treatment

Metacarpal

 Fractures

 

1.  Neck of 5th Metacarpal

2.  Metacarpal Shaft

3.  Metacarpal Head

4.  Base of Metacarpal Fracture Dislocations

5.  MCPJ dislocations

 

1.  Neck of 5th Metacarpal Fracture

 

Non operative Management

 

Accept 45o angulation

- will have finger extensor lag, but will recover

Facet Joint Dislocation

Definition

 

Facet joint dislocations secondary flexion distraction injury

 

Epidemiology

 

10%

 

Stages

 

1. Unifacet subluxation - interspinous process widening

2. Unifacet dislocation - 25% anterolisthesis

3. Bifacet dislocation - 50% anterolisthesis

4. Complete vertebral translation - 100% anterolisthesis

 

Unilateral Facet Joint Dislocation

 

Heterotopic ossification

Definition

 

Pathological bone formation in soft tissues

 

Epidemiology

 

In elbow

- 3% of trauma

- 89% if head injury + trauma

 

Types

 

Completely different

 

1.  Myosisitis Ossificans Circumscripta

- post traumatic

- more common

- recognised as a consequence of neurological injury

 

Knee Plica

Aetiology

 

Knee forms from 3 separate compartments

 

Plica represents normal embryonic synovial septum that persists into adult life

 

Epidemiology

 

20% of knees have medial patellar plica at arthroscopy

 

Symptomatic plicae much less common 1-2%

 

Mean age 14

 

Types

 

1.  Infrapatellar (ligamentum mucosum) 

 

Os Acromiale

Definition 

 

Failure of fusion of adjacent ossification centers

 

Epidemiology

 

Incidence 3%

 

Bilateral in 60%

 

Anatomy

 

4 ossification centers present in acromion

- pre-acromion

- mesoacromion

- metaacromion

- basiacromion

 

Polydactyly

Classification

 

Pre-axial / great toe / 15%

Central / 2-4 MT / 5%

Post-axial / 5th MT / 80%

 

Type A - articulated

Type B - rudimentary 

 

Epidemiology

 

2 in 1000 births

- 30% positive FHx

- autosomal dominant

 

Associated MT anomalies common

- block MT / Y-shaped / T-shaped /wide head

 

Treatment

 

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