surgery

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

Definition

Benign enlargement of the common digital branch

- usually 3rd webspace

Anatomy

Found at level of or just distal to MT heads

- deep to the deep transverse MT ligament

Epidemiology

Classically women between 40 and 60

Epidemiology

Uncommon

- dancers

- athletes

Aetiology

Hyperdorsiflexion of the MTPJ

Pathology

MT head dislocates plantar

- may buttonhole through capsule

- can prevent closed reduction

Blocks to Reduction

1.  Sesamoids

2.  Conjoint tendon

3.  Intersesamoid Ligament

Goal

- head that translates 50% in all directions

- allows 30^o ER with arm at side

- stable posteriorly

Pre-Op 

- antibiotics

- consider specific Propionobacterium cover

Indications 

1. Significant functional impairment

2. PIPJ contracture

- originally thought to intervene early

- Macfarlane showed residual FFD always about 30^o

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

3. MCPJ contracture >30^o

4. Trigger fingers

- must do limited fasciectomy 

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

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

Definition

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

Site

Epidemiology

Young men in 20's and 30's

Aetiology

High energy injuries

- fall from heights

- MVA

Mayfield Classification

Injury progresses from radial to ulna

- usually disruption proximal row either side of lunate

1.  Capitate usually displaces dorsally initially

- volar lunate dislocation is end stage

Ossification

Patella may develop from one or multiple ossification centres at 3 years

Failure of centres to fuse may produce bipartite or tripartite patella

- usually bilateral and painless

Classically superolateral

Classification Saupe

I   Inferior Pole 5%

II  Lateral 20%