ORTHOPEDICS

1. IDENTIFY THE FRACTURE

1. Fracture Clavicle

2. Fracture Acromion

3. Fracture spine of Scapula

4. Fracture First Rib

FRACTURE CLAVICLE

IMPORTANT POINTS

1. The most common bone injured in child and

during birth?

2. Which is the most common site for fracture of

this bone?

3. Which is more common malunion/nonunion?

4. Treatment modality?

5. Forces acting on the fragments?

FRACTURE CLAVICLE

FIGURE OF 8 BANDAGE

2. IDENTIFY THE X RAY.

1.ANTERIOR DISLOCATION OF SHOULDER

2.INFERIOR DISLOCATION OF SHOULDER

3.POSTERIOR DISLOCATION OF SHOULDER

4.FRACTURE GLENIOD CAVITY

2. IDENTIFY THE X RAY.

ANSWER :- ANTERIOR DISLOCATION OF SHOULDER

DISLOCATION OF SHOULDER

Can be Anterior Or Posterior or Inferior

ANTERIOR DISLOCATION

Preglenoid, subcoracoid, Subclavicular or intrathoracic.

Position:- Abduction & external rotation

Most common N injured :- Axillary(circumflex) Nerve

Treatment :- 1. Most common:-Kochers Method :- TEAM

Traction

External rotation

Abduction

Medial Rotation

2. Stimpson’s gravity method

3. Hippocrates Maneuver

IF RECURRENT ANTERIOR DISLOCATION

1.Hill Sach’s Lesion

2. bankart Lesion

3. Capsular Laxity

Tt:- 1. TUBS:- Traumatic, Unidirectional, Bankart’s lesion, Surgery for management

2. AMBRI:- Atraumatic, Multidirectional instability, Bilateral, Rahabilitation, Inferion capsular shift.

POSTERIOR DISLOCATION

Attitude:- Adduction and Internal rotation

Abduction and external rotation are restricted.

Xray findings:-

Electric bulb sign (Vacant glenoid sign)

Tt:- Rotating the arm laterally while applying the longitudional traction.

3. IDENTIFY THE FRACTURE

1. FRACTURE SUPRACONDYLAR HUMERUS

2. FRACTURE SHAFT OF HUMERUS

3. FRACTURE OLECRANON

4. FRACTURE CAPITELLUM

FRACTURE SUPRACONDYLAR

HUMERUS

DISCUSS THE TYPES

Extension and flexion types

Mode:- Fall on outstreched hand with hyperextension at elbow

Displacement of the distal fragment

(i) Posteromedial 70-80%

(ii) Posterolateral 20-30%

Name the Classification system used?

Gartland’s Classification

COMPLICATIONS

EARLY COMPLICATION:-

Vascular Injury :- Brachial Artery-- Volkmann’s Ischemic contracture

Nerve Injury AIN>Median N>Radial >Ulnar

LATE COMPLICATION:-

Malunion commonestGunstock Deformity

Myositis Ossificans

VIC.

4. IDENTIFY THE FRACTURE

1.FRACTURE PROXIMAL ULNA ONLY

2.GALEAZZI FRACTURE

3.MONTEGGIA FRACTURE

4.EPPEX LOPRESTI LESION

MONTEGGIA FRACTURE

DETAILS

TYPES :- 1. Extension type (M.C)- distal ulna &

head of radius angulates anteriorly . 2. Flexion

type

Complication:- 1.Posterior interroseus nerve

palsy 2.Unreduced dislocation of radial head 3.

Malunion 4. Synostosis 5.Myositis Ossificans.

Treatment :- ORIF (Maintain length of ulna)

5. IDENTIFY THE FRACTURE.

1. SMITH’S FRACTURE

2. COLLES’ FRACTURE

3. BARTON’S FRACTURE

4. FRACTURE SHAFT RADIUS

COLLES’ FRACTURE

ENNUMERATE THE DISPLACEMENTS

1.Impaction of fragments

2.Dorsal displacement

3. Dorsal tilt

4. Lateral displacement

5.Lateral tilt

6. Supination

CLASSICAL CLINICAL DEFORMITY

DINNER FORK DEFORMITY

TREATMENT

Mainly conservative

Closed Reduction :- Technique

Palmar Flexion & Ulnar Deviation

COMPLICATIONS

1. Stiffness of fingers,wrists,elbow, shoulder

most common avoidable complication of

COLLES’ fracture. Malunion Dinner fork deformity.

