ORTHOPAEDIC PRINCIPLES-A REVIEW

Instructional Course Lecture Series

2012-02-05T23:06:00.006+05:30

· ‘Pilon’ is a french word meaning ‘pestle’ and this term was coined by Etienne Destot in 1911 to describe fractures occurring within 5 cm of the ankle joint. · ‘Plafond’ means ‘ceiling’. This term was coined by

"PRINCIPLES" of Tendon Transfer Surgery

2011-10-20T00:23:00.000+05:30

principles of tendon tranfers (1) Supple joints before transfer, (2) soft-tissue equilibrium, (3) donor of adequate excursion, (4) donor of adequate strength, (5) expendable

Osteonecrosis of Femoral Head

2011-07-20T00:15:00.005+05:30

Osteonecrosis of femoral HEAD (Chandler’s disease) Aetiology Atraumatic – High-dose corticosteroid use – Alcohol abuse: >8 ml of alcohol per day is associated with increased risk – Smoking –

Current Concepts in Intramedullary Nailing of Femoral Shaft fractures

2011-04-26T22:56:00.011+05:30

CURRENT CONCEPTS IN INTRAMEDULLARY (IM) NAILING OF FEMORAL SHAFT FRACTURES Siddhartha Sharma, Hitesh Gopalan UINTRODUCTION Intramedullary (IM) nailing is one of the preferred methods for treatment of femoral diaphyseal fractures. Successful intramedullary nailing results in a short hospital stay, a rapid return of motion in all joints, prompt return to walking, and a relatively short total

Tibial Plateau Fractures

2011-03-13T13:26:00.003+05:30

Tibial Plateau FracturesAnatomical Pearls:The articular surface of the lateral tibial plateau is flat or slightly convex in relation to the medial tibial plateau that is concave, which provides greater congruity with the medial femoral condyle than on the lateral side.The lateral plateau is also higher than the medial plateau, accounting for the few degrees of varus of the tibial plateau in

DNB December 2010 Theory papers

2010-12-13T19:23:00.000+05:30

Paper 11. Define neuropathic joint. List the causes of neuropathic joint. Mention in brief the clinical features, diagnosis and treatment of neuropathic joint.2. Define gout. Describe in brief its clinical features, diagnosis and treatment.?3. Describe the broad principles of tendon transfer. Enumerate the tendon transfer for high radial nerve palsy.4. Discuss the indications of surgery in TB

Book Released

2010-11-14T23:45:00.002+05:30

Dear friends,Finally the book has arrived. Orthopaedic Principles-A Review is ready for you. I am here by attaching the cover page. The foreword has been written by Dr Ashok Johari, President of Indian Orthopaedic Association and Editor-in-chief of Journal of Paediatric Orthopaedics (B). - The book will run into 750 pages and will comprise 110 diagrams that are essential for understanding a

Anterior Shoulder Instability

2010-11-10T22:50:00.008+05:30

Definition• Stabilizing Factors• Tests - LAXITY TESTS, INSTABILITY TESTS• Imaging – Radiographs, CT, MRI, MR arthrography• Classification, Matsen’s TUBS & AMBRII• Surgical options: Anatomic Reconstruction (Bankart Repair and Montgomery and Jobe modification);• Non-Anatomic Reconstruction (Bristow Latarjet Procedure, Putti- Platt Procedure, Magnuson Stack Procedure, Neer’s, O’Brien)• Current

Foreword for Orthopaedic Principles-A Review

2010-09-28T20:54:00.003+05:30

FOREWORD The Indian Orthopaedic Trainees just like trainees elsewhere, need strong foundations in Orthopaedics and Traumatology. When it comes to examinations, however, they need a book which summarises the highlights of an orthopaedic topic. They should be able to go through it quickly and it should present important and factually correct information. In a sense, this

Formation of Indian Orthopaedic Trainees Association

2010-07-07T23:36:00.004+05:30

Message from Dr Ashok Johari,President,Indian Orthopaedic AssociationIOA President's Theme initiative on ‘Better Patient Care …. Through Education and Research’INDIAN ORTHOPAEDIC TRAINEES ASSOCIATION (IOTA), affiliated to Indian Orthopaedic AssociationOn a proposal by the President, IOA, the executive committee at its meeting in May, 2010, passed the creation of an Indian Orthopaedic Trainees

