1

AIMST UNIVERSITY

KEDAH, MALAYSIA

FACULTY OF MEDICINE

UNIT OF ORTHOPAEDICS

LOG-BOOK

NAME _______________________________________

MAT. NUMBER _______________________________________

BATCH ______________ GROUP _________________

POSTING FROM ______________ TO _____________________

YEAR V

NOTE

• STUDENTS MUST HAVE THE LOG BOOK WITH THEM DURING WARD
ROUNDS / CLINICAL SESSIONS.

• STUDENTS MUST OBTAIN SIGNATURES FROM THEIR SUPERVISING

CONSULTANT / DOCTOR ON A DAILY BASIS
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DECLARATION

I…………………………………………………Mat No:………………………, hereby

declare that this logbook is a record of all clinical cases that I have clerked in

and the clinical activities that I have been a part of , at Hospital Kulim, during

my MBBS Year III clinical posting in the unit of ORTHOPAEDICS from

…………………. to………………………………..

Signature

Name:

Mat. No:
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CERTIFICATE

Certified that this log book is a bonafide record of all clinical activities by

Mr. /Ms……………………………………., Mat No.........................................… during

his/her MBBS Year III clinical posting in the unit of ORTHOPAEDICS at Hospital

Kulim.

Signature : Coordinator Signature : Head of Department

Head, Unit of Orthopaedics Department of Orthopaedics

AIMST University Hospital Kulim Date:

Date:
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Goal
The overall goal in Orthopaedics is to train the individual to achieve the following objectives in
Orthopaedic surgery:

Objectives
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Knowledge
At the end of the course, the student should be able to:
• To be able to detect injuries of the bone and joint
• Be able to investigate and explain the principles of bone and joint injuries
• To detect, investigate & understand principles of common infections of bones & joints
• Identify congenital and other skeletal anomalies in the new born be able to advice and refer
them appropriately for correction or rehabilitation
• Recognize and advice basic investigation in detecting metabolic bone diseases
• Identify bony neoplasms and categorise them into benign and malignant tumors and
understand the principles in its management
• To educate individuals and provide them with a solid foundation for further study, including
self-study and continuing medical education.
• To educate individuals and expose them to basic research methodology in Orthopaedics so
that they may have a foundation to pursue their own interests.
• To educate individuals so that they may pass certifying examinations.

Skills
At the end of the course, the student should be able to:
• Detect and manage uncomplicated fractures.
• Identify complications of fracture - vascular injury, fat embolism and compartment syndrome
• Use techniques of splinting, plaster, immobilization etc. in acute emergency setup and
Orthopaedic wards
• Manage common bone infections
• Advise on aspects of rehabilitation Orthopaedic conditions.

Application
• Be able to perform basic Orthopaedic procedures (including Immobilization Skills), provide
sound advice of skeletal and related conditions at primary or secondary health care level

Year 3 posting for MBBS undergraduates in the department of Orthopaedics is for a period of 3 weeks.
Students are advised to focus and make maximum use of their posting period in this department in
understanding the fundamentals of taking a good clear, meaningful history in different
Orthopaedic conditions as well as learning the basic clinical approach and examination
techniques of various joints and bones.
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1.0 Guidelines for the Year 3 clinical posting 1.1 Clinical sessions
1. Students are advised to meet the Head of the Department at the hospital on day one of the
posting. Students shall also meet the Sister–in-charge of the wards that they would be visiting
during their posting.
2. Students are expected to present clinical cases in the hospital for bedside teaching. The
cases to be presented will have to be worked up the previous day. Students are expected to
prepare themselves by reading about the cases/s readied for presentation to the faculty
member the next morning.
3. All students in the group will prepare the case/s to be presented. The student identified by
the faculty during clinical sessions will present the case. All students should know about the
case and present it without looking into any book or paper.
4. Students will carry their instruments (knee hammer, measuring tape goniometer and
essential instruments for a basic neurological examination) for all clinical sessions during
the entire posting. It is mandatory for each one of you to carry a skin marker (eye liner) and
use it for any marking that may be necessary to be done on the patient during examination.
5. During end-of-posting clinical examinations no student will carry any book to the bedside.
The sanctity of an examination process has to be maintained and is as much the responsibility
of the student as that of the department. Students will take the allotted case for the examination
only on the morning of the day of the examination unlike other clinical days.
6. All students will strictly adhere to the dress code stated by the college / hospital at all times
during college / hospital hours.
7. Students will strictly adhere to the instructions stated in dealing with patients as mentioned
in their students handbook and this log book.

