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

Pavlov's ratio at each level from C3 to C7. | Download Scientific ...

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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