eGurukul In collaboration with Notespaedia exartietn BapeOfficial Notes Partner: Ml Notespeediecon abasic Artery ard Uhasieleqy Long bone = Ol: 22, Growth plate f length of bone 4 1 Zone of Reserve Celle Sharpeys fibres Perios! + Present over Metapha sis Diaphysis bone except: est Gartilage) ~ Joints 4 Metaphisis JU oe ~ Ayound : 2. Zone of Proliferation Sesampide Epiphysis i 3. Zone oO; Ero} 4 weakest J ‘le my Perlasteum 2 layers 4. Zone of Calcification > Minevalication outey Inner 6. Zone of OsciFication ans ae Muscle + Classification for growth plate attachment) Ay J inju Pe (Promotes new bone formation) > classification by Growth Plake injury -»"SALTER HARRIS “CLASSIFICATION” ‘active space.COMPOSITION OF BONE (14:28) ines) A Organic Matyix 8 Inorganic Minevals C. Watery (22-257) (60-07) G-31) a. Cells a: Calcium = Osteoblast b. Phosphate ~ Osteoclasts (Macrophage) I i Osteocyter b. Proteins iy 4 pat : pis alline " iype T Procolagen fore’ v (ails + Protein) ~ “ZO —__ © pomivevalict Tone ‘OSTEOD tse =" MINERAL 420 by Oskeosoxeomna, b Rickeks & i Paget's dis Wy Osteomalaca Coype Wl callagen = Gantage) > OSTEOD FOUND ABUNDATUT DEVELOPMENT OF LONG BONES (2438) 2uiS® @ Enchondral Oscification + Pre formed Gartilage — Bone b. Intramembranous Oscification: Direct formation of bone (Highly vascular Sheets of. condensed matvix) Eq- Skull , Maxilla. ‘active spaceGROWTH OF LONG BOWES 2e:$3 a Appositional pruth 2 f in width of bone — Meta /diaphysis b- Interstitial growth © in length of bone — Epiphy sis REGULATION OF CELLS (2846) 28:46 Osteoclast Mononuclear Fusion, &) Prager oat @) Osteoclast Rank a ( "Receptors va =U production (OBE) RM Fes mtn — 2steoblest P Blocks: ee Progeni . Activate rowth factor} Osteoblast) <— Nien fee when activated Resorption Bone ASSOCIATED PATHOLOGIES (3600) 36:00 Cells + Protein, + Mineval = Bone Osteoid, Calcium : Phos hate 7 Serum evaluation + Estimation of Vit. Peteoid Tetracycline labelling ‘active spaceCELL MARKERS (3107) 30:0F i Bone Formation Markers [I Bone Resorption Markers 1 Bone specific 1. Nand C chains of Telopeptides 2. Procollagen type 1C and LN 2. deoxy pyridinoline 3. Osteoedllcin Je ten) ed ine and 3. Ht rol 4 J Tiadonyyce Z “Keid. Phosphatase. REGULATION OF CALCIUM AND PHOSPHATE METABOLISM (44:13) A PTH > Parathyroid Hormone | Intestine = No divect effect 2. Kidney + 7 conversion of Vit-d (to active form) 3- Bond: Resorption (nek: Cat ,POys B- Vie-D3 1. Kidney : T (a absorption, + Poy 2. Intestine : * absorption 3: Bone : Net: (at, Poyt) ©: Calcitonin —> Bone resorption inhibition (Gat) active spaceOfficial Notes Partner: Il Notespcedus:com Defermitios } Cubitus = Elbow 2. Mannus = Wrist Fivst term4 3. Coxa. = Hip 4. Genu = Knee 5. Hallux = Metatarsophalangeal joint when part of the limb distal to the joint deviates: *Medially - Varus ~Latevalty - Valque IMORMAL PARAMETERS| 04:50 Cubitus Varuss# $C humerus |. Elbow : Norma) 5° 15° of Cubitus valgus Seater valgus: + lat condyle Y humerus Normal neck shaft angie lan°- 136° = 125° (adults) If Neck-shaft angle Jses - Coxa. vara —_ f ses - Coxa valgus 2. Hip * Newborn = 150° angle decreases with Vv Skeletal matuyity ; : Coxa. vara, : Neck of femur, Rickets Hip < Fibrous i lasia Coxa valga.: Gardent clastification of # Neck of femur (type 1) active spac3-Knee: AE Birth = (Bow legs) 6-[2 months : Max- Genu varum a Neutval J Then starts valgus v 3h -4 years: Max Genu valgus (0% 15°) L v F-3 years : Reduces —> Becomes Normal (eta) (knock Knees) Genu Varum }-» Physiological genu ‘algiom ona — Rickets (mc) + Gemu varum = MC deformity associated with Osteoarthritis of knee (in adults) : Blount$ dicease (in childven) active spaceIMAGES IN DEFORMITIES= Official Notes Partner: Il Notespcediaccon ComposiTioN OF BONE (02-18) On: i) a disease (ii) oe oo Gi) Browns tumour ) Ost sis im per Fecta. ff) Scurvy ¢ Mineral : (i) Rickets. Gi) Dbteomalacia 4 Combination disorder : Osteopovosic TRABECULAE (06-15) oes These ave Compoced of dense collagenous tissue which ave now present in Cancellous bones. Femur me Compressive. Tensile side “of bone side of bone medial) (lateral) “—™~ a]? 2? iw. JO iv. 20 i a haber : Healthy bone = All 5 groups visible on wera. * Lumbar vertebrae : MC affected in Osteoporosis Neck of femur # 2 ————#————_. active spaceOfficial Notes Partner: (visorders of Minevalisation) Rickets Osteomalacia Children Skeletally mature PiceeTs (0140) 0140 - disorder of childven (occuring before physeal closure) i Etiology ® Vit-D disorders — Ga deficienc Phosphorous deficiency T Renal locces ~ Low intake ~ Rickets of prematurity ~ Clinical manifestations : a en a. IS site to be examined - Skull > il (softening of skull) Parietal / Occipital bones (Favliest_ manifestation) > Frontal bocsin > Fontanelle - delayed closure b- Chest — Ricketic Romar + Painless Costochondya| Prominences + Deposition of Ostevid @ Zones > Pectus Carinatum : Prominence of Sternum > Harrisons Koay + Depression along attachment of diaphragm atV subcoastal magn.c Shovteing (Short stature) : Long bones a Diaphysis ae] ; is - Splaying and i b. Meta physic Spay an ag rageaing Prrequlay ¢ Knee ~ i) Genu varum i) Genu valgum 4 Hip - Cora vara, d- Muscular Hlaccdity /Musce weakness / Teton / Protruberant abdomen ~ Evaluation of the patient: i) Serum Ca/Ph /Vit.D > ‘sed il) S- alkaline phosphatase > Tsed ~ Treatment Supplement Ca/Ph: /vit.b > Maghoritg of vesponse i) Radiological monitoring - Appearence of white line avound metaphysic ) J d ten Tay! L Can be seen within I~ [¥ months ii) Metabolic assessment - Level of alkaline phocphatace active spaceInitially level of ie Phosphatase ~ High When minerals a Supplemented , theve is gra dual ae in’ Alk. Phosphatase As bone becomes healtng, level of Alk-POy —?Noxmal (nt -2 years) *To check if itis or to operate on @ child with Rickets Alk. Phocphatace | level Should be novmal Splaytng § Praying y wind swept debormiby active spaceOsTEOMALACIA (Z84Z) aaa Osteomalacia - Softening of bones Presentation - H/o minimal trauma. leading to pain Fracture line surrounded My Sclevosis Pseudofractuves ‘sae ee line if « loosers zone Sites :+ Pubic vami AE i “Neck of femuy i (due to pulsations of Femo'ral artery : teal of ; * Lateral maygin Sapula, ‘ithe , Protrusio Acetabuli or Otto Pelvis active spaceOfficial Notes Partner: Ml Notespcedus:com Scary ard Osteogeresisy Inperbectar scurw (00:25) "beficioney of ie ne a oat > te as of deprivation Cross linking of- C ie cen. in neonates) eg, U fibves Integrity of vesselc “If no cross _, Predisposition to linking hei orrha.ge * Clinical features L Bleeding fiat 2 Peeudoparaly sis: 3. Scorbutic Rosary : Painful , Shaxp Costochondva) _prominences. 4. Anemia. Cimpaived iron abcorption) 5. Poor wound heal 6 Hyperkeratosis , Arthralgia., Muscle weakness tive spaceX- vay features : | Osteopenia : Ground glass Appearence 2. Pencil tip Cortex 3 Wimburger sign 4. White line of Frankel - due to failuve of resorption of- Calcified matrix. 5: Pelican Spuv ( Projection in metmphycis) + Treatment : Vit-C Supplement. OSTEOGENESIS IMPERFECTA (1322) + Skeletal dysplasia, ¢ Hypoplasia) * Charactericed by genetic defect in Type coe Feit ae Quantitative Qualitative + AD/AR inhevitence + Clinical featurec : at tendency for +s, Rate of 3 healing - Normal b. Lower limp 4 move common (Femur >) © Growth avrest may be associated fos . vepeate active spacea Hype perlaxity of ligaments with Hyp ma of joints. @. Associated problems : -Malunion / deformit - OTTO Pel Ve f ¢ ~ Dislocations of patella, radial head (although vave) “When the diseace is severe, Skull is Soft and membranous . Death is due to Intracranial hemorrhage or Respivatory incuf ici ‘4 # Ocular involvement : conlam ir Retinal detachment Hyperopia. a Auditory involvement: Seen in 40-50} casec (Compression of nerve due to Soft ckull bones) Diagnosis = i) Positive fami hater ei ad Radiological i i) Electropho Canal i laghn Type “4 Specimen ~ A ibyoblact Cultured From Skin biopsy . ji) Prenatal usa - vl fractures active space“Toeatment + Seek Kebab atotomy. } ‘active spaceOfficial Notes Partner: Wl Motespeedia.com bagels lixease ard Ostecpelresive + t functional activity of Osteoclasts. ‘ Usually seen after yival infectionc. * More “common in males after 60 years of age. * MC involved = Pelvis / Tibia * Phases = i) Lytic phase : aBlade of grasc appearence / Candle flame appearence b. Osteoporosis oe ii) Mixed phase : a: Pictare frame [Wo vertebra a b- Cotton wool skull ii) Complications d- Steal Syndrome @ Cardide failure © Osteosarcoma © ( Intva- medulla ion yD 2° Hematopoiesis. <— Anemia /Pancytopenia. Hepatocplenomegaly * S-min : Normal + Both bone Cresorption and formation) markers ave raiced. * Treatment + BM transplant Y- IFN, etc. active spaceOfficial Notes Partner: + In Osteoporosis, all the constituents ave decreased in a proportionate manner. + T score falls below f the mean for healing young ‘aul of same sex. r Etiology sae related > Others : Lifestyle = Alcohol Smokin: High st intake Uw @ intake Bed ridden pr. : Hypogonadal states > GI disordere + Endocrine disorders : Drugs + Anti epile ptics Stevoids Methotrexate Antacids Aluminium) active space* Clinical features: Pain “Common sitec: Vertebrae Neck of femur [ Colles’ Distal radius : Investigations : i) s.minevalc — Normal il) X- vay —> * Compression vertebral # 9 4 Mnpacked #) a Me + Gach pine L cS ahr Nce- * Dowagers hum Al Singh index P Wh yer eer ol ~ Better than -1= Normal ~ =[to “25 * Osteopenia = al Energy ~ Below -2:5 = Osteoporosis 7 sserpme ty) active space* Treatment = a Drugs which inhibit ‘vesorption: 4. Bisphosphonates > Alandvonate Risedvonate Palmidyonate Ibandronate Zolendronic Acid > Given once ina year b- Calcitonin « Estrogen d- SERM 8. Drugs which promote bone -foxmation a Calcium b- Teripavatide : Syntntic analogue of PTH ¢ Calei'tonin ¢ Dual action > Strontium Ranelate D- Denosumab — Blocks Rank ligands. E Romosuzumab i Abalopavatide } newer drugs for Osteoporosis active space- Official Notes Partner: Notespeadisccon Caurer of- Sclereris: CHILDREN ADULIS I Caffeys disease 1 Avasculay Necrosis Ceongtnital Cortical Hyperostocis) Sel lmiting. 