Ankle and Foot

(Field) video analysis: to assess running style/faults

Post-traumatic synovitis; seen at arthrocopy

Lateral ligament reconstruction leaping (using the Brostrom/Gould operation) prevent

Ankle splints are needed in impact sports; to treat and injury

Fractured calcaneus; marked Now standard is to ORIF ORIF.

Fx/dislocation talus with displacement. URGENT

Fractured ankle; Reduce in ER, to lessen Soft tissue damage then ORIF.

Children

Children are more prone to head injuries and Should wear helmets in most sports

Avulsion tibial spine Dislocated patella, easy to reduce ( carries the ACL). but slow rehab. Re-attach ( see Fig. below).

Kohler’s disease, AVN talus children; Looks dramatic, but heals Spontaneously.

Fractures of the hip= disaster in high complication rate. ORIF stat.

Knee- OCD

Approach to menisectomy based on vascularity.

.Mal-tracking of the patella and version of the femur.

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epicondyle and possible entrapment in jnt. surgically re –attach with bony anchor .repetitive stress separation of med. Osteochondritis dissecans of the capitellum Large olecranon bursa Ulnar nerve Dyaesthesia Rupture lower end of biceps.Elbow Injuries Osteophyte formation behind elbow jnt From valgus extension overload Panner’s diseaseleads osteochondritis of the capitellum resulting in AVN. Little leaguer’s elbow.

.Markedly displaced S/C Fx humerus Closed reduction and held with 2 k-wires. Elbow joints=3 Elbow ROM.

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OA from valgus loads .

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Penetrating injury of the eye. Note the scleral whitening and corneal cloudiness due to alkali infiltration into the deeper corneal layers. Note damage done to the eye if intra-ocular pressure is increased in the presence of ocular penetration. triplelayered eye pad for eye injury suspected penetration. Never firmly pad or manipulate a suspected penetrating injury of the eye. with a reactive ciliary injection. Note: Acid burns not as bad as alkali burns as the latter penetrate the eye. Take great care of his remaining good ®eye. OCULAR EMERGENCY Subtle penetrating injury. . This lady brought to ER with a firm. Note from inspecting the pupil that there is a small intraocular foreign body (the corneal lesion is the perforation site). DO NOT PAD this way. easily missed and devastating. Left eye cannot be salvaged (needs glass eye). ALKALI Burn Alkali burn of the eye is subtle. Note obvious corneal abrasion (near the limbus).EYE ACID Burn Extensive facial burns and destroyed globe from ACID BURN accident to face and eye.

Pupils dilated with mydriatic. ovalshaped/irregular pupil and 360° iris detachment. Severe non-penetrating blunt trauma to eye with hyphaema.Heterochromia. The difference in iris colour is due to iron deposition in the left eye. after a long standing hyphaema (Fe comes from the haemoglobin). . Severe subconjunctival haemorrhage with extensive protrusion of the conjunctiva. Check-out for ocular damage such as an orbital fracture. EMERGENCY CT scan shows obvious Fx in Right orbit with herniation of intra-ocular tissue( fat or inferior rectus muscle). Fundoscopy shows a Fractional retinal detachment from a penetrating eye injury.

Easily missed. Head and Eye trauma. SCH. insect bite. palsy. Examine Face AND Eye. . Corneal FB.Blunt trauma causing iridodialysis of the superior iris(11 oclock) and Traumatic mydriasis. lacerations on lower eyelid and obvious VII n.

involving impacted 3rd molar tooth. CT of zygomatic Fx Internal fixation of mandibular Fx( mini-plates).Facial Skeleton Subcondylar Fx fixed with arch bars and guiding elastics. Angle Fx. .

18 yo M. Splenic abscess. pain and fevers. 25 yo. ultra-sound then urgent exploration. Occurred whilst skiing the moguls ( twisting action) Testicular rupture. with a viable testis which was debrided and repaired. Avulsed shattered both spleen . IVP reveals free extra-vasation of contrast from the collecting system. CT reveals splenic abscess drained by percutaneous drainage. 29 yo. 12 days after blow to upper quadrant. Kidney trauma. M. reveal large testicular rupture. M.GI/GU problems Torsion of the testis. footballer. soccer player hit in left loin n by knee.hit in scrotum. indoor cricket.

Approach to menisectomy based on vascularity .

Meniscal cyst Discoid meniscus .

