orthopedic-notes

Failed closed reduction, soft tissue interposition, greater tuberosity fracture, displacement >1cm after reduction, or large glenoid rim fracture.

Temperature, tenderness, crepitation, bony irregularity, measurement of lower limbs, sensation, and vascular assessment.

It can be used for long bones, pelvis, and almost any part of the skeleton.

Severe soft-tissue damage, open fractures, severe comminuted & unstable fractures, pelvic fractures, fractures with nerve & vessel damage, and ununited fractures.

Alignment refers to the fragment being tilted or angulated.

Consciousness, position of the patient, breathing, attachments, and observation of skin/deformity.

Gait, obvious external fixation, swelling, skin integrity, skin color, limb posture, and limb shortening.

1. By the force of injury 2. By gravity 3. By the pull of muscles.

Recurrent dislocation, unreduced dislocation, and traumatic osteoarthritis (OA).

The head lies in the subglenoid position.

Hippocrates method.

CT/MRI and radioisotope imaging.

How the injury happened.

U-slab.

Medially splint ends in axilla and must be well padded to avoid skin breakdown.

Pulse Rate (PR), Blood Pressure (BP), Respiratory Rate (RR), and Temperature.

Damage to soft tissue structures, over distraction, and pin-track infection.

1. To prevent displacement 2. To restrict movement 3. To reduce pain 4. To promote soft-tissue healing 5. To allow free movement of unaffected parts

1. Sustained traction 2. Cast splintage 3. Functional bracing

Pain, often followed by a history of trauma.

Fall on the point of the shoulder.

No more than 4-5 kg.

Inflammatory cells appear in the haematoma.

Plaster of Paris (calcium sulfate, Gypsum).

Deformity, pain, and swelling.

Outer fragment displaces medially and downward; inner fragment displaces upwards.

Pain and swelling localized to the acromioclavicular joint.

Elbow flexion leads to a prominent lump, and bruising may appear over the front of the arm.

Falls on the hand with elbow extended and forced into varus.

Displaced means the broken end moves out of place.

Translation refers to a shift where the fragment is displaced and loses its surface contact.

A direct blow to the arm.

Immobilization with an external cast.

To identify rotator cuff tear, particularly between 60-120 degrees of abduction.

Low energy fractures cause moderate soft tissue damage, while high energy fractures cause severe damage.

It assesses the blood's ability to clot, which is crucial before surgery.

Degree of contamination, length of time from injury to operation, and amount of soft tissue damage.

At least 2 layers with 50% overlap.

Pain, swelling, bruising, obvious deformity, and loss of function.

Strong, lighter, comfortable, cool, water-resistant, and radiolucent.

Immature bone, also known as woven bone.

History of trauma followed by pain, gradually increasing in severity, and limited movement.

Consolidation occurs, transforming woven bone into lamellar bone.

Injury to subclavian vessel or medial cord of brachial plexus.

NSAIDs or aspirin.

Previous anaesthesia, operations, injuries, and other musculoskeletal abnormalities.

If closed reduction fails or when the fracture involves large articular fragments.

It permits adjustment of length and angulation and allows reduction of the fracture in all three planes.

Oblique or transverse fracture.

Chest, pelvic, cervical, and concerned parts with 2 views (AP and lateral).

Maintain traction on injured limbs while replacing any dressing with a sterile pad and cleaning the surrounding skin.

Speed test and Yergason test.

Seated or standing with arm abducted to 90 degrees and brought forward by 30 degrees.

A closed spiral fracture.

Velocity of injury, safety measures, and treatment received in A&E.

Vascular compression.

Soft callus from cells changing into osteoblasts and osteoclasts.

Nerve injury (e.g., radial nerve palsy) and non-union.

Signs of vascular or nerve damage.

Group I (middle 1/3), Group II (lateral 1/3), Group III (medial 1/3).

Subluxation or dislocation at the affected site.

Thromboembolism, respiratory problems, and general weakness.

