CT

Issues

Rotator cuff

- often deficient

Bone stock

- often deficient

Glenoid

- often posterior version 

Management

Options

1.  TSR

Indications

- cuff intact

DDx

Parosteal OS

- bone is not continuous with cortex in MO

Aetiology

3% incidence in elbow joint trauma to some degree

Epidemiology

Adolescents & young adults

Usually between 12 - 21 years 

Throwing athletes / gymnasts

Little Leaguer's Elbow

- combination of capitellar OCD and MCL injury

- a repetitive throwing injury / seen in pitchers

Aetiology

1.  Trauma & Overuse

Common throwing sports / gymnastics

Epidemiology

Relatively rare

Average age 50

Men 4:1 Women

Usually dominant arm

Aetiology

Primary

- associated with strenuous manual labour

Secondary

- trauma

- OCD

- synovial chondromatosis

- valgus extension overload / MCL insufficiency

Aim

Reproduce the normal anatomical centre of rotation

Restore femoral offset 

Maintain equal leg lengths 

Usually template off normal hip

Template

1. LLD

2. Offset

3. Femoral component

4. Acetabular component

5. Osteotomy / femoral seating

Definition

The perpendicular distance from the centre of the femoral head to the long axis of the femur

Harris 1992

- aim for supra-physiologic offset 

- avoid making offset less than original at all costs & makes longer if possible

Soft tissue balancing equals restoring femoral offset

Effect of short offset

1.  Abductor lurch / Trendelenburg gait

Meyers & McKeever classification

Type I:   Undisplaced avulsion fracture

Type II:  Anterior portion displaced & hinged

Type IIIA:   Displaced

Type IIIB:   Displaced & Rotated

Epidemiology

Uncommon

- 4% OS

Females more common 

- similar to GCT

NHx

Less aggressive locally

- less metastasis

- size / location & duration of symptoms don't correlate with outcome

Arise from cortex of bone / periosteum

- parosteal 

- periosteal

- high grade juxtacortical

It was described in 1983 by Dr. Nora, and is sometimes called Nora's disease or Nora's lesion

Definition

Bizarre parosteal osteochondromatous proliferation 

Epidemiology

Rare lesion 

- occurs most commonly in the hands and feet

Adults in their 20's and 30's

Males = Females

Site

AKA

Bone island

Definition

Hamartomatous lesion 

- island of mature cortical bone found in the midst of normal cancellous bone 

Epidemiology

>10

M=F

Clinical

Asymptomatic x-ray finding (usually in adolescents)