a % w contents » 1: Fracture & dislocation (qeneral)-——-—-------——-—--—-—-— — (1) 2: Fracture of upper limb----n-nnne-n--n------eeee-eeeeee none 3. Dislocation of upper limb 4. Dislocation of lower limb — 5. Fracture of lowe limb —————————-————-—--____— G4) asFrackure «Definitions aExackure:- Complete or iheomplete break in carter continuity « orca Re Dislocation: complete los of contact betueen paris of a sein, eSubluxotion += incomplete (gartial) dislecahon. eDisplacement:— separation of tne 2 ends of breken bone. af healing, 20-3 wk — hemaloma + MQ «BG ux —posteoclast + callus + 6-12 wk > bone formation in calls 4. hematoma fermaHann se 2. cellular proli feratien- 3- new bone Facmahen (asfecblast). 4. Consolidation S- remodelling Cesteaclast) #factors offectiag Wealing. delayed anion) A age ( Page — delays healing). 2- infection —» cleloy healing. B- Bone Aveate :—e inGecken, humour, ete (delay heabing) 4. general health —» low remem by HI, DM, ete 9 w su interposition of soft Hue —s delay healing 6~ Blood supply Cb 8 supbly > deloy eating) J- inadequate smmobil'ation (t movement —» deloy healing). B- avascular necrosis Costeonecrosis) 9 - Pathological frarture. (diseased bore x%& due to miner traums). to— Use of steroid therapy: 41— others as Gaucher’s Adease (stomge Ais), sick! cell bj 2 EAL om —peorkical gop is bridged by bone © 4-2 yrs remodelling (normal arch “Toren matey° 2 Frachave () radiolagically :- callus formation - [B) clinically. 1- immobility of fragments of fractured bene. - abscence of tenderness on deep palpation. 3- angulation Stress (pressure) > Neb pair BEB unin Chealing) is suspected by 3 months (AifFers acwrdigg to age bene affected » -- - ets) - If ne bel by > 3 months bub <ém > Delayed union PERKINS pole anim ok UL > bw delayed Sree * LL ate eS ow Tibia Classifications of fracture = + om eld ages L-Traumatic % 2. chvect or indivect trauma. 2~ Pathological %+- % of diseased bene due 42 minor trauma exg- osteo my el elits, tumour , rickets ,..-..---ete- Mldde op enmonesh cute. bane, oil B- Stress (Fakigue)%&+- fmcture due + repeated mince trauma, _ eg March & “metatarsal bone”, VK 1s Secondary jst Common cause of pathol: 1- Simple (closed) & :- skin ovetying fracture i eimtact- R-compound (open) x%:- communicated bone uith exterior (ext: eminenmed) - there is high risk of infection. = needs extemal fixation. Hopes RK flackve TD &s connected to external enviaament Herough « hele in Me Skin, dle jur?UT SITIES IATL STITT ete seat ducati. ) ( 4K de Transverse x. (caused by divect Rrce), 2. Oblique Cangular or rotetonal farce)» 3+ Spiral . (rotational Bree). 4. Comminated: (more than 2 fagment) S- Segmental » ( separate segment) 6. avulsion . emman in children- 4- green SKK (incomplete % of one corer) ? 8. Butter Fly AR Q-~ impacted 1 rz Jo - stellate 3 11- epiphyseal separation eZ 12. intraarticular Caroses arkiular cartilage) (wd opermtion) Laie hematamm due to ye enzymes dr synsucem) 13—Hair ne Freche. gong eis, . 1-Undisplaced 3 :~ frachure Fagments are in anatomic alignment 2. Displaced y% s- occurs mainly with spiral or sblique SK - taper are = Side ty side. PQ = lending « - angulation. oZIS9 ~ votation . A- stable: remains in posthan after reduchen- 2"Stable. alsplaced after reduction. (needs infernal Gxatien) “Teronts_nokes minimal contamination soft issue sazury | Cephelosporin 98 he moderate gentamycin 272 hr penicillin (cleihia)) Gress “ ae « Grade II include high energy nyuig , comminted a, shotgun blast, sal watamination, ORD Bh dambmsS| cae Frackare 4 €GuStilo classifycatron:. Type Ise tow energy taguey » small clean wound Cétem)- Type Dee low , pwsually v Crlem)- Type hs. high ow ” » extensive Skin & SoPL Hisue lamage wills eagleaipabion Ty 1 bene can be adequately covered by sett Nisue. TEL sv cannct covered, with gertvsdeal stepping. We 2 asiecated with arterial mgucy that needs suigery.NOTES a Sot Assue Foye Fractured « 7 where the keene happery = Frachuse fs te be teal % t— @ Bache in Ueakened by a disease: . et corstice mectalla (y sunchin uhere abone wis alreedy boom paths ley we i wR eeu eae cackral bone pushed ints cancellus bone. Py ¥% Bor good He pew ony ve ety KL RE Frayne ” ~ commen language between collequee length = ophmom tHE mast cone C ocd yy rar Canatemnical redaction) ea NB:- Compre cred % aeeuls only in cancelleus boone. % Complications of total knee or hip replace ment t+ D- thamboembalism & ancesthesia complieatons. D- dislcaben & loosening - De Weary ostoalysss , infection , bleed’ ay- )~ neurvascalar rgury- D~ atleeratron of limb Veqgth. D-reFlex sympathede dystrophy, NB: Orthopaedic aS Grek cared! ~ Corthos = conect “stright™) (paideien = child) Je the art of coveckng & preventing deformities m chiklien —otth=paedic is a° branch of Surgury concerned with condihans ravelukng muStuls skeletal dau ma sports wgury ,clegenerekve dis. cafechons . tumour ang congenital disorders:Maller AO Classifcation «) Fk According to hecalizabion « SAK Hssue « dange g Severity Lecalizabions= Tehumerus 9-Aisrennn { sadune ulna) 3-Femue 4- Tia then ——s@upper Seyment- Qmillle. —_ @houser. type AA) Simple. OSpital @transv. Qoblique. B)Bge O Spal @eblique _conplekK (©). Cominucteh QSpiral @Seymentl Qcongler Cg 3 2 C Bscemples Femur willle Gemminucted Ccemplen Comminuabed A in middle. Segment of Rene)@ Fracture, etlistory :- sever pain , inability to move , swelling s_defeemity. © O/E - — swelling , deformity , ecchymesis & tenderness = inabilely to move , abnormal mebility may elicited. 0 S/S oF complicahons 1 eg - arterial ingucy (6 P) , nerve iapury,---ete =sheck (hypevslemic) [ 2 kemur at i] Diagnosis :- t — After L of biewd lost history examination , X-ray AP /Lat. Rule of 2 in x-rays —— Z sides = bilateral. Zveiws = AP+tat. 2 qpints= above & below 2 Kes =betere waller reduction TTeronhs nates ive teresuscatation if needed (ABC), = cwer the umund & clean sterile dresing & Splint the \imb. = give analgesia ( morphia 1S gg IV or Im) = |v Plutd Ge blood) if needed = prphylache ankbartic. - antitetanus (boaste dese