1.2 Small Group Teaching (SGT) sessions

1.These sessions have to be taken seriously and prepared meticulously.
2.All students will prepare for these sessions and the speaker will be decided by the faculty
during presentation.
3.These sessions are evaluated.
4.The group leader will collect the topics for these sessions on the first day of the posting.

1.3 Log book

1. Students will prepare 2 cases and submit it as per protocol to the department.
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2. Each student will ensure that he / she has worked up separate cases. No repetition of cases
will be allowed between two students.
3. This project will be be guided and evaluated for internal assessment.
4. The case has to be submitted by the student in person every week.
5. Corrections if any, should be completed and case should be documented in the log book and
the signature of the staff member should be taken for that case the following week.
6. If the logbook is not satisfactorily completed, the candidate will not be allowed to attend the
End of Posting exams. The log book has to be submitted to the HOD at the campus. This is a
PRE-REQUISITE to attend the end-of-posting examination.

1.4 Attendance
Students are expected to have 100% attendance during the clinical posting.

1.5 Conduct and behavior

Students are expected to follow dress code stipulated by the college and/or hospital at all times during
the posting. The department expects the students to exhibit professional approach and behavior at all
times and with all people during the posting. The department will deal with breech of discipline seriously.

1.6 Guidelines for case writing in Orthopaedics

1. Chief complaints of patient has to be recorded in a chronological order.
2. Details of each of the chief complaints have to be documented.
3. The common clinical symptoms encountered in diseases of the musculoskeletal system, that
of pain, swelling, deformity, stiffness of joints, disability, paralysis, limp etc should be enquired.
At the end of the history a summary of the same should be presented and a list of differential
diagnosis has to be discussed. The diagnostic sieve of congenital, developmental, metabolic,
injuries, inflammatory, infection, tumors, degenerative, and miscellaneous should be used to
narrow down to the diagnosis.
4. The history has to be written in detail as per the protocol and a structured provisional diagnosis
to be stated at the end of history. The provisional diagnosis should be justified. Differential
diagnoses should be written and points in favor of and against to be listed.
5. The objectives in general examination and methodology in local examination should then be
detailed with its findings.
6. No student will discuss any disparity / controversial issues with or in front of the
patients or the patient party. You may approach the faculty in the hospital or campus
and discuss any such doubts in person.

Important
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1. Every case record will be written according to protocol.

2. TWO (2) write-ups have to be presented in the log book..
3. Case write-ups will be submitted before the end-of-posting examination.
The candidate will not be eligible for the EOP exams if not submitted in time.
4. The department will retain the project work; hence you are advised to keep the copy of the
same for your immediate reference.

2.0 TEACHING AND EXAMS

2.1.1 CORE LECTURES

1. Fractures: Definition, Classification, Healing of fractures, Fracture stabilization

2. Complications of fracture: Fat embolism, compartment syndrome, mal-union, non- union
and epiphyseal injuries.
3. Open fractures: Definition, Classification, management, complications
4. Diabetic foot - Complications, pathophysiology in formation of an ulcer,
classification, complications and management.

2.1.2 Small group teaching (SGT)

1.Surface anatomy in Orthopaedics, Splints.

