osteoarthritis

Epidemiology

Usually after 50-60 years of age

Aetiology

Primary 90% of cases

Secondary

- AVN

- trauma

- instability

Pathology

Condensing Osteitis

Epidemiology

- seen in women over 40

Xray

- sclerotic and overgrown

CT

Definition

OA of the scapho-trapezium-trapezoidal joints

Epidemiology

50% patients with CMC OA have STT OA

F > M

Xray

Management

Non-operative Management

Natural history

Return to Sport

Shelbourne et al. Am J Sports Med 1999

- 133 patients with isolated PCL injuries followed for mean of 5 years

- 1/2 returned to sport at same level of play

- 1/3 returned to sport at lower level of play

https://pubmed.ncbi.nlm.nih.gov/10352760/

Agolley et al. Bone Joint J 2017

Acute management

Resuscitation

EMST

Neurovascular assessment

Investigations - exclude Pipkin, NOF

Emergent reduction / skeletal stabilisation

Assess stability

Re-evaluate sciatic nerve

Insertion Femoral Steinman Pin

Indications

- displaced acetabular fracture

Schatzker Classification

I.  Lateral Spilt 

- seen in young patient

- lateral meniscus can be incarcerated in fracture

II.  Lateral Split Depression

- often seen in young patients with high energy injuries

- vary in severity

Advantage

Fewer complications than TSR

Simpler procedure

DDx

OA

Psoriasis

CREST (scleroderma)

RA (rare form)

Other seronegative arthropathies

Hyperparathyroidism

Reactive arthropathy

Gout

Subluxation & dislocation

Diagnosis

Pisotriquetral view

- forearm positioned 30° supinated off the neutral position

- loss of symmetry between the pisiform and triquetrum is required for the diagnosis

- carpal tunnel view may be helpful in further assessment of the joint

Osteoarthritis

Clinical

More common problem

Options

Darrach's

- distal ulna excision

- best for elderly RA patient

Bower's interpositional hemiarthoplasty

Technique