Some queries
Polio tendon transfer and TA timing
when to perform glass slide sensory test in brachial plexus injury
role of MRI , myelography , EMG , in brachial plexus injury
two pint discrimination stast and dynamic importance
knee sagging ACL / PCL
Thumb ulnar border - sensation - PIA based flap ,reverse radial flap ; same for ulnar border.
Hand function
Grasp , Grip , Pinch
Expansile Lytic Lesion
GCT , ABC , SBC
Infection rate in open fractures
Gu I and II - 2-4 T%
Gu III - 10 %
Multiple Fractures
Child Abuse
Rickets
Osteogenesis Imperfecta
Osteoporosis
Nutritional deficiency
Prevertebral shadows in C-spine X-ray
C1 - 1 mm
C4 - 4 mm
C7 - 15 mm
Atlanto dens interval - 3 mm
3 lines
Anterior vertebral , Posterior Vertebral lines , Spinolamellar line
Damage Control Surgery
Permissive Hypotension
Haemostatic Resuscitation
Markers - PT -X3 , IL-6 , TSR
Methods of stabilization
compression
PSAG
EMBOLIZATION
SHOULER DISLOCATION
Unidirectional , reuslts in
Bankart's , Hill -Sachs lesion
Inferior and Middle Glenohumeral laxity
Multidirectional Shoulder Dislocation
reuslts in SLAP , SGH laxity
Paediatric Both Bone fracture
entry point - radius, proximal to Lister's tubercle
Ulna - posterolateral edge of Olecranon tip.
Knee Prosthesis Types
1.Hinged Knee
2. PCL Retaining
3 .PCL Substituting
TKR successful > 85 % in terms of pain,
THR successful in > 95 % in terms of pain .
Paraplegia in tuberculosis
who require surgery
1.a dry lesion
2.thick dural arachnoid complex
3. cord small and irregular
4.cord small and irregular
5. cord with features of myelomalacia
Who don't require surgery ?
preserved cord
cord edema , myelitis ,
fluid collection - extradural space
Spine approach - from posterolateral approach - can be managed anterior debris and stabilize all 3 columns.
Simple bone Cyst - fallen fragment sign
Osteoid Osteoma D/D
Ewing's Sarcoma
Bordie's abscess
Enchondroma D/D
Tubercular Dactylytis
Tumors like condition - ABC ,Simple Bone Cyst , Fibrous Dysplasia
Developing anomalies - Bone islands , Non ossifying Fibroma
Tumors of Unkown origin - GCT , Ewing's
Osteiod Osteoma which if > 1 cm , called it Osteoblastoma .
Vertebral Plana - FETISH Mnemonic
D/D
Fracture due to trauma
Eosinophilic granuloma
Tumor - leukemia , Myeloma, metastais
Infection - Tuberculosis
Steroids
Haemangioma
Histocytosis , GCT, Chondroblastoma, Osteoblastoma , Ewing's sarcoma - same treatment.
GCT d/d radilogically
Brown's osteoblastoma
Langerhan Cell Histiocytosis
ABC
Chnodromyxoid Fibroma
Ewing's Sarcoma
D/D
1.Infection
2.Oseoid Osteoma
3. Metastatic Neuroblastoma
4 . Clear Cell Sarcoma
5. Reticulin Cell
Bone scan to see bone metastasis
Histologically
resembles other blue cell tumors . t (11;22 ) (p24;q12)
PAS + owing to intracellular glycogen
PSA -ve - lymphomas which also have common antigen for B and T cell .
Haemangiopericytoma +ve for VIII
Small cell metastasis carcinoma and melanoma - cytokeratin +
worse prognosis
fever , anemia , WBC, ESR and LDH .
If increased suggests more extensive disease and poor prognosis.
old age (>12-15 ) and males suggest poorer prognosis.
Treatment
Neoadjuvant or adjuvant chemotherapy
both to treat distant metastasis
Radiotherapy - primary choice or an adjuvant after marginal excision.
or if wide excision possible without functional deficits then this can be opted.
5 year survival is 60- 75 %.
Osteosarcoma
2nd Decade - Primary type
Intramedullary Osteosarcoma
Parosteal OS
Periosteal OS
Telangeictatic OS
Surface OS
Clear Cell OS
Poor prognosis
rapid relapse after initial treatment , pulmonary nodules > 3 cm and multiple.
