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Skin traction Wt used maximally 5kg ,1/10 of body wt. Complications :- allergy,compartment syndrome, nerve palsy,failure of the kit.
Description :-bruises , clot of hematoma, sutured wound, patch of gangrene,blistering.
Balanced suspension=skeletal traction + thomas leg splint.Gallow’s traction Used in dislocation of lower limb and fracture of lower limbs and pelvis.Fracture of tibia.
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Thomas leg splint Other methods of immobilization :- 1-skin and skeletal traction. 2-pop 3-external and internal fixation 4-functional brace 5-fiberglass
Functional brace -allow mobility of joint -prevent stiffness. -light wt.
Skin traction kit wt used 1/10 of the body wt maximum (5kg)complications:-1-dermatitis2-allergy3-neurovascular injury4-failure of the kit5-compartment syndrome6-stiffness7-abrasion*if the traction was so tight in the leg ,what palsy can result?Foot drop ,due to common peroneal nerve palsy.External fixation :-transfixing pins to bone distal and proximal to fracture site ,holded externally by external frame. Indications :- 1-compound fracture. 2-infected fracture 3-fracture associated with vessels and nerve damage. 4-in bone lengthening. 5-in pelvic fracture. 6-severe comminuted fracture 7-severe multiple injuries in which early stabilization reduce the risk of serious complications.
From the left(mode of internal fixation). 1-screw 2-plate and screw 3-intermedullary nails. 4-internal locking nails 5-DHS. Complications :- 1-infection 2-refracture 3-implant failure 4-non union.
Describe the radiological finding you see:-xray of forearm of adult pt ,AP and lateral view showing transverse fracture of radius and ulna at lower third with overlapping and periosteal reaction. Enumerate the principle of two? -two views -two joints -two limbs -two injuries -two occasions. -two tissues. Rx :-ORIF+physiotherapy.
Description :- plain xray of arm and forearm and wrist joint of adult pt , lateral view, taken at date of ---- There is transverse fracture of the proximal one third of ulna subluxation of radioulnar joint and soft tissue swelling. Dx:-monteggia fracture. Rx:-ORIF (restore the length of ulna).
Why we take 2 films always? According to the rule of two , two views ,two limbs,two injuries, two joints, two occasions,two tissues. To compare and to find associated injuries.
Picture on the rt (down)Plain x ray of the carpal bone “wrist joint “of adult pt , AP view,showing transverse fracture of the scaphoid bone through the waistThe picture on the left fall on outstretched hand. Mechanism of scaphoid bone fracture.The picture on the Rtanatomical snuffbox.
Plain x ray AP&lateral view of adult pt ,no name , no date , showing circular opacity infront of elbow joint.Dx :-myositis ossificans.Other views on x ray-axillary viewposterior shoulder dislocation.-axial view-sky lineknee joint-oblique viewscaphoid fracture.
Some notes about bullets(from Dr.Muthana)High velocity missiles”>663m/sec”Low velocity missiles”<600m/sec”Steps of any bullets injury:-1.wound”laceration of skin”2.Shattering of bullet احتمال نلاقيها بمكان بعيد عن الاصابة 3.Cavitation :-propagation of eneergy inside the wound.4.Shock wave:-faraway from bullet path.
Dx:- femoral shaft fracture. Description :-extensive bruises , ecchymoses ,of the Rt arm of this female pt. Clinical sign:-wrist drop.
Description :-comminuted fracture of the shaft of humerus with lateral displacement of the pieces. Wrist drop By asking the pt to do dorsiflexion of wrist and fingers.
Dx:-cubitus varus deformity”gunstock deformity”.
Faciotomy To relieve compartment syndrome Done if 3 out of 5 become +veFracture neck of femur Intracapsular and displaced
Dx :- oblique and displaced fracture of tibia and fibula Do you agree about this alignment ?No ,I don’t agree.Dx:-Rt genu varus deformity. 1-septic arthritis. 2-suppurative arthritis. 3-persistent infection 4-growth disturbance.
Description :- Oval osteolytic lesion with no periosteal reaction developed in the upper part of the rt femur. Dx:-bronchogenic ca with secondary bony metastasis.
Anterior shoulder dislocation Axillary nerve injury with wrist drop as complication Presentation :-the pt support the arm with the other hand ,palpable or visible bony mass below the clavicle.
What problem this way of baby holding lead to? How you reduce it?
Describe the clinical and radiological change s seen in this patient? Mention its complications?This is an x-ray for a patient fallen on outstretched hand. Describe the direction of distal piece displacement? What is your diagnosis?
Dx :-mallet finger(sudden flexion injury ,the terminal phalanx droops and cannot be straight) Rx:-by cast.
Dx:-club foot.Talipes equinavarus.It is contracture of achilles .Dx:-US.Principle of Rxup to 1yr conservative(serial casting”stretching+casting”) ,beyond 1yrsurgery”osteotomy”.*bilateral 50% of cases.
Description :-lateral angulation of big toe ,with varus angulation of first metatarsophalangeal joint(BUNION).Rx:-if severeosteotomy.Mildconservative (wear suitable shoes).
Open book fracture (stable or unstable ) m.Of injury :- RTA.
Dx:Dashboard injury:post.dislocation of the hip. Presentation:-beauty queen posture(leg is short,adducted,internally rotated),severe pain. Rx:-Reduction under GA+ABCDE. Immobilization for 2 wks.
Mild varus deformity with swelling of the rt knee joint. Dx:-RA,OA,infection.
