definition

Hoffa fracture

Definition

 

Coronal plane fracture of distal femoral condyle

- intra-articular

- often only attachment is posterior capsule

 

Epidemiology

 

Rare

 

Mechanism

 

Usually a severe valgus trauma

 

Xray

 

Usually lateral femoral condyle

 

March Fracture

 

Definition

 

Insufficiency fracture

- secondary to exceeding fatigue threshold

- usually of second or third MT shaft

 

Epidemiology

 

Onset of new and very intense / strenuous physical activity

- i.e. new army recruits / dancers

 

Women with postmenopausal osteoporosis

 

Association

 

Cavus feet

 

History

 

Brailsford Disease

Definition

 

Adult form

- 45 year old females

- more severe than Kohler's

 

Symptoms

 

Intense pain +/- oedema & inflammation

- often pronounced limp

- marked flat foot with prominant navicular

 

Radiology

 

Navicular narrowed

- lateral part dense, sclerotic & thin

- occasional fracture line

Postero-Medial Corner Injury

Anatomy

 

Layers of the medial knee

 

Layer 1

- sartorius and sartorius fascia

 

Layer 2

- superficial MCL

- posterior oblique ligament

 

Layer 3

- deep MCL (meniscofemoral and meniscotibial ligament)

- posteromedial capsule 

 

MCL

 

Origin

- 3 mm proximal and 5 mm posterior to the epicondyle

 

Congenital Vertical Talus

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 

Background

DefinitionGarden 3 Displaced Subcapital

 

Fracture distal to articular surface & proximal to intertrochanteric region

 

Epidemiology

 

On average 4 years younger than intertrochanteric fracture

 

One year mortality as high as 36%

 

Only 1/3 will return to pre-fracture living environment

Morton's Neuroma

Definition

 

Benign enlargement of the common digital branch

- usually 3rd webspace

 

Mortons Neuroma Common Site

 

Anatomy

 

Found at level of or just distal to MT heads

- deep to the deep transverse MT ligament

 

Epidemiology

 

Classically women between 40 and 60

Crush Fractures

Definition

 

Minimal trauma fracture

- secondary to osteoporosis

- wedge fractures

 

Epidemiology

 

F > M

More common in elderly patients

 

Uncommon in men < 75

- look for alternative diagnosis

 

DDx

 

Renal failure

Malignancy - metastasis

Infection

 

Clinically

 

Can present with pain

Whiplash

Definition

 

Isolated posterior ligament injuries

- PLL / Posterior interspinous ligament / Paraspinal muscles

 

Excludes fracture / dislocation / HNP

 

Aetiology

 

MVA

Sport

Hyperflexion injuries

 

Symptoms

 

Large spectrum clinical presentation

- neck ache 

- nausea & vomiting 

- headache 

- visual symptoms

Non Union

Definition

 

Non-union

- arrest of progression to union at fracture site 

- > 6-9 /12

- no visible progressive signs of healing for at least three consecutive months

- individualise for each fracture

- when the surgeon believes the fracture has little or no chance to heal

 

Delayed union

- failure of fracture to unite within expected time

- still may spontaneously unite

 

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