2 Pagett diseace 2. Osteopetrosis 3. és iia 3 Lead Reeang 4. Fluorosis 4- Flouride 5. Osteoblastic metastasic 5. Hypervitaminosis D A. 6. Renal Osteody st vophy 6. Renal Osteodystrophy Idiopathic Rug ger Je “Spine — Renal Osteodystroy + r — Osteopetrosi is 4 Sclerosis adjacent to - Brownhé tumour end plates. OTHER NAMES: — Pagets disease : Osteitic deformanc Z -Ostéopetrosis = Marble bone disease / Albert Schonberg disease — Osteogenesis Imperfecta = Brittle Bone disease Osteopetrosis tive spaceOfficial Notes Partner: BF palin Ci . t r it ti of ti A ' Osteopovesis » Elderly patients :, usually females « Post menopamaol + Backache /#abter minimal frame, » Rickets: = child : Inability to walk property due te deborrnition Ob tay Li ab@ in tee chuck region % Osteowalasia ee * Age group: skelelalt malure patient * Yo vogue poin + No Wo trouma, ~ Long, sétdling ayeaplonnd +# ok difperovt stages bealiny « lng fue kas By loesars gone “ Unboalley coking, habits active space.D Scurvy » “Dietony clefficianey Of Vib C + Variable age -+ child ov adolescerds = Clinical $+ pBleading ques + Adult —> 5 Bory pairy ty Blaading quis % Onkeagorsls Inperbecke + Child 1 mulkiple frachre + D:D > BATTERED Baby signdreme + Bones will be severed bruised » dabermily J Umbs + Bue sclera + Prous Juveralis /Sobirn xing Paget's = © Fagats 5 Elderly persen 1 move than So er SSig Of age % (Multiple bony peru % pearing problem eappisceparrenls * + Child ey adolaxent oge group pabiont + Bony pains - Weakuuns / lethargy schild Is ndt eabing / feeding wall active space.+ fallow -0 anemicOffciat Notes Partner: IN Vloeypcadie + Stieletal Digplacia + dabeck in tue formation 6h bene * Streuckienal alonormalily in bone —» growth around epiphysis , metaphysis and Alaphysis is hampered + Further dichwbance in the growln 4 extranitios DEFINITION :.a structera) olonormality fn the beve itselb and it leads te dishivbonce in growth oy trunk | extremities = there ore mode Hhom 200 shelekal dysplacia + most t bom ove some genitcally pa “ Majesty Gh tam lead to Ghertielabuva! shinai + Height which ts lees thon 3 percentile G the chronological age 4 tha patient Propertionate Dispropertionate + Sitting awd shandi ight fold b comgoed's © | (SEREDAB] chost to establish wether the short stobere is proportionale or disproportionate wht Bits neonates head ts disprepotHonately targe + alraast Vutt dy tu bodies total tength ‘active Space:¥ Daring First year de Infancy LeHead grows rapidly and head céreumbenence > ches top Bs ta hand —+ Rible Symphisis —» Bolter dy tie fest. Hon Ay US: LS + <——_ vs ——_3 ¢—____ ts ——__> # Mt Birth Ratio: 1% 5 by (Sys ages 1:1 Abter lOy 4 age + Ratio $1, u-S gels shorter than Lis Diognosis 6, Skeletal 7 Hatowy Dieser a Rurrlesias <—” Lissette FeclicayAes Chieb complaint. [Baez] wrisse + thovbening o dist) Soteines *Midpostion a more prominent aad is alrorbest to, Uimles in aol a seqenant @, Lim fren /Hamecus) Genetic ally trommiled skeletod Digplacia 4 Achondreplasia : AD yOrteogenesis Imperbecta Ys IT ») Pyknodystos’s 5 Mabaphysead Chondraplasios 4 Diaphpseal Dysplasia. ‘active space > AD/AR 4 4DYNAMIC CLASSIFICATION + Excess Ay ee eS & oticulow conti lage contilage Porenabion i, Dysplania Epiphysealis b Spendyloepi physeal Swell Dysplasia 6 adiple epinpach tn trate we 5 Nyperchondroplanta Castilege Hypeplata ty Enchondronaatests b Achondreploota —~ me A Fathers te _ Failure te absorb 5 Mubliple erostoris \ Cerne | “Hypephakasia. . tosis comers. congenite/ tarda HYPERPLASIA BYPOPLASIA j ive diaphyseo) , 7 —= enn een Toile @ pevioshea) — Fatlme fy tees haaphaberen bone formation ee Osteoporeste lenpasyecta fenation + Oobeoporests congenita, active space= Official Notes Partner: Notespcediaccon Basic Teynircbogy & Cexa Vaya PEDIATRIC ORTHOPAEDICS (00:10) Terminologies: 4 Melia. - Limb 2. Amelia - Abscence of mb 3. Hemimelia~ One of the two paired bones is absent Radial/ ulnar Tibial / Fibular 4: Phacomelia - Seal like limb 5. Conjoined digts > Commonest congenital malformation b oa Failure of embry ological sepera of coal ee raion = Bent med xion of PIP joint usual little fh : bap Fcation if age ere ey “i ie v vm rodact ai oui % Madelung’ deformil Idaius si medial aspect ,it fails 4 develop and ie a Subluxates dorsally 410-MC muscle associated with nital abscence - Pectovalis 11! Pseudoartivosis - Causes —>CUngenital : Mc bone —> Tibia. athic = MC cause Non - union Post surgical Neurofibromatosis: poe“T]t* Excision + Bone grafting + Fixation PEDIATRIC HIP PROBLEMS © (12:45) “Pediatrie Hip Calendey : At birth OH 2-5 yes Septic artmitis (Tom Smith Arthritis) 49 yrs Perthet disease Brld yee Transient synovitis [0-5 yrs SCFE (Slipphd Capital Femoral Epiphysis) + Causes for limp : Painless Painful “CDH /oDH “Perthes * Congenital coxa vara. + SCPE *Lim¥ length discrepanet . ovitis J J apt arti coxa VARA (1:30) “Neck shaft angie <120° + Classification foY Coxa. Vara: ‘Congeita) <> haga raved femoral deficiency SCFE Devélopemental Perthes G Skeletal dysplasia #NOF Fy Cleido jal dysostosis ‘Traumatic hip of CoH Osteogenesis imperfecta Fibvol ysplas ia , Osteopetrosis active space*C/F+ Pain Shortening < 3cm Limitation of Abduction and IR “Te + HE angle > 40%, 260° - Observe > 60° or if Shortening ig progressive — Subtvochanteric Valgus Osteotomy * Fairbank 2 ~ Seperate triangle be Seen at sre ee active spaceOfficial Notes Partner: [0 Notespediccon @berthe’s Disease & SCEE = PERTHES DISEASE (00:10) * Osteochondvitis of femoral head 44 x Sean in growing childven i * Etiol > Exact’ unknown * Factors that may be etiologle Factors unlikely to be etiologic ~ Endocrinopat! 7 Hereditary inovitis i) pi ~ U¥ban environment Pas mt ing - cur: in ait / Tredelenberg gait lisa» ‘Abduction , Ee J Necrosis > Adduction, ER 5, ik Healin Restricted would be Abduction ,TR. Course vf disease : When disease starts @ early age theft and it occurs after 9 years Pagl active space reeRadiographic. Finding and. staging : Stage Clinical finding Redioraphy OF density stage Limp ; Pain vaviable ea Hild to intermittent Without” any subchondral # b Fragmentation sag way of pain me, ¢- Reossification stage Pain /limp start iesobving Flattening mal) impro\ 4 Healed_ stage Occassional limp - Osteochondal lesions — X-Rays * Catterall Salter Thom) A. No lose of ar Lateral Pillay Classification > B. >507:J in h ight © Height < 507: + Moy Show + agging Rope sign“ Rope like tadiodense line along the Intertrochanteric Ine. Represents edge of enoged femoral head > Cora Hagna (&) MRI - Most accurate investigation for Perthet G) Scintigraphy - Te scan Is “highly sensitive. @ arth Py Not commonly “tine tial stages for joint effusion. active “space-Treatment : Main aim —> Containment of femoral head in acetabulum Non- Surgical — Braces = Petrie Brace Scottish Rite Brace Surgical ad Osteotomy SLIPPED CAPITAL FEMORAL EPIPHYSIS (2:26) “When during a phase of rapid developement of bones , there is f stress dfe T weight and there is anterior and upward movement of fe cI epiphysis. * Epiphysis: remains + Male’ > Female + Classification = “Acute SFE: Prodvomal symptoms for £3 weeke presents with sudden fracture like episode after minor trauma. Salter Harris Type T injuries — Chronic SCFE+ Most Frequent form ; Adolescent patient preventing with vague groin pain — Acute on Chronic SFE: Prodvomal symptoms >3 week ; Sudden onset pain (exacerbation) “Etiohgy: In majority — Remains unknown active spaceMechanical factors Endoerinal factors Genetic: ~ Thinning of perichondyial ring complex. ~ Imbalances ~ Thyroid growth Serelacs te femoral read er Se hornibne - Change in inclination of adolescent ~ Chronic renal failure prental physis in velation to neck - Kleinfeltey sundvome and Shaft. — Tavney indie oul Hye po thyodem + Cl/F + Adolescent overwocight child 10-15 years Antalgic gait / sities alt og hor ER : Sectoral necsosis On flexion —> Hip goes in ER Also seen in Perfhes