xray

Definition

Humeral Avulsion of Glenohumeral Ligament

Incidence

Bokor et al JBJS Br 1999

- 514 cases surgical treatment traumatic instability

- incidence 7.5%

- 25% associated SSC tear

- likelihood of HAGL if no Bankart or MDI 27%

Atypical Femur Fractures

Site

Subtrochanteric

Lateral femoral shaft

Aetiology

Stress fractures

Associated with long term bisphonate use

Bisphosphonates

Black et al. NEJM 2020

- reduction of hip fracture risk v risk of atypical femur fracture

- 10 year period

Definition

Self limiting syndrome of unknown aetiology

- hip pain associated with osteoporosis of proximal femur 

DDx

AVN

- AVN of the hip in pregnancy is rare but possible

- TOH tends to be diffuse on MRI, while AVN is localised

- extends to neck and metaphysis

- transient osteoporosis has normal bone scan

Incidence

Rare

- M: F 3:1

Definition

Non-traumatic or traumatic condition of femoral head with bone death

Epidemiology

20 - 50 yo (average 38)

- M: F 4:1

NHx  

70-80% with AVN will progress within 1 year

AVN  

Largely related to degree of displacement

Incidence

Hawkins Type I

- 0% to 13% 

Hawkins Type II 

- 20% to 50% 

- usually only patchy and not a problem (rarely collapses)

Definition 

Disorder of immune system 

- antigen-antibody complexes

- stimulate release of proteolytic enzymes

- leading to vasculitis, synovitis and cartilage destruction

Characterised

Articular Effects

- synovitis

- ligamentous and capsular laxity

- cartilage destruction

- osseous erosion

Vasculitis

- rheumatoid nodules

Symptoms

Complain of pain with prolonged standing

Complain feet tire easily

Examination

Overall alignment

Heel raises

Epidemiology

Young men

Aetiology

FOOSH

- axial load, dorsiflexion and radial deviation

DISI occurs in ulna deviation

Herbert Classification

Type A    Stable acute fracture

A1 Tubercle

NHx

Convincing association with development of osteoarthritis

- arthritic changes beginning at radial styloid

- progress to scaphocapitate & capitolunate 

Types

Dorsal

- most common

Volar

Causes

1.  Acute traumatic peripheral tear TFCC with DRUJ dislocation

- usually major trauma

- dorsal or volar

2A.  Distal radial fracture