Experiences of Senior Orthopaedic Surgeons

2010-07-06T23:59:00.007+05:30

Hot Discussion in our forum:Forum Updates:Experts talk about their life as an Orthopaedic Surgeon:Posts by Dr Rajesh Purushothaman, Associate Prof, Calicut Medical College,Dr MC John, former Consultant Medical Trust hospital.Dr Ayappan Nair, senior consultant joins forum.Dr Shishir Rastogi(AIIMS), Dr NK Pradhan comments @ guestbookvisit:http://orthopaedicprinciples.com/forums/viewtopic.php?f=9&t=

Orthopaedic Principles Website

2010-04-29T10:54:00.004+05:30

Hi everyone,We hereby take pleasure in announcing the launch of our website,www.orthopaedicprinciples.comto look into the needs of Postgraduates and young orthopaedic surgeons. We are embarking on an “active discussion forum”, which is an extension of the highly successful communities that we run in orkut and facebook, with more than 700 postgraduate members altogether. The topics discussed are

SCHEUERMANN's DISEASE

2010-04-02T11:25:00.009+05:30

SCHEUERMANN DISEASEHitesh Gopalan U, MS, Senthilnathan MS MD.Theories of Origin  Scheuermann proposed that the kyphosis resulted from avascular necrosis of the ring apophysis of the vertebral body. Schmorl suggested that the vertebral wedging was caused by herniation of disc material into the vertebral body. Ferguson implicated the persistence of anterior vascular grooves in the vertebral

Intercondylar Fractures of the Elbow

2010-03-26T23:57:00.005+05:30

INTERCONDYLAR FRACTURESMechanism of injury: Is by a force directed towards an elbow which is flexed > 90° which causes the ulna to drive against the trochleaRiseborough and Radin Classification• Type I: Nondisplaced• Type II: Slight displacement with no rotation between the condylar fragment.• Type III: Displacement with rotation• Type IV: Severe comminution of the articular

Os Trigonum Syndrome

2010-03-18T22:52:00.001+05:30

• Is a cause of posterior ankle pain. • The lateral (posterior) tubercle of the talus has a separate center of ossification, which appears from ages 7 to 13 years.• When this fails to fuse with the body of the talus, it is called os trigonum• It lies lateral to the groove for the flexor hallucis longus (FHL) tendon• A cartilage connection may or may not attach the os trigonum to the talus. • The

ACROMIOCLAVICULAR JOINT INJURIES

2010-02-26T21:30:00.003+05:30

ACROMIOCLAVICULAR JOINT INJURIES Mechanism of Injury:1. Direct force is the commonest cause due to fall on the shoulder with arm adducted2. It can also occur with indirect force due to fall on the outstretched handFeatures of Acromioclavicular joint:• Is a diarthrodal (synovial) joint• Horizontal stability is provided by the acromioclavicular ligaments • The AC joint has a thin capsule that is

Madelung's deformity

2010-02-13T23:30:00.001+05:30

CONGENITAL SUBLUXATION OF THE WRIST (MADELUNG’S DEFORMITY)Pathogenesis (Brailsford): Stunted development of inner third of the growth cartilage at the lower end of the radius, due to still unknown cause. Growth of the outer two-thirds continues and, as a result, the radial shaft is bowed backwards, the interosseous space is increased, there is overgrowth of lower end of ulna and is subluxated

Pigmented villonodular synovitis

2010-01-30T20:05:00.005+05:30

PIGMENTED VILLONODULAR SYNOVITIS (PVNS)Definition:• Pigmented villonodular synovitis (PVNS) is a slow growing lesion of uncertain etiology arising from the synovial membrane, characterized by villous and nodular overgrowths of the synovial membrane of the bursa or the tendon sheath.• The appendicular skeleton, especially large joints such as the knee and hip joints are frequently

Osteoid Osteoma

2010-01-17T23:13:00.001+05:30

Osteoid Osteoma  Most commonly involves the diaphysis of long bones especially femur and tibia, and the proximal femur is the most common site. 50% of tumours involve the lower extremity Osteoid osteoma may have a unique ‘pathogenic’ nerve supply  Three types have been described: Intracortical (80%), cancellous and subperiosteal  The pain may be referred to an adjacent joint and when the

