Young men in 20's and 30's
High energy injuries
- fall from heights
- MVA
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
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
I Inferior Pole 5%
II Lateral 20%
90% respond
- very important
- 6 - 12 months minimum before offering surgery
1. Stretches
- quads stretches
- ITB
- lateral retinaculum
Most common
- fascia lata on greater trochanter
- iliopsoas on lesser trochanter
1. Intra-articular structures
- labrum
- ligamentum Teres
- loose bodies
- synovial chondromatosis
- osteochondoma
2. Extra-articular structures
- fascia lata on greater trochanter (common)
Variable
- may be up to 50% retear over time
- many asymptomatic
Apophysis appears around 7 years
Ossifies age 16 years
Normal apophysis may be some distance from shaft
- rarely may be fragmented
Dislocation
Paronychia is skin around nail plate
Eponychia is skin covering base of nail plate
1. Due to foreign material between nail plate and paronychium
2. By hang nail traumatising paronychium
Acute
- typically polymicrobial
- aerobes and anaerobes
Stenosing tenosynovitis of the first dorsal compartment of wrist
Most are middle aged women
Repetitive thumb movements
- abduction & extension
- combined with RD & UD movements
Any mechanical irritation
- foreign body
- prominent bony surface
- restricted fascial compartment
Dorsal Intercalated Segmental Instability / CID
Scapholunate joint
- C shaped
- 2-3 mm thick dorsally with transverse fibres
- thin palmar
Dorsal extrinsic ligaments
- V shaped, onto trapezium
Elderly population
Less common in younger population
Type I
Fracture lateral to the CC ligaments
- does not extend into the ACJ
- non displaced
- most common 4:1