Bhr & contaminates] fe Gusslo I) g covered & vaseline gauze & da dressing ,Later delayed LV or 29 shbching when thy wound is clean+ [if eound ‘not contamina’ a <6h at shee)(4) fracture = compound bone % is Fixed by extemal fration Crise, of infection iG intemal f&xatin “F8")- oPestepermtver. elevate the mb , antibyodre , analgesic = check circulation oF Limb rn next 36 hy “ampartwent yyadme! aafler Fle days if no infechon delayed 14 shtching- eLate ttt as mene & tender repair, SKA or bene graft. (External Ration diated W]Dompound K Qemminuled K te ey ou infeckien- (suspected fracturd):- eLower Limb —» the two limbs bandaged egether or the limb to weed back— splint. sUpper limb —» bandaged to chest. + Spine 3% —» pt Lifted bedily onto a firm surface. - feck ¥K Wy Collar or avid flexion b eetensin of upine HOSPITAL HE:: . r i E displiament- inciples ave :- reduction , immobilisation & rehabilitation. done in eink (iMraacKeer . x ou dewphasea) ¥ Cslaft %) : Beclesed red vedio so ag pie. ah de Meee ausualls "Umer GA, by bacon along axis of limb ~ it is a Subtype of closed reduchon . uclieval = done 0-3 in % Shaft of Femur & rome cervical dislecahion mreduced under divect uifibn & Pred. Ae Failed closed wiectin 2- Patholegical & 5- neurovascular compromise. 6- intra-arkcular $F. -Salter- Harris 3.4.5- Bald pt Cte avid long immobile) and pt heed 4> 3° home early B- poly trauma 4— non-union missed, >3wk union & Failed el Se Salke- Has 35 81d pi & pathslegi a Te Poly Trauma Ma aaeeae e CNo cast) >aoz}4) fracture ILIZATION) -ixatier) G encaarage \aalty- OREO. prevent dispbekement ,"mevement ato relieve pain. -NBr. % may heal without immob. eg % Fb, scapula & clavicle eMieHhed! :- D. Plaster cast (splint) = POP “plaster of paris” @- Conknucus traction. @.- internal Fixation. Plaster cast:~ may be below gabeve elbow & Shoulder Spica. = below &abave Knee & hip spica. fee : = Jacket plaster in Back 4 collar in neck. At first Iimb plaster is ful) padded cast then afler week (sedema subside) chagged 4 unpadded well moulded plaster cast. = Close watching over he next 36 he (ischemia), @.Continuation traction» when ms pull around YK displacement alter reducton oS in ®% sheft of femur. amtypes are Dskin trachon sp especially in - @-Te releve pain , relieve spasm @- pt waiting for sungury Q- In seme areas a5 %K shaft of femuc, cervical vertebra dislo Benibit of closed reducte ni— Ox minimize vik of nGeckon- @ higher rate of union —> will nol + evacuate hematoma (Sis 1 stage of heality NBs Nail :-EPSS)=Electrpalished stanless geal CAN) = standard non polished “Tetantum aluminum Niobium afhe palished TAN whamadutlan oil 4 bony edhesiant dcate tonplant removal valthowt camprmising Exahion. * circular Celazateet) thin Fin, less infection , withstorel fist ~@lrnear 9 Wicker qin, move, anfection - oa le s external BxatorsGonplisions ota s-—5 Local. General immediate early late GONerve ingury: Qiinfection — @- Malunion O-sephiemia apa 4 @-Non-unien @- ovT, Pe iS sales area 1B devel even @- ards @-visceral « - @. avascular necrosis G-Shock. @- Tendon @. shortening ©- Fak embolism ©- Teint affection @©-orTi @eReflex synpathic aysinphy Cvit © ) biacdene Complication oF 3% associated tompl: 4- Malunvon- 4- nerve , vessel, vascalar dceaden Q- Non-union R- Shack. Chemecrhayis, eho) y 3- delayed union 3 fat embolism 4- infection Ha DVT, PE, UTI. ARDS s -avascular necasis S- Compartment edt ous 6. Shortening 6- Saint affeckon Z Sudeks akophy osteorthtv hs MSHS osSifcans AMalunion :—.fregments united in imperfect pasiction —f slight &Kespedally in children no Kt Al marked refructure dey osteohmy with internal Syechion Delayed unions. no healing for > Sewnths buk 6m- , Sclemtic ends are formed ~ Types are © atrophic ,@ okigerophic & @ hyper tnphic- w there is fametion af false goin Cpseudsarthresi), especially with hypertrophic typea aie #Avasculac neccesis (AVN) (orteonectosis) occurs mostly in staphsid , Femoral head , bady of telus alse in navicular &lunate (by ssteachondritia) Me supe = on x-ray Bepear sclemtic “ rediodense” . 9 fem dsfa) ~ MRI fs mere Sensitive in the eacly sdages in De. —Risk factors for AVN ares. steraid, chronic alchols Sepkc acthitis, 2% adislecaton , sickl cell disease , Starge disease (Gaucher’s dis) , ‘diopathic (Chandler's 4). Shortening :- - dhe + malunien (over-riding), compression % , epiphyseal gevuth arrest ~ important in lower limb if >2em , corrected by shves \E Dsem operative lengthening equaliudin Nerve inrusy :- == OD. Neuroprexia s- physislegical “ne fecal lesion” [ace We eneati} == © Axonotmesis:-hwan cell damage) = cut of axon only [ loag hme] = =@- Neuntmesis ~ complehe cat of nerut [usually reed sucgury J. “NB: regenctaten of nerve nvsmelly iS 1-3 mm/ day - weVascular ingury :- - the commonest 2% aimciaked with is supracendylar 3 of humerus hich is commen in children. oedema” ~ingury caused by tear ,cut or spasm. or fight oat Cophind) = treated accarclingly if casted remove cast first displaced & de closed reduction Copan’ rater) =f rea imprvment open +eductin we 6 hes cf Spasm—> papaverine sclution Jif fear of cabo sbfching or grat, = Contusion Rspasm result in acute ischaemia & finally — Ischaemic. contracture of mascle “Volkmann's Contracture”. )*Niscecal inTucyt~ = eg - spleen Cin 1, 13 or HH Left ribs) , Viver - - urinary bladder urethra in % hip bone. *Tendon _‘epury mesg evlensor pallies fangus dendon in Calls (oust nadie) = usually treated by figuer of 8 Stitching “4endon epic” x Somport ment syndrome ;- eDeLnition:. increase sntracempartmental pressure suffered +o cause symptoms 4 Sighs+ = compartment ( fibro osseous) is space anatomically done belveeo deep fascia & bone (inchde ms & Hisue , yesiel--.) efieitiolagy > 1. 