Short Notes in Orthopaedics

 Viva 1  Mx of Crush Injury  Relevant History  Handedness , Occupation , MOI, Comorbidities  - Tetanus prophylaxisis- if indicated Antiseptic (Betadine ) dressing   Radiographs to exclude #s Wound Exploration  Repair nail under LA ( digital block and digital tourniquet)  Steps of procedure  Remove nail plate Inspect nail bed, wash thoroughly Copious lavage lavage Reduce fracture , stabilize using k- wire Removal- at 4 weeks fapairs mail bud i a Gutare (VICRYL fapide) 60 abebable Repair nail bed with a absorbable suture 6-0 ( vicryl rapide )  Wash and replace nail plate  Use Figure of Eight suture to hold nail plate in place  what to explain to patient ?  - Nat Plate falls off & new one comes which will be disfigured . -Risk of long term nail defirmity  -Discomfort in region of nail deformity  -DIP jt stiffness. Viva 2  →Describe radiographic findings, AP pelvic radiograph showing a dislocated ...

 Viva-1 what do you find in Wrist PA view ?  ( We don't have X ray ,  Suppose you saw an undisplaced fracture of Scaphoid )  Viva   Schapoid View - hand and wrist in ulnar deviation along with 15 degrees of cephalad angulation of X ray tube.  Indications of Internal Fixation of Scaphoid fractures  1.Displacememt > 1 mm  2. SL Angle > 15 degrees  3. Lunocaoitate angle > 15 degrees 4. Interscaphoid angle >20° (dorsal humpback) 5.Proximal pole # , Periluante dislocation  6.Delayed union Operative fixation in acute non displaced fractures  Non union Scaphoid fractures  Better early outcome scores in grip strength , ROM with fixation but no difference after 12 to 16 weeks  Rate of delayed union is less with early fixation . Complications  AVN of Proximal Pole  Non union  Mx of established non-union Arthritic changes not present  Fixation with bone graft         ( Di...

 You see a Photograph of a right little finger. MCP jt shows Flexion .  Diagnosis -  Dupuytren's Contracture  Risk Factors  Family hx, Liver disease, High Alcohol Intake  DM , Epilepsy Two main components in histology    Myofibroblast  Thick collagen Fibers  Mx.  Non operative  Observation , Night time splintage Injection - Steroids - reduces local tenderness                 -colllgenase Surgery  Permanent Fasciotomy  Mild cutaneous contracture at MCP Jt.  Segmental/Patmar fasciotomy   Regional fasciectomy ( Z plasty for closure /skin graft )  Dermo fasciectomy and skin grafting - PIP it arthrodesis - severe /recurrent disease  Amputation of digits  Counselling  Delayed wound healing  tendon,nerve,vessel injury  temporary and permanent numbness  necrosis of digit & amputation. Incomplete correction  Recurrence and...

 Inflamatory and Rheumatoid Disorders  Rheumatoid Arthritis Most common cause of chronic inflammatory joint disease  1-3 % , 4th or 5th decdes women affected 3 to 4 times more often than men. Causes 1) Genetic susceptibility 2) Immunologic reaction in joints and tendons 4) Rheumatoid Factors 5) perpetuation of inflammatory factors  6) articular cortilage distruction. Pathology  1)Joints and Tendons        Preclinical inflammation - increased ESR and CRP      Synovitis         Destruction         De formity 2) Extra articular tissues       1) Rheumatoid Nodules        2) Lymphadenopathy        3) Vasculitis        4) Visceral disease        5) Muscle weakness Clinical features Insidious onset Early stage soft tissue swelling     stiffness. muscle pain Tiredne...

Acute Osteomyelitis  Orthopaedic Diagnosis  History  2) Past History 3) Family History  4) Social background 5) Examination  Look / Feel / Move Special tests developmental milestones. C ) Investigations  Plain Radiography    Patient - soft tissue , bones and joints       using contact media 2- CT 3) IMRI 5-30, 000, stronger than Earth’s magnetic field 4) Diagnostic ultrasound  5) Radionuclide imaging - 99 m Tc B ) Blood tests CBC, ESR CPP - Non specific  - Tissue typing  - Rheumatoid factor  - Synovial fluid analysis. C) Bone-Biopsy  D) Diagnostic arthroscopy  Infection  Direct Introduction  (2) from contiguous infection  (3) indirect spread from blood stream Factors predisposing to bone infection  - Malnutrition & general debility" - DM - Corticosteroid administration - Immune deficiency -immunosuppressive drugs. - Venous stasis in limbs - Peripheral l vascular diseas...

 Look           Alignment of UE - Normal           Fullness of Anterior Shoulder           Skin - Normal           Muscles wasting               Always look from front , side and then back. If there is a mirror in front you can inspect shoulder                     movements from back also .           Feel           Temperature - Generally normal           Any tenderness ?           Lymph nodes on Axilla         Palpation starts from medial border of clavicle , along clavicle , shoulder joint, proximal humerus             and then again back to joint, along spine of scapula and all 3 b...

I found students really lost when doing a Brachial Plexus Injury clinical examination. If it is done in a sequence then it won't be. I have explained it in a simplified manner. Go from the front , then side and observe on the back on inspection. Then again do the 2nd round from front, sides and  to back on palation along with movement of joints. Then on third round i would do tinel's sign , sensory exam and muscle power testing on third round. And at last i would complete the examination measuring scars, if there is descrepancy of limb length and finally pulsation of brachial / radial and ulnar arteries / lymhp nodes  To pass any PG exam , a good history along with a comprehensive physical examination is a minimum criteria to be appreciated and be asked for treatment which allows you to pass the exam. All questions after that will help you be get extra.  i wish you all the best.  Please support me giving comments sothat i can work more on topics like these.  ...

Supracondylar Fracture  Patient Presentation         Age 6-10 years         MOI - Fall on outstretched hand with elbow on extension, breaks.   Olecranon serves as the fulcrum      and the stress concentrates in distal humerus. Anteriorly the perisoteum hinges.     Pain , swelling, deformity, bruising      Deformity (usually S shaped ) , skin puckering      Compartment syndrome         Blood vessels spasm/ contusion/ tear/ thrombosis     If capillary refill present , hand arm Dunlop traction done.      No role of Angiography , further delays the treatment.      Nerve Injuries, proximal fragment spike hits nerve.             3a Posteromedial displacement - Radial Nerve involvement             3b Posterolateral displacement - Median Nerve ...