymptomatic x-ray finding (usually in adolescents)