Nick G. Lasanianos

Periprosthetic Proximal Humeral Fractures

The four types of periprosthetic proximal humeral fractures according to the University of Texas classification system: type I proximal to the tip of the prosthesis; type II extending distal from the tip of the prosthesis; type III fracture entirely distal to the tip of the prosthesis; type IV fracture adjacent to the glenoid

Lesser Arc Injuries: Perilunate Dislocations

Perilunate dislocations with no associated fracture are called lesser arc injuries, referring to pure ligamentous trauma. Initially described in 1980, when the predictable sequence of ligamentous ruptrures leading to a perilunate dislocation of the carpal bones or a pure dislocation of the lunate from the rest of the carpus.

Femoral Neck Fractures

In 1935 Pauwels presented a classification for femoral neck fractures which mainly refers to intracapsular fractures and which relies on the angle of obliquity of the fracture line in relation to the horizontal plane.

Greater Arc Injuries: Perilunate Fracture-Dislocations

Greater-arc injuries are characterized by complete loss of contact between the lunate and head of the capitate and one or more fractures of bones surrounding the lunate. In contrast to lesser arc injuries which are purely ligamentous, greater arc injuries include both osseous and ligamentous injuries. These injuries represent dislocation of the lunate accompanied by fracture of one or more surrounding bones.

Whiplash Associated Disease

Whiplash associated disorder is the name given to a collection of symptoms including pain in the neck, head, shoulder and arms following rear end collisions. The classic explanation is that the head is suddenly jerked back and forth beyond its normal limits after a collision or car crash, causing the muscles and ligaments supporting the neck to be injured. More precisely, an upward force on the cervical spine causes abnormal movements of the lower cervical spine with damage to the zygapophyseal and other joints between the vertebrae, at least in some cases. The injury may or may not cause acute symptoms. Those symptoms may be contrived; they may be mild; or they may be serious. The treatment may or may not be effective and many patients may develop chronic problems. The outcome of the natural history of this condition is not predictable and thus Whiplash disease may be the reason for many legal proceedings. The Quebec classification is the most common grading system of Whiplash disease and is based primarily on pathoanatomy.

Post-Traumatic Radio-Ulnar Synostosis

This is a rare complication of forearm or elbow fracture. In 1987 Vince, based on a series of 28 adult patients with forearm fracture presented the following classification which applies to post-traumatic situations.

Ossification of the Posterior Longitudinal Ligament (OPLL)

This clinical situation, which comprises high prevalence in Japanese population, is characterized by hyperplasia of cartilage cells with eventual endochondral ossification of the posterior longitudinal ligament. As the most common site of ossification of the PLL is in the cervical cord, cervical myelopathy is the most common presentation. However, clinically significant ossification of the ligament has also been noted to occur in the thoracic and lumbar spine. Ossification of the PLL can present with pain, neurological deficit, or with acute neurological injury (even after a minor injury). However, given the prevalence of ossified PLL, the majority of patients with OPLL remain without significant symptoms.

TarsoMetatarsal Lisfranc Joint Dislocations

The tarsometatarsal joint carries the eponym of Lisfranc, who described an amputation at this level. In 1909 Quenu and Kuss presented a classification for tarso-metatarsal joint injuries which was modified in 1982 by Hardcastle. In 1986 Myerson relabeled this classification presenting its final form. The patterns described by this classification typically include combined fractures-dislocations. The dislocations involved in this type of injuries may be either monolateral or divergent. In monolateral dislocations the metatarsals are dislocated towards one direction (medial or lateral). In divergent dislocations the first metatarsal shifts medially and the remainder of the forefoot shifts laterally. Most commonly Lisfranc injuries involve the first, second metatarsals and the medial cuneiform, however more complicated patterns can be seen. Soft tissue Injuries of the Lisfranc joint (sprains) are classified by the Burroughs classification which was introduced in 1998.

Sternoclavicular Joint Injuries

The sternoclavicular joint is diarthrodial and is the only true articulation between the upper extremity and the axial skeleton. The articular surface of the clavicle is much larger than the articular facet on the sternum and both surfaces are covered with fibrocartilage.

Traumatic Shoulder Dislocation Types

The shoulder joint is the one with the greatest range of motion in the body, and as a result is particularly susceptible to subluxations or dislocations. Approximately half of major joint dislocations seen in emergency departments are of the shoulder. Shoulder dislocations may be Anterior (Fig. 10.1), which are the most common, Posterior (Fig. 10.2) or Inferior (Fig. 10.3) [1, 2].