Articular process fractures
Natural history
Superior articular process fracture
- potentially unstable
Inferior articular process fracture
- thought to be more stable
CT scan
Superior articular process fracture
- potentially unstable
Inferior articular process fracture
- thought to be more stable
RA
OA
AVN
Usually after 50-60 years of age
Primary 90% of cases
Secondary
- AVN
- trauma
- instability
Athletes with increase activity / distance
Women with eating disorders / amenorrhea
Compression / inferior neck
- < 50% protective weight bear
- > 50% emergent ORIF
Tension side / superior neck
- emergent ORIF
1. Capsular avulsions
2. Body / Nutcracker fracture
Epidemiology
- rare
Mechanism
- forced eversion / abduction of forefoot
- cuboid crushed between 4th and 5th MT and calaneum
Pathology
- displaced cuboid fracture with subluxation of tarsus
Coronal plane fracture of distal femoral condyle
- intra-articular
- often only attachment is posterior capsule
Rare
Usually a severe valgus trauma
Uncommon
< 1% Primary bone tumour
Young boys
- second decade
Similar to OO
Spine 30%
- especially posterior elements
Long bones 35%
Back or limb pain
- pain less severe than OO
Fracture distal to articular surface & proximal to intertrochanteric region
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