Short Notes in Orthopaedics

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

 1. Failure of Formation  2. Failure of Differentiation  3 . Duplication   4. Overgrowth   5. Constriction band syndrome   6. Miscellaneous    7. Generalized skeletal abnormalities  Failure of formation  Transverse    Longitudinal      Pre-axial - Hypoplasia -thumb/ radius     Post-axial - Ulnar Hypoplasia      Central - Cleft hand     Intercalalted arrest- Phocomelia  https://www.semanticscholar.org/paper/Nomenclature-for-congenital-skeletal-limb-a-of-the-Burtch/25d83583b0d67c1d3edc2f11e33a4db8ea5da45b/figure/0

 Depends upon predicted LLD at skeletal maturity Current - LLD   Radiological        Orthoroentgenography       Parallel beam scanography      CT scanogram  Predicted LLD at maturity      Menalus rule of thumb     Moseley straight line method     Eastwood and Cole method     Paley's Multiplier method      Aetiology           Post trauma           HME, Achondroplsia          Chrosomal (Turner's Syndrome )          Idiopathic      Surgery           Age and growth remaining           severity of deformity          severity of symptoms        Operations           Osteotomy , epiphysiodesis           Improve ROM - Sauve - Kapandji                                        -  Darrach   https://www.slideshare.net/NaveedJumani/limb-length-discrepency

Common in females B/L prominent ulnar styloid on dorsum and restricted supination ,DF and Radial deviation  Wrist deviation - ulnar and volar ward     Aetiology          Post trauma          HME, Achondroplsia         Chrosomal (Turner's Syndrome )         Idiopathic      Surgery          Age and growth remaining          severity of deformity         severity of symptoms       Operations          Osteotomy , epiphysiodesis          Improve ROM - Sauve - Kapandji                                 -  Darrach       Both - Wrist Fusion and osteotomy          https://www.researchgate.net/figure/a-                  Madelung-deformity-clinical-                                    picture_fig1_334069794                      https://www.llrs.org/patient-                                    conditions/madelung/

 It's a rigidity of of Ist metatarsal joint (MTP). Gait  alters. Great toe straightens , Callus develops on medial side of distal Phalanx.  MTP - knobby, tender dorsal bunion. Dorsiflexion of MTP - restricted. outer side of soles on footwears wear out. https://my.clevelandclinic.org/health/diseases/14665-hallux-rigidus Treatment     Not interfering activities                t hey can be left alone.    Intermittant Pain               I/A injection, local anaesthesiae along with corticosteroids.               Rock soled shoes               full length insole     Surgical Options                Chilectomy - removal of osteophytes                Extension osteotomy- Proximal Phalanx                 Arthrodesis                   10 degrees valgus and DF, 10 mm                            clearance                Arthroplasty                                  Interposition arthroplasty                                  Capsular Arthroplasty                                             metal

 Ankle swells up Calf wasting occurs Skin becomes warm and tender Movement gets Restricted  We have to examine knee and foot joints as well.   X-ray of Ankle Joint- Regional Osteoporosis                                              Bone abscess                                             Narrowing and irregularity of joint space       http://www.scielo.org.za/scielo.php?                       script=sci_arttext&pid=S1681-                                  150X2012000200004 Treatment             General ATT            Splint with foot in neutral position             Non-weight bearing in a caliper           

 Commonly involves Forefoot  MTP swelling, Tenderness   Clawing of toes    Corns on dorsum '         Plantar Callosities     Treatment      Special shoes with wide tox box to accomodate toes      Synovitis - Corticosteroids, Operative  Synovectomy       Surgery for clawing of toes       Surgery for Hallux Valgus - Excision Arthroplasty

https://www.huffpost.com/entry/volkmanns-ischemiccontracture_b_5a21657fe4b04dacbc9bd645  Inspect     Alignment of Upper Extremity     Comment on Supinated or pronated position.      of proximal and distal third forearm     Attitude of fingers - mostly flexed fingers.            and wrist with severe deformities      check cascade of fingers     skin with scars     muscles wasting    Feel     temperature     any tendernes  superficial and deep      check scar mobile or fixed   Movement            Active and passive           Elbow -                                                                                   Flexion/  Extension                           supination/pronation              Wrist  - Flexion/extension            Fingers - flexion/ extension     Check NV status    Limb length     Lymph nodes

  https://www.istockphoto.com/illustrations/confused-man Spine Trauma     role of steroid injection  Acetabular fracture - Tile classification Compartments of foot, UE, LE Milch Classification  PFFD Classification Fibular Deficiency Pseduoarthrosis of Tibia Tumor and Markers  Both Bone Fractures    Apex volar -supination  Scaphoid Fractures and management of complications  EMG changes after nerve injuries  Approaches to common fracture surgery  Borders of carpal tunnel,  Corona mortis Supracondylar Fractures with absent pulsation Medial Condyle Fractures  Lateral Condyle fractures and classification Foot injuries  Calcaneum Fracture  MC Fracture           Eaten-Besley  Pinning          Miniplate fixation          Bouquete fixation Verdan Zone flexon Tendon injury   How do you fix a lag screw in Neck of femur fracture steps of DCP plate fixation  Compartment syndrome management  Diastasis of Symphysis Pubis, explain the approach to manage this case at ER, Ward/ICU and OT  Thomas tests  

 Shuck Test     Grind Test      Ist MTP      Axial load and make round  Watson Test      From Position of DF and Ulnar deviation to PF and radial deviation     Thumb on scaphoid tubercle (just proximal to thenar region) LT Balotment  Here fingers are placed so as to hold lunate and triquetrum.Then triquetrum is attempted to move.   SL Balotment test  Here fingers are placed on scaphoid and lunate.Scaphoid is attempted to move. TFCC Compression- axial compression ,radial to ulnar deviation             Physiotutor Piano Key tests      press with the thumb on ulnar head.                      stabilizing the hand  Other tests     DRUJ compression test           hold distal radius and ulnar with 2 fingers,          pronate and supinate them.   Midcarpal instability - Pathognomic clunk on terminal ulnar deviation of the wrist.