Talar neck complications
AVN
Largely related to degree of displacement
Incidence
Hawkins Type I
- 0% to 13%
Hawkins Type II
- 20% to 50%
- usually only patchy and not a problem (rarely collapses)
natural history
Partial thickness tears
Clinical
Pain & Stiffness
- often more pain than FT tears
Bursal side tears more painful than articular
Articular side more common
May see in young patient overhead throwing
Examination
Painful arc
Impingement signs
No weakness
- function good
Ganglions
Epidemiology
Most common tumour of hand
F > M
2nd - 4th decade
Aetiology
Unknown
Trauma
Mucoid degeneration of collagen tissue
Synovial herniation
Location
Kienbock's disease
Definition
Avascular necrosis & subsequent disintegration of lunate
Aetiology
50-75% history of trauma
Occasionally seen in sickle cell / steroid use
Pathogenesis
Vascular Theory
Trauma disrupting vascularity
- single incident with disruption of blood supply
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
Management Options
NHx
Natural History of ACL deficient knee is variable
- functional instability 15% - 90%
- progression to OA is variable
Depends on level of patient demands / activity
1. Late meniscal injury in ACL deficient knee
15-25%
2. Function
Daniels Am J Sports Med 1994
- 292 ACL defecients knees
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
AVN
SONK vs Atraumatic AVN
>55 Often mid 30's
Aetiology & Classification
Definition
Idiopathic condition of the immature femoral capital epiphysis involving varying degrees of osteonecrosis
AKA
- Legg-Calve-Perthes disease
- coxa plana
Described in separate publications in 1912 by
- Legg (Boston)
- Calve (France)
- Perthes (Germany)
Epidemiology
M: F 4:1
1 in 740 males
Toe Walking
Epidemiology
70% male
70% positive FHx
20% learning difficulties
DDx toe walking
Early / late onset
Unilateral / bilateral
1. Habitual
Toddlers - child can heel walk
2. Structural
Fixed equinus - CTEV / arthrogryposis
Short / tight T Achilles
Space occupying lesion in calf