Introduction Clinical definition: an avulsion fracture of the cephalad or caudad edge of the vertebra adjacent to the apophyseal ring also known as: avulsed vertebral rim apophysis limbus vertebral fracture lumbar posterior marginal node slipped vertebral epiphysis Epidemiology prevalence 5.8-28% among adolescents and young adults age most commonly in 18-25 year olds literature reported in ages 8 through 69 years demographics male : female ratio age bracket location where in the body/bone risk factors smoking etc. Pathophysiology mechanism of injury (trauma) this is the mechanism of injury (valgus force on knee) pathophysiology this is the physiology (hormone feedback loop) pathobiology this is the molecular or cell biology of disease pathoantomy the anatomic junction between the ring apophysis cartilage and the endplate is weak Genetics inheritance pattern autosomal dominant mutations chromosome gene protein encoded for Associated conditions orthopaedic manifestations medical conditions & comorbidities Prognosis natural history of disease prognostic variable favorable negative survival with treatment Anatomy Osteology x Muscles muscles a Ligament ligament a Blood Supply x Biomechanics x Classification Classification A Type A • Characteristic A • Characteristic A Type B • Characteristic B • Characteristic B Type C • Characteristic C Type D • Characteristic D Presentation History (optional) this is a specific event the patient cites. "Heard a pop" Symptoms common symptoms location duration severity Physical exam inspection varus or valgus deformity ecchymosis & swelling diffuse tenderness motion document flexion-extension and pronation-supination crepitus should be noted varus/valgus instability stress test challenging but important for an accurate diagnosis neurovascular provocative tests Imaging Radiographs recommended views xrays that should alwasy be obtained on evaluation optional views secondary views that might give additional information findings disc space narrowing measuerment measurement A (Cobb angle) measurement A (pelvic incidence) sensitivity and specificity CT indications when do you order views best seen on sagital findings sensitivity and specificity MRI indications when do you order views best seen on T2 axial sensitivity and specificity Bone scan indications when do you order sensitivity and specificity Studies Serum Labs Invasive Studies Histology Gross anatomy Histology Immunostaining Differential Key differential (top 5) key distinguishing factor Complete differential tables Treatment Nonoperative nonoperative treatment A indications first line of treatment modalities heparin, aspirin, clopidogrel, IV thrombolysis, glycoprotein IIb/IIIa antagonists (abciximab, eptifibatide, tirofiban) Operative operative treatment A indications indication a indication b operative treatment B indications indication a indication b Techniques Operative treatment A approach soft tissue bone work instrumentation complications specific to this treatment outcomes Operative treatment B approach soft tissue bone work instrumentation complications specific to this treatment outcomes Complications Compliation A incidence risk factors treatment tested treatment in bold blue indications indication A Compliation B incidence risk factors treatment tested treatment in bold blue indications indication A