MRI

Hoffa fracture

Definition

 

Coronal plane fracture of distal femoral condyle

- intra-articular

- often only attachment is posterior capsule

 

Epidemiology

 

Rare

 

Mechanism

 

Usually a severe valgus trauma

 

Xray

 

Usually lateral femoral condyle

 

Crush Fractures

Definition

 

Minimal trauma fracture

- secondary to osteoporosis

- wedge fractures

 

Epidemiology

 

F > M

More common in elderly patients

 

Uncommon in men < 75

- look for alternative diagnosis

 

DDx

 

Renal failure

Malignancy - metastasis

Infection

 

Clinically

 

Can present with pain

Sportsman's Hernia

Definition

 

Groin pain in athletes

- secondary to tear in external oblique fascia

 

Epidemiology

 

Sports with aggressive adduction

- hockey / soccer

 

Pathology

 

Tears in external oblique fascia

- tend to be central

- around spermatic cord and ilioinguinal nerve

- pain may be from nerve entrapment

 

DDx

 

Adductor Longus Tear

MCL Insufficiency

AetiologyTommy John Surgery

 

Throwing injury

- seen in the throwing athlete

- repetitive microtrauma / valgus stress

- develop laxity

 

History

 

Initially

- lose velocity / accuracy

 

Develop medial pain

 

40% ulna nerve symptoms

 

Quadriceps Rupture

Epidemiology

 

Usually occurs in patients over 60

- due to decreased vascularity & collagen weakness

 

Younger patient on steroids / growth hormone

 

Occasionally occurs in young athlete with excessive contracture

 

Aetiology

 

Often preceded by quadriceps tendinosis

 

Proximal Hamstring Tear

Epidemiology

 

Adolescent apophyseal avulsion

- treat non operatively

- unless displaced > 2 cm

 

Adult

- soft tissue avulsion

 

Aetiology

 

Usually associated with sporting activities

- skiing

- water skiing

 

Violent contraction

- knee extended

- hip flexing

 

Anatomy

 

Biceps / Semimembranosus / Semitendinosus all attach here

 

Symptoms

 

Pain

General Management

Knee Dislocaton APKnee Dislocation Lateral

 

Definition

 

2 or more ligaments disrupted

- multi-ligament knee

 

ACL + PCL + one of collaterals 

- knee dislocation

 

Incidence

 

Rare

Chordoma

Definition

 

Primary malignancy arising from remnants of the notochord

 

Epidemiology

 

Rare malignant tumour

 

Middle-aged adults (50-70)

 

M>F

 

Location

 

In midline in axial skeleton

 

Base of skull 35%

 

Vertebrae 15%

- especially cervical

 

Sacrum 50%

 

PVNS

Definition

 

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

 

Epidemiology

 

Age: 20 - 50

Sex: M > F

 

Types

 

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully

 

Syndicate content