Sudeck’s Dystrophy (Reflex Sympathetic dystrophy)

Carpal Instability

Rupture of Extensor pollicis tendon

6. IDENTIFY THE FRACTURE

1. SMITH’S FRACTURE

2. COLLES’ FRACTURE

3. BARTON’S FRACTURE

4. FRACTURE SHAFT RADIUS

SMITH’S FRACTURE

SMITH’S FRACTURE

Distal Radius with Palmar displacement

Deformity seen :- Garden Spade deformity

7.IDENTIFY THE FRACTURE

1.FRACTURE CAPITATE

2.FRACTURE SCAPHOID

3.FRACTURE TRIQULATERAL

4.FRACTURE LUNATE

FRACTURE SCAPHOID

SALIENT FEATURES

Most common carpal bone fractured.

Most common site :-

Waist (70-80%), Proximal Pole (20%), Distal pole(10%), Tuberosity, Osteochondral Fractures.

Most common clinical finding :- Tenderness in Anatomical Snuff box. And

A force transmitted along the axis of 2nd metacarpal or pressure along the thumb produce pain in region of scaphoid.

RADIOGRAPHY

Best view is

Oblique view

Or Routine AP and Lateral views

TREATMENT

If undisplaced :- Scaphoid cast in dorsiflexion

and radial deviation.

If displaced :- Herbert Screw

MOST COMMON COMPLICATION

Avascular necrosis. Mostly at fracture of

proximal segment.

Others:- delayed union

Nonunion

OA of wrist

8.IDENTIFY THE FRACTURE

1. ROLANDO FRACTURE

2.BENNET’S FRACTURE

3.FRACTURE HAMATE

4.DISLOCATION MCP JOINT

BENNET’S FRACTURE

FORCES ACTING

9.IDENTIFY THE XRAY

1. JEFFERSON’S FRACTURE

2. HANGMAN’S FRACTURE

3. IMPROPER VIEW OF CERVICAL SPINE

4. DEGENERATIVE ARTHRITIS

HANGMAN’S FRACTURE

HANGMAN’S FRACTURE

1. Fracture of Pars Interarticularis of the C2

vertebrae with traumatic spondylolystheis of

C2 over C3.

2. Its basically a Fracture dislocation

3. Mode of Injury :- Extension with distraction.

10. IDENTIFY THE FRACTURE

1. FRACTURE NECK OF FEMUR

2. FRACTURE INTERTROCHANTRIC

3. DISLOCATION HEAD OF FEMUR

4. FRACTURE GREATER TROCHANTER

FRACTURE NECK OF FEMUR

NAME THE CLASSIFICATION SYSTEM USED

ANATOMICAL

PAUWEL’S GARDEN’S

GARDEN’S CLASSIFICATION

Incomplete fracture:- valgus impacted. Complete fracture but undisplaced

Complete fracture partial displacement Complete fracture total displacement

CLINCAL EVALUATION

External Rotation of the limb

Shortening of the limb

COMPLICATION

AVN femoral head

Non Union

Secondary OA

TREATMENT

1. Undisplaced fracture :- 3 parallel srew

fixation

2. Displaced <60 yrs:- CRIF with parallel screws

(Transcervical and subcapital)

For Basicervical DHS & rotation screw

60-70 years CRIF

firstfailsHemiarthroplasty

>70 yearsHemiarthroplasty, if pre existing

arthritisTHR

11.IDENTIFY THE IMAGE

1. POSTERIOR DISLOCATION OF HIP

2. ANTERIOR DISLOCATION OF HIP

3. FRACTURE ACETABULUM

POSTERIOR DISLOCATION OF HIP

MAIN CLINICAL FEATURE

Flexion,adduction and internal rotation.