disease , AVN “% Ray + Klelns line > A line drawn parallel to superior femoval neck. yymal line Trethované sign > If not intersected TO se (ries 7 "CT Scan: Not usually neccessary "Tead Scan: uptake in capital femoral epiphysis (gon » retonesen “ USG: Detection of early slip, effusion is there or not “MRI? Early SCFE can be Aiagnoced Treatment : Definitive TE — Fixation > If this fixation is done —> aan T chances of AVN active spaceOfficial Notes Partner: —=(DH & Bleurt’s Diseaxe= DDH (00:10) “CDH Congenital dislocation of hip ‘DDH ~ bet lepemental dysplasia of hip . Etiology - Proposed factors : ~ Ligamentous laxity of hip capsule (F>M) ~ Prenatal positic - Breech ~ Postnatal ~ Primary acetabully dysplasia. ~ Move if Western tries > Asian - Risk factors : p ‘Family H/o DDH ah | | * Bredch We hd WD + Female + First born White Rohl AoA + dlgohydvoamniac /Torkiolis /Metutereus adductuc SREY SR? ~CI/F: a. Neonate -> i-Bavlow test = Adduct hips oe 9 gente push Wp it will dislocal Most ii. Ortolani = Abduct + Pull provocative ii. Alig test / Galeazel sign: Compare the positions of knees test b. Infant = If the hip ic not veducible ~ limited abduction ~ Most veliable sign of Shortening C4aleazzi sign) dislocated hip. As met of thigh Folds active Space(J Walking + Toe walk ge toxevay + Perkin ne } Hlgeneinert ne ii, USq ~ Anvestigafipn of Choice for Screening fi. MRI - Toc for diagnosis Treatment + fye 1-6 months 6-18 months 8-24 months 24 months active space Abductor lurch / Tredelenbu In tve due to hip flexion (7 Lo oH Head should be in inferior inner Quadvant 4 TF mt present —> Head is dislocated Traction with cR Cact x 3 months 1 te Reduction mpt for CR/OR — Osteotomy, usually not 2 Gere or OR +t Femoral ShorteningBLOUNTS DISEASE (16:45) * Tibia varu : Growth vetardation on proximal tibia through (Gerw varum) medial aspect. Infantile Late_ Onset <3 year eee Tuvenile Adolescent 4-10 10 yrs Blount’ disease a J active spaceOfficial Notes Partner: B Matpeeiccom “(TEV & Acherdyeptaria = CONGENITAL TALIPUS EQUINUS vARUS (00:10) * Tali = Talus Pes = Foot * 1-2: 1000 live births * Etiology Tdiopathle ndvomic Ci° crev) (ey crev) * Deformities : i-Cavug- High axched foot li. Adduction¥ Occurs at fore foot 1 joint ii. Varus - Calcaneum iv. Equinus - 7 in Plantar flexion CAnkle joint Inversion + TaloCalcaneal joint ( SubTaar joint) + X-ray :-Talocalcaneal Angle (Novmal) —] J ~ AP. viet Deoen 55° 5 25°- 50" -Ih ¢TEV = 0° (varus) active space kires ANGLE+ Talus - 15 MT: 5°-15° (AP view) Turne negative 4 \ Aadduction deformity a | + Talus - 18t MT (Lateral view) - MEARY ANGLE Nomal= 0° Tf ani 4? > Pes Camus » Ga + Treatment Started preferably in iSt week of life. a PONSET TECHMRUE - Order of Correction : L Cayus > Adduction > Varus > Equinus All deformities ave corrected simultaneously 7 Normally 6-# plaster are mye / Not >I0 plaster Ls changed every §-Pdays * Tibia / Galcaneum = I0°-40° [ t in ange = Sfo Equims : ~Eguinus is always last to be corrected — Tenotomy of Tendoachilles t if J Soe vequived i] Once eae is achieved DB. splint Slight valgus and 70° abduction on “9 : Overcorvected position active space~ when - child starts walking» if needed CTEV Shoes : Lateval margin — Raised — Inversion Medial mavyin — Straight No heel =U Equinus “If Neglected [Relapse + je Se ears: PMSTR yf Tha 3 aba PMSTR+ Bony Corrections oe gileinrocubo fusion (Dur wyeré Osteotomy) je Taysectomi fs eet Te ArthyodesiY — TaloCalcaneal TaloNavicular CalcaneoCuboid ACHONDROPLASIA (18:22) “MC form of dwarfism “AD disorder “Pathophysiology. Fail ire of enchondval ossification (Bones remain short.) CIntramembranous and Periocteal ossification is normal) * Clinical features ~ Short stature — Lu life: length of femur ~Twunk height is (Nn) ~ Arm oe and Height — Reduced ~ Rhizomelic short + Shovtenin at is move in proximal bones Menta] and sexual lop ement is(N) ~ Hands are short / broad cena 3 fingers may be of equal length Stax “fish hind appearence > Trident sna appearence active space~ Radiography : Champagne appearence sang Sea ilo} i) ‘prenet [bullet shaped vertebra. active spaceOfficial Notes Partner Clinical Prexertations of Vaticrty Pediatrie Conditions + Men Presentation: Newbom Inbal complaint: 5 Ravens: “S feel Like - shortening in one leg ” 2g child 7 INTERNAL ROTATED HIP Initial complaint + Diserepency in groin crease Neglebed cos: TRENDELENBURG GAIT / WADDLINVG, GAIT TOMS SMITH ARTHRITIS Legs tham Sur 4 age at hip jot Presendotion : ty Fever: Higher grade ity Tenderness In groin iy Limb position: Flexion ea Abduction External rotation fy Child doesnt ware weight Y Pain Is co severe that does'nt alle movemud dy joimks Invedtigakion + USG + Huid seen Treatment: iy Traction on the Limb Rephrabe under US4 ee active space.Age Group : 4- Ggrs + Uy , 0-204. B/L Wo: Playing , suddenly child felldown , but he is walking and since than pain Keaps worsenivg - but vow gradually refwes to evan stand up “le: stage bs Synodts > F, AB, ER Stoge G necrosis -© AD-ER Reshicted movewent —» a, zeverly pelnbul > Facet] + Age group: © = 12yrs +H: ~ preceding "Yo upper respiratory tract injection + Adolescent age. group + Obese + 1O-1Sige Uf ev Bh + sudden onmet 45 poin + complication : Aveceular necrosis active spaceoe] *Clinteal diagnosis + combuced with congenital vertical tallus .- Official Notes Partner: Wl Notespcedusccon Basics of Tyaurra (ereral - 1 FRACTURE (0105) Break in continuity of cortex of bone: “Modes of =F: Trauma Pathological Sa bivect Indiveck MC cause : Osteoporosis L Transverse # Any 4 pattern * Types of —> Open ## vs. Close ## : # hematoma can come out of Wwoun Communicates with external environment) + Fracture healing — Stages cof hea healing : |. Stage li Stage * i 4 np gmniation [stage oF - ii Staze of soft callu etn iv: Stahe of cateification (gave ca amelar bone) heal ~ V: Stage 0; remodelling active space+ Factors affecting # healing: - Age (Young > Elderly) Fhe FON: Albacete @ + Associated diseaces - Anemia Diabetes + Intake of alcohol / smokin Type of bone Ccancelloucl> cortex) + ASsociated vadiation exposure High grade injuries - delayed healing * Most consistent sign of a # — Tenderness Most pathognomic: sign of a#> ‘Abnormal maby at sie + Fractures in Children: a: Greenstick 4 : Incomplete. transverce # in child - wheve periosteum is intact. b. Torus se: Buckling of cortex wl fi Normal Toruc# = Greenstick active space© Classification for growth plate injuries : “Salter - Havvis Classification * Type I> $ > Same tevel > FEEREDRD 4 e—Gp oo > Above level Tg “Usually managed conservativel ty Typed > L> lower level — hiyets PUEpiphysic) sz ?T? Total /Theveugh > “Epi; + Phycis + Meta “Anatomical veduction and fixation Is advised Tper > ER? Eraser [Cxush)—> (Pryce Ohh + “Worst outcome” > Growth arrest ype W > Perichondyial Ring injury active spaceOfficial Notes Partner: Ml Vlotespcediccon Baricy of Trauna Cereyal - 2 SPRAIN VERSUS STRAIN (00:25) * Sprain : injury to ligament: St vain: Injury to muscle SUBLUXATION VERSUS DISLOCATION (01:54) Subluxation Dislocation (Partial connection) (No connection) CLASSIFICATION OF OPEN FRACTURES (03:04) “Gustilo- Andevson Classification Type I - Clean wound ; <1em Type I - Wound >4 em, But without extensive soft tissue damage Type lll - Extensive soft tissue damage Je a Segmental at Communited # b. Contaminated Injury ; Peviasteal strpping , bone exposure c Vascular injury witch needs sti Yepaiy active spaceMANAGEMENT OF POLITRAUMA (0822) . According to ATLS guidelines : A- Airway patency + Cervical spine immobilisation. B- Breathing C - Circulation ; Ringer Lactate _, yxological ner Ea lockeletal Disability evaluation ; Neurological > Glasgow cies CoD E- Exposure Eye Opening Verbal Best Motor ve ay a) Pe ecpanse Response * Spontaneus - 4 ) © +To Sound - 3 * Oviented-5 + Obeys “To pain - 2 — Confused-4 — comthand-6 + Nevey = 1 * Inappropriate —* Localises words - 3 pain - 5 * Incomprehensible + Flexion - 2 withdrawal-4 ‘None - 1 + Abnormal-3 * Extension-2 + None ~ 1 *Min- = 3 13-15 * Mindy May = [5 9- 12+ Moderate 4-% © Severe 0c for soft tissues toc for stress + (Single site /unilateral) loc for ae # associated with Avasculay Necrosic c CT Scan Bone # - Caleaneum — 3D CT Scan Calcificatione active spaceOfficial Notes Partner: Ml Notespczdus:con Upper Limb - 4 ROTATOR CUFF (00SS) 4 muscles - Supraspinatous —> MC to get injured + Abduction (0* 15°) Infraspiatons 1 External rotation of shoulder Subscapularis -> Internal votation of shoulder “Lift off test * Grades of inny and treatment : Grade I > Tear <50/ articular surface grade IL Tear >50/ articular surface Grade IT Small to medium tear <3 cm; 1 tendon involved Grade > Hame »mascive teay = 3cm; Repaivable 5 2-3 tendons Gude D> Lange -mascive teay = 3 cm; Not vepaivable Grade IL > Retvacted massively 3 Irvepaivable tear, Intya-avticulay Treatment: patoorty rades |, II, Ill — Aythvoscopic vepair + Acyomioplacts oe 1V— Open frthroeco ne iy mt d Grade V—> Tendon transfer / Partial vepaiy Grade Vi Reverse total shoulder