operative

LC-1:  pubic rami fracture with sacral fracture

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

Definition

Rockerbottom foot / Persian Slipper Foot

Epidemiology

Uncommon

50% bilateral

Doesn't delay walking

- may present in toddler with callus under talus head

Associations

Congenital anomalies

- CNS disorders

- spina bifida & diastematomyelia ~10%

- arthrogryposis

- neurofibromatosis 

Mechanism

1. Direct lateral blow to patella

- usually with knee partly flexed and quadriceps relaxed

2.  Indirect low energy injury

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

Epidemiology

Average age 6 years

20% distal humeral fracture

- second most common elbow fracture after supracondylar

Mechanism

Pull Off 

- more common 

- fracture begins posterolateral metaphysis

- LCL, ECRL & ECRB attached to fragment

Push off

- varus force to extended EJ

Classification

Ossification

Primary

- 8 / 52 gestation radius & ulna

Secondary

- distal radius age 1

- distal ulna age 5

Non Operative Management

Unacceptable Position

< 10:  > 15^o malalignment

> 10:  > 10^o malalignment

Postreduction Positionin / Rule of Thirds 

Meyers & McKeever classification

Type I:   Undisplaced avulsion fracture

Type II:  Anterior portion displaced & hinged

Type IIIA:   Displaced

Type IIIB:   Displaced & Rotated

Definition

Metatarsus varus

- adduction of the forefoot at the TMTJ

Intrauterine positional deformity / packaging defect

Epidemiology

1:1000

- M = F 

- bilateral in 50%

- 10% have CDH

Aetiology

Unclear

Theories

- intrauterine positioning defect

- prone nursing