Marked shortening of the limb.

VASCULAR SIGN OF NARATH ABSENT

COMPLICATION

Injury to sciatic nerve

Avascular necrosis of femoral head

Myositis ossificans

Osteoarthritis

TREATMENT

It should be reduced under general anesthesia

as soon as possible.

ANTERIOR DISLOCATION

Clinically, limb is marked external rotation,

Flexion and abduction

Femoral head can be felt in the groin

12.IDENTIFY THE FRACTURE

1. FRACTURE LOWER END TIBIA

2. FRACTURE NAVICULAR

3. FRACTURE CALCANEUM

4. FRACTURE TALUS

FRACTURE TALUS

SALIENT FEATURES

Only bone without a muscle attachment

Blood supply:- 1. Posterior Tibial Artery 2. Anterior Tibial artery. 3. Peroneal artery

Tt:- Undisplaced B/k pop cast in PF (8-10 wk) Displaced – ORIF with CC screws

Cx:- AVN of body+Hawkin’s sign, Malunion , Non-union, Secondary OA.

13.IDENTIFY THE INDICATION IN XRAY

1.WHITE LINE OF FRENKEL

2.HAWKIN’S SIGN

3. SHENTON’S LINE

HAWKIN’S SIGN

14. IDENTIFY THE DEFORMITY

1. KLUMPKE’S PARALYSIS

2. ERB’S PALSY

3. DISLOCATION OF SHOULDER

4. FRACTURE RADIAL HEAD

ERB’S PALSY

DETAILS

Injury at Erb’s point C5-C6 (upper trunk)

Cause:- Birth Injury, Fall on shoulder, During anesthesia

Deformity :- Arm hangs by side adductd, medially rotated, forearm extended and pronated.

“Policeman tip or porter’s hand deformity”

Biceps and Supinator jerk lost

15.IDENTIFY THE IMAGE

1.MEDIAL CLAW HAND

2.ULNAR CLAW HAND

3.DUPUYTREN’S CONTRACTURE

4.VIC

ULNAR CLAW HAND

ULNAR NERVE INJURY

Can be High or Low

Low ulnar nerve palsy

FDP and FCU are spared

Muscles of hand paralysed

Hypothenar muscles:- Palmaris brevis

Adductor pollicis

All interossei(Palmar and Dorsal) and medial

two lumbricals.

ULNAR PARADOX

Ulnar claw hand is seen in lower ulnar n.palsy

due to involvement of Interossei but not in high

nerve palsy as in high lesion FDP of 3rd & 4th

Finger also paralysed.

16. IDENTIFY THE XRAYS

1. EWING’S SARCOMA

2. GIANT CELL TUMOR

3. CHONDROBLASTOMA

4. OSTEOCHONDROMA

GIANT CELL TUMOR

NAME OTHER EPIPHYSEAL TUMORS

Chondroblastoma

Giant cell tumor (Osteoclastoma)

Clear cell chondrosarcoma

DETAILS

Age group :- 20-40 years

Epiphysis

Malignant transformation 5%

Common sites:- Lower end of femur, upper end

tibia, lower end radius & upper end of humerus

Egg-shell crackling sensation on palpation.

RADIOLOGICAL

Solitary may be loculated, lytic lesion

Soap bubble appearance

None or minimal reactive sclerosis around the

tumor

TREATMENT

Curettage and bone grafting

Enblock excision/complete resection

Arthrodesis by using fibula

17.IDENTIFY THE TUMOR

Ewing’s Sarcoma

DETAILS

Malignant sarcoma arise in the bone marrow

(Medullary cavity).

Second most sarcoma in children (after

osteogenic sarcoma)

Age10-15 years

Sex M>F

Usually arise in Diaphysis, M.C femur & Tibia.

Translocation 11:22 seen in 85-95% cases.

RADIOLOGY

Onion-skin periosteal reaction.

Sun ray appearance

Codman’s triangle

TREATMENT

Highly Radiosensitive, Melts like snow.