arthroplasty. ctive spaceDISLOCATION OF SHOULDER (04:32) * MC joint to have recurvent diclocations. Types: aevior |_ Posterior | Inferior Attitude: Abduction + Ext- + Adduction + Int- 7 Hy perabduction. Rotation ‘rotation E Types: a. Pre -glenoid * More common in: * Salute posture ‘seen t sub- Seoracaid (ue) ~ Fall after electric c: Infraclavicular shock * Sulcus sign seen. Z Epllepey Clinical 4. Dugas test + Contour4 of shoulder] be norma) specific asi JERK test. Treatment: a- Kocheré xeduction| « x-ray: b. Hippocratic method} - Electric bulb sign i ¢ Stimpson’s Gravi Empty glenoidvsign) ee fotg Fos Kocheré eduction : Traction Ext. Rotation Adduction Medial Rotation STIMPSONS GRAVITY Hipoocrates Method METHOD => z tests: b. Hamilton ruler tect may c Caltnsys test Non' Steps 0; ‘ active spaceCOMMON POINTS (2451) * Complications “MC complication : Recurrence ~ MC acute complication : Aillary nerve inueg > Motor —> Deltoid , Teves minor Sencory > Regimental Badge sign Recurrence Ant: dislocation Post - dislocation - Hill Sach lesion ~ Reverse Hill Sach lesion Postevolateral acpect Anteromedial aspect of of humeval head humeral hea: ~ Bankart lesion x MeLaugin’ lesion. Ant- margin of glenoid active space= Official Notes Partner: Wl Notespoedia CLAVICLE (00:18) “MC bone # duvin delivery t “Mc site of #: C middied Yard (Medial 34 - Lateral Ys) + Medial fragment gets displaced upwards due to ScM. *Lateval frblament a ets displaced downwards que to gravity avd weight of the limb. «Treatment: Conservative - Triangular sting CBetter) ~ Figuré’ of 8 age * Complications + - Malunion (mc) y Injury to subclavian vessels, Brachial plexus - Shouley stiffness ACROMIO-CLAVICULAR INURY (0658) + due to fall on shoulder ~ Treatment: + Triangular sline y Valpttu band. PROXIMAL HUMERUS (08:50) ~ 4 parts: Head Greater tuberosity lesser —— Su gical neck active spaceClassification for Proximal humerus injury - NEERS classification sLpart # "3 part “3 part # “4 part # Majovit Hs in proximal humerus managed conservativel J d ta they ah displaced. J d Displaced # IF displacement > lem ov angulation > 46° Treatment : Uy Support: oy Shoulder immobilizer. Complication : nay to Axillary herve SHAFT OF HUMERUS (1444) * MC involves : Radial nerve —> Wrist drop. + MC site of involvement = distal ¥yr4 of humerus * Oblique # of ictal 4x4 = Holstein Lewis # § Managewient : U- Slab Hanging cast Uslab active spaceTHREE POINT BOM RELATIONSHIP (1835) Lat Med- + Assessed with elbow flexed Epicon picondyle - In elbow extension - all 3 points lie in a Straigh line * Conditions when: Olecrenon 4) a ic broken - # LE /H#ME /# Olecrenon 4) A is maintained - # Supracondylay humerus ©) Aic veversed - Post. dislocation of elbow “MC # around elbow in ‘young children * 2 types + Extension / Flexion JP 495-98 i. Displacement : Posteromed: > Postevolat. * Classification: Gartlandé Classification Type I + undisplaced Type LT: Partially displaced : Post-cortex intact Type IE : Completely igplaced Type + Complete loss of ant: and post hinger Unstable (ext-+ flexion) active spaceAnt. and Post. fat pad signs - ae + Treatment : areaced # — Conservative Partial 4 displaced —> CRIF_ k-wives) Complete displaced > ORIF Q Complications : ~ Immediate [Early 4 Newe injury ~ AMRU CAnt- Int-> Median > Radial > Uinar) Medial displacement -? Radial n- is at visk. Lateral displacement — Median n- and Brachial artery at visk. 2. vessel —> Brachial artery 3. Volkmans Ischaemia, > Flexor bigitorum Profundus (Mc) ~ Late 4. Malunion (MC) —> Cubitus varus (Gunstock deformity) T/t- French / Modified French Oteotomy 2. vic = Volkman’s “Ischaemic Contracture T/e - Twen buckle splint / Max page Operation 3 Myositis Ossificans active spaceOfficial Notes Partner: Ml Notespediecon ADDITIONAL INFO OW # SEP RACENAR OF HUMERVS (0035) * Dunlop Traction * Baumann’ (Humeval (cheer Angle ) Normal > 64° 81° >82’ > Cubitus varus LATERAL CONDYLE OF HUMERUS # (OF) oH of neceesity = Z lateral fle # Neck of fi # Galea zzi * Fixation = # Patella (dis placed), # Olecrenon (. placed) # Distal 1/3 of ulna # Distal Ys of tibia - # Lat. epicondyle —> # of neccesty ° Nenuion Tardy ulnay <— Progvecsive Cubitus nev¥e pals valgus activ space* Salter Havris Type Il > Type IV yn, "> Ke # passes # passes ayound ‘ne h Capitellum Gite, PULLED ELBOW (73:55) + Subluxation of- yadial head from annylay ligament o Age pep 2-6 years * Altitude - Elbow extended Forearm pronated * Treatment - Elbow flexed Forearm is supinated ELBOW DISLOCATION (18:15) * Gan be ant / pact fed: / at MC : bowet ving sign seen due to triceps. * 3 point velationchip —> Reversed ESSEX LOPREST! LESION (20:38) “Inlay to Interosseus membrane a " + Di ulna subluxation * # Radial head active spacePROXIMAL ULWA # WITH SUBLUXATION OF RADIAL HEAD (2282) # Monteggia * Commonect herve involved~ Post. ao n. — Finger drop Cinability ¥ to exteld) the Hibers # GALEAzz2z/ (2520) Reverse Monteagia + # distal Y3~¥ vadius * Dislocation of distal ulna + # of neceesi fy # DISTAL END OF RADIWs (27:10) + Colles Smith Barton chauffeur <— Extva- articular — <—intra- articular —> Radio- carpal jointCOLLES SeiTH(Z1430) <———— Distal end of radius ————————> <———_ Extva-articulay —____; DER at its corticocancellous junction around 2cm from the distal articulay surfate with typical displacement. Displacement : Libs + Lateral displacement /tilt 2. Impaction 3. Dorsal displacement / tilt 4. Supination Complications: stiffness (Mc) Malunion — Dinner fork deforml Rupture of EPL tendon’ sidecks % sty ay 1 tui tltrome I nora nee active space Palmar displacement Fragment) Cof distal’+ Partial intra-articular # of distal radius with subluxation or dislocation of caypals dorsally. S Types +- Volar - Dorsal CHavereur's # (40:03) + # of yadial styloid only. + Intva-articular # active spaceScArHole (4043) Sy ws LUNATE DISLOCATION (49:77) “MC carpal to dislocate “MC carpal fo get #: Scaphoid > Trigquetval “MC site of 4: Waist of Scaphoid “MC site oF AVN: Proximal pole of Seaphoid (due to Rel vograde supply) : Clinically , tenderness in anatomical snuff box. ray: AP/PA /tat- / oblique views + Best: PA > Oblique 7 May not Show # upto 2 weeks. *10C — MRI ‘Treatment - Conservative : §lass holding ov Tumbler hol. position * Complication - Non -union (Mc) AVN Carpal tune] syndrome Ea active space* Lunate dislocation Pevilunate dislocation —> Lunate is in position, Rest of aaypals ave dislocated * Complication - Carpal tunnel Syndrome TERY THOMAS SIGN (+925) Scapho~ lunate dissociation Significant disloaation >6 mm Subluxation - 3mm + IS Metacarpal base #: - Bennet : Partial Intra-articulay # Displacement of Bennet > APL tendon ~ Rolando: Communited intra-articular # Y/T shapedG0xer’s # (SZ:S0) # of neck of 5% metacarpal OTHrers (53:20) + Skiev’s Thumb / Gamekeepers Thumb Injuvy to ulnar collateval ligament y d of thumbs + Mallet finger - Avulsion of extensor tendon from distal phalanx. F siti . Jersey ’ - Imwry to Flexor digitorum profundus. active spaceOfficial Notes Partner: Ml Notespcedus:con Spire and Regicral Corditiens * Parts of vertebra, + Single column injury —> Conservative J a d Management + Two o¥ Three column injury > Surgjcal , Occiput a Yes movement (Flexion+ Extension) 5 a i } No movement (Rotation) 2SPINAL Inu (OS:SO) * Reflexes lost in spinal injury. cal Reflexes) + IS vefler to revert to normal - Bulbocavernous Reflex MOTORCYCLIST FRACTURE (0648) * Hinge # skull SF pf L Ant Divides skull into 2 halves Post. JEFFERSON FRACTURE (07:24) “MC # of C1 vertebra * Caused by axial compression force + extension P * Spinal cord usually not damaged. . Neurological deficits usually not acsociated . *10C- CT Scan * Treatment ~ Undisplaced stable injur > Cervical collar /Halo” cast ial Surgical intervention - min- cases active spaceHANGMAN'S FRACTURE (1044) : Spondylolysthesis of Co over G + ard ic # of C2 after # Odontoid. * Mechanism - Extension with distraction Hy er- extension ‘Axial Compression Flexion WitleLAsie Mure (18:33) * Acceleration - Deacceleration injury “Also known as ‘Sprained neck’ 5 Usually no vertebyal involvement but, ‘Spinal cord may be involved. CLAY SHOVELLER'S INURY (A535) + Avalsion of spinous process * anally seen at Cz >Ts active spaceCHANCE FRACTURE (17:20) + Flexion- distvaction injury * On impact > Sudden feign of Lumbar spine Bone and ligament ‘ail in tension around center of rotation (created by the seat belt) “Compression of vertebra along with a # line "brug all posterior eletents of vertebra. CONSERVATIVES MODALITIES FOR VERTEBRAL INUFY (2120) L. Cervical Spine: + Halo Gst + Crutchfield Tong 2. Cevvicodorsal Spine : Minerva Cast 3- Dorsal spine : ‘Taylor’ Brace + VASHE CAnt Spinal HyperExtension ) Brace active spaceVERTEBROPLASTY (23:38) * For ee vertebral + all * Cement used: Poly Methyl Meth Acsylate (pmma. er Hy et " Acryl IM) MC used cement in drthopaedics DISC HERMATION/ PROLAPSE (ZS:48) sais +3 types: Central least common) Pavacentral (Mc) side Lateral @ “MC site + Cs-Ge = Conical one Le-S; >Ly>Ls - Lumbar h * Central : Cauda