Short Notes in Orthopaedics

Findings Small foot , stretched skin  on dorsolateral region and thrown into creases along medial aspect scars and callosities head of talus palpable lateral convex border and medial concavity with furrows heel rotated medially and drawn up ancilliary   genu valgum ,   extrinsic  / intrinsic type gait - stumbling ROM -   ankle , knee , inversion , eversion at subtalar joint other examination  hip for DDH   Spine for Dysrahism   Cerebral Palsy   Polio - tight iliotibial band     cleft lip , palate , exomphalos  and congenital hernia correctible or not Impression -                    Primary or Idiopathic Secondary Clubfoot                     Recurrent Club Foot       Deformities in club Foot  equinus at ankle  varus and internal rotation  forefoot adduction and supination midfoot cavus others -  internal rotation of tibia  atrophy of claves and smaller circumference than others  small foot How do you look for equinus , v

Young boy or a girl height stunted Ratio of upper and lower body height proportion normal or not (normally 1:1) LE reaches upto middle thigh or down ? proportion of arm and forearms looks normal fingers shape is normal lower extremity look shorter alignment of LE on a photo shows multiplanar deformity of leg with anterior bowing and areas of flattening anateroposteriorly on leg knee and hip are at flexion attitude , Intelligence - normal Eye sight - normal head ,neck examination - frontal bossing , sclera color , dentition , neck webbing , chest any signgs or deformity , belly protuded or not , umbilical hernia or not , back - kyphoscoliosis or not , dimpling of hair or not , any swellings on upper or lower extremities gives  a clue to plan and proceed further Impression Rickets Osteogenesis Imperfecta    will have history of reccurent fractures with trivial trauma ,     family history     eyes color might be different , poor dentition Pol

Contour paraspinous muscles  Errector Spinae or    Sacrospinalis - Multifidus , Longissimus , Iliocostalis from medial to lateral Symmetry Pelvic Obliquity Step off deformity   Spondylolisthesis - body of involved vertebrae and rest of spine above slide forward Lateral - Normal lordosis ,                 hyperlordosis - flexion contracture of hip               flat back syndrome                        compression fracture of lumbar vertebrae                Gibbus - - sharp angular kyphosis kyphotic deformity                               TB Gait - antalgic heel walk - 10 steps ,  L4 testing at L 3-4 toe walking L5 - S1 testing ROM - flexion 80- 90 , 10 cm to floor extension 20 - 30 degrees  lateral bending - 20 to 30 degrees  rotation - 30 to 40 degrees measurement - Schober test Palpation spinous process counting L4-5 , level of iliac crest paraspinous muscles - tender , tone posterior facet joints muscle testing          fle

Look skin  , vertebral alignment , dimpling, tuft of hair Head , eyes , fact , neck , suprascapular/infrascapular region , hair level , Feel - Temperature, tenderness, spasm Sensory Examination upper limb  / upto c 8 power of muscles in upper extremities Pulsation Reflexes - Homan,s                     spine - humeral                    radial reflex                    cross adduction thigh                   clonus Special test - Gait, Rhomberg test, Spurling ,Lhermitte test,  Distraction test , valsalva test rule out problem of shoulder , brachial plexus and extra rib as they mimic the same sometimes. functional like in torticollis flow like from standing (front , sides and back ) , walking , squatting and sitting so as not to discomfort patients .

Torticollis Look Anterior  - head position - centre or deviated to one side with rotation                        decrease head and shoulder distance on one side                        facial aymmetry present or not ?                         eyes - nystagmus ?                                 taut sternocleidomastoid muscle                                         chest - muscles wasting present or not ?  Side -             ear close or touching the shoulder                        l ordosis                                   comment on deltoid contour and elbow extended  Back -                         b/l shoulder symmetrical                          normal hairline                          scapula at same level                          occiput flat or nomal ?  Gait / Squatting - Normal or not ?  Feel - comment of taut sternocleidomastoid muscles,               palpate on sternum, clavicle , AC joint, Scapula and Proximal humerus               palpate on C-spine  Movement      

Look Leg cylindrical Dorsum - swelling on dorsolateral region lateral to ankle joint skin - callosity forefoot - adduction toes alignment - normal midfoot - cavus lateal border convex hindfoot varus whole foot -shortened foot wears - worn out no torticollis , hip flexion normal spin - no patch of hair , scoliosis and dimpling feel - temperature normal ,          no tenderness  movement - active  active passive deformity correctable or not puslation - intact sensation intact motor power - muscles normal reflexes - achillies tendon reflex , babinski's reflex LLD , Lymph nodes            

Pratap Aryal   14 years   / boy    hospital no 017-1121000 , charikot , Nepal C/O – Lt elbow deformity for 11 years History of fall injury at the age of 3 years , and sustained injury around elbow . casted after 12 hours for 3 weeks ( no documents to know the fractured part in elbow ) Deformity noticed which remained static . No disabilities but he is not feeling well with the deformity Personal History – He is a right hand dominant boy studying in class 8. O/E Introduction of ownself Exposure upto Shoulder Maintain privacy of the patient Inspection   Attitude of the Lt upper extremity   Internally rotated   Alignment   - cubitus varus deformity Deformity is exaggerated in shoulder abduction No wasting of muscles on arm forearm and hand Normal overlying skin Palpation   Overlying temperature – normal Skin texture – normal No tenderness of soft tissue and bone Lateral condyle , olecranon process and medial condyle at same li