classification

Definition

Fracture of the pelvis caused by a low energy fall

Usually secondary to osteoporosis

Bleeding

Incidence of bleeding low unless on anticoagulation

Fracture pattern

Lateral compression injury

- pubic rami fracture

Indications

Osteoarthritis

Rheumatoid arthritis

Avascular necrosis

Epidemiology

Adolescent boys

Ossification

Proximal tibia / primary ossification centre

Tibial tuberosity / secondary ossification centre

- eventually merges with primary ossification centre

Ogden Classification

Type I - Tibial tuberosity ossification only

Definition

Bilateral Pars Fracture C2

- traumatic axis spondylolisthesis

NHx

Neurological injury uncommon

- fragments separate and decompress

Different to judicial hanging where spinal cord is severed

Xray

Definition

Burst fractures

- injury to anterior and middle columns +/- posterior column

Mechanism

Vertical compression

Epidemiology

10% cervical fractures

Most commonly C5/6

Pathology

Anterior & middle columns fail

- if severe, posterior ligament complex fails

Classification Leffert "OCRO"

I Open

II Closed

A  Supraclavicular 

- Preganglionic / Avulsion of Roots

- Postganglionic / Rupture of Trunks

B Infraclavicular

- cords & branches

C.  Post anaesthetic

III Radiation / Other

Tumour

Aetiology

Intrinsic

- inflammatory

- degenerative

Extrinsic

- traumatic

- spur

Epidemiology

F > 40

Associations 60% of cases  

- hypertension

- diabetes

- obese

- trauma 

- prior surgery

- steroids

Anatomy

3 facets

1.  Posterior facet (STJ)

2.  Middle facet (sustenaculum tali)

3.  Anterior facet (on distal medial aspect)

Anterior process 

- forms calcaneocuboid (CCJ) articulation

Thalamic portion 

- under lateral process talus

Tuberosities

Posterior tuberosity 

- posterior process / T Achilles attachment

Incidence

1 - 2 %

Anatomy

Medial Aspect of foot

- proximal to navicular

- part of T posterior tendon

Usually will fuse with navicular (50%)

Issues

1.  Probably not a cause of flat foot

- excising accessory navicular / rerouting / reattaching tibialis posterior

- will not help pes planus

2.  Pain

- may fracture