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Pain/paraesthesia in groin. reduce ASAP. Nerve tender at exit. Pain inner thigh with flexion reduced sensation Groin strain. Trochanteric bursitis Contusion of thigh at musculo-tendinous . X Ray of anterior hip dislocation OA hip from Skiing Ilio-inguinal n entrapment.pain with resisted beyond 90° Hot bone scan in jnt. Obturator n entrapment. Femur Anterior hip dislocation. 23 yo M. Hip.Pelvis. exacerbated by resisted adduction Snapping hip. Tender over injured AIIS.

side-stepping or pivoting .Myositis ossificans of the quads with mature bone formed Labral detachment at arthroscopy Hamstring sprain in resited extension in rugby tackle. Groin strain in cutting sports.

Hip pointer from direct blow to iliac crest Main nerves about the hip .

Air way management .Air splint neck collar on the ski fields A good air way can be obtained with a mask. Oral air-way is good if tolerated.

Removing helmet when neck suspected injured .

radial nerve palsy Typical presentation of shoulder.Shoulder Injuries (copyright 2008 worldortho) Shoulder dislocations: Fx surgical neck post reduction. N) Rotator cuff tear SLAP lesion(see Fig. ANTERIOR shoulder dislocation Typical posture of POSTERIOR (left) arm locked in internal rotation (partial)Brachial plexus palsy Patient voluntarily dislocation shoulder Post reduction ( posteriorly (Beware: these patients do poorly Excessive traction) with surgery) Winging of the scapula below) Following shl dislocation (damage to long. th. . patient with PRIOR hemi-plegia.

With large haematoma Rupture long head biceps (rarely Key to A/C injuries . (may require surgery) ® Anterior sterno-clavicular rarely operate Avulsion pectoralis operate) Major muscle. Dislocation.®Acromio-clavicular dislocation.

Only operate on Types 5 & 6 (“ ear-ticklers”) Pitching action .

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Posterior Hippocratic way to reduce shoulder scapula Y-appearance of lateral .Checking for anterior or posterior translation of shoulder in instability.

+ve impingement sign for rotator cuff pain .

Resect wedge-shaped acromial fragment in acromioplasty (better to rasp from lateral aspect) .Yergason’s test: resisted supination with flexed elbow=bicipital tendinitis.

Lift-off test for subscapularis pathology( pain/rupture) .

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Sport Hazards of the Environment Drugs in Sport (Copyright 2008 WorldOrtho) Essential for safe scuba diving Gastric erosion at endoscopy Death from decompression sickness. mask. Training in a hypobaric chamber altitude sickness for Everest Mountaineers are prone to from rapid ascent Frostbite with gangrene Re-warming with inhalational technique .telltale sign=blood in the there is gross oedema and rash. Barotrauma.

Decompression sickness.Office spirometry to diagnose. EIA. FEV1 and peak flow rate-a fall of >15% post-exercise confirms EIA. DCS Exercise-induced asthma. .

Ts may be inverted). first degree AV block. tall QRS In praecordial leads.ECG: Athlete’s Heart (Sinus bradycardia. Sites of possible blood loss and iron deficiency .

Sports Science Fracture healing Basic structure of bone .

microscopic Cartilage-superficial and deep perfiial and deep Muscle structure( the sarcomere is the work-horse).Hyaline cartilage. .

Length-tension curve of muscle action Peripheral nerves: sensory & motor .

no space left .Tendon structure Population growth.

The Mature Athlete Biking for active lifestyle Bone density studies determine risk of fracture. Mature endurance athletes (e. . Endurance Runners and in power sports (here is a knee replacement). X-country skiers) need more carbs & May dehydrate.g. Osteoarthritis is more common in elite athletes.

Injuries of the Mature Athlete .

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The physically challenged Athlete 16yo skier with hemiparesis ( from MVA at age 5) Sports Wheelchair design. critical at Olympic Competition .

Top Athletes Dangerous attitudes can disrupt the safe return to sport Leg press used early in rehab Assessing gastroc tension Assessing pelvic stability .

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Wrist and Hand Examination of the hand and wrist Correct/safe splint position LEFT) of hand correct buddy. is OK Finkelstein’s test is +ve in de tenosynovitis Flexed finger points Mallet finger Splint for mallet finger Scaphoid Impaction to scaphoid tubercle for scaphoid injury tenderness . interosseous n.strapping (on Ring Test (flexion of FPL Quervains and index FDP) is only possible when ant.

Rupture of both FDP & FDS Scapho-lunate Dorsi-flexed point dissociation with chronic tenderness. with ref. Large ganglion Arthroscopic view TFCC tear Isolated volar dislocation of the distal R/U jnt. . triquetrum Subtle step in line. Surface anatomy.up lunate& in mid-carpal instability. Fx hook of hamate.Digits all point To scaphoid tubercle. lunate in rotated scaphoid. seen on CT view scapho-lunate lig.

Landmarks for carpal tunnel surgery Sites of tendinitis .

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