operative

Distal biceps tendon rupture

Epidemiology

 

Dominant arm of middle aged men

- between 40 and 60

 

Aetiology

 

Sudden dramatic event

- sporting / weightlifting injury

- resisting heavy extension load

 

Pathology

 

Degenerative changes seen on histology

 

Types

 

Complete

- retracted / rupture of lacertus fibrosis

- minimally retracted

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

 

Forearm fractures

Ossification

 

Primary

- 8 / 52 gestation radius & ulna

 

Secondary

- distal radius age 1

- distal ulna age 5

 

Non Operative Management

 

Unacceptable Position

 

< 10:  > 15o malalignment

> 10:  > 10o malalignment

 

Postreduction Positionin / Rule of Thirds 

 

Tibial shaft fractures

Displaced Tibial Shaft Fractures

 

Acceptable reduction

- varus / valgus < 5o

- anterior / posterior < 5o

- rotation 5o

- shortening 10 mm

 

Poor remodelling potential

- valgus 

- apex posterior angulation  / recurvatum

- rotational alignment does not remodel

- shortening / in 2-10 year old average overgrowth is only 5mm

 

Coxa Vara

Definition

 

Deformity of proximal femur with neck-shaft angle <125°

 

Characterised by

- coxa vara

- decreased femoral anteversion

- limp / trendelenberg

- stress fractures

- early OA

 

Classification   

 

"ACDDC"

 

Acquired

 

2° to underlying disorder

- rickets

Metatarsus Adductus

Definition

 

Metatarsus varus

- adduction of the forefoot at the TMTJ

 

Intrauterine positional deformity / packaging defect

 

Epidemiology

 

1:1000

- M = F 

- bilateral in 50%

- 10% have CDH

 

Aetiology

 

Unclear

 

Theories

- intrauterine positioning defect

- prone nursing

 

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