2.Plaster of Paris, Tractions,
3.Internal & External fixation of bones, bone grafting.
4.Tourniquet, Amputations, Orthosis & prostheses
5.Deformities : Appendicular and Axial.
6.Orthopaedic Radiology

2.1.3 Emphasis during the posting

The emphasis during this posting will be in securing a sound knowledge in subject related anatomy,
taking a good history and arriving at a provisional diagnosis and relevant differential diagnoses based
on the history. Students should be able to chalk out objectives for general examination in each case and
do a relevant general examination. The student should also learn the fundamentals in local regional
examination. The student is also expected to get familiar to basic splints, tractions and other
immobilization apparatus / materials used in Orthopaedics.
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2.2 Tests and examination

During the third week of posting a clinical examination will be conducted by the bed side
focusing on the “emphasis” area of the posting. The marks obtained will be included for
continuous assessment evaluation.

Pre-requisites for attending end of posting examinations:

1.Log book to be submitted – duly completed and signed by the hospital and University
faculty from the department of Orthopaedics
2.Attendance should be minimum of 95% during the clinical posting

3.0 Minimum requirements and documentation of activities

The student is required to fulfill the following minimum activity during the posting
1. Clerk in 2 cases admitted to the ward you are posted to. Cases should be written up as per the
guidelines for case writing given by the department and shown to the college faculty. The
signature of the faculty has to be taken in the log-book.

4.0 Recommended books

Textbook
1 Bailey and Love’s Short Practice of Surgery.

2 Concise System of Orthopaedics & Trauma. : Graham Apley and Loui Solomon.

3. Textbook of Orthopaedics by John Ebnezar

4. Tractions and Orthopaedic appliances: John D.M Stewart and Jeffrey P. Hallett

Clinical manuals

1. Clinical Examination in Surgery: S S Das

2. Clinical Orthopaedic Examination: Ronald McRae

3. Demonstration of Physical Signs in Clinical Surgery : Hamilton Bailey

4. Netter’s Evidence Based Clinical Examination in Orthopaedics.

Reference book

Clinical Oriented Anatomy: Keith L Moore and Arthur F Dalley

Cases clerked from the ward and presented during the posting:
(Minimum of 2 cases should be presented to either the Hospital or University faculty)
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Signature of Hospital /
Name of patient & registration number
University faculty with date

Plaster room : Observed

(minimum 2 cases to be documented under each category)
Signature and seal of MO with date in each column
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1 2 3

Above knee
plaster

Below knee
plaster

Above elbow
plaster

Below elbow
plaster

Ward activities : Observed

(minimum 2 for each category)

Signature & seal of MO with date

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1 2 3

Skin traction

Skeletal traction

Application of

splints

Dressings

Catheterisation

Case 1

Name of the patient: Date of Admission Age:

Date of Clerking :
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Sex:
Occupation:
Race:
Religion:
Nationality:
Place:

a. Chief complaints :(symptoms + duration + chronological order):

b. History of presenting illness:

(elaboration of the chief complaints – for the duration for the complaints):
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c. Past history: (history prior to the duration of the chief complaints):

d. Previous treatment / Drug intake/ Drug abuse / Drug allergy:

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e. Family history:

f. Occupational history:
g. Menstrual history:

h. Personal and social history:

i. Systemic enquiry:
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j: Summary of the history: (relevant salient features from the history which makes a
difference in understanding the case):

k. Provisional Diagnosis: (with justification of the diagnosis based on history)

Differential Diagnosis / (with points in favour of and against)

l. Physical examination
General examination (head to toe inspection of the patient):
Objectives :
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Local examination:
1. Inspection:
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2. Palpation:

3. Range of movements: to be documented in a tabular format in relevant joints examined

REMARKS (IF ANY)
Joint RIGHT LEFT & INTERPRETATION
ACTIVE PASSSIVE ACTIVE PASSIVE
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4. Measurements:

Measurement Right Left DIFFERENCE

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Apparent limb length: Lower limb

: xyphisternum to medial malleolus

True limb length: Lower limb:

Anterior superior iliac spine (ASIS)
to medial malleolus
SEGMENTAL MEASUREMENTS
Femur : from ASIS - medial knee
joint line

Tibia: from medial joint line of knee

to medial malleolus

Arm / Humerus : tip of Acromion

to lateral epicondyle of humerus
Forearm / Radius: from lateral
epicondyle of humerus to radial
styloid process
Ulna : from tip of olecrenon to ulnar
styloid process

