Cause
Movement of iliopsoas tendon over femoral head / iliofemoral ridge / iliofemoral ligament
Audible or palpable snap in the groin
Hip moves from flexed / abducted / externally rotated position to extended / internally rotated position
10% of the population - usually painless
Move hip from flexed / abducted / externally rotated position to extended / internally rotated position
Activity modification
Stretching
Core strengthening
Indications
- pain < 1 year
- OA
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