Exertional Compartment Syndrome
Definition
Increased pressure within a closed fibro-osseous space
Aetiology
Seen in athletes, associated with repetitive exertion
Anatomy
Leg
1. Anterior compartment
- anterior tibial artery
- deep peroneal nerve
aetiology
Background
Definition
Osteochondritis Dissecans
- separation of avascular fragment of bone & cartilage
Epidemiology
M : F = 2:1
Mean age 18 years
- can present as young as 9
4:1000
Discoid Meniscus
Definition
Round or "D" shaped rather than crescenteric meniscus
- occupies > 70% of tibial surface
- 90% occur on lateral side
Epidemiology
Uncommon
- 1:100
- usually presents in children & adolescents
Common Peroneal Nerve Palsy
Incidence
Most common lower limb neuropathy
Aetiology
Valgus TKR - 3%
HTO - 10%
Direct Trauma / Compression
Knee Dislocation
Tibial fracture
Cast / Dressing
Lateral Meniscus Repair
Protrusio
Definition
Migration of the femoral head past the medial wall of the acetabulum / ilioischial line
Centre edge angle > 40o
Aetiology
Primary
Otto's Disease
- bilateral in one third
- middle aged females
- pain & decreased ROM early
- coxa vara & OA common
- ? causally related to osteomalacia
Painful THA
Aetiology
Intrinsic
Infection
Loosening
Thigh pain in uncemented
- micro motion at distal end of stem
- modulus mismatch
Stress fracture / insufficiency fracture
- pubic rami, sacral
Intra-operative fracture
Prosthesis failure
Subtle instability
Extrinsic
Nerve Injury
Epidemiology
Primary THR 1%
Revision THR 3%
DDH 5%
Sciatic nerve 90% of nerve palsy
Other
- femoral nerve
- CPN
- ulna / radial nerve from positioning
Aetiology
Direct
Laceration
- exposure / sciatic and superior gluteal nerve
- drill reamer / obturator nerve
- spike of cement / obturator nerve
Lateral condyle fractures
Epidemiology
Average age 6 years
20% distal humeral fracture
- second most common elbow fracture after supracondylar
Mechanism
Pull Off
- more common
- fracture begins posterolateral metaphysis
- LCL, ECRL & ECRB attached to fragment
Push off
- varus force to extended EJ
Classification
Femoral Fractures
Aetiology
Varies per age group
Trauma
- 60%
Non Accidental Injury
- 15 - 30%
- suspect if non walker / < 1 year
- walking status single best indicator of risk
- paediatric team to investigate
- history taking from parent
- consider metabolic investigations
Syringomyelia
Definition
Progressive and chronic disorder associated with cord cavitation & gliosis
Effects
Muscle wasting
Dissociate anaesthesia
Scoliosis
Neuropathic arthropathy
Epidemiology
M > F
No familial tendency
Aetiology
1. Idiopathic