4ight plaster Ccast). ace) 2> Fracture & disc locaton 3. crush inguty . revasculer2ation (as fos! Senbslechmy) 4 circumferential buen & cast. S-Chronic causes af aneurysm, tumour, eC/P ra picture of ischaemia (6 P) “th atteded is ate” — Pain (out of propartian te iagury) most important specially on flassive darsiflexin eae Lee Compartment pressure manitering Caermal =o mntly urgent > go mmHg or within 30 mmilg of dashlic BP) = Ds ts clinical. , pressure >4o diagneste, REEMA es o Treatment:--remove constichve casts splints. (Te=1 al WE S¥e dagen) - elevate limb. definitive te, Rasclotomy te release cmputments © Complications. - Rhabelemyelysis, renal failure (myeg lobi nurta) = Volkmann's contracture, cardiac aviest - gangrene watemoccuys due to intraarttalar % & proknged immbbiljzation. = treated by achve excercise , physiotherapy ¢manibulabion under GA. a Myositis ossificans (Posttraumatic ossification) bh woccurs due te stripping of capsule & pertosteum frum bones, lead +0 collector of blood under them —> hematoma around the geint—y hemetma invaded by osteololas+ and becomes ossified. = Commanest around elbow sa children “supraendy lar %" Treated by NSAID, reSt, excercises [manibulation is _completel Conknindicated more bleeding | . excdien (6-24 Ades = Cp, ortessaresm = Pain & marked point si ffnesy on the hand or frat of the insured timb. =the Cause is unknown , symptoms appears aller plaster removal. - = 0/e:- skin is red Kglesy , nail & hairs atrophied. = Dx:. X-foy — spotty ostoporesis (usually seuere)- att :- achve exercises +Local heat , physrotherapy eak theca a reenvery occurs fn 2-4 months mea te msome caseS may anced sympathechmy - (Gia alge sD strc ete uinie usually after 2 days q %- = %K femur mainly. = Fat globules —» tung Ac brain via blead vessels. ~ Heated by teox 02 with -uUncammon but very Se@rous , ccurs paihive pressure respinkion. e pessure ulcer prin tet in fechion : 2- pin losing 4 bieck 3= joint skffness 4 Nearvvesaalar demo s= misaligament GE epiphyiedd plake daaye12) Stach Trauma :- usally by high-speed vehicle accident (direc!) ropey, -Tk is rare (protected space of scapula) and if occurs wsually aSsedated with severe chest trauma Displacement :- Cmostly aie eccure in bedy but may ia neck of scopula) = over 4% of scapular % are not displaced ge Diagnasig - chest x-ray (may be missed) , CT scan wTieakment :- most scapular %« managed without surgery - + Suiggical reduchon is required m neck or glencid % « TEU, :- mechanis mainly indirect (Fall on outstretched hand) bub may be direct trauma. ePathalegy. commonest site is middle Y3 (gor) [frximl sx, distal 18x] Comnan ih children (unites rapidly Eout comphieabions). Displacement :- usually lista) Fragment displaces downumrd &medial. & CiPickuress-- Pain & tenhng of Skin » dJenderness, LOM-,.-—ete arm clasped to chest (te prevent movement) ~ sls of complication % Treatment: reduction , immobilization in arm sling (4-2 wk) with rehabilitation ( early movement once pain subsides. wdishel ¥3% if displaced (or any Vs if ends > 2em aparl) do open reduction & infernal fixation (ORIF) Gemplicakions + usually only cosmotic bump. =nen union/mal union , skPOness , chest Preums the raw ~newe (brachial) .vascatar ingury --- ede13)_fracture & NoP _— old pt 8K elles Mechanism :- fall on out stretched hand- (FOOSH) or direct. % Pathology z:- may involue surgical neck , ene or both humeral a tulserasibies « LGiphemenP? aswally in addeicton] y -Gemmen in Old aye grup Cespecally _sslesporshio) in aged high: ener: G-Es- no displacement G-T:- neck % + displacement G-I ow bw pone tuberisity K+ +two a sh of complications _beuises , k-G-I:- arm shag . G-Li- clsed reduction + immobilizaton- GM: open reduction & internal fixation CORIF) G.I +- prosthetic replacement —yrisk of avascular FANN Q@uascular nechosis), anillary nerve pulgy snen-unish malunion , skffness , arthatis. t © Shoulder ® sheples detteid Gewese shat) aus eMechanitm:- FOOSH (Callen cut stretched hand) ey alivect traums Pathology :- FoosH —yspinal ¥ , fall on elbow —> transvers or vblque x direct blow comminuted in abduction (f above deHstd insertion Ta tr adduction i€ below it Dx KC/P X-ray @P-Lat) » clo Pain, swelling, brudses Cmust est radial X- before & after treatment). wteatment:- commonly non-aperatve (closed redaction & rmmbdbilizahsn in cast from shealder to wrist with elbow flexion 90°). = if failed de ORIF “compression plate acres /intramedallery nail. radial N- tagucy + non/malunion , compactment syndrome iF tadial N- net recover in 3-4 month —» EMGae H) fracture Boh oF humerus grth is in the upper end Cav ower end) se even 38 angalation con be eked alone, bak even 16 ak Lauer pact an nek be catrected line ees QiSupraccondylar=— -It ts one of the commonest & most imp. 2% in Children & Mechanism 2- Fall on out stretched hand (FoosH) ve Pathalagy.- commonly of enleasion type (9s) but may be Flexion type (sx) *Dx & C/p -x-fay (Ap/tat) ie! =C/o Pain , LOM, -.-- ede ext # Treatment :—undisplaced beast in Hexion (3 wk) Crom shoulder to metacarpaph. 3-) ~displaced Xp reducton & samebilzation we k-wires Coercut. pinning) & Cast & elbas Flere a0” Complications. vascules ingury Coroshial @) , median ,ulaae of radial Ne ing = malunion , compartment Syndrome , sk ffnes) , Git cabilas valgus 9 ulna newrepatt) late defumity af Volkmann's contracture, Claw hand , --- ete a @ Spicondule %, We saa sey epicondyle capitulom J = commonly inchildren , it is avulsion % pulled by Flexor ms. ~ treated by cast for Suk , if displaced» may need ORIF = Complicated by ulnar N- ingury , ..--ete: ~Lateral cmdyle inclade (Let eplondyle, capitulum & lefetal part of tvechla) =Commonly mW children due 4 FOoSH , % pane pulled by extensor ms, ~usually treated by ORIF (because intmarkoular ¥x). = complicated by osteeacthea hs, mon union, cub/dus valgus Carcest of seowth on lateral side) 5 deluyed uhar neuritis.cde UBER direct trauma (fall onto the point of elbow). &Dx w C/E: x-ray (AP-lab)— Co Pain, loss of active extension Pathology, may be avulsion , transverse ox Comminuted K etreatment.