incidence

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

Definition

Tibial facture with break in skin

- open wound communicating with fracture or haematoma

Patient is immediately at higher risk of deep infection

Diagnosis

Wound continuously oozes dark red fracture haematoma

Epidemiology

Up to 1/4 of tibia fractures open

Gustilo and Anderson Classification

Grade 1

- wound < 1cm

- usually inside out

Incidence

10%

Requirements

70^o  swing phase

80^o climb up stairs

90^o climb down stairs + sit down in chair

100^o low chair

NHx

Stiffness usually subsides at 6-8/52

- generally improves out to 3/12

- slow improvement for up to next 9/12

Arterial injury

Incidence

0.05%

Types

1. Thrombosis

- most common scenario

- tourniquet with atherosclerosis

- indirect damage to vessel

- femoral or popliteal

2.  Embolisation

- atherosclerosis again

- blue toes syndrome post operatively

3.  Vessel transection

Incidence

Knee > Hip

- superficial position

- limited cover of well vascularised muscle 

- watershed area of skin blood supply anterior to the skin incision 

- much increased in fully constrained prosthesis 

Ideal < 1%

Risk Factors

Increased with

- revision

- prior infection

- RA / Psoriatic arthropathy

- DM

Incidence

Young men

Posterior / Anterior 9:1

Aetiology

High velocity injury

- head direction at impact decides direction of dislocation

Anterior Dislocation 

Externally rotated & abducted leg

- flexion = inferior dislocation

Definition

CP is a permanent disorder of movement and posture 

- non-progressive 

- brain injury before the age of two years

Strict definition excludes familial & progressive congenital problems & those acquired in childhood as a result of head injuries

Incidence

2-3 per 1000 live births

Higher in 

Incidence

Up to 8% patients with ACL reconstruction will have recurrent instability and graft failure

- increased with surgical inexperience

Graft can

1.  Be inadequate from the start

- inadequate tension

- poor tunnel placement

Pathogenesis

Virchow's Triad

1. Venous stasis

2. Hypercoagulability

3. Endothelial damage

Starts as platelet nidus at valves

- thrombogenic materials elaborated by platelets

- leads to development of fibrin thrombus

- thrombus grows

Thrombus may 

- detach as embolus

- be completely dissolved / recanalise

- organise with valve incompetence