infection

Observation

Curves < 20^o observation only at 3-6 month intervals depending on growth rate 

Non Operative Management / Bracing 

Never brace curves if patient Risser 4 or 5 

Indications

1.  Risser 0-2 (growth potential)

2.  Curve >30^o adolescent

3.  Curve >25^o with progression (5^o in six months)

Definition

Fracture which extends between the trochanters of the proximal femur

- lower limit is inferior border of lesser tuberosity

Anatomy

Extra capsular / well vascularized

The key to stability is the posteromedial cortex

Intraoperative glenoid fracture

Avoid by

- careful reaming and drilling osteoporotic bone

Management

1.  Rotate metaglene

- use locking screws to stabilise glenoid

2.  PA screws

- cannulated 4.0 mm screws

- inserted percutaneously from posterior

Haematomas

Great deal of dead space is created

- always use a drain

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

Incidence

Metaphyseal > physeal / SH2

Aetiology

FOOSH

Operative Management

Indications

Visible deformity

> 20^o angulation

Options

MUA

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)

Mechanism

Usually a direct blow 

- less commonly a fall on the outstretched hand

RTA / sporting accidents commonest causes

Can be pathological as a result of radionecrosis

- eg following radiotherapy for breast cancer.  

Incidence

Fractures of the clavicle are common

Anatomy

Radial bow radius

- important for rotation

Interosseous membrane

- Z pattern

- proximal radius to distal ulna

Mechanism

Direct blow

- ulna / night stick

Indications

RA 

- very good results

- 97% 10 year survival Coonrad-Morrey prosthesis

Other Dx 

- OA / post-traumatic arthritis / nonunion

- tend to have worse survival than RA

Haemophilia

- elbow joint commonly involved

- 90% of haemophiliacs

Acute unreconstructable fracture > 60