surgery

Etiology

Ankle sprain

- eversion / external rotation

Ankle fractures

Definition

Inflammation and degeneration of the achilles tendon in the midsubstance 2 - 6 cm from insertion

Definition

Intermediate grade chondroblastic osteosarcoma arising from surface of long bones

Epidemiology

Extremely rare

- 1% of all osteosarcomas

- 25% of surface osteosarcomas

Age 15-25

Location

Typically anterior proximal tibia

- diaphysis of major long bones

- humerus

Pathology

Greater trochanteric pain syndrome

Definition

Chronic lateral trochanteric pain

- abductor tendon tendonitis

- trochanteric bursitis

Epidemiology

Women 40 - 60 years old

Mechanism

? repetitive friction of iliotibial tract over GT

Symptoms

Pain over upper lateral thigh with activity

- often related to hip flexion

Femoral Neck Stress Fractures

Aetiology

Athletes with increase activity / distance

Women with eating disorders /  amenorrhea

Types

Compression / inferior neck

- < 50% protective weight bear

- > 50% emergent ORIF

Tension side / superior neck

- emergent ORIF

https://www.vumedi.com/video/arthroscopic-double-row-subscapularis-repa…

Technique

- extra-articular

Portals

- posterior portal very lateral so can see anterior aspect subacromial space

- port of Wilminton at anterolateral acromion to access SSC

- anterior portal in normal position, slightly more lateral so becomes working portal

Definition

Facet joint dislocations secondary flexion distraction injury

Epidemiology

10%

Stages

1. Unifacet subluxation - interspinous process widening

2. Unifacet dislocation - 25% anterolisthesis

3. Bifacet dislocation - 50% anterolisthesis

4. Complete vertebral translation - 100% anterolisthesis

Unilateral Facet Joint Dislocation

Goal

- head that translates 50% in all directions

- allows 30^o ER with arm at side

- stable posteriorly

Pre-Op 

- antibiotics

- consider specific Propionobacterium cover

Indications 

1. Significant functional impairment

2. PIPJ contracture

- originally thought to intervene early

- Macfarlane showed residual FFD always about 30^o

- may need to release  check rein ligaments / accessory collateral ligaments

3. MCPJ contracture >30^o

4. Trigger fingers

- must do limited fasciectomy 

Operative v Nonoperative Literature

1.  Buckley etal JBJS Am 2002

Prospective multi-centred RCT

- 309 displaced intra-articular fractures

- operative v non operative management

- 2 year follow up

Findings

- used patient orientated functional outcomes

- overall VAS and SF36 not significantly different between 2 groups

Improved Operative Outcome if

- not workers compensation

- women

- < 29