fracture

Anatomy

Posterolateral & Posteromedial tubercles

- separated by sulcus for FHL

- lateral larger than medial 

PL tubercle

- size variable

Epidemiology

< 10% of all talus fractures

Rare and often missed

Types

Clay-shoveler's

Definition

Spinous process avulsion

- typically C7

- can be seen in thoracic spine

Mechanism

Spinous process avulsion secondary to ligamentum nuchae

Complications

Subscapularis failure

Rotator cuff failure

Instability

Infection

Periprosthetic fracture

Aseptic loosening

Neurological injury

Parada et al. J Should Elbow Surg 2021

- 2224 aTSA complication rate 11%, revision rate 5.6%

Indications

RA 

OA 

AVN 

Contra-indications

Infection

Charcot

Paralysis of deltoid

Torn rotator cuff

Insufficient glenoid bone stock

Distal Tibial Fractures

Definition

Metaphyseal

Extra-articular

Intra-articular Extension

Issues

Femur

Multiplanar deformity

- worsend by previous surgery

- may require osteotomy

Acetabulum

Dysplasia often present

- not as severe as in DDH

LLD

Can be significant

Abductors

Have been short for long time

- difficult to restore length

Definition

Chronic, non metabolic bone disorder

Characterised by increased bone resorption, bone formation and remodelling

Epidemiology

Rare < 40

1 – 3 % population over 60

M > F

Aetiology

Unknown

Paramyxovirus implicated

- measles

- RSV

- canine distemper virus

Electron Microscope

Mechanism

Direct blow

- most common

Indirect

- forced knee flexion with foot fixed / maximally contracted quadriceps

Types

1.  Vertical

2.  Transverse

Position

- patient supine on radiolucent table

- place ECG lead and artery clip over centre of femoral head

- useful to put II ipsilateral to leg, and place knee on cassette