Operative v Nonoperative
Levy et al Arthroscopy 2009
- systematic Review
- improved outcomes with operative management
https://pubmed.ncbi.nlm.nih.gov/19341932/
Vicenti et al. Injury 2019
- systematic review
- two studies compare operative v nonoperative
Athletes with increase activity / distance
Women with eating disorders / amenorrhea
Compression / inferior neck
- < 50% protective weight bear
- > 50% emergent ORIF
Tension side / superior neck
- emergent ORIF
5 Annular pulleys
3 Cruciate pulleys
A1 and A5 expendable
Loss of other annular pulleys can lead to bowstringing
- A2 & A4 +/- A3
Rock climbers
- usually when slipping
May hear or feel a pop
Develop swelling / tenderness / pain
Bowstringing
1. Direct lateral blow to patella
- usually with knee partly flexed and quadriceps relaxed
2. Indirect low energy injury
Most common long bone fracture
Young patients / sports
Elderly / simple falls
MVA - often compound
Grade 0
- nil ST injury
Grade 1
Dominant arm of middle aged men
- between 40 and 60
Sudden dramatic event
- sporting / weightlifting injury
- resisting heavy extension load
Degenerative changes seen on histology
Complete
- retracted / rupture of lacertus fibrosis
- minimally retracted
Average age 6 years
20% distal humeral fracture
- second most common elbow fracture after supracondylar
Pull Off
- more common
- fracture begins posterolateral metaphysis
- LCL, ECRL & ECRB attached to fragment
Push off
- varus force to extended EJ
Age 0 - 5
- Salter Harris I
Age 5 - 11
- Salter Harris II
III / IV rare
Great remodelling potential
- 80% growth of humerus from proximal physis
Shoulder ROM compensatory
Age
- even older adolescents do well
Type I: Undisplaced avulsion fracture
Type II: Anterior portion displaced & hinged
Type IIIA: Displaced
Type IIIB: Displaced & Rotated
Metatarsus varus
- adduction of the forefoot at the TMTJ
Intrauterine positional deformity / packaging defect
1:1000
- M = F
- bilateral in 50%
- 10% have CDH
Unclear
Theories
- intrauterine positioning defect
- prone nursing