Short Notes in Orthopaedics

 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 borders of scapula  Movement           Abduction          Adduction           Flexion           Extension           ER         Special Tests                          Apprehension Test                     Anterior Drawer Test                      Jobe's Relocation Test                      Sulcus Test    Pulsation of Brachial arteries    Sensation  - Axillary N.                               Radial N.   

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.   Look -      (Front

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

 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                                 

Gait and Squad both are affected  Short Femur , scars ,shoe raise Knee - ACL/ PCL absent  Leg - Shaft of fibula absent  Foot - Size small, toes are absent , may be functional or not  Ankle - LM, MM may be absent  https://twitter.com/OBandarchi/status/1676081390796808193

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