malunion

Distal Tibial Fractures

Definition

Metaphyseal

Extra-articular

Intra-articular Extension

Mechanism

Direct blow

- most common

Indirect

- forced knee flexion with foot fixed / maximally contracted quadriceps

Types

1.  Vertical

2.  Transverse

Schatzker Classification

I.  Lateral Spilt 

- seen in young patient

- lateral meniscus can be incarcerated in fracture

II.  Lateral Split Depression

- often seen in young patients with high energy injuries

- vary in severity

Definition

Fracture which extends between the trochanters of the proximal femur

- lower limit is inferior border of lesser tuberosity

Anatomy

Extra capsular / well vascularized

The key to stability is the posteromedial cortex

AVN  

Largely related to degree of displacement

Incidence

Hawkins Type I

- 0% to 13% 

Hawkins Type II 

- 20% to 50% 

- usually only patchy and not a problem (rarely collapses)

Biomechanics

Able to achieve relatively high level of function after STJ fusion

- previously believed that isolated STJ fusion should not be performed

- believed that triple arthrodesis was operation of choice for hindfoot

- STJ fusion has superior result with less stress on AJ

Average loss of DF 30% / PF 10%

Position of hindfoot determines flexibility of transverse tarsal (CCJ & TNJ) joints

- imperative that fusion be positioned in ~ 5^o valgus 

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

Anatomy

Radial bow radius

- important for rotation

Interosseous membrane

- Z pattern

- proximal radius to distal ulna

Mechanism

Direct blow

- ulna / night stick

Meyers & McKeever classification

Type I:   Undisplaced avulsion fracture

Type II:  Anterior portion displaced & hinged

Type IIIA:   Displaced

Type IIIB:   Displaced & Rotated