surgery

Periosteal Osteosarcoma

 

Definition

 

Intermediate grade chondroblastic osteosarcoma arising from surface of long bones

 

Epidemiology

 

Extremely rare

- 1% of all osteosarcomas

- 25% of surface osteosarcomas

 

Age 15-25

 

Location

 

Typically anterior proximal tibia

- diaphysis of major long bones

- humerus

 

Pathology

 

Greater trochanter pain syndrome

Greater trochanteric pain syndrome

 

Definition

 

Chronic lateral trochanteric pain

- abductor tendon tendonitis

- trochanteric bursitis

 

Epidemiology

 

Women 40 - 60 years old

 

Mechanism

 

? repetitive friction of iliotibial tract over GT

 

Symptoms

 

Pain over upper lateral thigh with activity

- often related to hip flexion

 

Facet Joint Dislocation

Definition

 

Facet joint dislocations secondary flexion distraction injury

 

Epidemiology

 

10%

 

Stages

 

1. Unifacet subluxation - interspinous process widening

2. Unifacet dislocation - 25% anterolisthesis

3. Bifacet dislocation - 50% anterolisthesis

4. Complete vertebral translation - 100% anterolisthesis

 

Unilateral Facet Joint Dislocation

 

TSA Technique

TSR APTSR Lateral

 

Goal

- head that translates 50% in all directions

- allows 30o ER with arm at side

- stable posteriorly

 

Pre-Op 

- antibiotics

- consider specific Propionobacterium cover

Surgery

Indications 

 

1. Significant functional impairment

 

2. PIPJ contracture

- originally thought to intervene early

- Macfarlane showed residual FFD always about 30o

- may need to release  check rein ligaments / accessory collateral ligaments

 

3. MCPJ contracture >30o

 

4. Trigger fingers

- must do limited fasciectomy 

Management Intra-articular Fractures

Operative v Nonoperative Literature

 

1.  Buckley etal JBJS Am 2002

 

Prospective multi-centred RCT

- 309 displaced intra-articular fractures

- operative v non operative management

- 2 year follow up

 

Findings

- used patient orientated functional outcomes

- overall VAS and SF36 not significantly different between 2 groups

 

Improved Operative Outcome if

- not workers compensation

- women

- < 29

Heterotopic ossification

Definition

 

Pathological bone formation in soft tissues

 

Epidemiology

 

In elbow

- 3% of trauma

- 89% if head injury + trauma

 

Types

 

Completely different

 

1.  Myosisitis Ossificans Circumscripta

- post traumatic

- more common

- recognised as a consequence of neurological injury

 

Synovial Chondromatosis

DefinitionSynovial Chondromatosis Knee MRI

 

Chondroid Metaplasia of synovium affecting large joints

 

Nodules of hyaline cartilage

- formed in the subsynovial layer of joint capsules

 

Epidemiology

 

Rare lesion

Most common in 20's and 30's

Sex: M > F (2:1)

Monoarticular

 

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