Dx:-Baker’s cyst.Causes:-idiopathic/intra-articular pathology(meniscal tear)/RA/synovitis.Rx:-if asymptomaticleave alone.Symptomaticsurgical removal or aspiration.Description :-huge lt knee swelling with dilated veins, in a young, cachexic pt. DX:- 1.Tumour of bone. *we can diagnose it :-clinically,X ray, CT , MRI. Rx:-amputation.
Description :-sinus is present with red , circular area ,edematous. Ix:-culture . Dx:-chronic osteomyelitis,T.b
Blount disease :-genuvarus deformity “bilateral”Mostly affect negro,teenagers.The proximal tibia arrest growth posteromedially.Etiology:-hereditary.Rx:-early:-bracing.Late osteotomy.DDx:-perthe’s disease.
Meniscal injury:post horn “mostly affected in injuries”. Mechanism of injury:-sport injury:-twisting of semiflexed knee Peripheral zone of meniscus has good blood supply,while posteriorly:poor blood supply,mid zone:- no blood supply.
Mc murry test Appley distraction test.
Patellar fracture with displacement Rx: open reduction and internal fixation by tension wire
Osteomyelitis :-blood borne infection,affect the proximal tibia as there is paucity of WBCs here,pecular arrangement of BVs,tortous BVs,stasis of blood here,its frequent site of trauma.In the third photo©:rupture periosteumsinus formation.
Ganglion :- cystic swelling in the dorsum of the wrist .Most common site:-scapholunate ligament.Rx:if asymptomatic leave it.Remove it by simple means as hitting it by a book , incise and drainage.
Lay people method of casting which is wrong as the proper method for POP principle:- 1-should involve the joint above and below the fracture. 2-not too tight 3-not too loose
Dx :- Hand infection. Description :- swelling of the left hand,shiny skin ,red,loss of function, spindle shaped fingers with Bouchard nodules in the index of rt hand. DDx:- 1.Cellulitis 2.Deep space infection. 3.RA hand. Rx:-rest Elevation ABs Drainage if late
Swollen index finger and infected ring, with bruises and trauma to index finger Rx :-cut it.
Description :-Swelling +redness+warm+loss of function of the Rt leg with discharging sinus: pink to red discahrge. Ddx :- 1-chronic osteomyelitis 2-T.b 3-acute suppurative arthritis.
Dx :- foreign body intra-articularly. Indications of removal? 1-symptomatic. 2-causes irritation. 3-allergy. 4-near neurovascular bundle 5-causes infection,abscess 6-incidental finding 7-interferes with functional range of movement. 8-cosmetic
Adam test to diiferentaite between Functional or structural scoliosis .If increasedstructural.If reducedfunctional.
Ortolani and barlow test DDH
Pavlik Harness in infant less than 6mo Rx of DDH.Dx:-median n. injury. Description :- pointing sign caused by injury to anterior interosseus nerve.
Description:-Claw hand deformity with hypothenar muscles atrophy Dx:-ulnar n. injury.
Tourniquette Priniciple of its usage:-apply it in proximity to injury side, record the time at which you applied it .If it remained >6hrsdon’t open it crush syndrome will ensue.Time recommended for applying it :- 1-1.5hr.Cannula IV
Shaft of femur fracture with broken internal fixation device (plate and screw).Schober’s testUsed for Dx of skin pathologies.Procedure :-mark a point on PSIS ,then ask the pt to flex the back , if the tape measure moves > 5points normal ????Second photo straight leg raising test.
RA hand:-bilateral symmetrical synovitis,subluxation,dislocation,wasting,ulnar deviation,Bouchard nodes,swan neck,boutinnere nodes.
DDH Dx:-dysplastic acetabulum,displacement of femur. Other methods of Dx:- US,dynamic assessment.
Fracture tibia (closed fracture)with bruises,ecchymoses of the overlying skin, dressinh over the lt foot.
Dx :-acute osteomyelitis. Pt is toxic ,dehydrated,ill pt, with pus discharging from the sinus, red color (bloody) from the lt knee medially
Description:-periosteal reaction + onion peal appearance. Dx:- owing sarcoma Or osteosarcoma.
Dx:-Chronic Osteomyleitis. Description :-soft Tissue swelling With involcrum Rx:sequestrectomy With bone flap or Myocutaneous flap.
Unilateral blount disease
Rib fracture and open book fracture M.of injury:-multiple trauma.Femoral shaft fracture Rx(in child till 5yrs of age)=POP spika. Rx (after5yrs of age)=Internal fixation by flexible or rigid nail.
Fracture tibia and fibula (transverse fracture).
Bi malleolar fracture M. of injury:-supination and external rotation Rx :-ORIFIf being unilateralConservative cast.Fibular fracture
Description :-swollen lt leg . Ddx:- trauma,tumour ,infection.Dx :-exostosis Description :-single well defined bony outgrowth covered by cartilage with sessile base.
Well defined lytic lesuion withfallen fragment sign Dx:- simple bone cyst
Rain drop appearance Dx:-multiple myeloma. Presentation :-backache+RF+Old age.Subarticular lytic lesion ,eccenteric , in the metaphysis with thinning of cortex . Dx:-giant cell tumour.
Onion peal periosteal reaction : owing sarcoma or osteo myelitis
Ollier’s disease =enchondromaDescription :-loss of big toe,dry gangrene, Ddx :-diabetes,AAO. Mechanism of diabetes mellitus in causing this injury? 1-peripheral neuropathy 2-arterial insuffieicency. 3-decreased immunity 4-hyperglycemia.
Perthe’s disease.Rx:-skin traction ,osteotomy ,containment.Age :-4-8yrsunilatera ,fragmentation and flattening of femoral head .Presentation :-limping, pain limitation of movement.
الحمدلله رب العالمين تم كتابة الشرح اعتمادا على شرح الدكتور مثنى في سشنات العملي.