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
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
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
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
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
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
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
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
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
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
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
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
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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