Orthopaedics | Master Of Medicine

Category Archives: Orthopaedics

Compartment Syndrome

English: This is a picture of compartment synd...

English: This is a picture of compartment syndrome of the lower leg (Photo credit: Wikipedia)

Compartment syndrome results from increased pressure within an osseofascial space, leading to decreased perfusion pressure. If it is left untreated, muscle and nerve ischemia may progress to necrosis and fibrosis, causing Volkmann ischemiccontracture.Compartment syndrome is usually seen in hand and forearm

  • Etiology. Fractures that cause bleeding, crush and vascular injuries, circumferential burns, bleeding dyscrasias, reperfusion after ischemia, or tight dressings can lead to the syndrome.
  • Diagnosis is based on a high index of suspicion, clinical examination, and symptoms of pain that are exacerbated with passive stretch of the compartment musculature, paresthesias, paralysis, or paresis of ischemic muscles. Pulselessness may occur and indicates a late finding (and is usually also a sign of irreversible damage) or the presence of major arterial occlusion rather than compartment syndrome. Measurement with a pressure monitor of a compartment pressure of greater than 30 mm Hg confirms diagnosis.
  • Treatment for incipient compartment syndrome involves close observation and frequent examinations and should include removal of tight casts and dressings. Elevation of the extremity to, or slightly above, the level of the heart is recommended. Acute or suspected compartment syndrome requires urgent fasciotomies of the involved areas. Decompression within 6 hours of established compartment pressures is necessary to prevent irreversible muscle ischemia. Forearm fasciotomies involve volar, carpal tunnel, and dorsal compartments. Hand fasciotomies include dorsal incisions for interossei and adductor pollicis, thenar, and hypothenar compartments, as well as midaxial incisions of the digits (ulnar for the index, long, and ring fingers and radial for the thumb and small finger).
Source:Washington Manual of surgery

How to do phalens test for carpal tunnel syndrome

Carpal tunnel syndrome is due to the compression of median nerve in the carpal tunnel at the wrist.It usually occurs in a middle aged female,hypothyroidism,diabetes etc.In Carpal tunnel syndrome there is paraesthesia of lateral 31/2 fingers.Phalens test is a provocative test to produce the symptoms of median nerve compression in a patient who presents to the OPD.

How to perform Phalens test

Place the backs of both  hands of the patient together and hold the wrists in forced flexion for a full minute. (Stop at once if sharp pain occurs) . If this produces numbness or “pins and needles” along the thumb side half of the hand, the patient most likely have Median nerve entrapment (Carpal Tunnel Syndrome).

 

Initial treatment is analgesics, if not relieved steroid injections are given into the carpal tunnel.If the symptoms are not relieved still,the definitive treatment is surgical release flexor retinaculum to decompress the carpal tunnel.

Common test’s used in orthopaedics

Barlow’s test -CDH

Ortolani’s test -CDH

Galleazi test -CDH

Allis test -CDH

Harts test – CDH

Thomas test -Fixed flexion deformity

Allens test – Palmar arch integrity

Gaenslens test – Sciatica

Mc Murrays test – Menisci

Anterior drawer test – Anterior cruciate ligament

Lachmans test – Anterior cruciate ligament

Pivot shift test – Anterior cruciate ligament

Posterior drawer test – Posterior cruciate ligament

Apprehension test – Anterior shoulder dislocation

Phalens test – Carpal tunnel syndrome

Finkelsteins test – De Quervains disease

Adsons test – Thoracic outlet syndrome

Wringing test – Lateral epicondylitis

Cozens test -Lateral epicondylitis

Lift off test – Subscapularis

Common named bone fractures and affected sites

Aviators fracture – Neck of talus

Boxers fracture -Neck of 5th metacarpal

Bennets -Intra articular fracture,base of 1st metacarpal

Rolandos -Extra articula fracture,base of 1st metacarpal

Chauffer’s fracture -Fracture radial styloid

Chance fracture- Horizontal fracture through vertebra

Clay shoveller’s -Spinous process of T1

Cotton’s fracture -Trimalleolar ankle fracture

Pott’s fracture – Bimalleolar ankle

Galeazzi fracture -Fracture distal radius with dislocation of distal radio ulnar joint

Jefferson’s fracture – Burst fracture of atlas(C1)

Jones fracture – Base of 5th metatarsal

Hangman’s fracture – Axis

Monteggia fracture – Fracture proximal ulna with radial head dislocation

March fracture -stress fracture shaft of 2nd or 3rd meta tarsal

Masonneres fracture – Neck of fibula

Snith’s fracture- Reverse colle’s

Pond fracture- Depressd skull fracture in infants

Toddler’s fracture -Spiral fracture of tibia

Crescent fracture – Fracture iliac bone with sacroiliac disruption.

Different types of pelvis and associated conditions

Tri radiate pelvis – Rickets,pagets disease

Beaked pelvis -Osteomalacia

Funnel shaped pelvis – Android pelvis

Rachitic pelvis – Rickets

Nageles pelvis- One ala absent

Roberts pelvis – Both ala absent

Kyphotic/funnel shaped – TB/Rickets

Common Osteochonditis and their sites

Perthes disease – Femoral head

Panners disease – Capitulum

Keinbock disease – Lunate

Osgood Shattler disease -Tibial tubercle

Severs disease – Calcaneal tuberosity

Kohlers disease – Navicular

Freiberg’s disease – Metatarsal head

Scheurmann’s disease - Ring epiphysis of vertebrae

Calves disease – Central bony nucleus of vertebral body

Sinding Larsen Johansson disease – Lower pole of patella

Iselin’s disease – Traction epiphysis 5th metatarsal base

Bone lesions, the age group affected and their sites of origin

Knowing the age group in which bone lesions appear can be very crucial in the diagnosis of diseases concerned.The site of lesion is also important in diagnosing these diseases and determining appropriate treatment.

  1. Ewings sarcoma – 5 -15yrs
  2. Osteoid osteoma -5 -25yrs
  3. Osteosarcoma – 10 -20 yr, >40 yrs
  4. Osteoclastoma -20- 40 yrs
  5. Multiple myeloma – > 60yrs
  6. Perthes disease – 5 -10yrs
  7. Nutritional rickets – 1-2yrs
  8. Polio -1-2 yrs
  9. Acute Osteomyelitis -< 15 yrs
  10. Rheumatoid arthritis – 20-40 yrs
  11. Slipped capital femoral epiphysis -12 -16yrs
  12. Intervertebral disc prolapse -2 -40 yrs

Sites of Origin

Most of the bone tumours are diaphyseal in origin.

Epiphysis

  1. Osteoclastoma
  2. Chondroblastoma

Metaphysis

  1. Osteosarcoma
  2. Osteomyelitis
  3. Brodies abscess

Diaphysis

  1. Ewings sarcoma
  2. Osteoid Osteoma
  3. Multiple myeloma
  4. Bone secondaries
  5. Lymphoma
  6. Adamantinoma

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