management

Cause

Movement of iliopsoas tendon over femoral head / iliofemoral ridge / iliofemoral ligament

Femoral Neck Stress Fractures

Aetiology

Athletes with increase activity / distance

Women with eating disorders /  amenorrhea

Types

Compression / inferior neck

- < 50% protective weight bear

- > 50% emergent ORIF

Tension side / superior neck

- emergent ORIF

Types

1.  Capsular avulsions

2.  Body / Nutcracker fracture

Nutcracker fracture

Epidemiology

- rare

Mechanism

- forced eversion / abduction of forefoot

- cuboid crushed between 4th and 5th MT and calaneum

Pathology

- displaced cuboid fracture with subluxation of tarsus

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

Definition

Insufficiency fracture

- secondary to exceeding fatigue threshold

- usually of second or third MT shaft

Epidemiology

Onset of new and very intense / strenuous physical activity

- i.e. new army recruits / dancers

Women with postmenopausal osteoporosis

Association

Cavus feet

History

Pathology

Children < 6

- entire distal humerus physis is displaced

Xray

Distal physis not ossified < 1 year

- may be a difficult diagnosis

Definition

> 10 mg / dl

- must be corrected for albumin

Causes

Malignancy

- multiple myeloma / lung cancer / breast cancer

Hyperparathyroidism

- elevated PTH

Issue

High mortality associated with hypercalcaemia of malignancy

Physiology

40% albumin bound

50% ionised and active

Signs

Fall in level promotes tetanus

Chvostek sign

- tapping masseter muscle induces spasm

Trousseau Sign

-  flexion of thumb & wrist with extension of fingers

Carpopedal Spasm

ECG

Prolonged QT interval on ECG

Causes

1. Vit D Deficiency

Non operative 

Ponseti casting

Aims of treatment

1. Correct the deformity early

2. Correct it fully 

3. Hold the corrected position until foot stops growing

- AFO

- Denis Browne Boots

Timing

Start 1 - 3 weeks

- let parents settle and get used to diagnosis

- explain method and length of treatment required

Incidence

Decreasing incidence in recent decades most likely attributable to preoperative antibiotics

Risk 

Conventional discectomy </= 1%

Fusion 2%

Fusion & instrumentation 5-6%

Instrumentation doubles infection rate in lumbar fusion

Risk factors 

Diabetes