equina, Syndrome wy Pavacent ra): Trav ling ‘rook Lateral : Exiting Yoo! Son v Exiting Travellir 8 Tot J ‘roe Move commoni Compresced Motor Sencony Reflex Weakhess deficit Changes Ly Quadviceps Posterolat- thigh Patellay tendon Hip adductors Ant: knee Med: side of leq ls FHL Antlat. le Gluteus medins Dorsum of foot reat toe EDL and Brevis oth Wve space‘ Investigations 1. X-vat 2. MRIS ~ JOC 3 Myelogarphy * Treatment :1. Conservative 2 Surgical > + Epidural injections * Fenestratibn : aminoront + Laminecto' ny : Spondylolysthesis + Slip of one vertebra over another “ Spondlolysis: + Break at Pars Inteyarticulavis “ SpondiiastS * degenerative Change “ Spondulytts SA Flemnipatony ChangeSPONVOYLOLYSTHES/S (40:12) “MC level: Ly-Le >L5-S + Causes: Dysplastic Isthmic > Pars TA. > Le-S, Degenerative (McC) > Ly-Ls Post traumatic (Eq- Hangman’ #) Pathological (eq. An urys ja] Bone Cyst) «Presentation - Pain t Radiculopatng (N) oblique gray Lumbar spine - * Spondylolysis best in Obli i pol ag y= Seen in Oblique view in kK bat in neck of dog Collar around neck Spondyolysthesis ~ Best view - lateral ~ AP view - Inverted Nopolean hat sign active spaceScOLIOs/s (48ZS) * Lateral bending with rotation of vertebya. Idiopathic (Mc) Congenital a: Infantile @- Failure of formation <3 yens age Eg: wedge vertebra, By b. Juvenile t <1D years Hemivertebra, ¢: Adolescent (Mc) >10 years b. Failuve of segmentation “Block vert¥/brae B * Scoliosis defined by convexity of spine. + Postural Scoliosis v/s Pathological Scoliosis. Disappears on forward flexion 7 Angle seen > Cobbs angle 9 e 6 * Treatment = - Conservative Nha -Milwaukee Brace (Childven) an we - Risers Cast (Adults. . Surgery : Ant ox Post spinal Pusion 7 Kyphosis + Forward curvature of spineOfficial Notes Partner: Basics (0040) L. Shentons Arc *Made by joinin and ‘i + Broken in = 4 NOF , Dislocation of femoral head, VN 2. Tren ae iy test + Done to assess the integrity of al Ors ‘Supplies by a. NOF: #NOF, Coxa vara (Lever) b- Joint: Dislocation, AVN, # Acetabulum PELVIC. INWRIES (0410) * Max. blood loss = 1-5-2 + Classification use py Pista eh B/L both pubic rami Ant Post compression inj Rotationally ‘unstable weve) Stable ii, Malgaigne + Disruption o} ble mphusis with # Ilium near P sacve th hi Pos vase ae Lateral Compression ry, Vertically stable ; ier JJoint and opp- px: active space WZ i)v.Jumpers # + Forceful axial loadi ing of spine and pelvis. * leads to dissociation r , oF sacrum from lateval portion. vi. Crescent # + Bide Stable , smn unstable Post ST joint is due to disvuption of Tliac intack wing ? Complications : a Hemory hage b. Uvo- genibal injuries ¢ Nerves of Juntbo- sacral plexus d: Dia phragm (rave) ctive space=~ Official Notes Partner: Notespedicom Lewey Limb - 2 DISLOCATION OF HP JOINT (07:08) Anterior Postevior Central Most Common * Mechanism Impact occurs Impact on knee Femoral head is of Injury « with limb flexed, | when knee and hip |fovced mediall abducted and ave flexed and through floor’ ext. rotated. adducted. acetebulum. (dash- board injury) * Position of Hypevabduction Flexion Adduction hip at time Ext. Yotation ‘Adduction Neutral rotation fs injury Extension Internal rotation + Limb length ppavent- Shortenin Shortenin J "Matern J o : tion of AE groin At gluteal vegion Per vectal fembral head j Beg ¢xamination * Possible Femoval Sciatic nerve Urethra Complications! active spaceCLASSIFICATION FOR POSTERIOR DISLOCATION OF tip (0405) * Type I to Type T When the dislocation occurs with 4 of femoral head. 4 Subdivided by Cpe asain Type !'- Femoral head # Caudal to fovea cent-valis Type Il ~ Femoval head # Cephalic to fovea centralis Type Ill - Femoral head # + Femoral neck # Type V- Type 1/iN/it with acetabulay # Vascular Sin oF Naveth * H uy feporal pirtery pulsations ave not palpable. TREATMENT (1648) a: East Baltimore method b. Alli&: method © Bigelow d Sempron method active spaceNECK OF FEMUR FRACTURE (14:20) “Risk factors : - Postmeno} — Diabetes ~ Alcoholic * Classifications used : pausal /Age related Osteoporosis Intra a Anatomical classification — Subenpital } i ervical Cen — Trane — Basicervical + High ‘risk Expounelary) of AVN High tisk pf malunion b. Powells classification Type! < 30° Higher angle > Move unstable M3050" Ie mM >50° Angle between fracture line and horizontal. ¢. Garden’ classification + Based on alignment of trohaculae Type + Incomplet “aes -) Trabaculae not aligned Gu “Type Il: Complete a; unddicplaced ) >) ‘rabecae aligned C “Type il * Incompy displaced # \ etek \ Femoral held has not lost contact with NOF | But head Is h \zr So alignment byol active spaceType We Completely displaced Trabaculae lines ave not aligned in neck TREATMENT (33:30) re = { | il <65 years Some Rye hl Arp £3 weeks >3 weeks + THR (IF pre- ting arthyitis present) * Subcapital/ “MRI a ryvical “Seat Cannulated AN Gncellous Quadvatus femoris” DS Screw ‘ Valqus Rakeotsrny L | | fixation For displaced # * Basicervical # + Pediatric DHS active space# NOF #IT ny < Linch Shortening > 4 inch “ER of limb < 45° * Tenderness in eon. Over greater trochanter. COMPLICATIONS (42:00) 4. Avaseulay Necrosis (Mc) 2. Non-union 3. Malunion active spaceOfficial Notes Partner: Ml Notespediecon INTERTROCHANTER FRACTURE (00:20) * Classification - Boyd and Giffin + Implants ~ 4.DHS 2. Proximal femoral nail SHAFT OF FEMUR FRACTURE (0111) “Implant of choice ~ Intramedullary nail - Plates/ Ext. fixation /spich Flexible /, Rigid nails active spaceHOFFA’s FRACTURE (O10) Fracture of one or both femoval condyles in coronal plane. PATELLA FRACTURE (O+4S) ae Undisplaced # as inca [tube cast Tension band wivi apne t "9 # Olecrenon Medial malleolus + Communited #— Lowey part : Partial Ratellectorn whole patella * Total Pteectom Gumper's FRACTURE (08:00) + Depressed # of lateval tibial plateau with inju ‘ie LCL and nel a u i) active spaceISOLATED TIBIA FRACTURE, INTACT FIBULA (O19) If it shows delayed union / non-union Excision of fibula, (segmental) TODPLER'S FRACTURE (1140) * Oblique # of distal tibia in childven AWELE ErOMMS (12:22) 4. Potts fracture - Bimalleolar 2. Cottons # > Trimalleolay # 3. Pilons # - Distal tibia involving tibial plafon. 4. Maisonnaive # ~ Spival # of proximal fibula with ankle injuny 6. Tillaux # ~ Avulsion of tibial ‘Peagment- by ant- tibial figament Salter Hayris Type a active spaceTALUS FRACTURE (17:32) 2 E ponent a Aviators # —> # Neck of talus b- Shepherd # —> # Post: process of talus ¢- Snowboard # ># Lat- process of talus * Complication —> Avthvitis > AVN + loc Mel * Hawking sign - White line Sas u Subchondral vadiolucent band suggestive of atrophy of talus dome (Ap ya) Retained pnecaanity of talus (6-8 weeks) Fxcludec Osteonecrosis However, it ic not a Specific sign. CALCANEAL FRACTURE (ZZ52) “MC tarsal to get #ed % + Associated injuries oA ‘aneum a: Bowlers angle _(N:20"40") b- Crucial anele of Gissane (N- 100°- 120°) “In intra-articular +, Bowlers angle v Gissane- t active space“+ 10C » 3d CT Scan LISFRANE ‘FRACTURE (Z5:Z0) * Tarso - metataysal joint injury CHOPART FRACTURE (25:20) : Intertaysal joint injury » Injury to base of 7 metatarsal due to Peroneuc brevis STRESS FRACTURE (27:30) * Excessive Stress to @ normal bone — Stress # + # in abnormal bone with normal stress > Incuf ficiency + active space+ cafe > Associated with Marching >” Mach 3 “Tenderness around 2°4 MT neck for 2-4 weeks after beginning the aerobics /running. *|0C > MRI * Potential sites for Stress # 4- Femoral neck (Tension side) b Patella c: Ant. Cortex af tibia d: Medial malleolus @ 5% MT Proximal metaphysis +. Talay neck J Sesamoid of great toe active spaceOfficial Notes Partner: Ml Notespeadie KNEE JOINT (01:00) Cruciate Ligaments + Mechanism of injury to ligaments of knee: taf PEON menisci yee Mee Coonen impact occurs lateral I8 stwucture to get dama. wan’ ascodated) with iy ue . {meniscus fF “Seating ecomd J “Haemavthrosis ’ + Feeling of givin i: : sa “malt ACL PCL <—— Extra. synovial —— <— Intva-chpsular —> + Attachment : 4: On tibia: Immediately behind | q-0n tibia: Behind post- ‘the ant. horn of méd- meniscus} horn of medial meniscus. dears backwards and Upwards, forward and lat erally to join the post. medially to join the post. ire $ medial surface of part of intel Surface lateral femoval condyle. of medial femoral condyle. active space+ Anteromedial —> Tight in flexed knee | Antevolateral bundle —> Bundle ‘ Posterolateral —> Tight in extended knee | Posteromedial bundle— Bundle Injuries of ACL ave move Common than PcL. CAvulsion) * Clinical tests: a. Loctrnani, teck 4: Posterior tibial sag Acute cases <— b. Ant. drawer test b. Posterior drawer test ¢- Pivot shift test © Reverse pivot shift test Lachman's Ped d Quadviceps active test . Investigation: mel /Artnvoscopy ~ Definitive /Diagnostic + Treatment : Reconstruction of ligament > Hamstvings) active spaceROTATORY INSTABILITY OF KNEE (2y:I0) Instability Damaged Structure Test done + Antevolate val “ACL, LCL * Pivot shift tect *Lateval knee capsule * Ant drawer test with foot int. ‘Yotated to 30° + Antevomedial “ACL, MCL + Ant drawer test “Medial knee capsule with Foot ext. rotated to 15° + Posterolateral “PCL, LOL *Arcuate ligament + Reverse pivot * Popliteus shift test * Dial test “Bounce Home test / Passive extension test ” Patient lies supine —> Foot is placed in examiners hand — knee is Campletely flexed and allowed ‘to extend passively Normally, knee should extend completely > (N) feel: Sharp, firm oy solid J o J "Pendpoint The feel can never be empty. COLLATERAL INJURIES (33:35) ‘Tested by Varus or Valous Stress test. + MCL (Tail collateral lig) > usually the 1 to ge injured. 