Documents

21. Orthopaedics

Description
ORTHO
Categories
Published
of 25
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Related Documents
Share
Transcript
  ã Corrections in Maheshwari- ◦ M/C # at birth--> Clavicle ◦ Thurston Holland sign--> Salter harris type 2 ◦ M/C nerve injury in supracondylar # --> ▪ nt! interosseous nerve ▪ Median ▪ adial ▪ lnar ◦ Cast in CT$%--> bove &nee cast 28. Which of the following about facial bone fractures is not true- '!Ma(illary #)s are classi*ied into +e-*ort #s2!+e *ort ,, # which involves *loor o* the orbit is also called blow out # ------ans!Tear drop sign is a *eature o* blow-out *ractures.!Tripod # is the *ractures o* ygo0a1iscussion- 1hingra3 '4567low out # ã only orbit o* eye is involvednot 0a(illary bone6 ã Tear drop sign8- ay *inding6--> (9 Caldwell luc S( 46.Hypophosphatemic rickets: all are true except- '!Secondary hyperparathyroidis0-----ans2!1e*ect in :CT o* &idneys!;o achitic rosary.!8 - lin&ed do0inant1iscussion-hypophosphete0ia-->dentin part is e**ected ã Synovial *luid e(erts an inhibitory e**ect on bone union by dissolving the callus! ã 7rittain<s procedure 9 e(traarticular arthrodesis o* hip joint usually per*or0ed *or tuberculosis o* the hip joint! This involves sub-trochanteric osteoto0y and place0ent o* a tibial cortical gra*t across the osteoto0y site into the ischiu0= and then application o* a hip spica! ,nternal *i(ation is not used! ã unlop!s traction  is used in--> supracondylar *racture hu0erous ã 7owler<s thu0b - perineural *ibrosis due to repeatative co0pression o* digital nerve o* the thu0b while grasping ball! ã ompartment syn#rome - Most co00only a/w supracondylar *racture o* the hu0erous and tibial sha*t! +ac& o* pulse rarely occurs in patients= as pressures that cause co0part0ent syndro0e are o*ten well below arterial pressures and pulse is only a**ected i* the relevant artery is contained within the a**ected co0part0ent ã $olkman!s sign - ,t is possible to e(tend the *ingers only when wrist is *le(ed :-?5 Maheshwari6 ã M/C site o* injury in swi00ers- shoulder ã $(cision o* head o* the radius in children- :ro(i0l 0igration o* the radius resulting in sublu(ation o* the in*erior radio-ulnar joint and instability! ã %ump sign - tenderness with withdrawal grading used in so*t tissue tenderness6 ã &ulge sign - Seen in &nee e**usion also called ballot0ent o* patellae6 ã @anavel<s *our cardinal signs *or tenosynovitis-'!Ainger is uni*or0ly swollen2!Ainger held in slight *le(ion *or co0*ort!Course o* in*la0ed sheath is 0ar&edly tender.!:assive *inger e(tension causes intense pain Highly sensitive *or *le(or tendon in*ection6@anavel<s sign does not include high te0peratre though it 0ay be present! ã ;ight cries are characteristic o*--> Tubercular arthritis ã cro-osteolysis seen in S+$! ã +i0ping in a Child!!!!  0ost co00on cause and they occur in  di**erent age groups!!!!  ◦ Congenital hip dysplasia - B- years= 1( by rtolani test and ltrasound!!!!!!! ◦ +egg-:erthes - .-? years= avascular necrosis o* *e0oral head !!!painless initially!!!! later pain appear!!!!:ain 0ay be re*erred to &nee!!!!!! ◦ Slipped capital *e0oral epiphysis - >'' years obese adolescent= thin& de*icient gonads  ndrogens causes closure o* epiphysis 6 :ain 0ay be re*erred to &nee!!!!!! ã To0 s0ith arthritis o* hip joint is d/t9 :yogenic in*ection ã The only di**erence b/n endochondral and intra0e0branous ossi*ication is the  microen'ironment  in which bone *or0ation occurs! The bones *or0ed can not be distinguished 0icroscopically or 0acroscopically! ▪ ,ntra0e0branous ossi*ication - ,n *lat bones o* the s&ull= bone *or0ation occurs through the di**erentiation o* osteoprogenitor cells *ro0 0esoder0 and is acco0panied by vascularisation ▪ $ndochondral ossi*ication - steoprogenitor cells di**erentiate into chondrocytes and establish a cartilage 0odel o* long bones which is used as a sca**olding *or bone *or0ation! ã (soriatic arthropathy - ◦ :resentation is li&e a polyarthritis but with distal ,: joints o* hands involved6 ◦ Classic s&in lesions ◦ adiography- 1,: involve0ent= including the classic D pencil-in-cup D de*or0ityE 0arginal erosions with adjacent bony proli*eration Dwhis&eringD6E s0all-joint an&ylosisE osteolysis o* phalangeal and 0etacarpal bone= with telescoping o* digitsE and periostitis and proli*erative new bone at sites o* enthesitis! There is cup-li&e erosions and bony proli*eration with e(pansion at the base o* the ter0inal phalanges and tapering o* the pro(i0al phalanges! ◦ (9 Steroids ã )harpey!s fibres   bone fibres = or perforating fibres 6 are a 0atri( o* connective tissue consisting o* bundles o* strong collagenous *ibres connecting periosteu0 to bone ! ã 11H- M/C in girls= on le*t side= breech presentation0ore in e(tended breech6= *irst born child = CS ã *li+aro's techni,ue principle - osteogenesis reFuires dyna0ic state--> either a controlled distraction or a controlled co0pression ã G,;T ,;%+%$M$;T ,; ;$ +,C 1,S 1$ S ◦ SI ,;MI$+, a**ects upper li0bs jts- glenohu0eral jt= elbow and wrist ◦ T7$S 1 S+,S a**ects lower li0b jts- &nee= hip and an&le ◦ 1,7$T$S M$++,TS a**ects Tarsal and Tarso 0etatarsal joint! ã ,;1,CT,;S A :$; $1CT,;  $ D; CSTD 9 ◦ ;on union ◦ pen *racture ◦ Co0pro0ise in neurovascular structures ◦ rticular *racture ◦ Salter harris ,,, ,% % ◦ Trau0a ã ustilo an# n#erson classification of open fractures ã Type ,9 clean wound s0aller than ' c0 in dia0eter= appears clean= si0ple *racture pattern= no s&in crushing! ã Type ,,9 a laceration larger than ' c0 but without signi*icant so*t tissue crushing= including no *laps= degloving= or contusion! Aracture pattern 0ay be 0ore co0ple(! ã Type ,,,9 an open seg0ental *racture or a single *racture with e(tensive so*t tissue injury! lso included are injuries older than ? hours! Type ,,, injuries are subdivided into three types9 ã Type ,,,9 adeFuate so*t tissue coverage o* the *racture despite high energy trau0a or e(tensive laceration or s&in *laps! ã Type ,,,79 inadeFuate so*t tissue coverage with periosteal stripping! So*t tissue reconstruction is necessary! ã Type ,,,C9 any open *racture that is associated with vascular injury that reFuires repair!Major advantage o* open redction is shorter period o* i00obilisation! He0ato0as at the site o* *racture 0ay be i0portant *or early healingE open reduction which generally involves re0oving the clots in the *ield= could contribute  to a delay in bone healing and to non-union! ã Goint disease with synovial *luid having nor0al to slightly elevated neutrophil count and nor0al 0ucin clot study-->steoarthritis and neuropathic arthropathy are the two nonin*la00atory joint diseases! ,n*la00atory joint diseases have high neutrophil count and poor 0ucin clot test6 ã Third degree sprain- o omplete  tear o* liga0ent o *ten the pain is minimal o He0arthrosis is noticed within 2 hours o Goint will open upi* liga0ent is stressed o eFuires surgical repair ã M/C involved 0uscle in %,C--> *le(or pollicis longus=*le(or digitoru0 pro*undus ã Aracture o* lateral condyle o* hu0erous is a type ,% epiphysial injury= accurate reduction is i0portant i* nor0al growth o* the elbow is to be