forearm

Multiple Hereditary Exostosis

AKA

 

Diaphyseal Aclasis / Multiple Osteochondromas

 

Definition

 

Heritable skeletal dysplasia

 

Epidemiology

 

AD with variable penetrance (96%)

 

Malignant Transformation

 

Incidence of malignant transformation much higher 

- 10% overall

- 1 % / year

 

Chondrosarcoma (CS) > Osteosarcoma (OS)

 

Forearm Fractures

Ossification

 

Primary

- 8 / 52 gestation radius & ulna

 

Secondary

- distal radius age 1

- distal ulna age 5

 

Non Operative Management

 

Unacceptable Position

 

< 10:  > 15o malalignment

> 10:  > 10o malalignment

 

Postreduction Positionin / Rule of Thirds 

 

Compartment Syndrome

Definition

 

Circulation of tissues within a closed osteofascial space are compromised by increased pressure within that space

 

Most common 

- anterior leg compartment

- flexor compartment forearm

- deep posterior leg compartment

 

Aetiology

 

Prerequisite is volume restricting envelope 

- fascia & skin

- POP

- dressings

 

1.  Increased contents

 

Bleeding / edema 

- fracture

Upper Limb Amputations

General Principles

 

All possible length should be preserved consistent with clinical judgement

- function of amputated stumps decrease progressively with each higher level of amputation 

- prosthetic rejection by patient increases with the more proximal amputations

- most ADL'S can be performed adequately with one limb, so don't use prosthesis

- all nerves are drawn distally into wound & sectioned so they retract well proximally to bone level of amputation