ILA module 5

Dr. Amin Abdel-Razek ,MD

Lecturer Of Orthopedic Surgery
And Traumatology
 1
 A professional football player, 28 years of age, during a
soccer match, felt and heard a click from his left knee.
The player was trying to kick the ball by his right foot
and on doing so he twisted with his body on his left knee.
The player couldn’t continue and asked for medical help.
 The medical team hurried to the player, and found that his
left knee was swollen , when compared to the right side,
severely painful, and decided that the player shouldn’t
complete the game.
 The player was transferred to a specialized medical
center where the left knee was properly examined.
 Plain X-ray was free. Magnetic resonance imaging of the
left knee revealed torn medial meniscus of the left knee.
Knee injuries
-bony
- soft tissue
• Extensions of tibia, serve to deepen articulation with femur
• Proximal surface concave, distal flat

• Medial meniscus
– Semicircular, comma
– 3.5cm in length
– Posterior horn larger
– Transverse ligament connects posterior fibers of anterior horn medial meniscus
to lateral meniscus
– Femoral and tibial attachment s enlarged by deep fibers MCL
• Lateral meniscus
– Almost circular
– Covers a larger portion of tibia than medial meniscus
– Anterior and posterior horns same width
– Anterior (Humphrey) and posterior (Wrisberg) meniscofemoral ligaments attach
posterior horn to MFC = these ligaments pass anterior and posterior to the PCL

• Anterior to Posterior:
– M – anterior horn of medial meniscus
– A – ACL
– L – anterior horn lateral meniscus
– L – posterior horn of lateral meniscus
– M – medial meniscus
– P – PCL
Anterior cruciate ligament
Injuries of the meniscus
 2
 70 years old lady, fell on her outstretched right hand, at home.
She felt sever pain and couldn’t move her right wrist and within
few minutes the wrist region became swollen as well as the
back of her right hand and fingers.
 She presented to the causality, and when examined, her right
wrist looked from the side as a dinner fork, with marked
swelling of the right hand and fingers. Also the lower part of
her right forearm was freely movable and a crepitus could be
heard when trying to move it.
 As a first aid, a splint was applied to her right wrist and
forearm, and plain X-ray of the right wrist region was
requested.
 X-ray revealed fracture of the lower inch of the right radius.

(Colle’s fracture)
 Anatomy
Bony
Scaphoid fossa Lunate fossa

Sigmoid notch

DRUJ
 Anatomy
• TFCC major
stabiliser of ulnar
carpus & radioulnar
joint
• Articulates with both
the lunate and
triquetrum
 Anatomy
• Normal movement
-150 deg flex/ext
-50 deg radial/ulnar
deviation
-150 deg pron/sup

• Axial load-80% radius

-20% TFCC
Radiological Parameters

23°
12mm
Radiological Parameters

11°
Wrist bones
Fracture lower radius
Fracture lower radius
 Fracture Healing (callus formation)
1 Inflammation (Haematoma)
• Bleeding occurs from
– Bone ends
– BM Vessels
– Periosteum
– Damaged soft tissues
Forms # haematoma between bone ends & beneath elevated periosteum
• Infiltration
– Inflammatory mediators & low O² attract inflamm cells
– Inflammatory cells migrate in
PMN 1st
Then M'phages & Lymphocytes
– Mediators

• Organisation
– Fibrin scaffold forms
– Neoangiogenesis & fibroblasts form from Granulation Tissue
2 Repair
• Osteoprogenitor Cells Origin
1 Transformed Endothelial cells
2 Periosteum
3 Osteogenic Induction of Mesenchymal cells in surrounding ST

• Resorption
– Removed by
– O'clasts
– M'phages
• Soft (Primary) Callus
• Consists of:
– Fibrous tissue
– Cartilage
– Woven bon
3 Remodelling
• Woven bone replaced by lamellar bone
• Haversian Systems laid down along lines of stress