7 active spacMENISCAL INJURY (85:46) + Functions: - Prevent impingement of capsule and synoviu ding movements — Horn ~ Lubwieating action * Mech: of injury : *¢/F + Recurvent locking of knee joint + Medial Sener move commonly injured than lateval meniscus. Ca + Lies in weight bearing axis. aS aK * Larger theh lateval /meniscus. \! \I LAY + Attathed at marine by capsule of knee joint. * Clinical tests: + McMurvayt Test + Supine position + Apleys ‘ina Test: Prone position a Squa’ test * Investigation » MRI / Avthoscopy F-vertical tear (MC) Bucket handle tear (Post-horn of menisci) 2. Hovizontal tear 3. Radial tear 4- Combination * Treatment Red Zone —> Repair on white zane —> Excision (Partial Menisectomy) active spaceOfficial Notes Partner: Wl Ntespeediccon ects REGIONAL CONDITIONS (00:20) 1. Pica Sinedvome: + Remnants of Synovium septations in knee. Usually they ppear after birth. + These Plica with minimal trauma. can produce severe inflammation of knee. “There can be ifr ce Lateval plica + Treatment : Excision 2. Osteochondvitis! diswecans “MC affected : Knee pnt + Softening and dis integration of a part of joint surface. “There be @ smallv necvottc patch on bone. “MC seen on lateral aspect of medial femoral condyle “MC cauce for looce bodies in knee in young patients. “Treatment + Microfracture technique Excision of fragmé Fixation 9, ent active spacePATELLA ALTA /BAJA (08:00) an wy it sing patellad patel El = Blumensaat line : Line through root of intercondylar y nokeh Lowey pole of patella should touch a thie line “Insel Salvati Index : ateilartendon_length : Patellay length W) 08-12 <0-8- Patella Baja /intra. CHONDROMALACIA PATELLA = (2:35) ‘ ya patients, females, velated with abnormal pesition of knee + C/F: Patients cannot keep knee flexed for long (Softening of i} if J unde rsar face) | Theatre [nema all sign Treatment : Rest NSAIDs Muscle Stretching c. Hamstving 7 Quad vice ps active spaceQ- ANGLE = (15:48) Angle formed between the line Joining ASIS —> Center of — Tibial patella. Tuberocity G+ Quadviceps ) angle in fi sr &- angle sed = §enu valqum 4 femoral anteversion Ext. tibial torsion patexaly positioned tibial JServcity PATELLAR CLUNK SYNDROME — (14:10) * Clink heard at 30%45° o| the fen being extended “Nodule is formed ~at vior pole of patella at post. surface of guad cep Mendon : knee flexion while active spaceANKLE LIGAMENT INJURIES (23:40) “One of the most stable joints. * Basic anatomy Medial Lateral Fibvous Collateral / Collateral Capsule an lig. ee I *Tibiotalay lig. * Talofibulay fi lig. Absent from : *Tibiocalcaneat liq. Ant. + Ant. infevioy part “Tibionaviculay Ig. Post * Post. Superioy part + Calcaneofibulay Ig. % Plantay Galcaneo Navicular ligament (Spring ligament) > Medial arch support of febt + Structures injured on Inversion of ankle : F Fracture of St MT base (Jones #) L = Lateral Collateral Injury CATFL > Calcaneofibulay lig.) A> Avulcion of Lateral malleolus A> Avulcion [injury to Sustentaculum tall P — Peroneal tendon injury * Classification used fox ankle injuvies : Lauge Hansen Classification Mechanism + i- Supination + Adduction — Transverse # of fibula Vertical # of medial malleolus (MM) active spaceii. Supination: Eversion > ATFL MC mechanism Deltoid ent #MM je Post- malleolus / dicta) fibula iil. Pronation: Abduction > # MM Rupture of Syndecmotic lig. # fibula abode joint iv. Pronation: Eversion —> # MM # Fibula. Cabove joint) Tibiofibulay ig v. Pronation: Dorciflexion > # MM / Ant. maygin of tibia # fibula CaboveY level of MM) CHRONIC ANKLE INSTABILITY (38:50) * Seen after repeated ankle sprainc. + Treatment : Conservative — Lateral wedge added to shoe heel. Low heels //No heels Muscle Streching Surgical > Broctyom procedure (ATF repair) Watson Jones operation : Pevoneuc brevis tendon Used to veconstruct ATFL or Calcaneofibular lig. Evans technique active spaceIa-Holstein lewis } 6- whiplash lo- Monteqgi a, ; isi . 4 Galeazzi 5-colles § St DEseex 3. Barton i ; echauffer PE tore 3: Bennet Rolando 41. Mallee. <—— Subcapitel gee Trance J 2. Boxers # fe ae # fat H Book # Hoffa’ Samper Becta handle § ; é "vescent Pott, < Ankle: i i } waters Maisconaive abn, Tillaux se sere Ghopart<— Intertarsal joint lisfvanc <— TMT Tones’ active spaceOfficial Notes Partner: ll Notespcedus:con Bagic Veripheral Newe ljuries STRUCTURE OF PERIPHERAL NERVE (01:30) Fasicles (Peyineurium) ] “S \ / Myelin sheath \ Epineuvium CLASSIFICATION OF PERIPHERAL NERVE INJURIES (06:00) Seddon’ — Sunderland * Neuyopraxia, <— Type lt + Axontemesis: rat ‘ + Endoneuvial inju TZ : Combination of Type I and Type IL + Neuvoteme sis wy ne xz mn we HL: Combination of any Cope I-y) DEGENERATION OF NERVE (11:30) Proximal end : Primary or Retrograde degenexation Distal end = Wallevtdh degenera ‘ion J REGENERATION OF NERVE (12:30) + occurs @ Linch /month » Imm day + Clinical assessment -*Tinelé sign’ active space* Assessment : By pevcussing on course of nerve distal to proximal. * Progyession in dfreté “occurs > Proximal to distal and is Seen in Sunderland Type I and ID The Land XY — After Surgical ‘repair PRE AND POST GANGLIONIC INJURY (21:30) Features : Pre-gangjionic ‘ost gangfonic: d. Site Proximal to dorsal root ena Distal to dorcal voot gangiion i.e. avulsion from spindl Yord 2. Spontaneous Cannot recover Potential to recover ‘recover 3 Surgical J Not possible Repairable Yepair 4 nosis Poor Beltey 5. Histamine Positive Negative test PROGNOSIS OF NERVE INJURY AFTER NEURORAPHY (26:00) a. N~> Neuropraxia bE? Early repair 1° Repair — 6 hours er 1° Repaiy—> 3 to 18 days 2° “Repair —? After gap CR Radial nerve —> Overall, best prognacis (Pure n. > Mixed n-) av> Vasculavity intact €- E> End to end repair —HE-not posible, cing of gap > 2 cm vogue graft ctive spacegap of: Median n. - 2em [lens “Ulnar n-- Y-Sem aes vee ne = 68cm herve mobitication 44> Growing age (Young > Elderly) SUTURING OF NERVE (32:00) 8-0,9-0,10-0 Monofilament Nylon ave used. active spaceSpecific Vewe ljuries - 1 BRACHIAL PLEXUS (00:30) Roots (Ventral) Trunks divisions Cords Terminal Branchec 4: Supraseapalay n Te Ls sect Mf Drenee ay nt e qg—|_ a _4 . pose aout $:Long thoracic n- > Splint used for Brachial Plexus injury : Aeroplane splink ERBS PALSY (04:20) “MC nerve injuy Areca with one, “It occurs, die Uto injury at Exkt po . Pavaly sed nevves: i. Rook C5 i Root Ce iii- Musculocutaneous n. iv. willary 1. v. Nerveto subclavius Vi. Supra scapular nerve * Attitude i limb - Avm: Adducted ; Limb ‘Int. yotated and Pyonated Elbow: Extended — * policemant tip deformity ” active spaceMuscles involved : “Movements Jock: Arm - Abducted = Supraspinatous , deltoid Elbow Flexion — Biceps ', Brachialis Limb - ER and Supination — Infraspinatous , Teves minoy, Supinator KLUMKES PALSY (16:50) * C8 and Ti involved. + TL > Provides ental supply to jntyinsic muscles of hand . So, pavakycis leads to Claw a Unopposed action of long Plexoys and extencor oF fingers liane locs on medial acpect of forearm (T,)Y and hand upto little finger @) . Wasting of muscles + Hast, injury ic associated with involvement of Cervical Suempatnetic ane q © Syndvome J — Ptosis — Miosis — Anhydrosis — Enophthalmos — Loss of ciliospinal veFlex LONG THORACIC NERVE (22:40) * Supplies a anterior Paralysis —> Winging of Sapula, SUPRASCAPULAR NERVE (2u:00) (0-15*) Supplies Supraspinatus —> Abduction J atrophy of shoulder girdle Infraspinatus > ERAXILLARY NERVE (25:20) Supplies Deltoid > Abduction (15*-90") Teves minor> ER MUSCULOCUTANEOUS NERVE (26:15) Supplies Biceps i tr Brachial } Pera ah een Coracobrachialis ~ Flexion of Shoulder Adduction of shoulder active spaceOfficial Notes Partner: Ml Notespcedus:com Specific Nowe Iyjanicy - 2 RADIAL NERVE (00:10) “Continuation of Post. cord of brachial plexus + G-Th * Nerve Supply + Above elbow i. Above spival ve ~ Trees ‘toa | hand) ~ Post- utenede of avm li In Spival groove el ral et : of forearm — Lot. Cut-n. of aym — Anconeus ~ Triceps li. Bw spival groove and lat. epicondyle, | Brachial m J —Brachiovadialis —ECRL + Wrist Finger i, Jeo up spline active space b-Below elbow iby Post. interocseus n. “APL “EPL and EPB * Extensor indices + Supinator + Ext. digitorum . ext. i minim “ECU * ECRB | iciat Ys of humerus ist drop PIN># Mon adie! Finger drop sper branch “Grae pO” web spaceMEDIAN NERVE (l2:50) * Labourers nerve G-h * Muscles Supplied : Sensory Supply is Arm — None |-Palmay aspect -3% lateval fingers (supplied by ulnay