classification

Burst Fractures

 

Definition

 

Burst fractures

- injury to anterior and middle columns +/- posterior column

 

Mechanism

 

Vertical compression

 

Epidemiology

 

10% cervical fractures

Most commonly C5/6

 

Pathology

 

Anterior & middle columns fail

- if severe, posterior ligament complex fails

Injury

Classification Leffert "OCRO"

 

I Open

 

II Closed

 

A  Supraclavicular 

- Preganglionic / Avulsion of Roots

- Postganglionic / Rupture of Trunks

 

B Infraclavicular

- cords & branches

 

C.  Post anaesthetic

 

III Radiation / Other

 

Tumour

Background

Aetiology

 

Intrinsic

- inflammatory

- degenerative

 

Extrinsic

- traumatic

- spur

 

Epidemiology

 

F > 40

 

Associations 60% of cases  

- hypertension

- diabetes

- obese

- trauma 

- prior surgery

- steroids

 

Background

Anatomy

 

3 facets

 

1.  Posterior facet (STJ)

2.  Middle facet (sustenaculum tali)

3.  Anterior facet (on distal medial aspect)

 

Anterior process 

- forms calcaneocuboid (CCJ) articulation

 

Thalamic portion 

- under lateral process talus

 

Tuberosities

 

Posterior tuberosity 

- posterior process / T Achilles attachment

 

Accessory Navicular

Incidence

 

1 - 2 %

 

Anatomy

 

Medial Aspect of foot

- proximal to navicular

- part of T posterior tendon

 

Usually will fuse with navicular (50%)

 

Issues

 

1.  Probably not a cause of flat foot

- excising accessory navicular / rerouting / reattaching tibialis posterior

- will not help pes planus

 

2.  Pain

- may fracture

Management Bone Defects

AORI / Andersen Orthopedic Research Institute

 

T Tibial  F Femoral

 

1.  Contained Metaphyseal Defect

 

2.  Damaged Metaphyseal

A.  One Condyle

B.  Both Condyles

 

3.  Deficient Metaphysis +/- collaterals +/- extensor mechanism

 

1.  Contained Metaphyseal defect 

 

Background

DefinitionKnee dislocation

 

Multi-ligament knee injury (MLKI)

- 2 or more ligaments disrupted

 

Knee dislocation

- ACL + PCL + one of collaterals 

 

Mechanism of injury

 

High energy (MVA)

 

Low energy (sport)

- low energy has 5% arterial injury

 

Bipartite Patella

Ossification

 

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

 

Classification Saupe

 

I   Inferior Pole 5%

II  Lateral 20%

Monteggia

Paediatric Monteggia APPaediatric Monteggia Lateral

 

Definition

 

Fracture / plastic malformation of proximal ulna with dislocation of radial head

 

Xray

 

Radio-capitellar line disrupted

 

Talar neck fractures

Epidemiology

 

Second most common  hindfoot after calcaneal fractures

 

Aetiology

 

Aviators Astragalus

 

Fall from height

- hyper-dorsiflexion injury

- neck of talus strikes the anterior tibia

 

Anatomy

 

More than half surface covered by articular cartilage

- medial articular wall straight

- lateral articular wall curves posteriorly