OA Mangement with Varus Knees
Detailed history, physical examination , investigations .
Treatement
Life style modification
weight reduction ,
Varus Knee offloading braces
Oral Medications - Analgesics , NSAIDs
I/A - DPM , Hyaluronate compounds
Surgery - Osteotomy - High Tibial Osteotomy ,
Arthoplasty
Read about coventry and Mc' Murray's hip osteotomy .
Limb Salvage surgery pre-requisites
Intact extensor mechanisms
Intact sensory nerve supply
Sauvegren method for age prediction using Olecranon process on X-ray for assessing growth in
idiopathic scoliosis.
Spinal Shock
state of areflexia sensory motor and autonomic.
Treatment
Methylprednisolone injection
patients presented with in 8 hours
Bolus - 30 ml per kgs in 15 mins
Maintenance - 5.4 ml /kg / hr over 23.45 hours
https://emedicine.medscape.com/article/793582-treatment#d11
MRI images
STIR - Fat Supression
FLAIR - Water suppression
Pavlov Ratio
its a ratio of the distance from midpoint of posterior portion of vertebral body to nearest point on the spinolaminar line divided by the anteroposterior width of vertebral body.
It help to diagnose stenosis.
Some conditions that pose risk of stenosis are
Os-Odontorium ,failure of ossification
Down's Syndrome
Kellpel Feil Syndrome
Sprengel's Deformity
Other Conditions
RA
Jefferson's Fracture
Laminoplasty - it a surgical procedure to increase the volume of spinal canal.
Both Bone fracture
Volar Angulation
Supination mechanism of injury - it leads to fracture with volar angulation . This has to be immobilized in pronation
Dorsal Angulation
Pronation mechanism of injury - it leads to fracture with dorsal angulation. This has to be immobilized in Supination mode.
Previous concept - pronator teres of proximal side leads to pronation of the proximal fragment so put cast in pronation which is no more applied.
Mantoux reading - palpable elevated induration measured in transverse axis.
two point discrimination
Static
Dyanimc
How to measure cavus
Knee saggin - ACL and PCL injury
when to perform glass slide sensory test in brachial plexus injury
role of MRI , myelography , EMG , in brachial plexus injury
two pint discrimination stast and dynamic importance
knee sagging ACL / PCL
Thumb ulnar border - sensation - PIA based flap ,reverse radial flap ; same for ulnar border.
Hand function
Grasp , Grip , Pinch
Expansile Lytic Lesion
GCT , ABC , SBC
Infection rate in open fractures
Gu I and II - 2-4 T%
Gu III - 10 %
Multiple Fractures
Child Abuse
Rickets
Osteogenesis Imperfecta
Osteoporosis
Nutritional deficiency
Prevertebral shadows in C-spine X-ray
C1 - 1 mm
C4 - 4 mm
C7 - 15 mm
Atlanto dens interval - 3 mm
3 lines
Anterior vertebral , Posterior Vertebral lines , Spinolamellar line
Damage Control Surgery
Permissive Hypotension
Haemostatic Resuscitation
Markers - PT -X3 , IL-6 , TSR
Methods of stabilization
compression
PSAG
EMBOLIZATION
SHOULER DISLOCATION
Unidirectional , reuslts in
Bankart's , Hill -Sachs lesion
Inferior and Middle Glenohumeral laxity
Multidirectional Shoulder Dislocation
reuslts in SLAP , SGH laxity
Paediatric Both Bone fracture
entry point - radius, proximal to Lister's tubercle
Ulna - posterolateral edge of Olecranon tip.
Knee Prosthesis Types
1.Hinged Knee
2. PCL Retaining
3 .PCL Substituting
TKR successful > 85 % in terms of pain,
THR successful in > 95 % in terms of pain .
Paraplegia in tuberculosis
who require surgery
1.a dry lesion
2.thick dural arachnoid complex
3. cord small and irregular
4.cord small and irregular
5. cord with features of myelomalacia
Who don't require surgery ?
preserved cord
cord edema , myelitis ,
fluid collection - extradural space
Spine approach - from posterolateral approach - can be managed anterior debris and stabilize all 3 columns.
