Under-riding toe
- toe lies beneath adjacent toe
- congenital deformity
Due to tight FDL & FDB
- capsule initially normal
- becomes constricted with time
Usually 3rd toe
- flexed, ER, medially deviated
Deformity accentuated when standing
Ankle dorsiflexion
Hyperextension of MTPJ and PIPJ / DIPJ flexion
- usually all toes affected
1. Complex hammer
- hammer toe with MTPJ extension
- hammer usually affects second toe
2. Curly toe
Disorder of immune system
- antigen-antibody complexes
- stimulate release of proteolytic enzymes
- leading to vasculitis, synovitis and cartilage destruction
Articular Effects
- synovitis
- ligamentous and capsular laxity
- cartilage destruction
- osseous erosion
Vasculitis
- rheumatoid nodules
Paronychia is skin around nail plate
Eponychia is skin covering base of nail plate
1. Due to foreign material between nail plate and paronychium
2. By hang nail traumatising paronychium
Acute
- typically polymicrobial
- aerobes and anaerobes
Intra-articular proximal ulna fracture
Articulates with trochlea
- may have a central bare area
Triceps insertion
- via broad aponeurosis which blends with anconeus and CEO
Undisplaced fracture
- need to ensure triceps mechanism is intact
Osteochondritis Dissecans
- separation of avascular fragment of bone & cartilage
M : F = 2:1
Mean age 18 years
- can present as young as 9
4:1000
Round or "D" shaped rather than crescenteric meniscus
- occupies > 70% of tibial surface
- 90% occur on lateral side
Uncommon
- 1:100
- usually presents in children & adolescents
The perpendicular distance from the centre of the femoral head to the long axis of the femur
Harris 1992
- aim for supra-physiologic offset
- avoid making offset less than original at all costs & makes longer if possible
Soft tissue balancing equals restoring femoral offset
1. Abductor lurch / Trendelenburg gait
Migration of the femoral head past the medial wall of the acetabulum / ilioischial line
Centre edge angle > 40o
Primary
Otto's Disease
- bilateral in one third
- middle aged females
- pain & decreased ROM early
- coxa vara & OA common
- ? causally related to osteomalacia
Extraskeletal bone formation in periarticular tissues
- HA crystals within osteoid matrix
Different to calcification
- osteoid matrix laid down
1. Myositis Ossificans
- post traumatic