This blog is for students preparing for exam or looking for short notes in orthopaedics in different topics. We are trying to give a quick insight of Orthopaedics written in exam oriented manner.
Tuberculosis In general , Rest and Nutrition Chemotherapy Surgery if needed . Dorsal Spine - Approach to surgery A bit ambiguous Many prefer to do Anterior Transpleural. Some choose Anterolateral/posterolateral extrapleural and posterolateral approaches Posterolateral Approach(Martin 1970) Dura exposed by Hemilaminectomy first and then operation extended laterally to remove posterior ends of 2 to 4 ribs, corresponding transverse process and pedicles. He thinks Anterolateral approach a very risky one. Approach to Atlanto-occipital and Atlanto-axial joint Numerous structures on the way anteriorly Supine position, Neck on 5-10 degrees hyperextension ,Trachesostomy done Transoral Anterior Approach Uvula, Soft palate bissected , Hypopharynx packed, 5 cm long incision given, Flaps
Coxa Vara Painless limp, LLD gradually worsening , Unilateral or bilateral in 30-50 % cases Prominent trochanters Pelvic Tilt- LLD Trendelenburg test or delaye trendelenburg test + ve B/L waddling High Greater trochnater - supratrochanteric shortening, Decreased abduction, (decrease in articular trochanteric distance ) and internal rotation (due to decreased anteversion) may have out toeing r/o cervical instability causing limping Types of Coxa Vara https://quizlet.com/au/304405013/coxa-vara-flash-cards/ Mangement Depends on Hilgenreiner Angle (HEA ) https://www.orthobullets.com/pediatrics/4041/developmental-coxa-vara > 60 degrees - wait and watch 45-60 degrees - wait and watch Goals of surgery Neck shaft angle (more or equal ) to 140. degrees Correct version Ossification and healing of inferomedial. fragment Restore ATD (Articulo-trochanteric distance AND abductor mechanism (length -tension
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 involvement Gartland and Wilkins Classification Extension type fracture 1. Undisplaced Fracture 2. Displaced Fracture , posterior cortex is. intact 3. Displaced fracture, posterior cortex breaks Flexion type occ
Hip Joint Ball and Socket joint. Hip fracture is any fracture involving Interochanteric region head, neck or acetabulum. 310,000 Hip fractures in the United State in 2003 1/3 rd - receive a hip replacement. 10.3 - 15.2 billion dollars / year Elderly – Vast Majority Co-morbidities Femoral Neck Fracture Fracture Healing is delayed due to - I ntracapusular neck- No Cambium layer - Synovial fluid clears out haematoma and inhibits fracture union - Haematoma causes pressure on head Mechanism of injury • Directly on lateral hip • Twisting mechanism • Fatigue or insufficiency fracture, then fall • In younger - RTA / fall from a height Risk Factors of Hip Fractures • Osteoporosis and Falls Lifetime risk -17.5 percent for women : 6 percent for men • Average - women 77 years old : men 72 years old • Low socioeconomic status • Cardiovascular diseas
Boyd Amputation -Tibiocalcaneal arthodesis, heel pad preserved. ( https://www.semanticscholar.org/ ) ( Modifizierte Pirogoff-Amputation | SpringerLink ) Pirgoff Amputation Amputation at ankle. part of calcanuem left in the stump , Calcaneum cut vertically. Advantages long lever arm , self suspension , good proprioception , end wt bearing. Disadvantages poor cosmesis , too long to use standard foot , no possibility of prosthetic foot fitting
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