1. Capsular avulsions
2. Body / Nutcracker fracture
Epidemiology
- rare
Mechanism
- forced eversion / abduction of forefoot
- cuboid crushed between 4th and 5th MT and calaneum
Pathology
- displaced cuboid fracture with subluxation of tarsus
Coronal plane fracture of distal femoral condyle
- intra-articular
- often only attachment is posterior capsule
Rare
Usually a severe valgus trauma
Insufficiency fracture
- secondary to exceeding fatigue threshold
- usually of second or third MT shaft
Onset of new and very intense / strenuous physical activity
- i.e. new army recruits / dancers
Women with postmenopausal osteoporosis
Cavus feet
Children < 6
- entire distal humerus physis is displaced
Distal physis not ossified < 1 year
- may be a difficult diagnosis
> 10 mg / dl
- must be corrected for albumin
Malignancy
- multiple myeloma / lung cancer / breast cancer
Hyperparathyroidism
- elevated PTH
High mortality associated with hypercalcaemia of malignancy
40% albumin bound
50% ionised and active
Fall in level promotes tetanus
Chvostek sign
- tapping masseter muscle induces spasm
Trousseau Sign
- flexion of thumb & wrist with extension of fingers
Carpopedal Spasm
Prolonged QT interval on ECG
1. Vit D Deficiency
Aims of treatment
1. Correct the deformity early
2. Correct it fully
3. Hold the corrected position until foot stops growing
- AFO
- Denis Browne Boots
Timing
Start 1 - 3 weeks
- let parents settle and get used to diagnosis
- explain method and length of treatment required
Decreasing incidence in recent decades most likely attributable to preoperative antibiotics
Conventional discectomy </= 1%
Fusion 2%
Fusion & instrumentation 5-6%
Instrumentation doubles infection rate in lumbar fusion
Diabetes
Most common pattern cord injury
Hyper-extension injury in middle aged man with osteoarthritic spine
Usually C3/4 and C4/5
Most common type / in older patient with pre-existing spondylosis / OPLL
- hyperextension injury
- compression of the cord
- anteriorly by osteophytes
- posteriorly by infolded ligamentum flavum
Bilateral Pars Fracture C2
- traumatic axis spondylolisthesis
Neurological injury uncommon
- fragments separate and decompress
Different to judicial hanging where spinal cord is severed