Simple bone Cyst - fallen fragment sign
Osteoid Osteoma D/D
Ewing's Sarcoma
Bordie's abscess
Enchondroma D/D
Tubercular Dactylytis
Tumors like condition - ABC ,Simple Bone Cyst , Fibrous Dysplasia
Developing anomalies - Bone islands , Non ossifying Fibroma
Tumors of Unkown origin - GCT , Ewing's
Osteiod Osteoma which if > 1 cm , called it Osteoblastoma .
Vertebral Plana - FETISH Mnemonic
D/D
Fracture due to trauma
Eosinophilic granuloma
Tumor - leukemia , Myeloma, metastais
Infection - Tuberculosis
Steroids
Haemangioma
Histocytosis , GCT, Chondroblastoma, Osteoblastoma , Ewing's sarcoma - same treatment.
GCT d/d radilogically
Brown's osteoblastoma
Langerhan Cell Histiocytosis
ABC
Chnodromyxoid Fibroma
Ewing's Sarcoma
D/D
1.Infection
2.Oseoid Osteoma
3. Metastatic Neuroblastoma
4 . Clear Cell Sarcoma
5. Reticulin Cell
Bone scan to see bone metastasis
Histologically
resembles other blue cell tumors . t (11;22 ) (p24;q12)
PAS + owing to intracellular glycogen
PSA -ve - lymphomas which also have common antigen for B and T cell .
Haemangiopericytoma +ve for VIII
Small cell metastasis carcinoma and melanoma - cytokeratin +
worse prognosis
fever , anemia , WBC, ESR and LDH .
If increased suggests more extensive disease and poor prognosis.
old age (>12-15 ) and males suggest poorer prognosis.
Treatment
Neoadjuvant or adjuvant chemotherapy
both to treat distant metastasis
Radiotherapy - primary choice or an adjuvant after marginal excision.
or if wide excision possible without functional deficits then this can be opted.
5 year survival is 60- 75 %.
Osteosarcoma
2nd Decade - Primary type
Intramedullary Osteosarcoma
Parosteal OS
Periosteal OS
Telangeictatic OS
Surface OS
Clear Cell OS
Poor prognosis
rapid relapse after initial treatment , pulmonary nodules > 3 cm and multiple.
OA Mangement with Varus Knees
Detailed history, physical examination , investigations .
Treatement
Life style modification
weight reduction ,
Varus Knee offloading braces
Oral Medications - Analgesics , NSAIDs
I/A - DPM , Hyaluronate compounds
Surgery - Osteotomy - High Tibial Osteotomy ,
Arthoplasty
Read about coventry and Mc' Murray's hip osteotomy .
Limb Salvage surgery pre-requisites
Intact extensor mechanisms
Intact sensory nerve supply
Sauvegren method for age prediction using Olecranon process on X-ray for assessing growth in
idiopathic scoliosis.
Spinal Shock
state of areflexia sensory motor and autonomic.
Treatment
Methylprednisolone injection
patients presented with in 8 hours
Bolus - 30 ml per kgs in 15 mins
Maintenance - 5.4 ml /kg / hr over 23.45 hours
https://emedicine.medscape.com/article/793582-treatment#d11
MRI images
STIR - Fat Supression
FLAIR - Water suppression
Pavlov Ratio
its a ratio of the distance from midpoint of posterior portion of vertebral body to nearest point on the spinolaminar line divided by the anteroposterior width of vertebral body.
It help to diagnose stenosis.
Some conditions that pose risk of stenosis are
Os-Odontorium ,failure of ossification
Down's Syndrome
Kellpel Feil Syndrome
Sprengel's Deformity
Other Conditions
RA
Jefferson's Fracture
Laminoplasty - it a surgical procedure to increase the volume of spinal canal.
Both Bone fracture
Volar Angulation
Supination mechanism of injury - it leads to fracture with volar angulation . This has to be immobilized in pronation
Dorsal Angulation
Pronation mechanism of injury - it leads to fracture with dorsal angulation. This has to be immobilized in Supination mode.
Previous concept - pronator teres of proximal side leads to pronation of the proximal fragment so put cast in pronation which is no more applied.
Mantoux reading - palpable elevated induration measured in transverse axis.
two point discrimination
Static
Dyanimc
How to measure cavus
Knee saggin - ACL and PCL injury
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