osteoarthritis
Background
Epidemiology
Much less common than hip and knee OA
Patients tend to be younger
Isolated STT OA
Definition
OA of the scapho-trapezium-trapezoidal joints
Epidemiology
50% patients with CMC OA have STT OA
F > M
Xray
Management
Management Options
Non-operative Management
Natural history
Return to Sport
Shelbourne et al. Am J Sports Med 1999
- 133 patients with isolated PCL injuries followed for mean of 5 years
- 1/2 returned to sport at same level of play
- 1/3 returned to sport at lower level of play
https://pubmed.ncbi.nlm.nih.gov/10352760/
Agolley et al. Bone Joint J 2017
Management
Acute management
Resuscitation
EMST
Neurovascular assessment
Investigations - exclude Pipkin, NOF
Emergent reduction / skeletal stabilisation
Assess stability
Re-evaluate sciatic nerve
Insertion Femoral Steinman Pin
Indications
- displaced acetabular fracture
Tibial Plateau
Schatzker Classification
I. Lateral Spilt
- seen in young patient
- lateral meniscus can be incarcerated in fracture
II. Lateral Split Depression
- often seen in young patients with high energy injuries
- vary in severity
Latarjet / Bristow
Bristow
Concept
Non-anatomical bony block
- transfer of coracoid process through subscapularis
- dynamic anteroinferior musculotendinous sling
- provides subscapularis tenodesis
- preventing lower portion from displacing proximally as arm abducted
- when shoulder in vulnerable position abduction and ER
Management
Deformity
Varus / extension / external rotation
Options
Intertrochanteric
Base of Neck
Subcapital
Osteotomy
Valgus / flexion / internal rotation
Intertrochanteric / Southwick
Technique
- biplanar
- valgising / flexion / internal rotation
Background
Definition
Displacement of proximal femoral epiphysis in the immature hip
- due to imbalance of mechanical and endocrine factors
Epidemiology
Age Peak Incidence : M 12-14; F 11-13; Slight downward trend due to earlier maturation of children
L hip > R
10 / 100 000
Bilateral SUFE
No endocrine abnormality
- 20% at time of of diagnosis
- another 20% during diagnosis
- up to 60% with long term follow up