operative management

Thigh Pain Uncemented Femur

Epidemiology

 

Ranges

- up to 4%

 

Clinical

 

Focal pain

- typically anterolateral thigh

- often tender

- corresponds to tip of stem

 

Aetiology

 

1.  Instability

 

Types

- early

- late / failed bony ingrowth

 

Cause

- micromotion at distal stem

Hemophilia

Definition

 

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

 

Haemophilia A

 

FVIII deficiency

 

X-linked disorder

- 1:10 000

- all ethnic groups

Sinus Tarsi Syndrome

Anatomy

 

Osseous canal between talus and calcaneum

- interosseous talo-calcaneal ligament

- cervical ligament

- joint capsule

- nerve endings / arterial anastomoses

 

Sinus Tarsi

 

Aetiology

 

Flat foot / overpronation

Inversion / sprain

 

Pathology

 

Management

Non-Operative

 

Education regarding shoe wear

- extra wide / large toe box

 

Insoles

- longitudinal arch support

- pre MT dome for metatarsalgia

- podiatry to attend to callosities

 

Toe spacers

 

Analgesia

 

Operative

 

Indications

 

1.  Continued pain and discomfort

2.  Difficulties with shoe wear

Accessory Navicular

Incidence

 

1 - 2 %

 

Anatomy

 

Medial Aspect of foot

- proximal to navicular

- part of T posterior tendon

 

Usually will fuse with navicular (50%)

 

Issues

 

1.  Probably not a cause of flat foot

- excising accessory navicular / rerouting / reattaching tibialis posterior

- will not help pes planus

 

2.  Pain

- may fracture

Trochanteric Bursitis & Gluteus Medius

Trochanteric Bursitis

 

Mechanism

 

Repetitive friction of iliotibial tract over GT

 

Aetiology

 

Overuse in athletes

Common post THR

 

May be associated with gluteus medius tears

 

Symptoms

 

Pain over upper lateral thigh with activity

- often related to hip flexion

 

Examination

 

Talar Neck Fracture

Epidemiology

 

Second most common  hindfoot after calcaneal fractures

 

Aetiology

 

Aviators Astragalus

 

Fall from height

- hyper-dorsiflexion injury

- neck of talus strikes the anterior tibia

 

Anatomy

 

More than half surface covered by articular cartilage

- medial articular wall straight

- lateral articular wall curves posteriorly

Calcific Tendonitis

Definition

 

Mid-substance calcification of the rotator cuff

- part of a metaplasia secondary to hypoxia

 

Supraspinatous CalciumSupaspinatous Large Deposits

 

Aetiology

 

2 groups of patients

 

Capitellar OCD

Epidemiology

 

Adolescents & young adults

 

Usually between 12 - 21 years 

 

Throwing athletes / gymnasts

 

Little Leaguer's Elbow

- combination of capitellar OCD and MCL injury

- a repetitive throwing injury / seen in pitchers

 

Aetiology

 

1.  Trauma & Overuse

 

Common throwing sports / gymnastics

Medial Epicondylitis / Golfers Elbow

Incidence

 

10% of elbow tendonitis

 

Aetiology

 

Overuse injury

- poor swing in golf

- poor throwing technique

- overuse of topspin in tennis

- occupational (repetitive hammering / screwing)

 

Some patients also have lateral epicondylitis

 

Examination

 

Tenderness CFO

 

Stimulate pain

- flexion of WJ with fingers resisting

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