surgical options

Hoffa fracture

Definition

Hoffa Fracture Xray

 

Coronal plane fracture of distal femoral condyle

- intra-articular

- often only attachment is posterior capsule

 

Epidemiology

 

Rare

 

Mechanism

 

Usually a severe valgus trauma

 

Xray

 

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

Curly Toe

Definition

 

Under-riding toe

- toe lies beneath adjacent toe

- congenital deformity

 

Pathology

 

Due to tight FDL & FDB

- capsule initially normal

- becomes constricted with time

 

Clinical

 

Usually 3rd toe

- flexed, ER, medially deviated

 

Deformity accentuated when standing

 

Ankle dorsiflexion

Coronoid Process Fracture

BackgroundClassification Coronoid Fractures

 

The coronoid is the most important portion of ulno-humeral articulation

 

Reasons

1.  Provides anterior buttress

2.  Anterior capsule and brachialis attach to coronoid

2.  Anterior band of the MCL attaches to it

- distally and medially on sublime tubercle

Massive Tears

DefinitionsMassive RC Tear High Riding Humeral Head MRI

 

Massive tear 

 

1.  > 5cm 

- retracted to humerus / glenoid margin

 

2.  At least 2 complete tendons

- lose SS / IS or SS / SC

 

Classification

 

Management Summary

Rheumatoid Hands Xray

 

Rheumatoid Arthritis Diagnostic Criteria

 

1987 American College of Rheumatology 

 

Need 4/7 (MAX RANS)

1. Morning Stiffness

2. Arthritis of 3 areas > 6/52

3. Xray changes

4. Rh factor

5. Arthritis of Hand > 6/52

6. Nodules

7. Symmetric Arthritis > 6/52

Management Options

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

Keratotic Deformities

Definitions

 

Corn

- accumulation of keratotic layers of epidermis

- thickened epithelium elevates prominence causing further pressure

 

Hard Corn

 

Due to extrinsic pressure from footwear

- most common on lateral aspect of 5th toe

- over head of proximal phalanx

 

Soft Corns

- on the condyle of proximal phalanx between the toes