-uncisplaced (< zm , stube)—» cast Celbaw 45° 7 — Displaced —s oR IF cE transuerse —s long screws 5 Keamplicetin, 4 nenanion E avulsion of comarnated > card triceps, celnserted sransvese < einsertie + GB Types °F Mant. ACeI~ © cabenisel ankles) OF © Flevion (past: ge ise lateral Satine) pe Sip R theft ulna rads ith, real Mead dsl Canter) veper V3 we Definition :~ fracture of aeuail ulna @ dislocaten of head of radias (proximal radioulnar zeint). Ke Mechanism + FOOSH 5 hyperpronation or direct. aE Patholegy,~ D-antecer Agpe Ceommen)—> anh dislocation 6f heed of radius @-Posteriae Hype (rare) —arevecse es San HX Treatment :-—ORIF (open reduction & IF) —4* restore length sf ulna by reducing %K then replace head of radius. elemplications radial head %& /disbcaten 4 non/malunion + a = posterior indersseous N- infucy in 2% 5 Poor usrish Dehasion eDefinition:- 3% of madivs (at gunction of middle 4huer Y4) & clislecahion of distal (inferior) radioulnar seint. Treatment: ORIF as monteggia %.Definition :- fracture of the distal end of radius (2em above wrist) with dorsd Chackward) displacement. sy iupination = Mos} common %& tm Women PYe “osteaporasis xMechanism + FOOSH (fall on out Sirebched hand)- © kal IE w Pathology distal Apgment of a displaced dorsally marked prominence with dinner- Fark appearance. CIPI Swelling , eechymastd , tenderness , dinner- fark. defarmity éTheotment Dclosed reductam ander GA ~~» thenar grip methed Corrs traction on Ringers with couunter traction of arpa with Fleved elbow. put Thenar eminence over distal Ragment Cpresing forward) and other hand thenar over pasion Fragment (press backward) » a push distal fragment +2 ulnace Side & pronate i Bimmebilaahion (4-6 we) ” for dorsal displ: aisfal — Pravimal fajnent "Faynent AComplicahany » + sublaxacion of nferioe madbulnar Jo = Joind shhfness , osterartheitis » Sudeks atwphy ~ fendon injury ( exlensor pollicis lengus tendut rephire) sears ober M=® ales Sat tet Gast ‘rons foe @_ Smith's focture, :- ae ae -Ib is the reverse of calles Fracture: forward cirplacement) Meh e pronchian Qe WBartON RR trks ackicular Ke distal mdius 4 wrist disleexhenFA_Srachure @ Radial “head Ae. + weMechanism:. FOOSH , commen th young adulh “im children ~~» 2% Neck of radius.” etteatment +O Aduk Oa undispleced —» rest in arm Sling Ge displaced —» ORIF (iF axgslakion 736°) eles | Ge comminuted —» excision head + prosthesis Qe comminuted + clears disleextion —y as @ Bchildren « alisplecement < 3s" —y rest in sling: + displacement 38s open ot close educha, (ever excise in children) Sunngiitstickonny 1 ised of 3 the ulna , due do diet blow 4a fare aren Cheldiag up erm pate Ace) Semmenest ste oP XK %Mechanism:. FOOSH ., commen in young men x Pathology:-usually fansuecie % & no displacement ~ the most commen %K around weSb CLP: pain on wrist movement, tenderness in andtomicr| snufPbex [asually undisplaced. | ADK. X-ray AP/Lal /scophsid view (uirist extended g-ulnar deviatia) thene scan, t CT sun. Cig. de elinieai) Curey may be -ve in TH 2 uk softreat as séarhoid % and ve-xeay 2 WR later- HTreadment :-undisplaed —» Plaster Cerend from ellen + metacor ph pharyngeal joint covering provimal phalyax of the thumb). “cup helding position cast” ia = displaced —p reduckion +inmeb, (ye may ceeded) Ecenplicadion > AVN Cevabar recnsis) ae of pracinal pl Fragment [scaphoid applied fom distal only] (> | TD12) fra (& *Boxer’s fracture :- = Frcfure of the hee “Sl the St metacarpal bene wih ank- angulakion- 2S HrH = intraark cular XK of base of the BH Mc. bene Rolando 1 ieee = Gominuted infa-acicular % of base of 1% pic bone en NB Bennett %& is fhe mest Gammon fype of thumb (Br 3% around allots -4- sypracendylar ae of humerus -2- Montaggia ag de -3-~ proximal Chead) of radius aHe eprcondylar %* R. MB: *& around 5. Galear % dsb. 2 ~ Colles ~3 ~ Smith & Barton 3K NB? 3K of Lemur commen in adult Que + RTA) ra old Cdue te metastssis) childien —> Ht cleied eduction & fenton, adult —> oRIF (bette nailing then Flahing) EM nail pide kserew BB - (Bye stosis):- made ulnar Wide of bene connectty tuo bones eerses © congenital Crore) Uswally bone aleny Mwkast. memb fe very Wry) ne Hlo Wanme- © Post trawmatic —p small Inidge, H/o Hanuma caasing hematoma 9 i Recher UNG in MOF Biewten benes etomplievtin toss 1 SuqinaWon & preaction: eH f= Prevention by mterael Paation- ection vb bene — Oth SF agsue i bebveen @ dean te prevent hemctema cilechony 5 ‘early more) @ excise mnediate after sanery pornBarton Amith Halle $caphoi Ss va “) a ey dinner Fork.Oe % Clavicle Caed/ Foosty/ Doxoserd Qisplaimeh / Cosaotic RUMP OiE sumpical wot humensc /Adsuaiar/inynrg Aedilany y/2pen @ Radial N-igjur @ *wpracrd lar /Childten [Aispleeed entered /inhary aed exterior Ms attndel folab epiceatje effected 0 osteoortc Baden hn OES orsal displ fe Giediek ve td rsa di sthcenert (SP ojan O switws: frees D scapula /Diveck trauma] anbapicel e asso Craked € West tiem Most Ye tH Gout os ace RON A Cla - Nigh Fick / isolaked #ulra/ direct Slow to Rveow, aleozz i tf radius ya “ exer # bused St Metacorpal bore ft Head radius /Foost/R atcordiThe glenchumeral (shoulder) gaint is the mit commonly dislscted Joint jin the body since stability is sacrified Por mobion «/ Soe Rtn cause RTA =vecurrence rate depends on qge of * clislocahon [Ye yr = 24%] Taronte pete, 1-aswdated fracure of tuberssity , glenoid rim. Q- yetator cuff tear , shoulder stiffness rot esau re ate fo MUA Commi bulation andir anne bess B- reeurvent/unveduced dislocation: ad 4 requ te axillary n/artery , brachial plexus sagury. Saker. capsule Aigenaad t- Anterior dislocatten. Shape of bene 2+ Posterior dislocation. Gx pee 3- recurrent ant. dislecatron: Pobete GEE ot 4—~ others aS habitual dislecatten B= DFO Z™ recsnts nates indirect - FOOSH abducted x externally rotated arm) ~direct:. blew 4o posterisr shoulder. ~Pain deformity , arm slightly abducted with external redahion, the elbow is supported gy the other hand, Limited