Non-union
- arrest of progression to union at fracture site
- > 6-9 /12
- no visible progressive signs of healing for at least three consecutive months
- individualise for each fracture
- when the surgeon believes the fracture has little or no chance to heal
Delayed union
- failure of fracture to unite within expected time
- still may spontaneously unite
Neurological pain in arm after injury in sport
- usually due to brachial plexus injury
Contact sports
- ice hockey
- rugby
- american football
- basketball
Brachial plexus injury
Cervical nerve root injury
Traction injury
- hit onto shoulder
Infection of skin and subcutaneous tissue
- spreads across fascial planes
- many microbes can be responsible
Type 1 Polymicrobial
Type 2 Monomicrobial
Group A Beta Hemolytic Strep (S. pyogenes)
- most common cause monomicrobial
S. Aureus / MRSA
Vibrio
Chronic Regional Pain Syndrome
CRPS 1
Sympathetically mediated pain syndrome
- excessive or exaggerated response of extremity to injury, surgery or disease
Manifested by
- intense or unduly prolonged pain
- vasomotor disturbances
- trophic changes
- delayed functional recovery
CRPS 2
HIV
Risk seroconversion
- 1 in 250
- 50% less with gloves & blunt needle
US Public Health Service Guidelines
- recommend 2 drug therapy for 4 weeks post exposure (AZT and 3TC)
- consider if patient's virus is resistant, and change medications accordingly
Hepatitis C
Seroconversion risk varied reports
Hereditary bleeding disorder due to defective and/or deficient factor VIII molecule
Inherited X-linked recessive disorder
- occurs almost solely in males
- female carriers usually asymptomatic
- 30% have no family history
FVIII deficiency
X-linked disorder
- 1:10 000
- all ethnic groups
5 Annular pulleys
3 Cruciate pulleys
A1 and A5 expendable
Loss of other annular pulleys can lead to bowstringing
- A2 & A4 +/- A3
Rock climbers
- usually when slipping
May hear or feel a pop
Develop swelling / tenderness / pain
Bowstringing
Chronic, non metabolic bone disorder
Characterised by increased bone resorption, bone formation and remodelling
Rare < 40
1 – 3 % population over 60
M > F
Unknown
Paramyxovirus implicated
- measles
- RSV
- canine distemper virus
Electron Microscope
1/3 caucasian women > 64
Insufficient bone mass at time of skeletal maturity
- peak bone mass is achieved at age 25
Rapid loss of bone after menopause
Low body weight / weight loss / history of smoking / steroids
Type 1
- postmenopausal
- high turnover / osteoclast mediated
- F x 6
Metatarsalgia
- preMT dome
Claw toes
- wide deep toe box
Foot drop
- AFO
Insensate foot
- custom orthosis
Varus
- lateral heel wedge
- AFO (flexible)
- medial iron with lateral T strap