INTERPRETATION OF FINDINGS

5. Specific tests:
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m. Systemic examination: (Examination of relevant systems: draw diagrams wherever

necessary):

n. Summary:

o. Provisional diagnosis: (with points in favor of the diagnosis based on history and
examination findings):
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p. Investigations with results (With normal values and interpretation of findings);

Radiology (with photos / Xerox of X-rays)

Type / Region /
Date
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AP view

Lateral view

Other views

Radiological conclusion

q. Final Diagnosis: (based on history, examination findings and investigations):

r. Treatment:
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s. Follow up:

DISCUSSION (Based on final diagnosis)

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Signature of faculty and date

Case 2
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Name of the patient: Date of Admission Age:

Date of Clerking :
Sex:
Occupation:
Race:
Religion:
Nationality:
Place:

j. Chief complaints :(symptoms + duration + chronological order):

k. History of presenting illness:

(elaboration of the chief complaints – for the duration for the complaints):
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l. Past history: (history prior to the duration of the chief complaints):

m.Previous treatment / Drug intake/ Drug abuse / Drug allergy:

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n. Family history:

o. Occupational history:
p. Menstrual history:

q. Personal and social history:

r. Systemic enquiry:
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j: Summary of the history: (relevant salient features from the history which makes a
difference in understanding the case):

m. Provisional Diagnosis: (with justification of the diagnosis based on history)

Differential Diagnosis / (with points in favour of and against)

n. Physical examination
General examination (head to toe inspection of the patient):
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Objectives :

Local examination:
6. Inspection:
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7. Palpation:

8. Range of movements: to be documented in a tabular format in relevant joints examined

REMARKS (IF ANY)
Joint RIGHT LEFT & INTERPRETATION
ACTIVE PASSSIVE ACTIVE PASSIVE
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9. Measurements:
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Measurement Right Left DIFFERENCE

Apparent limb length: Lower limb

: xyphisternum to medial malleolus

True limb length: Lower limb:

Anterior superior iliac spine (ASIS)
to medial malleolus
SEGMENTAL MEASUREMENTS
Femur : from ASIS - medial knee
joint line

Tibia: from medial joint line of knee

to medial malleolus

Arm / Humerus : tip of Acromion

to lateral epicondyle of humerus
Forearm / Radius: from lateral
epicondyle of humerus to radial
styloid process
Ulna : from tip of olecrenon to ulnar
styloid process

INTERPRETATION OF FINDINGS

10. Specific tests:

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t. Systemic examination: (Examination of relevant systems: draw diagrams wherever

necessary):

u. Summary:

v. Provisional diagnosis: (with points in favor of the diagnosis based on history and
examination findings):
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w. Investigations with results (With normal values and interpretation of findings);

Radiology (with photos / Xerox of X-rays)

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Type / Region /
Date

AP view

Lateral view

Other views

Radiological conclusion

x. Final Diagnosis: (based on history, examination findings and investigations):

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y. Treatment:

z. Follow up:
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DISCUSSION (Based on final diagnosis)

Signature of faculty and date

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Case 3

Name of the patient: Date of Admission Age:

Date of Clerking :
Sex:
Occupation:
Race:
Religion:
Nationality:
Place:

s. Chief complaints :(symptoms + duration + chronological order):

t. History of presenting illness:

(elaboration of the chief complaints – for the duration for the complaints):
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u. Past history: (history prior to the duration of the chief complaints):

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v. Previous treatment / Drug intake/ Drug abuse / Drug allergy:

w. Family history:

x. Occupational history:
y. Menstrual history:

z. Personal and social history:

aa. Systemic enquiry:

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j: Summary of the history: (relevant salient features from the history which makes a
difference in understanding the case):

o. Provisional Diagnosis: (with justification of the diagnosis based on history)

Differential Diagnosis / (with points in favour of and against)

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p. Physical examination
General examination (head to toe inspection of the patient):
Objectives :
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Local examination:
11. Inspection:

12. Palpation:
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13. Range of movements: to be documented in a tabular format in relevant joints examined

REMARKS (IF ANY)
Joint RIGHT LEFT & INTERPRETATION
ACTIVE PASSSIVE ACTIVE PASSIVE

14. Measurements:
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Measurement Right Left DIFFERENCE

Apparent limb length: Lower limb

: xyphisternum to medial malleolus

True limb length: Lower limb:

Anterior superior iliac spine (ASIS)
to medial malleolus
SEGMENTAL MEASUREMENTS
Femur : from ASIS - medial knee
joint line

Tibia: from medial joint line of knee

to medial malleolus

Arm / Humerus : tip of Acromion

to lateral epicondyle of humerus
Forearm / Radius: from lateral
epicondyle of humerus to radial
styloid process
Ulna : from tip of olecrenon to ulnar
styloid process

INTERPRETATION OF FINDINGS

15. Specific tests:

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aa. Systemic examination: (Examination of relevant systems: draw diagrams wherever

necessary):

bb. Summary:

cc. Provisional diagnosis: (with points in favor of the diagnosis based on history and
examination findings):
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dd. Investigations with results (With normal values and interpretation of findings);

Radiology (with photos / Xerox of X-rays)

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Type / Region /
Date

AP view

Lateral view

Other views

Radiological conclusion

ee. Final Diagnosis: (based on history, examination findings and investigations):

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ff. Treatment:

gg. Follow up:

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DISCUSSION (Based on final diagnosis)

Signature of faculty and date

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Case 4

Name of the patient: Date of Admission Age:

Date of Clerking :
Sex:
Occupation:
Race:
Religion:
Nationality:
Place:

bb. Chief complaints :(symptoms + duration + chronological order):

cc. History of presenting illness:

(elaboration of the chief complaints – for the duration for the complaints):
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dd. Past history: (history prior to the duration of the chief complaints):
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ee. Previous treatment / Drug intake/ Drug abuse / Drug allergy:

ff. Family history:

gg. Occupational history:

hh. Menstrual history:

ii. Personal and social history:

jj. Systemic enquiry:

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j: Summary of the history: (relevant salient features from the history which makes a
difference in understanding the case):

q. Provisional Diagnosis: (with justification of the diagnosis based on history)

Differential Diagnosis / (with points in favour of and against)

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r. Physical examination
General examination (head to toe inspection of the patient):
Objectives :
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Local examination:
16. Inspection:

17. Palpation:
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18. Range of movements: to be documented in a tabular format in relevant joints examined

REMARKS (IF ANY)
Joint RIGHT LEFT & INTERPRETATION
ACTIVE PASSSIVE ACTIVE PASSIVE

19. Measurements:
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Measurement Right Left DIFFERENCE

Apparent limb length: Lower limb

: xyphisternum to medial malleolus

True limb length: Lower limb:

Anterior superior iliac spine (ASIS)
to medial malleolus
SEGMENTAL MEASUREMENTS
Femur : from ASIS - medial knee
joint line

Tibia: from medial joint line of knee

to medial malleolus

Arm / Humerus : tip of Acromion

to lateral epicondyle of humerus
Forearm / Radius: from lateral
epicondyle of humerus to radial
styloid process
Ulna : from tip of olecrenon to ulnar
styloid process

INTERPRETATION OF FINDINGS

20. Specific tests:

 63

hh. Systemic examination: (Examination of relevant systems: draw diagrams wherever

necessary):

ii. Summary:

jj. Provisional diagnosis: (with points in favor of the diagnosis based on history and
examination findings):
 64

kk. Investigations with results (With normal values and interpretation of findings);

Radiology (with photos / Xerox of X-rays)

 65

Type / Region /
Date

AP view

Lateral view

Other views

Radiological conclusion

ll. Final Diagnosis: (based on history, examination findings and investigations):

 66

mm. Treatment:

nn. Follow up:

 67

DISCUSSION (Based on final diagnosis)

Signature of faculty and date