surgical options

Definition

Coronal plane fracture of distal femoral condyle

- intra-articular

- often only attachment is posterior capsule

Epidemiology

Rare

Mechanism

Usually a severe valgus trauma

Xray

Non-Operative

Education regarding shoe wear

- extra wide / large toe box

Insoles

- longitudinal arch support

- pre MT dome for metatarsalgia

- podiatry to attend to callosities

Toe spacers

Analgesia

Operative

Indications

1.  Continued pain and discomfort

2.  Difficulties with shoe wear

Non-operative Management

Natural history

Return to Sport

Shelbourne et al. Am J Sports Med 1999

- 133 patients with isolated PCL injuries followed for mean of 5 years

- 1/2 returned to sport at same level of play

- 1/3 returned to sport at lower level of play

https://pubmed.ncbi.nlm.nih.gov/10352760/

Agolley et al. Bone Joint J 2017

Definition

Fracture below lesser trochanter / proximal 5 cm femur

Aetiology

Young patients / high velocity injuries

Old patients / osteoporosis

Definition

Under-riding toe

- toe lies beneath adjacent toe

- congenital deformity

Pathology

Due to tight FDL & FDB

- capsule initially normal

- becomes constricted with time

Clinical

Usually 3rd toe

- flexed, ER, medially deviated

Deformity accentuated when standing

Ankle dorsiflexion

Background

The coronoid is the most important portion of ulno-humeral articulation

Reasons

1.  Provides anterior buttress

2.  Anterior capsule and brachialis attach to coronoid

2.  Anterior band of the MCL attaches to it

- distally and medially on sublime tubercle

Definitions

Massive tear 

1.  > 5cm 

- retracted to humerus / glenoid margin

2.  At least 2 complete tendons

- lose SS / IS or SS / SC

Classification

Rheumatoid Arthritis Diagnostic Criteria

1987 American College of Rheumatology 

Need 4/7 (MAX RANS)

1. Morning Stiffness

2. Arthritis of 3 areas > 6/52

3. Xray changes

4. Rh factor

5. Arthritis of Hand > 6/52

6. Nodules

7. Symmetric Arthritis > 6/52

NHx

Natural History of ACL deficient knee is variable

- functional instability 15% - 90%

- progression to OA is variable

Depends on level of patient demands / activity

1.  Late meniscal injury in ACL deficient knee

15-25%

2.  Function

Daniels Am J Sports Med 1994

- 292 ACL defecients knees

Definitions

Corn

- accumulation of keratotic layers of epidermis

- thickened epithelium elevates prominence causing further pressure

Hard Corn

Due to extrinsic pressure from footwear

- most common on lateral aspect of 5th toe

- over head of proximal phalanx

Soft Corns

- on the condyle of proximal phalanx between the toes