Metal on Metal Bearing in Hip Arthroplasty

2010-01-06T23:48:00.004+05:30

Metal on Metal (MoM) - Are associated with decreased wear rate compared to conventional polyethylene- Mixed film lubrication appears to be the operative mechanism in most metal-on-metal hip joints- With metal-on-metal bearings, in contrast to polyethylene bearings, a larger-diameter bearing actually produces lower wear rates than does a smaller-diameter bearing- Larger-diameter bearings have a

Floor Reaction Orthosis

2009-12-26T22:38:00.002+05:30

FLOOR REACTION ORTHOSIS (FRO) Revolutionary orthoses: Custom fabricated, moulded plastic device that supports the ankle and foot area of the body and extends from below the knee down to and including the foot.It was described by Saltiel for the use of weak quadriceps or plantar flexors in 1969 It holds the ankle in equinus to prevent the heel from touching the ground. As the body weight brings

DNB Theory Paper 2009 December

2009-12-18T19:30:00.000+05:30

DNB Orthopaedics Theory December 2009Paper 11. Post-operative pain management. Describe patient control analgesia. 2. Clinical features and management of stove in chest. 3. Indications of Limb salvage surgery in malignant bone tumors. Describe the techniques of limb salvage in osteosarcoma. 4. Uses of botulinum neurotoxin in Orthopaedic surgery. 5. Define pigmented villonodular synovitis.

Parathormone(PTH)

2009-12-11T19:32:00.000+05:30

Composition and Mechanism of action:• Endogenous PTH is an 84-amino-acid peptide that is largely responsible for calcium homeostasis• Although chronic elevation of PTH, as occurs in hyperparathyroidism, is associated with bone loss (particularly cortical bone), PTH can also exert anabolic effects on bone• Unlike antiresorptive therapies that reduce bone resorption, parathyroid hormone (PTH) is an

DEVELOPMENTAL COXA VARA

2009-12-06T13:20:00.003+05:30

DEVELOPMENTAL COXA VARAAetiology: primary defect in endochondral ossification of the medial part of the femoral neck.Other theories regarding aetiology:• Excessive intrauterine pressure on the developing fetal hip• Vascular insult• Faulty maturation of the cartilage and metaphyseal bone of the femoral neckBilateral in 30% to 50% of patientsClinical Features:• Present after they have started

Ganglion Cyst

2009-11-22T18:07:00.002+05:30

a) Ganglions, Ganglion Cysts –  Account for 60-70% of soft-tissue tumours of the hand. The disease is common in females in their third and fourth decades.  Usually arise adjacent to tendons. May also be intraosseous or intratendinousAetiology (theories):– Formed by herniation of the synovial lining in which a one-way valve mechanism is created– benign tumors of synovial origin– A rent in the

The inspiring story of GERHARD KUNTSCHER

2009-11-16T22:50:00.002+05:30

GERHARD KUNTSCHER (1900-1972) - Served in the German army during the Second World War. - Kuntscher was prejudiced academically and ‘was never offered a chair’. - Developed the Kuntscher nail for the treatment of femur fractures- The first intramedullary nailing was performed in 1939 University of Hamburg’s Department of Surgery- German military initially disapproved of Kuntscher’s IM nailing

Musculoskeletal Manifestations of HIV infection

2009-11-15T18:29:00.000+05:30

MUSCULOSKELTAL MANIFESTATIONS OF HIV INFECTION• The etiologic agent of AIDS is HIV, which belongs to the family of human retroviruses (Retroviridae) and the subfamily of lentiviruses• The most common signs and symptoms are fever, fatigue, and a maculopapular skin rash and seen in 90 % patients with acute infection• Around 50% to 70% also complain of myalgias, arthralgias, and paresthesias, which

Calcaneal Fractures

2009-11-11T12:51:00.001+05:30

CALCANEUM fracturesMechanism of Injury: fall from height or motor vehicle accidentClassification:a. Extra Articular Fractures• Anterior process fractures• Tuberosity fractures• Medial process fractures• Sustentacular fractures• Body fractures not involving the subtalar articulationb. Intra Articular Fractures (Essex Lopresti Classification) Intra- articular fractures involve the subtalar joint.

