operative indications

Management

Non-Operative

 

Education regarding shoe wear

- extra wide / large toe box

 

Insoles

- longitudinal arch support

- pre MT dome for metatarsalgia

- podiatry to attend to callosities

 

Toe spacers

 

Analgesia

 

Operative

 

Indications

 

1.  Continued pain and discomfort

2.  Difficulties with shoe wear

Management

Acute management

 

Resuscitation

 

EMST

Neurovascular assessment

Investigations - exclude Pipkin, NOF

Emergent reduction / skeletal stabilisation

Assess stability

Re-evaluate sciatic nerve

 

Insertion Femoral Steinman Pin

 

Indications

- displaced acetabular fracture

 

Olecranon Fracture

Definition

 

Intra-articular proximal ulna fracture

 

Anatomy

 

Articulates with trochlea

- may have a central bare area

 

Triceps insertion

- via broad aponeurosis which blends with anconeus and CEO

 

Management

 

Non operative Management

 

Undisplaced fracture

- need to ensure triceps mechanism is intact

Syringomyelia

Definition

 

Progressive and  chronic disorder associated with cord cavitation & gliosis

 

Effects

 

Muscle wasting

Dissociate anaesthesia

Scoliosis

Neuropathic arthropathy

 

Epidemiology

 

M > F

No familial tendency

 

Aetiology

 

1. Idiopathic

 

Tarsal Coalition

Definition

 

Congenital fibrous, cartilaginous or bony connection of 2 or more tarsal bones

- due to failure of segmentation

 

Peroneal Spastic Flat Foot

- tarsal coalition

- tarsal pain

- reduced STJ motion

- rigid pes planus

- peroneal muscle spasm / tightness

 

Epidemiology

 

Present in 6% of population

- symptomatic in 1% of population

 

Bilateral in 50%

 

Lis Franc

HistoryLis Franc

Jacques LisFranc De St-Martin (1790 - 1847)

General Surgeon in Napoleonic army

 

Mechanism

 

High energy

 

1.  Twisting / Abduction injury of forefoot

- original description is fall from horse with foot caught in stirrups

- MVA

 

2.  Axial Loading

 

Spondylolisthesis Degenerative

Definition

Spondylolithesis L4/5

Spondylolithesis caused by

- facet joint degeneration

- no pars or dysplastic pathology

- disc space usually preserved

 

Most common at L4/5 level

 

Epidemiology

 

More common in elderly females

- F: M = 5:1

 

Diabetics

 

Thoracic Disc Disease

Epidemiology

 

0.05% incidence

- rare due to stabilising effect of rib cage

- even more rare to have symptoms

 

Reasoning

1.  Discs are narrower

2.  Foramina larger

3.  Thoracic spine

- facet joints orientated for rotation

- lumbar spine for flexion extension

- flexion is typically the motion which ruptures annulus

 

Anatomy

 

Lumbar Herniated Discs

Epidemiology

 

Sciatica > 2/52 1.6%

 

M:F = 1:1

 

Most common L4/5 

L5/S1 inherently stable 

 

Risk factors

 

Sedentary lifestyle

Smokers

Frequent driving

Heavy lifting 

 

Anatomy

 

Annulus Fibrosis

- circumferential, multilayered rim

Cervical Radiculopathy

Definition

 

Clinical diagnosis

- based on a sclerotomal distribution of motor &/or sensory symptoms or signs

 

Caused by impingement of exiting nerve roots

- HNP

- zygo-apophyseal / facet joint hypertrophy

- neuro-central joint hypertrophy

 

May be acute or chronic

 

Epidemiology

 

M>F

 

Peak age 50-54

 

C7 > C6

 

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