management

Anatomy

Radial bow radius

- important for rotation

Interosseous membrane

- Z pattern

- proximal radius to distal ulna

Mechanism

Direct blow

- ulna / night stick

Epidemiology

Usually occurs in young people

- often previous history of tendonitis ± steroid injections

Location

Usually at level of inferior pole of patella

- less common at tibial tubercle

- mid-substance ruptures rare

Clinical

Severe pain

Palpable defect

Extensor deficit / unable to SLR

Xray

Patella alta / high riding patella

Definition

Increased pressure within a closed fibro-osseous space

Aetiology

Seen in athletes, associated with repetitive exertion

Anatomy

Leg

1.  Anterior compartment

- anterior tibial artery

- deep peroneal nerve

Epidemiology

Most common in lateral meniscus 9:1

Peak incidence 20-40

Aetiology

Probably 2° to infiltration of joint fluid into extra-articular tissues

- almost always associated with horizontal cleavage tear

- creates a flap valve in lateral 1/3 of LM

Symptoms

Usually present with pain

- activity related

May notice lump

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

Anatomy

1. Seebacher's 3 layers of the medial knee

Layer 1

- sartorius and sartorius fascia

Layer 2

- superficial MCL

- posterior oblique ligament

- semimembranosus

Layer 3

- deep MCL (meniscofemoral and meniscotibial ligament)

- posteromedial capsule 

2. MCL

Superficial MCL

Issue

Most common reason for litigation against orthopaedic surgeons in THR

Usually from lengthening

Complications of LLD

1.  Nerve palsy

Sciatic nerve - tolerate average 4.4cm lengthening

Common peroneal nerve - tolerate average 2.7 cm lengthening

Lengthen by up to 15-20% of the resting nerve length

- but in reality is unknown and multifactorial

Incidence

2-3% of cases 

- doubles with infrequent operator

- second most common reason for revision after loosening

Australian Joint Registry

- dislocation accounts for 14.8% of revisions

Positions

Posterior dislocation

- hip flexed, adducted, IR

Mechanism

FOOSH

Epidemiology

Age 6 as maximum ligamentous laxity

- < 4 - physeal separation

- > 8 - dislocation

Male > F

Pathoanatomy

Supracondylar region in 6 year old is thin

- thinnest at olecranon fossa (2-3 mm)

Types

Age 0 - 5

- Salter Harris I

Age 5 - 11

- Salter Harris II

III / IV rare

Issues

Great remodelling potential

- 80% growth of humerus from proximal physis

Shoulder ROM compensatory

Age

- even older adolescents do well