n-) Ul. Dorsal aspect + All muscles of thenay eminence ~ Distal part’ of lat-3% Fingers * Examination : - Of Wrist : FCR> On Plxion of wrist —> it deviates in opposite divection. — of Thumb: 0 Mii it "thay flee es ie brevis = Pen test \3 opp gp of mace — of Fingers em —> silallep ¥ Fos High level injury ane active spaceULNAR NERVE (30:20) * Musicians nerve Gal «Wrist : FCU: On flexion wrist oes In opposite deviation * Thumb : Adductor pollicis Bool tect ie of Flexor pollicis Lr * Frament sign * igh level Low level *FCU,FDP to ring /little Finger paralysed * Intevoccei - Palmay : PAD Card test Dovsal * DAB > Eqawa test active spaceOfficial Notes Partner: Notespzediaccone i. Carpal tunnel + Median nevve ii Guyons canal > Ulnay nerve ti. Pronator syndvome > Median n- under Pronator teres iv. Gia paresthetica > Superficial branch of Radial n- ¥ Cubital tunnel syndvome > Wnay n- between 2 heads of Fou vi. Radial tunnel Syndrome > pc Pr ae Qhvade of Frohse * Radial Recurrent Artevial Fan vii. Thovacic outlet syndrome > Lower trunk of brachial plexus vill. Inguinal igament > Lat cut-n- of thigh 7 Meralgia pavesthetica ix. Fibulay neck > Common peroneal n. > Foot dvop x Taysal tunnel — Tibial n- xi. Digits (toes) > Digital n> Mortont metatarsalgia, active space# clavicle a + Brochiol Isuloclowioun vessel Proximal hummus #/ dis locolion Aarne + Prillorry Ne injuegy Le ttofar: Debteid + Prt Inbverssiono 17 si madial tv. +R: Radial - [ iron ADM >R>u + Rejivnandal “Y Fish tail deforeiy band sige + epiconly Le # Cole's: medial N- # ane epicondale : ia + Carpal hana Vinow Ne injury Spelveve — |e Tali ulwon N- poly ose D # Montogia. “Pash alevesse ub \eFinger dropScopenat 4 deh w. fMertoin metatar salyia. inheryOfficial Notes Partner: Notespcedie: OSTEOMYELITIS (1:00) * Types - Acute 4 Subacute Chronic. ACUTE 0M — (02:06) * MC type of bone infection “MC Seen in children and M >F. Pi ; fests fe togenous (Mc) wy due to: loop arrangement of- vessels + ph Rity at metaphysis Me organieme : Overall > S. Aureus Iv drug abusers —? Pseudomonas Prsbried ventral therapy —> Fungal Sickle “cell, Hb — Salmonétla Human bite — Eiknella Animal bite — Pasteurella. Neonates —> Streptococcus Group B “MC joint affected in young patients : Hip ‘active space* Patholo Infection @ metaphysis jd Vv J Local inflai to al inf ria ry vesponse Local ischaemic necvosic of bone v Abscess formation + ti Na in alent yy prescue Cortical vials and breach Spread of gs in subperiosteal space If left untreated — Formation of Sequestrum XR Chronic Osteomyelitis + Clinical features : + Bony tenderness (localised) “Sutng * toca) fmpevature Is raised +High grade fever + Joint stiffness ; Child does not move limb due to pain (Pseudopavalysis) * Diagnosis i-ESR and CRP> getter than ESR —> Raised within 6 hours and retums to ¥ novmal by end of Is week. Peak elevation in 3-5 days ahd returns to normal after almoct 3 weeks of Starting treatmart ii- Local acplvation > Best way to diagnose the infection active space— Culture and Sensitivity of aspirate iil X% vay > pet ie negative. J toV3rd J Soft tissue eles = e sange) can i seen on lott day iv. usq > Helps in aie a acute hematogenous om from soft tiscue conditions like Cellul veMRI-> Show changes within 24 hours — Changes in bone marrow and Alco reveal’ interocceus o¥ subperiosteal ‘tollection Soft tissue Wi-Bone scan—> Common isotopes used: Technitium 49 — diagnoce in 24-48 hours Gallium after onset Indium + Treatment : + Antibiotics + Suv + Supportive treatment Ls correct de! sath fF affected part of limb. . Complications : Chronic OM * Pathological # + Acute Py enic arthvitis + Growth” “disturbances SuBacuTE 0M (29:50) * Signs and symptoms ave minimal. + 3° probable ons -T host resistance - + bacterial virulence ~ Administration of Anti jotics before onset of Symptoms.‘usual causative organisms + S- Aureus S- pidevmidis ‘Feature: Consistent ,mild to moderate pain — Only symptom Fever r J v P Systemic Symptoms minimal eed lytic area with Surrounding Sclerosis : Diagnosis = Biopsy and culture x abst pay not be precent but granulation tiscue is present. *T/t- Cuvettage i TV antibiotics followed y oval antibiotics > 6 weeke + Brodiet Abscess: - localised form of Subacute OM. ~ Usually involves oy bones in lower limbs. ~ Intermittent pai will be there. dhe ; Usually no peece in qvity > diagnosis is confirmed by culture o a qd J adcen fe fddue f -Te: Cavettage and Antibiotice CHRONIC om (38:25) * Hallmark: i. Sequestrum — Dead bone surrounded = granulation tissue —dense as compared to normal bone as there is no deminevali sation. li. Involucrum - Reactive new bone formation ~ Seen around sequestrum active spaceWi-Cloaca - Apertures in involucrum + Guses > Can be TB, Fungal, ek. * Clinical sign and symptom = ~Tendevnece is Valve always present — Chronic cela i sinuc! = Commonest presentation - Bone is ivregul i? thickened f Adjacent joMt ca become stiff. * Treatment : a :@ window is made in bone and dead bone Is ‘removed . done when proper involucrum is formed else pathological # can occur. with ~ Saucevization 4 can be supplemented with Continuous irrigation Cuction and drainage: Saline and } Negative ‘suction pump active space~ Antibiotics - os - Excision of bone — Amputation + Complications as 2. Growth abnormalities in childven. > Deformity { Shoxtening 3. Pathological # 4 Joint Vstiffness 5 6 Amybidosis ) GARRES 0M (6:20) ee en (+ Non suppurative , Selevasing 0M ~ Marked sclerosis and / Cortical thickening and distension of béhe nad + Featuves: + 8-10 [Youn adults Meeltitent the = “ Swelin J and tenderness over localised area ‘TESR al je is “T/t + Usually , no treatment: is etely helpful active spaceCHRONIC MULTIFOCAL NON SUPPURATIVE 0M (01:00:00) * Chronic non bacteria] 0M : — Involves childven and adolescent. + Multifocal, recurrent ‘ lesions > Metaphysis of long bones oa emit Pustulocis rostosis oes + No abscess in ieee lesions. ‘ hildven can have Ch-MOM. + T/t - Palliative Antibiotics A have no vole. active spaceOfficial Notes Partner: Ml Notespediccon TE Osteeryectitis * Causative ism eae 8 octet “f 2 some 1° focus > ai) s/ mph nodes + RouteY of spr Sad: Hematogenous or trom curva han issues “MC ‘eletal” Site affected Vertebya. : Potts spine POTTS SPINE (03:16) “MC skeletal site - Vertebva > Hip > knee level of spinal ae can be involved ; MC- Lowey thovacic > Upper Lumbar y eof involvement wf vertebra: Spinous procers* Pathology : Involvement of contiquous area of adjacent vertebra leads to oH destruction of vertlbva F adi ~ Wedge collapse —Concentvic collapse Cos ce os re fais Cs r : * Abscees formed is known as “Gold Abscess’ Due to exudative -veaction No sic of Inflammation Comp! iced of WBC, Serum, Caseouc material, bone debris , TB bacilli * Abscess formed can now travel to other sites. ~ Abscess of thovacle spine ey vupture into mediastinum oy it can alco reach to ante: Chest wall in parasternal area or intercoastal verrels. ~ Lower dorsal oy Lumbar region "Abscess can go to Liiae focca. (Psoac abscess) lumbar triangle lina?’ liqament- HV there is aft psoas“ dBscess it can lead to Bf hip flexion FeTiP defo rrmity * Clinical features: “Active stage -> Insidious onset of pain , weight lose, loss of appetite, malaise, sweating, fever ~ Features @ spine > In “d jorsal 5} ine QED Spine is stiffs Spasi of vertebral muscles activ spaceDuring Sleep, muscles get relaxed so they allow movement b/w ‘inflamed surfacts > Night viet’ * Investigations: se ieray: ¥ in IV-dise space destruction of vertebra Soft tissue shadow may be seen 2. CT Sean: Can detect smal) pavavertebyal abscesses 3- MRI: Statue of Compression of spinal cord 4 Biopsy CT quided biopsy * Treatment + 4. ATT 2. Rest / immobilization of affected part- 3 High protein diet , Inprove anemia. POTTS PARAPLEGIA (25:25) Early oncet- paraplegia Late onset Paraplegia. <2 yrs of onset of symptoms [disease >ayrs of onset of symptoms “riflepatay edema + Caseous tissue mn “TB granula tissue " TB debvis TB © abscess + Sequestra from vertebral bodies * Gaseous tissue + deformit {gibbous)> Canal stehost Ci/F: The paraplegia is spastic to start with and most prominent sign is clonus. ! late, bh es cha. v active spaceostaqer: of Potts Pavaplegia.: Stage I: walks normally {No motor weakness Ankle clonus ~is present Extensor plantar’ vesponce with or without bvisk tendon reflex. Stage L: Patient manager to walk with or without support Spasticity 0} 2p) Fmbs Stage IL: Patient is bedvidden Spastic paraplegia in extension. Stage TE + Patient with flexor spasm / Paraplegia. in flexion, ‘Treatment : J. ATT Cal ith Sti, + “Bed vest *T]t > Intensive Phase Tsoniazid Ix6-6 months Rifamplcin (Bactericidal) ofl jordin — Continuation Phase Teoniazid I: 3-4 months Pyrazinamide followed b Teebaeid ] AWS monthe Rifampicin active space> Prophylactic phase ale Isoniazid Jevrsimonen Ethambutol > IP patient is admitted , Streptomycin replaces one of the drugs. except Isoniazid - Peel diseace with majo bone destruction with threatened acute sphosis or Para pares. a nae