all movement, # Sublypes oP ant. dish-:- ——p subeoreoid, subglene’d, Subclalar and adn thoracic20) facture empl aheasid Fosse = X-ray CAP/La)S humeral head medial & inf, to glencicl fesse Chest of humerus first dislocalete inferiorly then anteriorly +o ee pssition) Gabo esid is ees t+ closed reductisn uneler GA (speinly if pt marcaer 4 TathackD focher's methed :. = apply downward traction with (ao elbow Flexion) -then do external rotation for S-6 min- = Adduct Hhe arm (by crossing elbow in front beady te midline) then rapidly ratete it medially. seuchion CRaclion — BEET toting > adduction —s medial rotachon)=feom ippacemhic=-qelheds. at og ee apply traction of extended , semi abduckd arm with counter tracttan using Poot ia axa. — ~ airect backward pressure overhumeras head, Crise brachial plesus ingury there fare ast reammended) - stap arm te tran\s (add-+ MR): warm shag for 2 weeks /Bllowed by rehabi litetion - check posteredaction K-voy & neurvasalar stahas. @put pt supine pasition movement y uiove mee agive goed oxstean =O Spontaneous redaction Re : =f = direct 1. blow 2 anterior Shoulder- with arm bardulec gravity (ut) = adduction d& medal rebheton > gpilephe seimure , elechic shack. -arm held in adduchon & medial (internal) rotation . = flat shoulder ,paminent caracad , complete LOM (limithon of mven)21 fracture = Xray = AP/Lat + axillary view 4rans.- scapular). CNB dislecation may be avised in AP view) — Finding aves -t- empty glensid Posse -2- head of humerus disecked upward (v. medial) -3- electric light bulb oppearana head. AA Reduction: closed reduction under G.A —» Leleral rotation of the arm with direct ferward pressure upon head p rae : ee Thanet) = Ceo ae at ee? icra ne is aren Sling ox Shoulder Spica fer & weeks Fallewed by rehabilikction pest. islocation only cempicabe by reewrcance = fecurrent Arama , lax Ligament & Capsule. ~ disleeahen eccur when arm abducted , extended & beterally nteted eg dhecing cambing the hair, fhe capsule & gleneid labrum Stripped from ant. margin =f glencid rim)p (subclertealar pain is the commonest positron). ( ofé —> ~+ue quelle. = Kray Cavillagy veers) —poffill Sachs lesion + divot (depression) on post. superiag part of head sf humerus [due 40 forceful impaction against glensid tina] ebony Bankart leSienr- avulsion of the anterive glensid labrum (with attached bane fragment) fam slensid nin. = CT Senn maRT (Soft disue) , acthrosts py Cbx oo ) a y GBr> [Take gud Krbs\— ss, when are 4 athuck F period of attack’ Chow ba ae) - ask about Hy sin22\ Fractuve | KTreatment :— —> operstive ‘ - he Subsespularis & Zemale ave shortened & Hohted dy everlogping of reefing [4 limit external tation |. OD Hoy Ltn = reattachment of glensid labrum & capsule . @-vthers_as I Bristows eperation:. —reinfrdement of ant. inf. capsule. DB Bone - biack aperation:_ - being coracid in fant «fF Shoulder do prevent recartend ant. alislecat on. CB(berkart Biistos aBane bleck done if E hill sac leven) onions] humeral Park oStetemy —b URicof Retrvesion of head GiTvabitualclislocatien) —Some pesple with very lax ligaments can dislocate the eulder and reduce it over kever this referred to as habitual dislocation. . - Hs" Rcurtent dislocahin bud painlest. ~Gan oaxure in other garnts as elbow, parila ede > NBs if anterioc ck’slecation is mised or neglected the tte is: (2 tk young a Suk dislocrtion —s closed reduction >buk Hsopen 4 =f old S30k 4 —sopen uv x DS sok + 5 ne te © superisin" NB Dead ach syndromes yosd ulky athletes Z goed muscles but ais Noe capsule se labrum alue to over-we —> malt! Airectional snstabittly —habiheal sublexation of yoiet(22\_ frackwre Gnkerior dislecation ) aMechanism :- fall on the shoulder. ‘HO/E:- Visible & palpable prominence . we eEE e- clesed reduction usith chivect pressure on front of Joint- Grisk oP recusrence , int. fixation visk of ingury te vesels) = Ik is an emergency as may cause compression of large vessels in the necde ,so must reduced immediately « CX ,: wei @-< sein’) Meshasiso fall onto shoulder with adducled arm (onls Kp of showlde Causing partial tear (Sublaxation) or camplete tear (cl'slocation) = C/Picluce :--p ipa ble step deformity behween clavicle Racomien (toronis nste) = pain with adduction /Iimited ROM Gif sublax.one defends «Diagnosis: x.y “ shess view” Wp Sky im patient's hand > — dislocation more clear. 10K YF” Treatment: Sublaxahian > arm sling G-3 wk) ice , analgesia = Disb cation ~» open reduction prepair foen ligament & rateinal Fixation Z scred. xGomplicationse. oFleoarthetis 6 aac eink » failure of reduction “treated by asthindesis after spen reduction”Frachure GPasterion dislecation) common” pMechanisna:. fall on outstretched hand (FoosH) . CLP: Pain , LOM, elbow held in semflexed position. ~0/€:- hp of clecranon felt higher than level of 2 epicandyles. eTrealment:— clased reduction (pall forearm wit semi fle xed elbow) —immebilisahon in above elbow plaser < flexed elbow Ie” for 3 uk followed by rehabilitation. = neglecta cases (>Xuk) de open reduction CAnterier dislocation) Dp eMechantien Pall onto Hp of elbow = usually olecranon iS iucleniay = alusay operative :-teduce ulna & radius then fx the fracture. i wearpal dish.» weMechanism :- FOOSH with hand ntation eTypes :- fon a Valer Canderior) rile bi —o (he distal ras main) (EB wsvally ale cath scaphaid a especially pecilunete dish [RB mresty rot diagnosed —achanie pain &uinst instal! lidy mart. [ante desl. is the commonest dy may acate median Al. CoMPRESION achsed or aren reduction ust plaiter 6-¢ Wk -2 Adhesive capsulitis _Diserder characterized by progressive pain & skfFness of the Shoulder , usually resolue spontaneously after 18 months. we Mechanism Cpathslesy) i 7 may reselue fn 971% men tht, 1 Primary adhesive copsulilis -= fdiopathic usually Keciated € DM 2-Seconday adhesive capsuli due te prolonged immobilisation , Alloway ML, sheke shoulder trauma. eUnknovsn 5 copsule saflamm. —5 fibrosis > gradual Pata adecreased