TIBIA VARA (BLOUNT DISEASE)

2009-11-08T12:48:00.005+05:30

TIBIA VARA (BLOUNT DISEASE)Classification: - Infantile form: Presents in children 0–4 years old Juvenile form: Presents at >4–9 years of age in obese children Adolescent form: Presents in children >10 years old; has excellent prognosis with surgeryAetiology:• Abnormal compression on the posteromedial aspect of the proximal tibial physis, causing retardation of growth from that area • Or

Tumour Biopsy Principles

2009-11-08T11:28:00.000+05:30

PRINCIPLES OF TUMOUR BIOPSY:1. Biopsy should be done only after clinical, laboratory, and roentgenographic examinations are complete. This will help in planning the placement of the biopsy incision. It will also help to make an accurate diagnosis2. Place small incisions whenever possible, also use small capsular incisions over the tumour thus reducing bleeding3. The biopsy track should be

FIBROUS DYSPLASIA

2009-11-03T22:29:00.000+05:30

Fibrous Dysplasia • originally described by Lichtenstein in 1938 and by Lichtenstein and Jaffe in 1942• represent approximately 5% to 7% of benign bone tumors• A sporadic disorder of osseous and fibrous tissue development characterised by postzygotic mutation of GNAS1 gene coding for stimulatory G protein.• Analysis of the Gs α subunit in patients with fibrous dysplasia, as well as in those with

Stem cells in Orthopaedic Surgery

2009-11-01T22:41:00.000+05:30

STEM CELLS IN ORTHOPAEDIC SURGERY A stem cell is an ‘immature’ or undifferentiated cell which is capable of producing an identical daughter cell.  Stem cells must have a capacity for self-renewal giving rise to more stem cells, and the ability to differentiate into tissues of various lineages under appropriate conditions They may be totipotent, pluripotent or multipotent, depending on type

Acetabulum fractures

2009-11-01T00:32:00.000+05:30

FRACTURES OF THE ACETABULUM Letournel and Judet Classification• Letournel and Judet devised the column concept where the anterior column was formed by the iliopectineal component and the posterior column was formed by the ilioischial component. • The acetabular dome is formed the junction of the two columns. • Both the columns have an inverted Y shaped construct• Based on degree of columnar

Osteosarcoma

2009-10-29T23:16:00.000+05:30

• These are spindle cell neoplasms that produce Osteoid • It is the second most common primary malignancy of bone behind multiple myeloma.OSTEOSARCOMA CLASSIFICATION• High grade Intramedullary Osteosarcoma• Low Grade “ “• Telengiectatic Osteosarcoma• Surface Osteosarcoma1. Paraosteal2. Periosteal3. High Grade Surface Osteosarcoma• Osteosarcoma of the Jaw• Multicentric osteosarcoma• Secondary

Perthes DIsease Current Concepts

2009-10-24T11:15:00.000+05:30

Perthe's disease- aetiology:G. C. Perthes in Germany, J. Calvé in France and A.T. Legg in America described the disease almost simultaneously, in 1910.Synonyms: Coxa Plana; osteochondritis deformans juvenilisAetiology:Theories and Supporting Evidence1. Compromised Vascular supply: Angiograms and laser Doppler flow studies showing that the medial circumflex artery is missing or obliterated in many

Femoroacetabular Impingement

2009-10-23T14:20:00.001+05:30

Femoroacetabular impingement aetiology ▪ The presence of aberrant morphology involving the proximal femur and/or the acetabulum results in abnormal contact between the femoral neck and the acetabular rim during terminal motion of the hip. ▪ Ganz described two types of FAI: cam impingement and pincer impingement. ▪ Cam impingement: Cam impingement occurs when an abnormally shaped (ie,

Aneurysmal Bone Cyst

2009-10-23T14:08:00.000+05:30

Aneurysmal Bone Cyst• Nonneoplastic vasocystic tumour • Age group: 10-20 years old(peak age: 11 years)• Can occur in any decade of adult life, but nearly 80% occur in the 2nd decade• Represent 1.5% of all primary bone tumors• Maybe primary or secondary( arising in other tumours)• Frequency: distal femur> proximal tibia> proximal humerus> distal radius. • The vertebrae are involved in 12% to 27%

PROTRUSIO ACETABULI (OTTO PELVIS)

2009-10-22T23:43:00.000+05:30

The German pathologist Otto first described Protrusio acetabuli, (also known as ‘arthrokatadysis’,) in 1824. Hence also known as Otto PelvisAetiology:Idiopathic, or primary protrusio acetabuli: no causative factors are found in this group· Secondary protrusio acetabuli: The causes are as followsInfectiousü Gonococcusü Echinococcusü Staphylococcusü Streptococcusü Mycobacterium