ical complications not improving in 3-6 weeks. > For wigchanical stability of spine ~ Recurrence in neuval ~complications. * Surgeries that can be done => Costotvaneversectomy (limited role) Anterior / Antevolat ‘al decompression of spine Arthyodesis of spine Lommineetefiy Features Better Prognosis Poor Prognosis cdegree of cord involved Partial Complete. ration of cord involvement Shorter Long (712 months) red of onset Slow el je Younger El erly ~ Type Enid onset Late “onset ~ General condition 4 Poor ~ Vertebral disease ictive Healed fe 4 photic defor <60° >60° active spaceTB OF HIP JOINT (54:05) +294 MC skeletal site after vertebra. + Involvement : 1 ( MC cite - Acetabulumn ©) GN Head of femur ~\EX ) Neck ar / Stage Clinical Finding Ren fain Se) ER ion of joint, ‘Ay t lengthening ) th prac ta pa in position of max. Capacity) IL. Early Arthritis Flexion ,Adduction, IR (Muscle spasm) CAppavent shortening) I. late Arthvitis i R Qoint is dest veyed) TE. Advanced Arthritis Flexion ,Adduction, TR Cistocation /Subluxation) rr >» 7 y er active space Radiotogien| features « Soft tissue edema + Articulay become had ™ Ravefiction of bones * Femoral head evosions @ margins /Acetabulum * Joint ae is maintained soe destruction»* Flexion defor oF hip assessed b hd Meet defy bp age unt action *T/t + 4. ATT 2. Rest , Physiotherapy /Geneval cave of patient TB OF KNEE JOINT (01:08:07) + Pathology : Hematogenous spread “y ries Dissemination in synovium o Subchondral bones J Remains as TB synovitis. + Synovial membrane becomes coni congested and sama with tubercles Toint fluid in > Granulation tissue + mage to articular < Pannus formation margin + Destruction of bones and Ngamente + C/F: With progression oo is gross destvuction of knee and Surrounding jeture 1 mane meget Son of meting active spaceoye Knee — Flexion , Posterolateral subluxation, ER and Abduction b TB OF OTHER JOINTS — (o1:16:16) “Gavvies seca’ - Dry TB of Shoulder fF Poot Prognosis * Spina ventosa - TB dactyltis HEALING IN TB (01:17:00) “By “ankylosis? Avtinadese Patho! fasion of a joint Done surgically gy Fibyous No movement Movement + Painless Painful active spaceOfficial Notes Partner: Il Notespcedue: emeiics Arthyitis jenic. Or Suppuvative arthritis vs due to Prhactevia invading a joint — can be due to: - Hematogenous read 7 Adjacent: site of Osteomyelitis = Diectly from trauma or” surgery /cellltis + More common in: - Rheumatoid arthvitis ~ Seen after joint replacement sur — Iv dru ld i wy — Alcohol ~ Diabetic ~ Common Organisms : ~ Neonate /Rheumatoid arthritis /Hemophilia —> Aureus ~ <2yeaxs — H influenzae / $.Aureus - > en — S.Aureus ~ Sexdaily active adults — Neisseria a Elden — S-Aureus / Streptococci Treatment = Principle - To save the joint “debridement of inflamed tissue + Antibiotics + Supportive therapy Tom Smith arthritic * Septic arthritis of hip in infants active spaceHAND INFECTIONS — (08:00) 41.Pavonychia. "To van around" ~ S-Auveus Ga ~ Infection of soft tissue fold around the = Fingernail Zs or Pain tenderness / swelling on one oy both sides of nail. Can be at base of ~nail Tt - Incision and drainage of abscess + Chronic Paronychia. = decurs when naile ave having long exposure to water Epoauchin is thickened Tht Methy! prednisolone 2. Felon - Infection of subcutaneous tissue of distal i ip oF fi This occurs due to penetrating trauma to the er. Finger) Tit - Antibiotice and drainage of abscess. S Tenoeymovitic of flexor tendon sheath - Occurs due to spread of adjacent pulp infection. a he sprend of adjacent pulp infec ~Tendernett ove involved sheath igid position of finger in flexion In on attempting perextencion of fingers ~ Sweling of involved part of the hand +T/t* Antibiotics Splintage fompdscion if needed active spaceofc notes Partner: taper Reuke Osteomyelitis Op: +fain , fever , lecal wise im temp Oe: Rewielogy amd bleed investigation sy child adult 2. Clrenic Osteomigalihs . Ye + Hallmonks @ Ye. sabcormpelits rs iil sla chonnding Wo <— Pioscess + Subacute Osteorryelitis + 2FF and ON complaints Is; TB sal features Oy cofeomyelit's “lest Gy weight % appetite sevening vise Sf tempratune active space.Official Notes Partner: Ml Notespcedus:con Basics of Bere Turreury L.Location 2. Natuve 3. Special feature BASICS (06:50) * MC Presentation — Pain {swatting * Classification for staging of tumours + "Enneking Classification " A. Benign: i- Latent —> Well defined margin of thick vim of veactive bone. Resolves spontavieous| ii. Active > Intracapsular but aé ively growing » Thin cortex and well defined mavgins Extended Curetta ii. Aggressive > Extyacapsular, broken the reactive bone and cortex Extended Gueettage and Marginal Excision B. Malignant : Stage Grade Site Metastasis ITA uw) Intracompartmenta] t IB } i Etracomart mental No IA High Intracomp. IB J Extracomp. I — A my Any Present ctive spaceSCORING SYSTEM FOR PREDICTION OF PATHOLOGICAL # MIRELS: CRITERIA Variable 4 2 Site Upper limb Lower limb Pain Mild Moderate Size Sere PULSATILE BONE TuMoURS (20:10) A 8. Giant Cell tumour ¢. Aneuxysma] Bone st D- Angio endothe lioma, E. Real and Thyrold metastasis active space (ig: 30) 3 Pevityochantey Severe 24g Lytle azLOCATION oF TUMOURS /NATURE OF TuMouRs (21:20) d+ CT [att 1-Non ossifying 1. Osteold Osteoclastoma Fibvoma’ Osteoma |, | 2.+ Chondroblastoma 2. Osteochondroma | 2. « Fibrous "S * Cleay cell ae pricemeny "dysplasia. Chondyo sarcoma, a 3. Ewings Ae fray Sardtima | ualgnant : 4.* Adaman- be bere! ‘Agim. tiOMAL of Taetbacdena Malignant D/D FOR MULTIPLE Lesions (PoLYosToTIC LESION) (34:10) A: Histioeytosis 8. Enchol ¢ Osteochondyoma Dd E. Multiple rhyeloma. F. Metastasi 4. Hemangioma H- Infect I Hyper pavathyroidison active spaceLESIONS OF SPINE (a6: 40) © 240 Yeare - Metastasis © 230 yeart ~ Histoeytosic Multiple myeloma vena biter ia. Octeoid’ osteoma Chovdomna. (Sacrum) Osteoblastoma fF Post- ABC elementsOfficial Notes Partner: Ml Notespediccom OSTEOID OSTEOMA (00:40) + Me true mneg bone tumour. * Childven ; <30 years ; Males > Females + Pain, NSAIDs relief CPG and Cox in lesion) : Any bone cat be involved except skull. ¢ “aan Teg * Increased uptake “double density sign Hotter spot in hot area, 4+ sign Central focus of T uptake within surrounding lowe uptake + Treatment + NSAIDs Pelvis /long bone ~ RadioPrequenc at) ablation d Enblock resection / Cure tage active spaceFIBRous DYSPLASIA (07:14) aban (mat Teplaced by fibrous tissue o at sis > Meta/Epi * Devel temental mmomaly + Be seeade * Hy pophos ia be ascociated. abn lemur /Tibik > Ribs >Maxilla : Malignant trancPormation is rave. “Histology: Appeavence of irregular woven bone spiculer a Pith “anu ‘stroma, fr RMA! tery psrenc “aay : Shepherd crook deformity Ground geass ppearence’ Syndromnic associations : ~MeCune Aig ndrome : Polyoctotic fibrous dysplacia. = with cutaneot ntation and’ endocrine abno¥malites. ~ Mazabraud Syndrome : Polyostotic fibrous aysplasia. with intvamirsculay — las. “Treatment: “For extensive disease : Bisphocphonate Pain | deformity / : Osteotomy + IF Pathologic # active spaceNON OSSIFYING FIBROMA (14:60) *Fibvous Cortical defect * Histology + Defect is filled with spindle shaped cells distributed in + Giant cells and foam cells always present. UNAS well defined, lobulated lecion, located eccentetcally at metaphysis “Treakment : Dissolve spontaneoucly with skelekal maturity ' curetbage and bon’ grafting CHONDROMA (20:46) “Tumour of line cnetiage o Phalanges Enchondroma ‘Islands of hyaline cavtil ™ hyal * Metaphycic oF long bone. Cenchondral ossification) él Syndvomic ‘velations : : oe enchondromatoses with deformity al th ing. (3-5 f- malignancy visk) Ee val sro Maine enchondromatoces with ‘multiple hémangio 007: meen visk active space* Radiography: Centrally placed radiolucent avea at junction of ved meh and sap a J + Wisps ema heats Fan like meta| &ptation “Treatment : Enblock resection / Cuvettage + grafting OSTEOCHONDROMA = (27:12) “Common ; developemental wey (Not @ true tumour) * Metaphysics > Grows with skele No Bets after skeletal maturity * Pedunculated / Secsile Stalk is deviated away From growth plate / joint line j/Overiying Cartilage > 2em : Malignant transformation | Usually painless, but aan lead to sudden pain ov JP L ‘complications Pathological # sneoim (false) Bursitis Malignant tranc formation Ner¥e comprecsion +Trevors disease: Intva-articulay epiphyseal osteochondroma, “Treatment : wait /watch Excision active spaceUNICAMERAL BONE cyst (34:15) + Developemental /Reactive lesion + first “2 decades (M>F) i hysis . (mo) \ : (MC sites) + Active + Distance bfw cust and physis <1! cm Latent : nee We ere, >lom * Most active during skeletal growth Heal Spontaneously + True gst (ved My epithelium <1 mm) ity. Cyst ie eccentric to Cee Parvely lytic we ] ae *Aspivate = 3 H/o trauma ~ Blood “Treatment : Aspivation — Steroid Sclerosants Curetiage t+ BG ANEURYSMAL BONE CysT (40:40) * 6-20 years + Mild moderate bin ft, weeks to months *Not V true tumours * Proximal humerus > Distal femur Post- elements of spine active space