achve & pative ROM. = Increased pain (atect sleeping) stiffness oa “A Treatmenk + = physiotherapy , NSAID: s arm sting /catraarheuler steratd casection, ~Arkhis scopic OR nermel sane copsular d'shucton. fay —pNetmal Rotator calf consists of 4 ms (Subsapularis, supraspinahns ,/nfaspinahw and feres minor)- oa retahe caf ms are inseche greater datberesiy of humerus ExcEPT pret ako . Subbscopular!s lever tuberosity. = tothe calf ms stabilize shoulder during movement eipecially at abductan- CRckar calf syndrome) + @ Acute tendenitis “calaFied” —» supraspi natous tend envtis © Chronic tendenitis —p» Impengement syndrome - © Frozen shoulder —» Adhesive capsulit’s. @ Rotator cuff tear.eee tcl, QiAcute caletied “Fendinss + = inflammation of supraspinnhus fendan sith cal ficahon which removed later by macephage more in young aye. = Unknown aehelegy & reslue spontanecsly Sin 2-3 Wk. = Treated by NSAID , if no respanse—> sngect laal steroid Zanaestesia, ch recarient Cases —» Surgical remaval of att @echronic tendenitis / Gopeagement syodreme) Gapraspineleus ledentis) Rotator cuff syndveme) #- Pain on abduction of Shoulder with Preedem of pain at ertremifies (belween So—l20°) Meshes —impengement of supraspinatous tendon by a subacmmial bone Spur, due to impingement by over use. — ~ [Ho-So years} i Pain on abduction 60 -128° *o Deep -arm sign: passive abductsn of the avm abeve (20 then aSk pt te adduct Slowely —¥ pt rep arm on ceaching 120° ete Neer's Hest 2. Pain with pasive forward ~ flexion helueen 120-170°. -oild (wear):. —» NSAIDS, physiotherapy, —Maderate Ctear)+—p as mild + stemid iagechin = Severe (repaid) —p may supgical repair (ph canack abduct),cackur2, @ jursemaid’s elbos) = Annular Ugament ships between head of radus & capitulum 2 fuollows pull on childs foreacmfrule out child abuse) sCommen at 2-6 yr [due 4 underdeveloped radial herd) =C/P:- Revearm i pronated. “in extension” ane ~Pain , LOM » tender radial head» pieudeperslysiy ” Ute closed reduction (gente spinetion hile maviag from extension te Fleyin) + =may immebilize in 1 day mm acm Sliny 4 Pain relieve. eI (stable) :- transverse through gristh plate , Hb: closed neductin IL (above) :- through metaphysis Se grouth plate TE (len): theoygh epiphysis te plate & dleny greuth plate a TW CHyasgh) ~ Hrrough epiphysis & metaphysis eV (Ram) » crush tagury of growth plate (Salter = Steble , above joe, Lbeaygh & Ram)most kClessificetion commen DAgquired dislocchon:-Q- tmumabe —(ant, pdt. & central). @- Pathological —> neoplastic, septic arthritis. @- post-paralylic ~» polio, cerebral pulty. (Hh congenital hep diss (pH) see defiaity” Mechanism -. severe force to knee with hip & Knee Flexed 90° + adducted hip. (ig tree inte dashboard in RTA) Pothologys head of femur displaced supertor & lateral posteriosly “tward ileum ” eClinical Pickuse: (leq is ~Shorfened Plexe and_intecna = no bruises or ecchymatis at hip —-» indirect trauma. = fo obvieus swelling ~— whip pint os deep seint Coulky m3) BDiggnasis~> x-ray pelvis Ar/ Lat. > emply acebbulum, dvs. head = CT sun to excite x HOF & acetabular rim shah G vk Tieatmenk> Q-clased reduction :. under GA = pt supine with hip & knee Flexed 30” = Sugean pulls upward with LR Clat- nk) of the Femar /uhile an assistant grasps the peluis through iliac crest.Fracture @_Immobilisation :~ by skeletal dracton through @ pin applied thrugh femeral condyles with WH fer 3-6 le @-_Rehabilitetion :- achive excersite - = gradual Wt bearing by using the crutches. @-Nere. iaqury ~+ Sciatic -y foot drop -[in 257] @- Vascular « —~ Superior gluteal actesy- @- assecdated % + acetabulum Cpost vim), head eof femur shaft of femar [Not neck J (Th Late complicahon :- © mypsitis ossficans -Cavoided by gentle manibulation . SAID @- post traumatic ostesar theitis eee @ skffness. © avascular necrosis (AVN) of HOF :- appear on xray 0 T density Cearly) , later destructon & Rugmentation atreated by hemiadbroplas DUB head of femur supplied by u - Ge @- capsulac BV —smain in adult / , @- arlery of HOF tn Iegamentam A eres a main iN in fant r Q- metephgsen BV. Grlay © HOF U aw. of Dbfurater ® Mechanism : blow to knee with hip widely abducted., on forcible abduchon & lateral rotvhen (LR) Ee Pathelagys- HOF Chead of Row) daplaced ant Coward sblurcter ramen) % Clinical flclures...leg is lengthened (or numal) , abducted Teeth aad derally meted. Csherteniag prevented by redus femoris Jendon)acture = absolite Lom , HOF may palpable in groin or visible sTieatment ©. closed reduction :. under GA- wapply traction of flexed Wb with MR ©. tmmobilitahions. Skele+a| traction (3-6 ik) we Diagnssis = x-ray AP/Lat (AP may looks nacmal so de Lat view) Complication: M- a vascular necrosis @- oblurater N & vessel inqury femoral N- KveSse| aqucy. @- oStesacthatii, shffness. Mechanism :- trauma to greater trochanter (direct 8 Pathology 1- HOF is displaced centrally tword pelvic (medially) & C/picture, +. 1eg in neutval position (ns MR at LR) sight abduction sharten'ag. = marked bruises, ccchymasis sn Gy. tubersity- Treatment Reduction &immabiliaation by: traction [gradual | transverse & longitudinal siteletal action) = total hip replacement if acetabular % xCompfcalions: [a early. :. visceral ingury by ans! | HeF ey Bladder action © Bklake 2 sh Plies, myestis ossificuns , oStesactheit's » AVN GB any acate distention tm any park math vedced gin She except OD cortral hip Atal. and © facet sl. of carve spine XNOF 1 shortening #LR + abduction . Posk. Dis:- Shortening +MR + adduchon +Flevien Ant. Dis: lenglheniag + LR + abducton. Ceatal Dis: Shoctening + Neubad + Abduchen mt Srachion31) fracture A TTypes = O- Traumatic Cacute) dislocation @- recurrent dish. @- habitual disk. ‘Risk Factors:-@ young female @-high-ridiag Patella CPclella alt») @ obesity genu valgus @©- shallow sntercondylar grrove @veak vastus medialis @- tight lateral rehnaculam. Tefonte Ne v Keaact sudden severe contrachon of quadricep muscle against a flexed Knee - at