xray

Hoffa fracture

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

 

Usually lateral femoral condyle

 

March Fracture

 

Definition

 

Insufficiency fracture

- secondary to exceeding fatigue threshold

- usually of second or third MT shaft

 

Epidemiology

 

Onset of new and very intense / strenuous physical activity

- i.e. new army recruits / dancers

 

Women with postmenopausal osteoporosis

 

Association

 

Cavus feet

 

History

 

Osteoblastoma

Epidemiology

 

Uncommon

 

< 1% Primary bone tumour

 

Young boys

- second decade

 

Location

 

Similar to OO

 

Spine 30%

- especially posterior elements

 

Long bones 35%

 

Clinical

 

Back or limb pain

- pain less severe than OO

Brailsford Disease

Definition

 

Adult form

- 45 year old females

- more severe than Kohler's

 

Symptoms

 

Intense pain +/- oedema & inflammation

- often pronounced limp

- marked flat foot with prominant navicular

 

Radiology

 

Navicular narrowed

- lateral part dense, sclerotic & thin

- occasional fracture line

Background

Definition

 

Congenital Talipes Equinovarus

 

Congenital abnormality of the foot characterised by 

- hindfoot equinus & varus 

- forefoot Adduction

- midfoot Supination

 

Latin: talus - ankle / pes - foot / equinus - horse like

 

Clinical

 

Foot

- pipe stem calf

- short wide foot

- small heel

- curved lateral border

Background

DefinitionGarden 3 Displaced Subcapital

 

Fracture distal to articular surface & proximal to intertrochanteric region

 

Epidemiology

 

On average 4 years younger than intertrochanteric fracture

 

One year mortality as high as 36%

 

Only 1/3 will return to pre-fracture living environment

Perthes

Issues

 

Femur

 

Multiplanar deformity

- worsend by previous surgery

- may require osteotomy

 

Acetabulum

 

Dysplasia often present

- not as severe as in DDH

 

LLD

 

Can be significant

 

Abductors

 

Have been short for long time

- difficult to restore length

Crush Fractures

Definition

 

Minimal trauma fracture

- secondary to osteoporosis

- wedge fractures

 

Epidemiology

 

F > M

More common in elderly patients

 

Uncommon in men < 75

- look for alternative diagnosis

 

DDx

 

Renal failure

Malignancy - metastasis

Infection

 

Clinically

 

Can present with pain

Paget's Disease

Definition

 

Chronic, non metabolic bone disorder

Characterised by increased bone resorption, bone formation and remodelling

 

Epidemiology

 

Rare < 40

1 – 3 % population over 60

M > F

 

Aetiology

 

Unknown

 

Paramyxovirus implicated

- measles

- RSV

- canine distemper virus

 

Electron Microscope

Background

Definition

 

A fixed equinus deformity of the forefoot in relation to the hindfoot 

- resulting in an abnormally high arch that fails to flatten with weight bearing

- deformity may be forefoot, hindfoot or combination

 

Foot CavusFoot Cavovarus

 

Aetiology

 

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