operative options

Sportsman's Hernia

Definition

 

Groin pain in athletes

- secondary to tear in external oblique fascia

 

Epidemiology

 

Sports with aggressive adduction

- hockey / soccer

 

Pathology

 

Tears in external oblique fascia

- tend to be central

- around spermatic cord and ilioinguinal nerve

- pain may be from nerve entrapment

 

DDx

 

Adductor Longus Tear

Management

Non Operative

 

Options

 

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

 

ITB Friction Syndrome

Pathology

 

ITB rubbing on LFC

- long distance runners (slow running more at risk than fast)

- cyclists (seat too high, improper technique)

 

ITB becomes tight, especially posterior portion

 

Develop inflammed tissue under ITB

- synovium

- bursa

 

Aetiology

 

Overuse 

- sudden increase in distance

- hill running

- genu varum 

- improper shoe wear

Intertrochanteric Fractures

DefinitionHip Intertrochanteric Fracture Type 3

 

Fracture which extends between the trochanters of the proximal femur

- lower limit is inferior border of lesser tuberosity

 

Anatomy

 

Extra capsular / well vascularized

 

The key to stability is the posteromedial cortex

Subtrochanteric Fractures

Definition

 

Fracture below lesser trochanter / proximal 5 cm femur

 

 Subtrochanteric Fracture Long SpiralSubtrochanteri Fracture

 

Aetiology

 

Young patients / high velocity injuries

Old patients / osteoporosis

Flexible Flat Foot

Symptoms

 

Complain of pain with prolonged standing

 

Complain feet tire easily

 

Examination

 

Adult Flatfoot Clinical Valgus Hindfoot Clinical

 

Overall alignment

 

Heel raises

 

Stiffness

Functional range

 

30- 130o - Flexion / Extension

50o each - Pronation / Supination

 

Aetiology

 

Extrinsic

- skin / subcutaneous tissue

- capsule (anterior / posterior)

- collateral ligament contracture

- muscle contracture

- HO

 

Intrinsic

- articular deformity / malunion

- articular adhesions

OCD

DefinitionTalus OCD MRI Coronal

 

Fracture talus through articular cartilage into subchondral bone

- 2° force transmitted from distal tibia

 

Osteochondritis dissecans v osteochondral fracture

 

Epidemiology

 

6% ankle sprains

Average age = 25 

M > F

 

Bunionette

Definition

 

Painful prominence of lateral eminence of 5th metatarsal head 

 

Coughlin Classification 

 

Type I deformity 

- prominent lateral condyle 5th metatarsal head

- lateral condylectomy

 

Type II deformity 

- lateral bowing of 5th metatarsal

- chevron osteotomy

 

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