osteoarthritis

Options

Darrach's

- distal ulna excision

- best for elderly RA patient

Bower's interpositional hemiarthoplasty

Technique

Definition

Degenerative arthritis at trapeziometacarpal joint (CMC)

- trapezoid - metacarpal

Epidemiology

Commonest hand joint involved in OA 

Most common in older women                                      

Epidemiology

Extremely uncommon

Stability provided by joint capsule /costoclavicular & interclavicular ligaments 

Recurrent instability uncommon

Many apparent dislocations in adolescents may be growth plate injuries 

-will remodel without treatment

If OA from chronic dislocation may resect SCJ

Aetiology

Post-traumatic (type III clavicle fractures)

Idiopathic

4 patterns 

1. OA with osteophytes 

-  contribute to impingement

2. Osteolysis with resorption & gross osteoporosis 

Epidemiology

Male & Females > 60 years

- X-ray evidence of OA

Symptomatic 

- 25% females

- 15% males

Affected joints

Base thumb

PIPJ / Bouchard's nodes

DIPJ / Heberden's nodes

Epidemiology

Relatively rare

Average age 50

Men 4:1 Women

Usually dominant arm

Aetiology

Primary

- associated with strenuous manual labour

Secondary

- trauma

- OCD

- synovial chondromatosis

- valgus extension overload / MCL insufficiency

Epidemiology

1 in 10 patients with symptomatic knees have isolated PFJ OA

Aetiology

Obesity

Repetitive deep flexion

Malalignment

Lateral patella tightness

Blunt trauma

Symptoms

Anterior knee pain

- rising from chair

Definition

No accepted definition

Chronic joint disorder in which there is progressive softening and disintegration of articular cartilage

- accompanied by new growth of cartilage and bone at the joint margins

- these changes secondary to mechanical failure of hyaline cartilage

Essentially no inflammatory component

Classification

Primary 

Idiopathic

Definition

Body Fracture

- fracture line exits inferior surface behind lateral process

- into posterior facet

- intra-articular body fracture

Neck Fracture

- fracture line exits inferior surface anterior to lateral process

- in front of sinus tarsi

- extra-articular neck fracture

Types

1.  Shear

2.  Crush

3.  Posterior Process