nonoperative

 Scapular process fractures

Types

Coracoid process

Scapula spine

Acromial fractures

British Athletics Muscle Injury Classification (MRI)

Issues

Operative v Nonoperative

Levy et al Arthroscopy 2009

- systematic Review

- improved outcomes with operative management

https://pubmed.ncbi.nlm.nih.gov/19341932/

Vicenti et al. Injury 2019

- systematic review

- two studies compare operative v nonoperative

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

Anatomy

5 Annular pulleys

3 Cruciate pulleys

Pathology

A1 and A5 expendable

Loss of other annular pulleys can lead to bowstringing

- A2 & A4 +/- A3

Aetiology

Rock climbers

- usually when slipping

May hear or feel a pop

Develop swelling / tenderness / pain

Bowstringing

Mechanism

1. Direct lateral blow to patella

- usually with knee partly flexed and quadriceps relaxed

2.  Indirect low energy injury

Epidemiology

Most common long bone fracture

Aetiology

Young patients / sports

Elderly / simple falls

MVA - often compound

Tscherne Soft Tissue Classification

Grade 0

- nil ST injury

Grade 1

Mechanism

Usually a direct blow 

- less commonly a fall on the outstretched hand

RTA / sporting accidents commonest causes

Can be pathological as a result of radionecrosis

- eg following radiotherapy for breast cancer.  

Incidence

Fractures of the clavicle are common

Epidemiology

Dominant arm of middle aged men

- between 40 and 60

Aetiology

Sudden dramatic event

- sporting / weightlifting injury

- resisting heavy extension load

Pathology

Degenerative changes seen on histology

Types

Complete

- retracted / rupture of lacertus fibrosis

- minimally retracted