Pathological bone formation in soft tissues
In elbow
- 3% of trauma
- 89% if head injury + trauma
Completely different
1. Myosisitis Ossificans Circumscripta
- post traumatic
- more common
- recognised as a consequence of neurological injury
Chondroid Metaplasia of synovium affecting large joints
Nodules of hyaline cartilage
- formed in the subsynovial layer of joint capsules
Rare lesion
Most common in 20's and 30's
Sex: M > F (2:1)
Monoarticular
Fracture which extends between the trochanters of the proximal femur
- lower limit is inferior border of lesser tuberosity
Extra capsular / well vascularized
The key to stability is the posteromedial cortex
Fracture below lesser trochanter / proximal 5 cm femur
Young patients / high velocity injuries
Old patients / osteoporosis
CP is a permanent disorder of movement and posture
- non-progressive
- brain injury before the age of two years
Strict definition excludes familial & progressive congenital problems & those acquired in childhood as a result of head injuries
2-3 per 1000 live births
Higher in
Self limiting syndrome of unknown aetiology
- hip pain associated with osteoporosis of proximal femur
AVN
- AVN of the hip in pregnancy is rare but possible
- TOH tends to be diffuse on MRI, while AVN is localised
- extends to neck and metaphysis
- transient osteoporosis has normal bone scan
Rare
- M: F 3:1
Non-traumatic or traumatic condition of femoral head with bone death
20 - 50 yo (average 38)
- M: F 4:1
70-80% with AVN will progress within 1 year
Simple sprain
- injury to ATFL
- will almost always get better in 6-8/52
Complex sprain
- associated injury
- suspect if patient slow to recover
- diagnose most things on MRI
Instability
- clinical diagnosis
- most will get better with appropriate physio
Mallet
- DIP flexed
- MTP / PIPJ neutral
Hammer
- PIP flexion
- DIPJ neutral / extended
Simple - MTP not involved
Complex - MTP hyper-extended
Claw
- PIPJ and DIPJ flexed
- MTPJ hyperextended
Curly toe
- PIP and DIP flexion
Disorder of immune system
- antigen-antibody complexes
- stimulate release of proteolytic enzymes
- leading to vasculitis, synovitis and cartilage destruction
Articular Effects
- synovitis
- ligamentous and capsular laxity
- cartilage destruction
- osseous erosion
Vasculitis
- rheumatoid nodules