e(pected= and it is treated by  ,A usig two @-Jires ã $arliest diagnosis o* acute osteo0yelitis--> 7one scanit shows increased blood *low to the bone at the site o* in*ection! ã Sub-0etaphyseal translucency is the classic radiologic *inding in child with leu&ae0ia! ã nkylosing spo#ylitis- o Seronegativenegative rheu0atoid *actor6 o H+ 7-24 positive o ,nvolves pri0arily young 0an between '5-B yrs o C/A-  ,nsidious onset o* 0orning sti**ness in lower bac& that persists *or >0ths and i0proves as day progresses or with e(ercise  Sclerotic changes in the sacroiliac area are the *irst radiographic evidence o* disease! :atients have di0inished anterior *le(ion o* the spine= which is docu0ented with the )chober test 0easure the ability o* a patient to *le( his/her lower bac&6! $ventually the vertebral colu0n *uses to produce the classic bamboo spine/ o Seru0 ; is negative because it is not a collagen vascular disease or a variant o* rheu0atoid arthritis!:atric& test- done *or sacroilitis!!!!!!! ã %arious tests- o 0inkelsein test/--1  chronic stenosing tenosynovitis de Kuervain)s test6 o  currey test--1  evaluation o* &nee *or meniscal  tears o 3rtolani test--1  evaluates newborns *or congenital hip dislocation ã ite5s angle:  > 5 degree reduced in CT$%6 o @ite inde(- Telocalcaneal angles in : and +ateral views ã &ohler5s angle--1 educed in 0ost # o* calcaneu0 o angle b/n talus and calcaneu0 o ;--> 5 degree ã &or#en!s 'iew--1 diagnosis o* Calcaneal *ractures! ã 3bli,ue popliteal ligament  is e(tra-articular in &nee joint! ã ,liac crest are the co00onest site *or ta&ing bone gra*ts! o Jhen the gra*t is reFuired *or osteogenic  purposeas in non-union6= cancellous  bone gra*ts are pre*erred! ,t is available in plenty *ro0 iliac crests and upper end o* tibia! o Jhen gra*t is used *or providing stabilityas *or *illing bone gaps6= cortical gra*t is used! Aibulae are the co00on source o* cortical bone gra*ts! ã Aracture o* the clavicle- o Co00on *racture o* all the age groups o Co00on site is junction o* 0iddle L outer thir# o uter *rag0ent displaces me#ially an# #ownwar#s  because o* the gravity and pull by the pectoralis 0ajor 0uscle attached to it  o Shoulder sti**ness is a co00on co0plication ã vascular necrosis a*ter trau0a is seen in- o Head o* *e0ur o :ro(i0al pole o* scaphoid o 7ody o* talus o :ro(i0al pole o* lunate &asic science an# anatomy-. alcium ion transport me#iate# by- '!steoblast2!steocyte---------------ans!steoclast.!ll1iscussion- ã 3steoblasts- ▪ :rinciple bone *ro0ing cell! steoblasts are 0odi*ied *ibroblasts! ▪ ich in al&! :hosphate! ▪ ;or0al osteoblasts are able to lay down type-' collagen and *or0 new bone! ▪ Aor0 ru**led borders ã 3steocyte - ▪ Spent osteoblast ▪ ole in osteolysis 0ain role--> though all are involved6 ▪ ,nvolved in Ca and other 0ineral transport ã 3steoclasts- ▪ steoclasts= on the other hand= are 0e0bers o* the 0onocyte *a0ily! ▪ ich in T : Tartarate resistant acid phophate6 ▪ 7one resoption ▪ +ie on houship lacune ▪ u**led borders e(ist on osteoclast 2. ells in howships lacunae- '!steoblast2!steocyte!steoclast--------------ans.!ll 7. uyons canal is for '!Median nerve2!lnar nerve---------------ans! adial nerve.!:,;1iscussion- ã uyton<s canal- ◦ Content- wrist--> ulnar nerve= ulnar artery ◦ Medially--> pisi*or0 and ha00ate *or0 the boundryHandlebar palsy- lnar nerve co0pressed 4. er#ys tubercle is- '!ttach0ent o* iliotibial band---------------------ans2!nterior aspect o* lower end *e0ur!:osterior aspect tibia .!Medial aspect tibia1iscussion-
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks