operative

 Scapular process fractures

Types

Coracoid process

Scapula spine

Acromial fractures

LC-1:  pubic rami fracture with sacral fracture

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

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

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

Rockerbottom foot / Persian Slipper Foot

Epidemiology

Uncommon

50% bilateral

Doesn't delay walking

- may present in toddler with callus under talus head

Associations

Congenital anomalies

- CNS disorders

- spina bifida & diastematomyelia ~10%

- arthrogryposis

- neurofibromatosis 

Mechanism

1. Direct lateral blow to patella

- usually with knee partly flexed and quadriceps relaxed

2.  Indirect low energy injury

Epidemiology

Young men

Aetiology

FOOSH

- axial load, dorsiflexion and radial deviation

DISI occurs in ulna deviation

Herbert Classification

Type A    Stable acute fracture

A1 Tubercle

Epidemiology

Most common tumour of hand

F > M

2nd - 4th decade

Aetiology 

Unknown 

Trauma

Mucoid degeneration of collagen tissue

Synovial herniation

Location