Hoffa fracture
Definition
Coronal plane fracture of distal femoral condyle
- intra-articular
- often only attachment is posterior capsule
Epidemiology
Rare
Mechanism
Usually a severe valgus trauma
Xray
definition
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
Brailsford Disease
Definition
Adult form
- 45 year old females
- more severe than Kohler's
Symptoms
Intense pain +/- oedema & inflammation
- often pronounced limp
- marked flat foot with prominant navicular
Radiology
Navicular narrowed
- lateral part dense, sclerotic & thin
- occasional fracture line
Congenital Vertical Talus
Definition
Rockerbottom foot / Persian Slipper Foot
Epidemiology
Uncommon
50% bilateral
Doesn't delay walking
- may present in toddler with callus under talus head
Associations
Congenital anomalies
- CNS disorders
- spina bifida & diastematomyelia ~10%
- arthrogryposis
- neurofibromatosis
Background
Definition
Fracture distal to articular surface & proximal to intertrochanteric region
Epidemiology
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
Hangman's
Definition
Bilateral Pars Fracture C2
- traumatic axis spondylolisthesis
NHx
Neurological injury uncommon
- fragments separate and decompress
Different to judicial hanging where spinal cord is severed
Xray
Morton's Neuroma
Definition
Benign enlargement of the common digital branch
- usually 3rd webspace
Anatomy
Found at level of or just distal to MT heads
- deep to the deep transverse MT ligament
Epidemiology
Classically women between 40 and 60
Crush Fractures
Definition
Minimal trauma fracture
- secondary to osteoporosis
- wedge fractures
Epidemiology
F > M
More common in elderly patients
Uncommon in men < 75
- look for alternative diagnosis
DDx
Renal failure
Malignancy - metastasis
Infection
Clinically
Can present with pain
Whiplash
Definition
Isolated posterior ligament injuries
- PLL / Posterior interspinous ligament / Paraspinal muscles
Excludes fracture / dislocation / HNP
Aetiology
MVA
Sport
Hyperflexion injuries
Symptoms
Large spectrum clinical presentation
- neck ache
- nausea & vomiting
- headache
- visual symptoms
Non Union
Definition
Non-union
- arrest of progression to union at fracture site
- > 6-9 /12
- no visible progressive signs of healing for at least three consecutive months
- individualise for each fracture
- when the surgeon believes the fracture has little or no chance to heal
Delayed union
- failure of fracture to unite within expected time
- still may spontaneously unite