Tt:- Radiotherapy, Chemotherapy and Surgery.

18. IDENTIFY THE INFECTION

1. OSTEOCLASTOMA

2. ACUTE OSTEOMYELITIS

3. CHRONIC OSTEOMYELITIS

4. TUBERCULAR OSTEOMYELITIS

CHRONIC OSTEOMYELITIS

SALIENT FEATURES

Hematogenous/exogenous

Age gp:- <2 years or 8 to 12 yrs

Site:- Metaphysis

Mc.Org:- Staph aureus

I.V drug abusers :- Pseudomonas

Parenteral Therapy :- Fungal

SC hemoglobinopathies:- Salmonella

SALIENT FEATURES

ESR-24-48 hrs, CRP-12-24 hrs

Skeletal changes may not be seen upto 10-12

days.

Soft tissue swelling after 1to 3 days

Technitium99 scan confirm the diagnosis

within 24-48 hrs.

Tt:- Antibiotics (I.V-2weeks+oral 4 weeks)

COMPLICATIONS

1. Chronic Osteomyelitis

2. Acute exxacerbation

3. Growth abnormalities

4. Sinus Tract malignancies (SCC-very rare)

5. Pathological fractures

6. Joint stiffness

7. Amyloidosis-AA type

Sequestrum Infected dead bone within a soft

tissue envelope

Its avascular so leaves antibiotic ineffective

and appears dense than normal bone as no

decalcification.

19. IDENTIFY THE CONDITION

1. OSTEOARTHRITIS

2. RHEUMATOID ARTHRITIS

3. GOUT

RHEUMATOID ARTHRITIS

DETAILS

Multisystem disorder, mainly attacks joints.

Inflammatory synovitis.

F>M

Importanat feature :- Sparing of the DIP joint.

DEFORMITIES

1. Boutonniere deformity

2. Swan neck deformity

3. Z- Deformity

FELTY SYNDROME

Chronic Rheumatoid Arthritis

Splenomegaly

Neutropenia

TREATMENT

1. Rest , NSAID’s, Splintage

2. Drugs

3. Intraarticular Injections

4. Physiotherapy

5. Surgery :- Correction of Deformities

20. IDENTIFY THE XRAYS

1. METASTASIS

2. DEGENERATIVE CHANGES ONLY

3. OSTEOPOROSIS

OSTEOPOROSIS

Commonest metabolic disease

Abnormally low bone mass

CLINICAL FEATURES

Back pain secondary to vertebral compression

fracture

Most common site dorso lumbar spine

Other Colles’ fracture and Fracture Neck of Femur

S.Ca, S.Ph and S.Alkpo4 are normal

RADIOLOGICAL

Cod fish appearanceBiconvex vertebral

bodies

Ground glass appearance of bones

GOLD STANDARD FOR DIAGNOSIS

Dexa scan

DRUGS USED FOR TREATMENT

Inhibit Resorption :- Bisphosphonates

(Etidronate/Alendronate), Calcitonin, Estrogen,

SERM

Stimulate formation :- Teriparatide, Calcium,

calcitriol

Both actions:- Strontium ranelate

21. IDENTIFY THE CONDITION

1. OSTEOPOROSIS

2. BONE ISLAND

3. OSTEOARTHRITIS

4. AVASCULAR NECROSIS HEAD OF FEMUR

AVASCULAR NECROSIS HEAD OF

FEMUR

COMMON SITES

Head of Femur Fracture Neck of femur

Proximal Pole of scaphoidThrough waist

Body of Talusthrough neck of talus

COMMON CAUSES

Fracture Neck of femur

Alcohol, Corticosteroids abuse, Smoking

Gauchers Disease

Sickle Cell disease

Perthes disease, SCFE

Polycyhtemia

Pancreatitis

GOLD STANDARD TO DIAGNOSE

MRI

22. IDENTIFY THE CONDITION

1. OSTEOMYELITIS

2. MYOSITIS OSSIFICANS

3. ELBOW DISLOCATION

4. FOREIGN BODY

MYOSITIS OSSIFICANS

DEFINATION

Extraskeletal heterotropic ossification that

occur in muscle and other soft tissues

CAUSES

Traumatic (most common)

