Friday, June 18, 2021
Monday, June 14, 2021
TIBIAL INTERCONDYLAR EMINENCE FRACTURE
Fracture of the intercondylar eminence (tibial spine) indicates partial or complete detachment of the ACL from the tibia and is most commonly found in children. This fracture is usually caused by hyperextension of the knee or a sudden twisting motion. Forceful traction resulting from a direct blow to the distal femur on a flexed knee may also result in this fracture. If the fracture is displaced, the loose fragment may block motion and cause severe swelling and hemarthrosis. Type I fracture of the tibial spine is an incomplete fracture, whereas type II is complete but nondisplaced. Type III fractures are described as type IIIA (complete and displaced) and type IIIB (complete, displaced, and rotated out of position).
OSTEOCHONDRITIS DISSECANS AND OSTEONECROSIS
Osteochondritis dissecans (OCD) is a defect in the sub-chondral region of the apophysis or the epiphysis of a bone, often with partial or complete separation of the bone fragment. When this occurs in the distal femur, it is a common source of loose bodies in the knee. Whereas OCD most often affects the posterolateral aspect of medial femoral condyle, it can also occur in other regions of the knee, as well as the shoulder, elbow, and foot.
DISLOCATION OF KNEE JOINT
Dislocation of the knee joint must be distinguished from dislocation of the patella. Whereas a patella dislocation involves the patellofemoral joint, a knee dislocation involves the tibiofemoral articulation. Any dislocation is an emergency, and dislocation of the knee is no exception. Reduction should be achieved as soon as possible. Striking the knee against the dashboard during an automobile accident is the most common cause of injury, but athletic injuries are also common causes. The popliteal artery and its branches are often damaged during dislocation of the knee. Therefore, arterial injury must be suspected in every knee dislocation. A thorough neurovascular examination should be performed before and after reduction, and an ankle- brachial index (ABI) should be obtained as well. If there remains any question of arterial damage, the patient frequently will undergo arteriography or CT angiography and any necessary arterial repair should be done immediately.
DISRUPTION OF QUADRICEPS FEMORIS TENDON OR PATELLAR LIGAMENT
Damage to the quadriceps mechanism generally occurs when there is active contraction of the quadriceps femoris muscle against forced flexion of the knee. Most ruptures of this extensor mechanism occur in older patients. At the time of injury, the patient experiences sudden pain, which may be associated with a tearing sensation about the knee. The tendon may be weakened by age-related degenerative changes or by pathologic changes due to psoriatic arthritis, rheumatoid arthritis, arteriosclerosis, gout, hyperparathyroidism, diabetes, chronic renal failure, or corticosteroid therapy.
KNEE LIGAMENT INJURY
Ligament injuries (sprains) of the knee are very common in athletes. In first-degree sprains, the ligament is trenched, with little or no tearing. These injuries produce mild point tenderness, slight hemorrhage, and swelling. Erythema may develop over the painful area but resolves in 2 or 3 weeks after injury. Joint laxity is not present, and the injury does not produce any significant long-term disability. Appropriate treatment consists of rest and muscle rehabilitation. Seconddegree sprains are characterized by partial tearing of the ligament, resulting in joint laxity, localized pain, tenderness, and swelling. When stress is placed on a joint during examination, the examiner should still feel a definite “end point” to the joint movement. Because the ligament is only partially injured, the joint remains stable; thus, vigorous rehabilitation alone will likely be sufficient treatment. Third-degree sprains produce complete rupture of a ligament, making the joint unstable. Tenderness, instability, absence of a definite end point to stress testing, and severe ecchymosis are the hallmarks of third-degree sprains. Surgical intervention may be needed.
MENISCAL VARIATIONS AND TEARS
The meniscus is normally a crescentic structure, although several forms of discoid lateral menisci have been described. These range from a complete disc to a very rare ring-shaped meniscus with abnormal thickness. The common explanation for these variant discoid forms assumes that the normal meniscus is formed from an original discoid shape and that the discoid lateral meniscus is a congenital variant in which the central portion does not degenerate with time. This theory would explain the variously shaped menisci found at surgery. However, no discoid menisci have been found in fetuses and a review of comparative anatomy shows no mammal with such a pattern of formation.
Sunday, May 30, 2021
Thursday, April 29, 2021
Monday, April 19, 2021
|IMAGING OF OPEN AND ARTHROSCOPIC ELBOW DEBRIDEMENT|