Clay-shovelers
Clay-shoveler's
Definition
Spinous process avulsion
- typically C7
- can be seen in thoracic spine
Mechanism
Spinous process avulsion secondary to ligamentum nuchae
Spinous process avulsion
- typically C7
- can be seen in thoracic spine
Spinous process avulsion secondary to ligamentum nuchae
Subscapularis failure
Rotator cuff failure
Instability
Infection
Periprosthetic fracture
Aseptic loosening
Neurological injury
Parada et al. J Should Elbow Surg 2021
- 2224 aTSA complication rate 11%, revision rate 5.6%
RA
OA
AVN
Infection
Charcot
Paralysis of deltoid
Torn rotator cuff
Insufficient glenoid bone stock
Metaphyseal
Extra-articular
Direct blow
- most common
Indirect
- forced knee flexion with foot fixed / maximally contracted quadriceps
1. Vertical
2. Transverse
Athletic / high impact exercises
First described in ballet dancers (Burrows 1956)
- tension side of bone / lateral side
- progression to complete fracture has been well documented in athletes
Point tenderness
- lateral aspect of tibia
Over time develop bony lump
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
Young men in 20's and 30's
High energy injuries
- fall from heights
- MVA
Injury progresses from radial to ulna
- usually disruption proximal row either side of lunate
1. Capitate usually displaces dorsally initially
- volar lunate dislocation is end stage
Initial press fit
- implant geometry fits the cortical bone in the proximal femur
- good initial mechanical stability
Biological fixation for success
- good press fit
- minimal micromotion
- bony or fibrous tissue ingrowth or ongrowth
Convincing association with development of osteoarthritis
- arthritic changes beginning at radial styloid
- progress to scaphocapitate & capitolunate