operative indications

Non-Operative

Education regarding shoe wear

- extra wide / large toe box

Insoles

- longitudinal arch support

- pre MT dome for metatarsalgia

- podiatry to attend to callosities

Toe spacers

Analgesia

Operative

Indications

1.  Continued pain and discomfort

2.  Difficulties with shoe wear

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

Definition

Intra-articular proximal ulna fracture

Anatomy

Articulates with trochlea

- may have a central bare area

Triceps insertion

- via broad aponeurosis which blends with anconeus and CEO

Management

Non operative Management

Undisplaced fracture

- need to ensure triceps mechanism is intact

Definition

Progressive and  chronic disorder associated with cord cavitation & gliosis

Effects

Muscle wasting

Dissociate anaesthesia

Scoliosis

Neuropathic arthropathy

Epidemiology

M > F

No familial tendency

Aetiology

1. Idiopathic

Definition

Congenital fibrous, cartilaginous or bony connection of 2 or more tarsal bones

- due to failure of segmentation

Peroneal Spastic Flat Foot

- tarsal coalition

- tarsal pain

- reduced STJ motion

- rigid pes planus

- peroneal muscle spasm / tightness

Epidemiology

Present in 6% of population

- symptomatic in 1% of population

Bilateral in 50%

Definition

Spondylolithesis caused by

- facet joint degeneration

- no pars or dysplastic pathology

- disc space usually preserved

Most common at L4/5 level

Epidemiology

More common in elderly females

- F: M = 5:1

Diabetics

Epidemiology

0.05% incidence

- rare due to stabilising effect of rib cage

- even more rare to have symptoms

Reasoning

1.  Discs are narrower

2.  Foramina larger

3.  Thoracic spine

- facet joints orientated for rotation

- lumbar spine for flexion extension

- flexion is typically the motion which ruptures annulus

Anatomy

Epidemiology

Sciatica > 2/52 1.6%

M:F = 1:1

Most common L4/5 

L5/S1 inherently stable 

Risk factors

Sedentary lifestyle

Smokers

Frequent driving

Heavy lifting 

Anatomy

Annulus Fibrosis

- circumferential, multilayered rim

Definition

Clinical diagnosis

- based on a sclerotomal distribution of motor &/or sensory symptoms or signs

Caused by impingement of exiting nerve roots

- HNP

- zygo-apophyseal / facet joint hypertrophy

- neuro-central joint hypertrophy

May be acute or chronic

Epidemiology

M>F

Peak age 50-54

C7 > C6