Articular process fractures
Articular process fracture
Natural history
Superior articular process fracture
- potentially unstable
Inferior articular process fracture
- thought to be more stable
CT scan
treatment
Atlanto-axial instability
Definition
Loss of ligamentous stability between atlas and axis
Can cause impingement of the spinal cord
Etiology
Internal snapping hip
Cause
Movement of iliopsoas tendon over femoral head / iliofemoral ridge / iliofemoral ligament
Metacarpal
Fractures
1. Neck of 5th Metacarpal
2. Metacarpal Shaft
3. Metacarpal Head
4. Base of Metacarpal Fracture Dislocations
5. MCPJ dislocations
1. Neck of 5th Metacarpal Fracture
Non operative Management
Accept 45o angulation
- will have finger extensor lag, but will recover
Facet Joint Dislocation
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
Heterotopic ossification
Definition
Pathological bone formation in soft tissues
Epidemiology
In elbow
- 3% of trauma
- 89% if head injury + trauma
Types
Completely different
1. Myosisitis Ossificans Circumscripta
- post traumatic
- more common
- recognised as a consequence of neurological injury
Knee Plica
Aetiology
Knee forms from 3 separate compartments
Plica represents normal embryonic synovial septum that persists into adult life
Epidemiology
20% of knees have medial patellar plica at arthroscopy
Symptomatic plicae much less common 1-2%
Mean age 14
Types
1. Infrapatellar (ligamentum mucosum)
Os Acromiale
Definition
Failure of fusion of adjacent ossification centers
Epidemiology
Incidence 3%
Bilateral in 60%
Anatomy
4 ossification centers present in acromion
- pre-acromion
- mesoacromion
- metaacromion
- basiacromion
Polydactyly
Classification
Pre-axial / great toe / 15%
Central / 2-4 MT / 5%
Post-axial / 5th MT / 80%
Type A - articulated
Type B - rudimentary
Epidemiology
2 in 1000 births
- 30% positive FHx
- autosomal dominant
Associated MT anomalies common
- block MT / Y-shaped / T-shaped /wide head
Treatment
Elasto Fibroma Dorsi
Condition
Strange scapular tumour
- typically bilateral
- occurs in lat dorsi
Complain of lump which appears around scapula
Imaging
Looks like muscle on CT
Behaviour
Benign
Histology
Shows marked amount of elastin