Short Notes in Orthopaedics

 Viva 1 A child has hx of fever, malaise & painful walking on his right side.  How to approach patient ?  Assess in line of Septic Arthritis and Acute Osteomyelitis  How do you manage ?  Detailed Hx. -  Treatment Hx. -  Past Hx. -allergy to Amy medications if any  Examination- BP , pulse , Temperature  Local examination  Gait  Inspection  Resting Posture of Hip (FABER )  ROM  local tenderness  USG - hip effusion 7 mm  Inv.  AP / Lateral radiographs of hip - to r/o fractures , any structural abnormality Predictive markers of hip sepsis  Temperature> 38 .5 deg. Celcius  WBC > 12,000 cells /mm3  ESR > 40  NWB  X 1 = 3 % , x 2= 40 % ,x 3 = 93 % ,x 4= 96.6 %  Sx .  Anterolateral Approach to hip  Remove ellipse of capsule , allow free drainage  Samples for c/s  Irrigation  Hip Spicas - post operative -to prevent subluxation and dysplasia...

 Viva 1  Mx of Crush Injury  Relevant History  Handedness , Occupation , MOI, Comorbidities  - Tetanus prophylaxisis- if indicated Antiseptic (Betadine ) dressing   Radiographs to exclude #s Wound Exploration  Repair nail under LA ( digital block and digital tourniquet)  Steps of procedure  Remove nail plate Inspect nail bed, wash thoroughly Copious lavage lavage Reduce fracture , stabilize using k- wire Removal- at 4 weeks fapairs mail bud i a Gutare (VICRYL fapide) 60 abebable Repair nail bed with a absorbable suture 6-0 ( vicryl rapide )  Wash and replace nail plate  Use Figure of Eight suture to hold nail plate in place  what to explain to patient ?  - Nat Plate falls off & new one comes which will be disfigured . -Risk of long term nail defirmity  -Discomfort in region of nail deformity  -DIP jt stiffness. Viva 2  →Describe radiographic findings, AP pelvic radiograph showing a dislocated ...

 Viva-1 what do you find in Wrist PA view ?  ( We don't have X ray ,  Suppose you saw an undisplaced fracture of Scaphoid )  Viva   Schapoid View - hand and wrist in ulnar deviation along with 15 degrees of cephalad angulation of X ray tube.  Indications of Internal Fixation of Scaphoid fractures  1.Displacememt > 1 mm  2. SL Angle > 15 degrees  3. Lunocaoitate angle > 15 degrees 4. Interscaphoid angle >20° (dorsal humpback) 5.Proximal pole # , Periluante dislocation  6.Delayed union Operative fixation in acute non displaced fractures  Non union Scaphoid fractures  Better early outcome scores in grip strength , ROM with fixation but no difference after 12 to 16 weeks  Rate of delayed union is less with early fixation . Complications  AVN of Proximal Pole  Non union  Mx of established non-union Arthritic changes not present  Fixation with bone graft         ( Di...

 You see a Photograph of a right little finger. MCP jt shows Flexion .  Diagnosis -  Dupuytren's Contracture  Risk Factors  Family hx, Liver disease, High Alcohol Intake  DM , Epilepsy Two main components in histology    Myofibroblast  Thick collagen Fibers  Mx.  Non operative  Observation , Night time splintage Injection - Steroids - reduces local tenderness                 -colllgenase Surgery  Permanent Fasciotomy  Mild cutaneous contracture at MCP Jt.  Segmental/Patmar fasciotomy   Regional fasciectomy ( Z plasty for closure /skin graft )  Dermo fasciectomy and skin grafting - PIP it arthrodesis - severe /recurrent disease  Amputation of digits  Counselling  Delayed wound healing  tendon,nerve,vessel injury  temporary and permanent numbness  necrosis of digit & amputation. Incomplete correction  Recurrence and...

 Inflamatory and Rheumatoid Disorders  Rheumatoid Arthritis Most common cause of chronic inflammatory joint disease  1-3 % , 4th or 5th decdes women affected 3 to 4 times more often than men. Causes 1) Genetic susceptibility 2) Immunologic reaction in joints and tendons 4) Rheumatoid Factors 5) perpetuation of inflammatory factors  6) articular cortilage distruction. Pathology  1)Joints and Tendons        Preclinical inflammation - increased ESR and CRP      Synovitis         Destruction         De formity 2) Extra articular tissues       1) Rheumatoid Nodules        2) Lymphadenopathy        3) Vasculitis        4) Visceral disease        5) Muscle weakness Clinical features Insidious onset Early stage soft tissue swelling     stiffness. muscle pain Tiredne...

Acute Osteomyelitis  Orthopaedic Diagnosis  History  2) Past History 3) Family History  4) Social background 5) Examination  Look / Feel / Move Special tests developmental milestones. C ) Investigations  Plain Radiography    Patient - soft tissue , bones and joints       using contact media 2- CT 3) IMRI 5-30, 000, stronger than Earth’s magnetic field 4) Diagnostic ultrasound  5) Radionuclide imaging - 99 m Tc B ) Blood tests CBC, ESR CPP - Non specific  - Tissue typing  - Rheumatoid factor  - Synovial fluid analysis. C) Bone-Biopsy  D) Diagnostic arthroscopy  Infection  Direct Introduction  (2) from contiguous infection  (3) indirect spread from blood stream Factors predisposing to bone infection  - Malnutrition & general debility" - DM - Corticosteroid administration - Immune deficiency -immunosuppressive drugs. - Venous stasis in limbs - Peripheral l vascular diseas...