outcomes

Issues

Operative v Nonoperative

Levy et al Arthroscopy 2009

- systematic Review

- improved outcomes with operative management

https://pubmed.ncbi.nlm.nih.gov/19341932/

Vicenti et al. Injury 2019

- systematic review

- two studies compare operative v nonoperative

Distal Tibial Fractures

Definition

Metaphyseal

Extra-articular

Intra-articular Extension

Patella Baja

Aetiology

Congenital

Acquired

- trauma

- post ACL reconstruction / TKR

- chronic quadriceps rupture

Issues

Decreases ROM

Associated with early OA of the PFJ

Diagnosis

Blackburne-Peel ratio at 30 degrees flexion

Pathology

Children < 6

- entire distal humerus physis is displaced

Xray

Distal physis not ossified < 1 year

- may be a difficult diagnosis

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

Definition

Facet joint dislocations secondary flexion distraction injury

Epidemiology

10%

Stages

1. Unifacet subluxation - interspinous process widening

2. Unifacet dislocation - 25% anterolisthesis

3. Bifacet dislocation - 50% anterolisthesis

4. Complete vertebral translation - 100% anterolisthesis

Unilateral Facet Joint Dislocation

Definition

Present with pain but not instability

Types

Traumatic

Degenerative

Different treatment algorithms for each

History

Ulna side wrist pain

- may be worse with rotation

- opening doors and jars

History of trauma

Examination

Local tenderness DRUJ

Mechanism

1. Direct lateral blow to patella

- usually with knee partly flexed and quadriceps relaxed

2.  Indirect low energy injury

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