Virchow's Triad
1. Venous stasis
2. Hypercoagulability
3. Endothelial damage
Starts as platelet nidus at valves
- thrombogenic materials elaborated by platelets
- leads to development of fibrin thrombus
- thrombus grows
Thrombus may
- detach as embolus
- be completely dissolved / recanalise
- organise with valve incompetence
Most common
- fascia lata on greater trochanter
- iliopsoas on lesser trochanter
1. Intra-articular structures
- labrum
- ligamentum Teres
- loose bodies
- synovial chondromatosis
- osteochondoma
2. Extra-articular structures
- fascia lata on greater trochanter (common)
Repetitive friction of iliotibial tract over GT
Overuse in athletes
Common post THR
May be associated with gluteus medius tears
Pain over upper lateral thigh with activity
- often related to hip flexion
Self limiting syndrome of unknown aetiology
- hip pain associated with osteoporosis of proximal femur
AVN
- AVN of the hip in pregnancy is rare but possible
- TOH tends to be diffuse on MRI, while AVN is localised
- extends to neck and metaphysis
- transient osteoporosis has normal bone scan
Rare
- M: F 3:1
Stage 0
Natural history mixed
- depends on size of lesion and diagnosis
- treat if becomes asymptomatic
- may benefit from bisphosphonates
Stage 1 / Normal X-ray, abnormal MRI
Forage: 80% G/E
Bisphosphonates
Stage 2 / Abnormal X-ray with cysts and sclerosis
A: As for Stage I
Spinal deformities are found in 20% to 80% of patients with OI
Severe disease with nonambulatory status
Scoliosis in OI may progress after skeletal maturity
- may be related to weakened osteoporotic bone
Poor results
Scoliosis 10 to 15 x more common in patients with spastic quadriplegia than spastic diplegia
Typically
- spastic quadriplegic patient
- long C shaped curve
- lumbar apex
- progressive past maturity
- pelvic obliquity / dislocated or subluxed hips
- can extend into cervical spine
- high risk of respiratory compromise
Sitting in wheelchair
Hygiene
Improper nail trimming
Tight shoes & socks
Poor hygiene
Repetitive trauma to distal toe
Curved nail bed in elderly
1. Inflammation
- painful irritation about embedded nail plate in lateral groove
2. Infection
Hyper-dorsiflexion injury to 1st MTP joint
Grade 1 - Mild sprain
Symptoms
- minimal swelling / ecchymosis
Management
- return to play immediately
- RICE / NSAIDS
Grade 2 Partial tear plantar plate
Symptoms
Mechanism
Clenched knuckle
- tooth often penetrates capsule of MCPJ (60%)
- can injure the bone (58%)
- usually 3 / 4 th MCPJ
Associated Injury
Boxer's fracture
- 4th / 5th metacarpal head
Extensor tendon Laceration
Pathology