Short Notes in Orthopaedics

 Claw Toes           Hyperextension of MTP , PIP and DIP                     flexion   Hammer Toes           Extension of MTP joint, PIP acute flexion,              DIP in extension    Mallet          DIP in flexion  https://www.londonorthopaedicsurgery.co.uk/foot-ankle-conditions/toe-deformity-small-toes/

Restriction of ROM with no initiating factor. common association - DM and Thyroid disease https://www.buoyhealth.com/learn/frozen-shoulder Stages      1. Painful freezing     2. Progressive Stiffness     3. Resolution O/E -      diffuse tenderness     both active and passive motion restricted   Investigations     X-ray to differentiate primary and sceondary frozen syndrome     Bone scan to differentiate from RSD.     MRI - to rule out other pathology     Arthroscopy  - therapeutic and diagnositc       Management      Analgesics      USG/ TENS     Steroids - I/A      Stretching exercises     MUA - sequence                    FEAR (Flexion, External Rotation, Abduction, Adduction, Ext rotation, Internal Rotation)     Arthroscopic Rel...

 Deposition of Calcium Hydroxyapatite crystals along Supraspinatus tendon 1.5 - 2 cm away from insertion. https://en.m.wikipedia.org/wiki/Calcific_tendinitis  Investigations   X-ray of shoulder joint  Ultrasound -more sensitive for diagnosis and treatment   Treatment   Ist line - non operatie   Needling and lavage under USG guidance  ESWL  Surgery for those with symptoms progressing and failing to respond non-operative measures.

 Pain on anterior shoulder  https://redefinehealthcare.com/biceps-tendinopathy/ Investigations           Plain radiography to look for Bicipital groove and outlet view           USG scan             MRI with gadolinium enhanced arthrography to identify SLAP tears.             Arthroscopy   Treatment            NSAIDs          PT- strengthening rotator cuff muscles           Intra-articular tenodesis                     debridement - 25-50 %                   tenotomy or tenodesis > 50 %    SLAP tears           Associated with glenohumeral instability and rotator cuff tears.     ...

 Causes      Cervical Rib     Anomalous Scalenius Muscle      Types                1. Neurogenic - Upper Plexus Type                                              - Lower Plexus Type                2. Vascular  https://my.clevelandclinic.org/health/diseases/17553-thoracic-outlet-syndrome-tos     Sites of compression          1. as plexus passes over first rib           2. under clavicle by subclavian tendon          3. underneath the coracoid process      Provocative Tests        Adson , Wright, Roos      Investigations             Plai...

 Suprascapular Nerves (C5, C6 )     Compression - Ganglion, Labral Tears      Above supraglenoid notch, Supra/Infra-scapular muscles      Below Spinoglenoid notch -infraspinatus       https://www.raynersmale.com/blog/2018/5/9/suprascapular-neuropathy-a-case-study Clinical Features      Lateral shoulder pain     wasting of supraspinatus and infraspinatus muscles      Loss of abduction and External Rotation    Management      EMG     Nerve Conduction Studies      Treatment      Trapezius muscle splitting approach      Decompress notch     Arthroscopic debridement of the notch     Spinal Accessory Nerve Injury  Management      Non-operative after 12 months with good compensation      Options             Neurolysis ...

 Principles of Treatment      1. Structural Instability           traumatic or atraumatic - Operative Procedures required      2. Non-structural Instability          Muscles patterning - Non operative treatment  https://medium.com/@JFSCunha/shoulder-instability-bankart-injury-32325c1fb853   Structural  Abnormalities     Anatomical Repairs           Bankart Repair      - reattachment of Bankart lesion to margin of glenoid by open or arthroscopic                     technique           Hill-Sachs lesion repair- transfer infraspinatus to fill defect to prevent redislocation      Non Anatomical Repairs           Latarject  Procedures - Coracoid to anterior glenoid rim with conjoint tendons ...

 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...