2 groups
- young patient with high velocity injury
- older patient with comminuted, osteoporotic fracture
In the second group fixation can be very difficult
Hinged Joint
- trochlea axis is centre of rotation
- 40o anterior angulation in sagittal plane
RA
- very good results
- 97% 10 year survival Coonrad-Morrey prosthesis
Other Dx
- OA / post-traumatic arthritis / nonunion
- tend to have worse survival than RA
Haemophilia
- elbow joint commonly involved
- 90% of haemophiliacs
Acute unreconstructable fracture > 60
Pain relief combined with a balanced range of motion, strength & stability
Painful arthritic knee
- OA
- RA
Functional limitation
Ideal Patient
- > 65
- thin
Migration of the femoral head past the medial wall of the acetabulum / ilioischial line
Centre edge angle > 40o
Primary
Otto's Disease
- bilateral in one third
- middle aged females
- pain & decreased ROM early
- coxa vara & OA common
- ? causally related to osteomalacia
FOOSH
Age 6 as maximum ligamentous laxity
- < 4 - physeal separation
- > 8 - dislocation
Male > F
Supracondylar region in 6 year old is thin
- thinnest at olecranon fossa (2-3 mm)
Varies per age group
Trauma
- 60%
Non Accidental Injury
- 15 - 30%
- suspect if non walker / < 1 year
- walking status single best indicator of risk
- paediatric team to investigate
- history taking from parent
- consider metabolic investigations
Jacques LisFranc De St-Martin (1790 - 1847)
General Surgeon in Napoleonic army
High energy
1. Twisting / Abduction injury of forefoot
- original description is fall from horse with foot caught in stirrups
- MVA
2. Axial Loading
Chronic instability due to rupture of one or more parts of the lateral ligament
Progressive injury
1. Anterolateral capsule
2. ATFL
3. CFL
Can lead to ankle OA over time
