management

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

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

Pathology

Children < 6

- entire distal humerus physis is displaced

Xray

Distal physis not ossified < 1 year

- may be a difficult diagnosis

Definition

> 10 mg / dl

- must be corrected for albumin

Causes

Malignancy

- multiple myeloma / lung cancer / breast cancer

Hyperparathyroidism

- elevated PTH

Issue

High mortality associated with hypercalcaemia of malignancy

Physiology

40% albumin bound

50% ionised and active

Signs

Fall in level promotes tetanus

Chvostek sign

- tapping masseter muscle induces spasm

Trousseau Sign

-  flexion of thumb & wrist with extension of fingers

Carpopedal Spasm

ECG

Prolonged QT interval on ECG

Causes

1. Vit D Deficiency

Non operative 

Ponseti casting

Aims of treatment

1. Correct the deformity early

2. Correct it fully 

3. Hold the corrected position until foot stops growing

- AFO

- Denis Browne Boots

Timing

Start 1 - 3 weeks

- let parents settle and get used to diagnosis

- explain method and length of treatment required

Incidence

Decreasing incidence in recent decades most likely attributable to preoperative antibiotics

Risk 

Conventional discectomy </= 1%

Fusion 2%

Fusion & instrumentation 5-6%

Instrumentation doubles infection rate in lumbar fusion

Risk factors 

Diabetes 

Epidemiology

Most common pattern cord injury

Hyper-extension injury in middle aged man with osteoarthritic spine

Usually C3/4 and C4/5

Mechanism

Most common type / in older patient with pre-existing spondylosis / OPLL

- hyperextension injury

- compression of the cord

- anteriorly by osteophytes

- posteriorly by infolded ligamentum flavum

Definition

Bilateral Pars Fracture C2

- traumatic axis spondylolisthesis

NHx

Neurological injury uncommon

- fragments separate and decompress

Different to judicial hanging where spinal cord is severed

Xray

Epidemiology

Rare

- unilateral

- bilateral

Mechanism

Compression

Lateral Compression

Rotation

Clinical

Skull base pain

Cock Robin

Cranial nerve injury

Classification Anderson & Montesano

Type I

Impaction of a condyle