fracture

Distal Tibial Fractures

Definition

Metaphyseal

Extra-articular

Intra-articular Extension

Ossification

3 - 5 years old

Management

Undisplaced

- manage in plaster in extension

Displaced > 3 mm

- ORIF

Patella sleeve fracture

- usually small inferior fragment seen on xray

- patella high riding on xray / alta

- is actually large cartilaginous fragment avulsed with retinaculum

- can be osteochondral

Issues

Femur

Multiplanar deformity

- worsend by previous surgery

- may require osteotomy

Acetabulum

Dysplasia often present

- not as severe as in DDH

LLD

Can be significant

Abductors

Have been short for long time

- difficult to restore length

Definition

Chronic, non metabolic bone disorder

Characterised by increased bone resorption, bone formation and remodelling

Epidemiology

Rare < 40

1 – 3 % population over 60

M > F

Aetiology

Unknown

Paramyxovirus implicated

- measles

- RSV

- canine distemper virus

Electron Microscope

Mechanism

Direct blow

- most common

Indirect

- forced knee flexion with foot fixed / maximally contracted quadriceps

Types

1.  Vertical

2.  Transverse

Position

- patient supine on radiolucent table

- place ECG lead and artery clip over centre of femoral head

- useful to put II ipsilateral to leg, and place knee on cassette

Epidemiology

Athletic / high impact exercises

Aetiology

First described in ballet dancers (Burrows 1956)

- tension side of bone / lateral side

- progression to complete fracture has been well documented in athletes

Signs

Point tenderness

- lateral aspect of tibia

Over time develop bony lump

Definition

Fracture which extends between the trochanters of the proximal femur

- lower limit is inferior border of lesser tuberosity

Anatomy

Extra capsular / well vascularized

The key to stability is the posteromedial cortex

Epidemiology

Young men in 20's and 30's

Aetiology

High energy injuries

- fall from heights

- MVA

Mayfield Classification

Injury progresses from radial to ulna

- usually disruption proximal row either side of lunate

1.  Capitate usually displaces dorsally initially

- volar lunate dislocation is end stage