Adolescent apophyseal avulsion
- treat non operatively
- unless displaced > 2 cm
Adult
- soft tissue avulsion
Usually associated with sporting activities
- skiing
- water skiing
Violent contraction
- knee extended
- hip flexing
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
Diaphyseal Aclasis / Multiple Osteochondromas
Heritable skeletal dysplasia
AD with variable penetrance (96%)
Incidence of malignant transformation much higher
- 10% overall
- 1 % / year
Chondrosarcoma (CS) > Osteosarcoma (OS)
Young men
Posterior / Anterior 9:1
High velocity injury
- head direction at impact decides direction of dislocation
Anterior Dislocation
Externally rotated & abducted leg
- flexion = inferior dislocation
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
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
Dominant arm of middle aged men
- between 40 and 60
Sudden dramatic event
- sporting / weightlifting injury
- resisting heavy extension load
Degenerative changes seen on histology
Complete
- retracted / rupture of lacertus fibrosis
- minimally retracted
Osteochondritis Dissecans
- separation of avascular fragment of bone & cartilage
M : F = 2:1
Mean age 18 years
- can present as young as 9
4:1000