nonoperative

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

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

Types

Age 0 - 5

- Salter Harris I

Age 5 - 11

- Salter Harris II

III / IV rare

Issues

Great remodelling potential

- 80% growth of humerus from proximal physis

Shoulder ROM compensatory

Age

- even older adolescents do well

Meyers & McKeever classification

Type I:   Undisplaced avulsion fracture

Type II:  Anterior portion displaced & hinged

Type IIIA:   Displaced

Type IIIB:   Displaced & Rotated