Padhahgy, ~ dishceto always lateral. due to true. (x C/Picluce :--Knee gives way with walking , unable to straighten it. = severe pain, enderness , swelliny , Kinibed erdention® knee A Dissnasig. x-ray Apalet , Skyline view of patella. +ve patellar apprehension test (apprehension on let displace patelle) EiTteatments- reduction (closed) & immabilisction sm cast Cy-6 wk) with rehabilidetion Cprgressive Wt bewing & quadriceps sheahhing) @Xkcuent St) - eMechaniion + 28 acde doh. tah Pathology s. usually coused by coggerital facts “Yench af high patella, genu valgus , underdeveloped Femara condyles ~ Supgical fightenig of medial capsule and release of (ateral retinaculum “dene also by transposition of ligamentum jatellae to new insertion —» medial & distal t opginal snSerhin in tibia“ vastus medialisrte Kite i) each time then knee is flexed te a cemtain degree - KE ecewrs cithout significant pain, & with each certad Fleyon unkke vecurant dil. in which pt may be nstmal for Yks ar months between athach. ~ePatholegys usually there & abnormality m™ vastus lateralis OF epeoduiceps (sherkenigg due te Mbresi.) 5 Leben dislscabn by flevion selterdmenty velesse CAivision) of tyht ms "mystery of tha vastus aberali3) « NB tao Quadeceps muscle consists of :~ Ovastys medialis. @- vastus intermedius @ vastus lateralés G@ Recdus femos2 =Guadriceps is inserted ato upper part af patella which is attached 4p tbial fubereity by the Wyamentum patella SS Extension mechanism) NGi~ difbence bet Nevien defoami ty Ga 8) & xed flexion defimay + Flexven deform means Gt Cannst enxtad Ke achvely Couk can be pasively -br fixed Pteyien meant cand pattively eivected.(33) fracture fines recon y— Mi Fete. seMechaniims igh energy traam 42 < kyperextended knee = Tk vey rare Cienee Belable by Uy , capsule, “m?) rePathsleggs tibia duplaced Pardererly , anteiiely jametial or (etera] due to captured Ygaments. Cast is most cominan) RCL Pilure Knee iastelilily effasion , Pain = alway cheskK vascular status Crest. dish —> vascular agus) “eDRgnatty: lated, xray ah egclude tibial ucture. ectreadmente — chsed’* reduction immabilisatin om plaster + rehabilitation - Complications CL vascular iasury Cpeplitend). @. sheoartherts. @. instability of lene. @- asecated fructare .“xMeckanism + pelvic 2% caused by high enefgy traum either chvect ey vunover er indirect transmitted through fetnar- focal swelling . tenderness deformity . peluic insabiltty - a 5/5 30 compl cation aS hematurta Curethral of bladder iagury). = X-foy AP /Lat Aira rotationally Stable, verhcally Stable eclassificadtion « Ce volakunally unstable ,verbilly Stble Ae Judet and Letournel classification Cin roledianatly unstable - vertically unstable? = assess genitourinary fagsiy (iF inabved Ahe H ensideced bedrest , mobilize with walling aids- -Type B&G > eternal om faternal Pxation (alse may treates| by traction " Canvas sling” « A- hemorrhagic sheck 2- bladder /urethral injury Cmembransut pac) gy rectum B- nerve sajury: 4— arthrits (este) , S- Persistent sacroiliac pink pain Ccgener (& NoF): = Common in elderly(>6s) mere in Female (Rost menspause) due to costes porosis =" patholgical a” = Falldowsn on grester trochanter with Ieteral rotational force. —ypeally occurs after slipping. am Hlo fallow & pt cannot getup unaided & sever pain LOM = 0fe marked later) whation with abduchin:, short lrmb and LOM or ever ampossible to move (fain). inter tochontic. een ea cast Seb) e Cooper's classification intracapsular K NSF othe intracopsular %XAOF is clasified by 2. Q. Garden's classi foakion 1 Caccording te diplecemen!) GL: incomplate % with no Ais placement- e GT: complete « « no a + GseD Gl Complete 4 minimal + (5 gey et IX GIL +- complete «@ Severe ss em sCenarding 4v site): @-Delbeh_clesification » 4- SubcapitaL » 2-4rans cervical. 3- baal x. r LNB: capisle of hip goint is attached x) anterorly to inter rrchantyic Gas and ‘middle. Posterterly 4 bray of the neck. w34 Fracdwe D Grade L & TL :- internal Bralen Ley PHS (ajnanic hip res) B- GIT & TW + according + age = eee = If >6o yr ZW hemiarthmplasty o¢ THR Il << Go yr—peORIP (open reducen & IF» DHS) ahemiarthmplasdy if failed ceductin ev developed avatar necrosis Extmcapsaler XNOF :- faternal frcation by DHS. B\- Moores pins nat used in adulk as it bends @oreale xecomplications, »- leuk can be done for paraplegic pk Cust well) @intiacepsalac +~ avascular necrosis jnenuman , astevarthiki, ... ete NB:- nonunion is mainly caused by Pbisnolykc enaymes taside synsvial fluid (prevent hematoma) . but alse by peer flood supply 8 tmpect teduchan Be IF Snenanion is Heated by hemarthaplashy it 750 yr (if IL hast) ..--ete. you must de —> Knee examination, vaicwar assess, pelvis x-ray) DHS = Dynamic hip Screw PEN = Proximal Rmoral Avil. ~Conhinusus tractin + Thomas splint -ORIF Cinbramedllary nail ar plate & scres) 9 see nubicahon of TE ~ external Fratton if open ® or pt with malkiple caparyGa fracture ‘eMechanitm :- c high energy trauma (RTA) in young adults & low energy trauma in old Costes parosis), x fathology : quadiccep ~The distal fragment is tilted anbettorly by quaddiceps but may be ‘posterialy by gastrocnemius. = Pains swelling , deformity & Lom Gc ey *cheabment s = Blight displacement —-p skeletal Hacton of Abia. = Severe Asplacement —b open teduchan & tnt. Gxation (RIF) « [RBI iF ty AAP xray one condyle seen small R Vefagular than other —> means rtukien ocawe mv to ORIE Mechanism: high ene(gy trauma or axial loading x C/Picture :- extreme pain, Knee e Ffusion(hemarthrosis) + doughy sensation selnvestigation:- X-rayg- condylar w (one comdyle % s displaced upuard) or intercendylar (Huo condyles % § split apari) MV, kTteatment:-- GRIF & early mobilizahion x strengthening = hemarthrosis must be aspicated Gest (as sem at pussible).Fracture Mechanism :- ~Femoral condyles driven tots proximal Hbia . se Strong bending farce accompanied with axial force. Ge ACRE (bumper %) = Tenderness ;hemacthrasis. , Treatment 1 We commiauted Medial condyle % —» ORIF.