Non traumatic (Pseudomalignant myositis

ossificans)

Progressive (Myositis ossificans progressive)

COMMON SITE

Elbow- Most common,

Following injuries

MUSCLES SPARED

Diaphgram

Cardiac muscles

Extraocular muscle

Smooth muscle

23.IDENTIFY THE APPLIANCE

1. MINERVA JACKET

2. LUMBAR CORSET

3. PAVLIK HARNESS

4. TLSO

PAVLIK HARNESS

CDH or DDH

Congenital Dislocation of Hip or Developmental

dysplasia of Hip.

SALIENT FEATURES

Risk Factors:-

First borns, females , Faulty IU positions, Familial, Oligohydroamnios

Pathology

Head is small

Femoral neck is excessively anteverted.

Acetabulum is shallow

Inverted Limbus Labrum of acetabulum is folded in cavity of acetabulum.

CLINICAL FEATURES

Limitation of abduction and external rotation

Limb in adduction, Internal rotation and flexion

Asymmetrical thigh fold.

Galeazzi sign

BILATERAL CDH

Waddling gait Duck like waddling

Lordosis

Short stature

Compensatory genu valgum

INVESTIGATION OF CHOICE

USG

CLINICAL TESTS

Ortolani Test

Barlow Test

TREATMENT

1-6 months von rosen splint

6-18 months Batchelors cast or frog leg

cast

18 months Open reduction with

femoral shortening

3-8 years OsteotomySalter’s

24. IDENTIFY THE DISEASE

1. METATARSUS ADDUCTUS

2. CTEV

3. TIBIAL TORSION

4. CONGENITAL VERTICAL TALUS

CTEV

SALIENT FEATURES

Primary or Idiopathic

Or Secondary to:-

Neurologic disorders

Paralytic disorders

Arthrogryposis multiplexa

Etc.

TREATMENT

Correction and splintage

Ponsetti method

CAVE- Correct Cavus, Adduction, Varus and

equinus

Denis brown splint

In failed/neglected Even triple arthrodesis

25. IDENTIFY THE DISEASE

1. OSTEOPOROSIS

2. RICKETS

3. SCURVEY

RICKETS

DEFINATION

Metabolic disorder of growing bone(immature

skeleton).

Can be due to lack of

Vitamin D, Calcium or Phosphate

CHANGES SEEN

Thickening of growth plate

Widening of growth plateif at costochondral junctionRachitic rosary

Cupping or flaring of metaphysis

Fraying of metaphysis

Softening and deformity of long bones

Bowiing of diaphysis

Widening of epiphysis

SKULL

CraniotabesEarliest Manifestation

Delayed closure of anterior fontanelle

26. IDENTIFY THE IMAGE GIVEN

1. HALO CAST

2. MINERVA JACKET

3. TLSO

MINERVA CAST

USE

For stabilization of fracture of cervical spine

27. IDENTIFY THE OBJECT

1. CRAMER WIRE SUPPORT

2. HUGH OWEN THOMAS SPLINT

3. BB SPLINT

4. BOHLER’S TRACTION SUPPORT

Hugh Owen Thomas splint

WHERE IT IS USED

Initially made to support the T.B of the knee

Now also used to support the fractures around

the shaft of femur.

28. NAME THE INSTRUMENT

1. JESS FIXATOR

2. ILIAROV FIXATOR

3. PIN TRACTION SYSTEM

ILIAROV FIXATOR

USED FOR

Elongation of the bone or to cover the

segmental loss of bone.

29.IDENTIFY THE PROSTHESIS

AUSTIN MOORE PROSTHESIS

THOMPSON PROSTHESIS

BIPOLAR PROSTHESIS

THOMPSON PROSTHESIS

AUSTIN MOORE PROSTHESIS

THANK YOU FOR YOUR COOPERATION

HOPE WE HAD A NICE AND INTERESTING

SESSION

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