Short Notes in Orthopaedics

 Find out age , family history positive if any(Heridatiary Multiple Exostosis/HME, Hypophosphatemic Rickets, Bony Dysplasia )  https://www.medicalnewstoday.com/articles/319894 Physical Examination     Gait      Squatting     Standing - Quadriceps , Patella forward, forefoot , Obvious Genu Valgum Deformity     Side -          Any scars                            Knee in extension     Back -        Popliteal swelling, comment on calf muscles                           Heel varus  Ask patient to lie down      Feel -           Temperature normal, no bony/ soft tissue tenderness                      ...

 Pes Cavus  https://thetagoeclinic.co.uk/pes-cavus/ Important Causes A. Heriditary Motor Sensory Neuropathy   Also called as Charcot-Marie-Tooth Neuropathy     Characterized by motor and sensory neuropathy.                 1)              Weak Tibialis Anterior (TA)                                         &                     Normal Peroneus Longus                                leads to                       Ist Metatarsal Drop                   2)   ...

 Classification      Bado -    Anterior - 75 - 80 %                        Posterior - 5 % , common in adults                      Lateral     -   15-25 %               Any type associated with radial shaft.         fracture , rare.  https://rayorthos.com/bado-classification-of-monteggia-fractures/ Management      ATLS review      Full history     Examination - r/o other injuries , open wounds, compartment syndrome, DNVS     Further radigraphs          Urgent reduction and fixation     Direct approach to ulna                Internervous plane - ; ECU (PIN) and FCU (UN)           ...

 How do you approach a patient with shaft of himerus fracture with radial nerve palsy?     Approach based on ATLS.      Exclude other injuries - NV, Open wounds, compartment syndrome      AMPLE History     Analgesia     Splinting      Collar and Cuff with gravity traction     Fracture can be managed non-operative or operatively based on fracture displacement and fracture                geometry  https://nerveclinic.co.uk/nerve-injuries/nerve-injury-after-fracture-or-dislocation     Early Immediate Exploration Criteria for Radial Nerve Injury     ( https://www.aofoundation.org/trauma/about-aotrauma/blog/2023_03-      blog-moharram-lambert-radial-nerve-palsy)     Open Fractures with Radial Nerve Palsy         High velocity injuries - Gunshot wounds, Penetrating wounds, Severe soft tissu...

  C5 displacement over C6 , (displacement > 50 % , it's a Bifacet dislocation ) Delayed Diagnosis of B/l facet dislocation :a case report.Julie O Shaughnessy et. al. Only shows C7 and is inadequate for trauma C-spine lateral radiograph.  Management       - ATLS guideline -remove helmet visor to gain access to eyes , nose and mouth.     - Exclude other injuries.     - Full imaging of spine / full neurological examination - ensure this is isolated injury.          - Spine surgery consultation for reduction                          Close or Open      - Exclude a prolapsed disc which damages cord during reduction.                 If no MRI scanner, can we reduce with patient awake ?          Yes, we can reduce. We can monitor patient awake, alert .Serial ne...

 Subtrochanteric Fractures      Common in elderly people.     Causes - simple fall from standing.                                    Fragility or Pathological fractures                         High energy fractures     Russel Taylor Classification                           1. Intact Pyriformis fossa                                        A. Lesser trochanter intact                                        B. Lesser trochanter detached          ...

A young  pedestrian was hit by a car and sustained Mid shaft of tibia fracture of her left leg. After 24 hours, he suffered from shortness of breath. Chest X-ray is shown as below. What may be the cause.  Fat Embolism in Pulmonary Artery Upright portable AP chest x-ray showing hypovolemia secondary to a pulmonary embolism, knowns as Westermark sign. Image courtesy https://emergencymedicinecases.com/wp-content/uploads/2012/03/015-15-Figure-1.jpg Radiographic other findings PA chest xray in a patient with a PE. Arrow denotes the area of pulmonary infarction, known as Hampton hump.  Image courtesy  http://www.imagingpathways.health.wa.gov.au/images/pe/ham.jpg  Sometimes Atelectasis is found. What is Damage Control Orthopaedics (DCO) ?          Planned and staged surgical strategy in management of polytrauma patients to minimize effects of              second   hit on already limited physiolo...

 Approach to patient  with a hip dislocation   AP radiograph showing a posterior hip.      dislocation     ATLS Protocol is followed. Don't miss to say X-ray pelvis, C-spine lateral view and CXR-AP view                             to  r/o other injuries                    document NV status of limb along with findings on hip                    additional view of Hip Lateral and CT-Hip joint incase there is a acetabulum fracture                    adequate analgesia                     pelvic specialist consultation    How to treat this injury ?       Consenting , explain risk of fracture      ...

 Like any other joint dislocation, its a surgical emergency.                                    https://www.orthobullets.com/trauma/1043/knee-dislocation Causes        Motor Vehicle Collision       Sports related injuries        Falls Initial Assessment     - NV status before and after reduction     - If any vascular injury ,exploration and angiography      - Normal pulse does not rule out vascular injury , measure ABPI (< 0.9 - ABNORMAL ) Classification   Based on direction of dislocation of tibia in relation to femur           Anterior - dislocation most common.     upto 20 % spontaneously relocate and dont fit into classification.                https://emedicine.medscape.com/artic...

Result of high energy trauma resulting with a heavy axial force of talus which bursts tibial plafond over   talus  AP radiograph of Ankle shows a multifragmentary Pilon fracture.                                                   https://ota.org/for-patients/find-info-body-part/4687 How do you approach ?     ATLS review     R/o concomitant injuries     R/o compartment syndrome     NV status , observe signs of open injury or degloving injury     temporary splinting, analgesia, obtain AP/Lateral views and  CT -study       plan and do  definitive management  Classification of Pilon Fractures           Type 1 - essentially non-displaced                      2 - d...