(Comminuted) © Lateral condile x —p-Undisplaced yconsewabive (pina henasthnsis + plate’) + displaced markedly or comminuted —» ORIF (¢ bene graft) © Bicondylar 1% ——p ORIF C may be combined with external Srxation) (NB) Schatzker clasiP. of kbial bpe Ts lateral condyle % withouk depretiionarp tk conservehve typed vw wb ORIF (Gone graF) fope Ts central depression & intuch edges 6 Swe lomt diel ar ORE PTs meatal conde we Hote We Biandyler as Cootal delat.) Pipe WI i Biagslae HK with, mrebphos!s % Coephyedd Acwatsnuity = numerous , including high energy (RTA), falls , sporhay snyuries -(@aitcamman open B) we Chalcs! fiedure 1. ~ Pan, sSwlelliag yaesthe = SIS of complcatin :- Compactment syadmme (high tacidlence) , nerve gvesse] ay. *LTieatment 1M rail, ~ closed & —p undiplaced —» sharght leq cast (6 wk) , diplaced oRIF ~ Open HK —> Fesuscitachion (ARC) cleaning, exfernal Sxahon »---ete. ecompl’cadionss. neurovascular ingury & compartment gyadnm have high incidence. = nen/mal union. ed hese 4, » Otfeanyl Hs. associated % of Fibula.: acaken eMechanism, 2 Stele & —@) L-Ditect trauma p> Fall ot blows on Knee comminubed XD , ony contrac en 2~Indirech trauma —pr by “nomen oF aie Gay *Q avulsion Pructwe & HGlinicel Pledure -Ch: Painful swelbiag meu alls marked deaderness , extension lost » efRusten Chemorthresis) Treatment 1 ~ stellate (ne diplacement) —p inmali lization in plaster G8 we) e904, = Comminuted % —& Patellechmy (excision of potells & repair qnodetcap’) = Transverse 3% —p-oRIF (by a screw driven verbally vpuard)e plasterB tvk si@ pe DUS yr do patellectsmy ravulsion y—p: excision of Fragment & deaden is repaired. 1- Ostecarthechs 2- Nea-unan. 3. Skffness of kneé. “Ng effect of Patelleclmy :- Power of Lull extension is slighty impaired especially oa climbing or descending Iedders or stairs. NB if achewar saree of patella is med ne oRIF Hi indeck (ie saback pint) ~? conrevuds NB:. extesion mechanism fF = TT quaddeeps my Quads Jaden 5 petelle> lig. paket > Word Averaitly patellar RreKinaclamFractures of Patella Nondisplaced tans- Displaced transverse Transverse fractuie Severely comminuted verse fracture with fracture with tears with comminution of fracture intact retinaculum in retinaculum distal pole — Repaired with Lower poles excised Patella removed. pins through completely, and patellar quadriceps femoris Vertical drill figament reattached to. tendon sutured to E> holes ana remainder of patella patellar ligament see 2? tgure-of witn wite through drill with nonabsorbable tension bend holes, Retinaculum Sutures, letinaculum Trested wih (ong leo vite and repaired repeired cast for 4~6 weeks suture of fovlowed by passive retinaculum and active range-of- mation exercisesia Ho] Fracture “ORE FEACTIRSI Sous te Mechanism + GAbducken & or lateral lation (commenst): 1-Lateral malleclus Cor distal end of fibula) shear-oFf . 2- Medial malleclis 9% Ctnnsuerse avulsion). 3— Medial collateral Uy. Cdelfoid (%3) strain. 1- Medial malleelus shear- off. 2- Lateral callateral by strain 3-Fibular Ructure- 4- One malleslus may Practurad (First degree) « pl 2. Tour mallee? ,, « C second ov), yX 3-Tive malleali yg with pastersr dp of tbial orteukor, surkace (pesterior mallealas) (Third degree) x Classification — “ Weber (Danis. weber) classification :— Type A :-(infia -syndesmotic): 9K below level of gyadsmosis. ek = pure inversion ingury. A Type B s- Ctans -ayndesmebie):- 9% af level of gyndesmadd. = eversion & external mtaton Coommenst)- Tyre _C :- (supra syadesmebd) 3% abave level of syadesmasis. = external pofational qgury + x Disge05i + Gale of ottawa in weray) Yay only required iF :-@ Pam at malleoli & tenderness on themv © inabilly t WE bear afer cqury. “Wetonge avtey -x-tay AP/lat , mothe view Ly Ganicle at IS* MR —y true view of ankle x zoiat space) = CT sean moy repaired annClinical Plcture 1 = Pain, swelbkay , tnability to Wt bearcay on affected leg. = defeaity eTreatment + (eles eres cast) One malledar %K:- platter immabilization. Cf diplacd oRiF) = Tise malleal’ % - plaster vmmabilirehin Cf displaced oRIF) wuslly = Pibular 3X :- ORIF (+pen reduction &1F) m Pisplaced X & dislocatin:- ORIF NB indications of oRIF in ankle are :- Gall % dislocation @aill type c frachares @-Timalleslar %(med- slat 4 post) ©-talar tit >(o° (NB:- Tibis- fibular dtastasis consists of G- rupture of medial Wy dink kbinfibure \y- @. lateral shift of talus. @- fracture of shaft of Shula (due abd +18) x strong ley y eversion medial ig (delteid lig) ‘Mechanism :. sudden twishng withZ investen—p lateral ellaleral ay HSLpicture Pain, bruising , swelling, tenderness , Passive in/eversion Painha Rindestigadion: x-ray ( localized soft Assue swelling » avulsion 3% lat malleds) + Tiesdinenk +- Gude I(minsopie tr):- Rest, Jee , Gnpettion, Clevachin GOH, ) Grade I (macrascepic tear): ShaP ankle in dorsifleyan & eversion 4-6 uke Grade IE (complete tear): sperabue repairs ATF: Ant: tale PTF = Post. CF = caleanes -fibulan Tarwnte Wot fibular42} fracture ~Grade Ty mild ankle mversion inquey (no tear, intact fers only sketa) Tuy 25-50 % tom Kbers- I -y se- 45% tom Kbert- Ws complete torn CRadislosieal chssit. oF Va~ fay) = Grade L— 0-2 mm (cansewatve : ices analgesia, elastic bandage , rest 1 wie) I 42-5 mm (as I + pluster “back slop" 2 uk) + Te 45-lo mm Cas E sphster Ay 6 wk). Z — Plomm (ten) (suggi cal repaic , plaster 3 WK. physn therepy sugun matt cane within q week Latter 4 wh #brsis owure]. Aetiis evden rapa) xMechanisen:—loadiag actly , shop ago spects(49 tennis, basket ball) ~ Secondary to chronic eadenitts , Stewid ‘age chon x clinical Piclure- audible pep , sudden poin , palpable gap » weak plantar Plein, ve thompson test (re pasive plantar flexion) % Treatment;..fo demand or elderly —» cast foot in plantar fleyim SZ. Wig demand —s cucgical repair + cast 6 -% Whe. most commn site af ruphure is cm Pam infertion ble blood suppl fhe poorest Hower bob B2% ®