incidence
Accessory Navicular
Incidence
1 - 2 %
Anatomy
Medial Aspect of foot
- proximal to navicular
- part of T posterior tendon
Usually will fuse with navicular (50%)
Issues
1. Probably not a cause of flat foot
- excising accessory navicular / rerouting / reattaching tibialis posterior
- will not help pes planus
2. Pain
- may fracture
Management
Definition
Tibial facture with break in skin
- open wound communicating with fracture or haematoma
Patient is immediately at higher risk of deep infection
Diagnosis
Wound continuously oozes dark red fracture haematoma
Epidemiology
Up to 1/4 of tibia fractures open
Gustilo and Anderson Classification
Grade 1
- wound < 1cm
- usually inside out
Stiffness
Incidence
10%
Requirements
70o swing phase
80o climb up stairs
90o climb down stairs + sit down in chair
100o low chair
NHx
Stiffness usually subsides at 6-8/52
- generally improves out to 3/12
- slow improvement for up to next 9/12
Vascular Injury
Arterial injury
Incidence
0.05%
Types
1. Thrombosis
- most common scenario
- tourniquet with atherosclerosis
- indirect damage to vessel
- femoral or popliteal
2. Embolisation
- atherosclerosis again
- blue toes syndrome post operatively
3. Vessel transection
Management
Incidence
Knee > Hip
- superficial position
- limited cover of well vascularised muscle
- watershed area of skin blood supply anterior to the skin incision
- much increased in fully constrained prosthesis
Ideal < 1%
Risk Factors
Increased with
- revision
- prior infection
- RA / Psoriatic arthropathy
- DM
Hip Dislocation
Incidence
Young men
Posterior / Anterior 9:1
Aetiology
High velocity injury
- head direction at impact decides direction of dislocation
Anterior Dislocation
Externally rotated & abducted leg
- flexion = inferior dislocation
Background
Definition
CP is a permanent disorder of movement and posture
- non-progressive
- brain injury before the age of two years
Strict definition excludes familial & progressive congenital problems & those acquired in childhood as a result of head injuries
Incidence
2-3 per 1000 live births
Higher in
Background
Incidence
Up to 8% patients with ACL reconstruction will have recurrent instability and graft failure
- increased with surgical inexperience
Graft can
1. Be inadequate from the start
- inadequate tension
- poor tunnel placement
Basic Science
Pathogenesis
Virchow's Triad
1. Venous stasis
2. Hypercoagulability
3. Endothelial damage
Starts as platelet nidus at valves
- thrombogenic materials elaborated by platelets
- leads to development of fibrin thrombus
- thrombus grows
Thrombus may
- detach as embolus
- be completely dissolved / recanalise
- organise with valve incompetence