Diaphyseal Aclasis / Multiple Osteochondromas
Heritable skeletal dysplasia
AD with variable penetrance (96%)
Incidence of malignant transformation much higher
- 10% overall
- 1 % / year
Chondrosarcoma (CS) > Osteosarcoma (OS)
Sartorius
Rectus femoris
Athletic / high impact exercises
First described in ballet dancers (Burrows 1956)
- tension side of bone / lateral side
- progression to complete fracture has been well documented in athletes
Point tenderness
- lateral aspect of tibia
Over time develop bony lump
Most common long bone fracture
Young patients / sports
Elderly / simple falls
MVA - often compound
Grade 0
- nil ST injury
Grade 1
Fracture which extends between the trochanters of the proximal femur
- lower limit is inferior border of lesser tuberosity
Extra capsular / well vascularized
The key to stability is the posteromedial cortex
Most common site for skeletal TB
- usually haematogenous spread
- can be direct from lung
1. Peridiscal (50%) - originating in metaphyseal region
2. Central - high incidence of vertebral collapse
3. Anterior - instability less common with less bony destruction
Affects multiple contiguous vertebrae
Period of pain relief after disc surgery
- followed by increasing back pain & occasional leg pain
Pain may be disproportionate to physical findings
Low grade fever common
SLR & femoral stretch tests elicit pain in some cases
Good initial results but unacceptably high failure rate with longer follow-up
Problems
1. Too stiff (low ultimate strain)
- poor resistance to abrasion
- ligament failure by attrition most common
2. Recurrent synovitis, infection, loosening and osteolysis
OCD
OA - Osteophytes
Meniscus
Pain
Locking
Clicking
Can cause chondral damage
OA Loose Bodies
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%