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

AO Classification

Types

1. Supracondylar

2. Unicondylar

3. Intracondylar

Xrays

Supracondylar / Extra-condylar

Indications

< 60 with good bone stock and preserved joint space

Reduction

Union rates increased with anatomical reduction

Options

- closed reduction

- open reduction / if closed reduction fails

Accept

- no varus

- < 15^o valgus

- < 10^o AP plane

Definition

Garden 1 / 2

Algorithm

ORIF

- ~ 15% displacement rate with non operative management

- increased risk of non union

- reduced hospital in patient stays

Options

Cannulated screws

DHS + derotation screw

3 cannulated screws

1.  Anterior process

Part of complex sprain / easily missed

- non operative if small

- ORIF if large and displaced

2.  Tuberosity fractures

Need ORIF if displaced

- have T Achilles attached and can put skin under threat

- ORIF (usually closed reduction and screw)