surgery

Anatomy

C5, 6 from Upper trunk

Posterior triangle

- arises upper trunk and passes backward through posterior triangle

- under belly of omohyoid

- deep to trapezius to the suprascapular notch

Runs through suprascapular notch

Definition

Instability in at least 2 planes

- postero-inferior

- antero-inferior

- antero-postero-inferior

Epidemiology

Recognised as a common problem 

- often misdiagnosed

Most patients athletic

Aetiology

Post-traumatic (type III clavicle fractures)

Idiopathic

4 patterns 

1. OA with osteophytes 

-  contribute to impingement

2. Osteolysis with resorption & gross osteoporosis 

Definition

Injury to ulnar collateral ligament of thumb MCPJ

Aetiology

Initial description

- chronic laxity of British gamekeeper's thumb's 

- no specific trauma

- secondary to breaking pheasant's neck

Acute trauma

- snow ski

- ball games

Valgus / forced abduction

Anatomy

UCL

Epidemiology

Dominant arm of middle aged men

- between 40 and 60

Aetiology

Sudden dramatic event

- sporting / weightlifting injury

- resisting heavy extension load

Pathology

Degenerative changes seen on histology

Types

Complete

- retracted / rupture of lacertus fibrosis

- minimally retracted

Anatomy

1. Seebacher's 3 layers of the medial knee

Layer 1

- sartorius and sartorius fascia

Layer 2

- superficial MCL

- posterior oblique ligament

- semimembranosus

Layer 3

- deep MCL (meniscofemoral and meniscotibial ligament)

- posteromedial capsule 

2. MCL

Superficial MCL

Indications

Young adult 

- 16 - 30 years old

- monoarticular disease

- heavy demand 

Exhausted options of osteotomy

- risk of THA failure  / multiple revision surgeries considered too high

Aims of arthrodesis

Maximise bony contact

Minimise shortening

Definition 

Malignant cartilage producing tumour 

Epidemiology

20% of primary bone tumours

3rd most common

- 1 in 500 000

Relatively non-aggressive / usually Grade I

Average age 40

Male > Females

Two Distinct Types

1.  Primary Chondrosarcoma

Arises de novo

Epidemiology

1% of US population

0.1% of Australia

M:F = 20:1

Groups

- homosexual 80%

- IV User 5%

- heterosexual 8%

- haemophilia 2%

- blood transfusion 1.5 %

Aetiology

Unprotected Sex

Blood

- needle sharing

- blood products

- accidental transmission with infected blood in health care setting

Definition

Infection of bone 2° blood-borne bacteria

Epidemiology

Most common children

- peak 10 years

True haematogenous OM rare in adults

- usually involves spine

M: F 2:1

Site

Most common femur & tibia