fracture

Background

The coronoid is the most important portion of ulno-humeral articulation

Reasons

1.  Provides anterior buttress

2.  Anterior capsule and brachialis attach to coronoid

2.  Anterior band of the MCL attaches to it

- distally and medially on sublime tubercle

Epidemiology

2 groups

1.  Elderly

- low velocity injury

- osteoporotic

- need to start bisphosphonates

2.  Young patients

- high velocity injury

Anatomy

Distal Radius Angles

- radial volar tilt 11°

- radial inclination  22°

- radius is 11 mm longer than ulna 

- ulna variance 2mm positive on average

Non operative Management

Indications

< 20^o sagittal

< 30^o coronal

< 3 cm of shortening

Options

Concept

Femur

- removal of femoral head cartilage

- resurfacing with metal

- cemented / uncemented

Acetabulum

- standard technique

Bearing surface

- metal on metal

Indications

Relatively young man (40 - 50)

OA

Anatomy

3 Sesamoids may be present in great toe

- 2 almost always present on plantar aspect of MTPJ

- 1 may be present on plantar aspect of IPJ

MTPJ sesamoids most important

- embedded in FHB tendons

- held together by intersesamoid ligament & plantar plate

- each side of crista / inter-sesamoid ridge

- articulate with plantar facets of 1st MT

Tibial usually larger than fibula

Xray Assessment

A:  Alignment

B:  Bony

C:  Canal

D:  Disc

S:  Soft tissues

Goals of surgery

1.  Correct deformity

2.  Restore stability

3.  Decompress neural elements if required

MRI

Advantage

- defines level of conus

- may need anterior rather than posterior surgery if lesion above conus