indications surgery

Medial Epicondyle

Ossification

Apophysis appears around 7 years

Ossifies age 16 years

Normal apophysis may be some distance from shaft

- rarely may be fragmented

Aetiology

Dislocation

Epidemiology

2 groups

1.  Elderly

- low velocity injury

- osteoporotic

- need to start bisphosphonates

2.  Young patients

- high velocity injury

Anatomy

Distal Radius Angles

- radial volar tilt 11°

- radial inclination  22°

- radius is 11 mm longer than ulna 

- ulna variance 2mm positive on average

Non operative Management

Indications

< 20^o sagittal

< 30^o coronal

< 3 cm of shortening

Options

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

NHx

Natural History of ACL deficient knee is variable

- functional instability 15% - 90%

- progression to OA is variable

Depends on level of patient demands / activity

1.  Late meniscal injury in ACL deficient knee

15-25%

2.  Function

Daniels Am J Sports Med 1994

- 292 ACL defecients knees