fracture

Clay-shoveler's

Definition

Spinous process avulsion

- typically C7

- can be seen in thoracic spine

Mechanism

Spinous process avulsion secondary to ligamentum nuchae

Complications

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%

Indications

RA 

OA 

AVN 

Contra-indications

Infection

Charcot

Paralysis of deltoid

Torn rotator cuff

Insufficient glenoid bone stock

Distal Tibial Fractures

Definition

Metaphyseal

Extra-articular

Intra-articular Extension

Issues

Femur

Multiplanar deformity

- worsend by previous surgery

- may require osteotomy

Acetabulum

Dysplasia often present

- not as severe as in DDH

LLD

Can be significant

Abductors

Have been short for long time

- difficult to restore length

Mechanism

Direct blow

- most common

Indirect

- forced knee flexion with foot fixed / maximally contracted quadriceps

Types

1.  Vertical

2.  Transverse

Epidemiology

Athletic / high impact exercises

Aetiology

First described in ballet dancers (Burrows 1956)

- tension side of bone / lateral side

- progression to complete fracture has been well documented in athletes

Signs

Point tenderness

- lateral aspect of tibia

Over time develop bony lump

Definition

Fracture which extends between the trochanters of the proximal femur

- lower limit is inferior border of lesser tuberosity

Anatomy

Extra capsular / well vascularized

The key to stability is the posteromedial cortex

Epidemiology

Young men in 20's and 30's

Aetiology

High energy injuries

- fall from heights

- MVA

Mayfield Classification

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

Goal

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