Swollen and deformed elbow, tenderness over the lateral condyle, painful passive wrist flexion.

For fractures that cannot be reduced non-operatively or are inherently unstable.

Bone is transfixed above and below the fracture with screws, pins, or tensioned wires clamped to a frame.

Spiral fracture.

1. Restoration of normal surface anatomy 2. Rapid improvement in pain & neurovascular deficits

Tissue destruction and haematoma formation.

Supracondylar humerus fracture.

Check for axillary nerve intactness and sensation at the deltoid.

Benzylpenicillin + Flucloxacillin or a second-generation cephalosporin, given every 6 hours for 48 hours.

91%.

Fall on the outer prominence of the shoulder.

Impingement of subacromial structures.

Partial or complete rupture of the acromioclavicular or coraco-clavicular ligaments.

A fall followed by pain in the shoulder.

Competitive swimming or a weekend of house decorating.

Used for the acute management of distal radial and ulnar fractures.

Closed reduction and open reduction.

CNS, CVS/RS, GIT, and GUT assessments.

Stronger but can slide if angled.

Put the elbow through the full range of movement to check stability.

Active exercise, assisted movement (continuous passive motion), and functional activity (everyday tasks).

Recurrent dislocation and stiffness of the elbow.

The medullary cavity is reformed.

Involvement of surrounding soft tissues, joint issues, local edema, inflammation, severe tissue damage, and vascular impairment.

A single highly stressful, traumatic incident causing a break at the point of impact.

Vascular and nerve injuries.

By starting exercises early.

Reduction under sedation or GA followed by immobilization in a chest arm bandage for 3 weeks.

Axillary nerve injury resulting in paralysis of the deltoid and anesthesia over the lateral aspect of the shoulder.

Supraspinatus function.

Subscapularis function.

Fracture of the clavicle.

Same principle as balanced traction, but without counter-traction.

Posterior displacement is greater than anterior displacement.

1. External fixation 2. Internal fixation

Segmental and comminuted fractures, either open or closed.

Sutured within a few hours of injury after debridement and incision.

20% of body weight.

Precise reduction and immediate stability.

Pin infection, nerve, and vascular injury.

X-ray.

Post-traumatic stiffness, disuse stiffness, regional pain syndrome, and arthritis.

Patient should be fully relaxed under anaesthesia.

Allows for early functional range of motion and weight bearing, while relieving soft tissues and maintaining alignment.

Come immediately for assessment.

Degeneration and disruption often associated with rotator cuff problems.

Rotation indicates that the bone looks straight but the limb has torsion deformity.

Altered length can result in shortening of the bone due to muscle spasm.

To check for hemoglobin (Hb) and evaluate overall blood health.

Fall on the outstretched hand.

Rest, local heat, and deep transverse frictions.

To achieve adequate apposition and normal alignment of bone fragments.

Traction is applied to the distal limb of the fracture, exerting a continuous pull along the long axis of the bone.

Soak plaster in water at room temperature until air bubbles cease.

Numbness, movement, and sensation of the distal part.

Heavy, fragile when in contact with water, and radio-opaque.

Sepsis.

Thin wire and Steinman pin.

Rest in a triangular sling and analgesics.

Conservative treatment with a cuff and triangular sling.

Osteoporotic individuals after middle age.

Fixating small fragments onto the main bone.

1. Reduction, 2. Hold, 3. Exercise.

A full thickness rotator cuff tear.

Preglenoid, subcoracoid, subclavicular for anterior dislocation; subcromial, subglenoid, subspinous for posterior dislocation.

Hinged external fixation.

A fracture caused by normal stress acting on abnormally weakened bone, such as in osteoporosis or bone tumors.

A fracture through the growing physis that damages the cartilaginous growth plate and can lead to progressive deformity.

Immediate care of the pin-site and administration of antibiotics.

To take additional views for difficult-to-detect fractures, particularly in severe force injuries.

Irrigate thoroughly using copious amounts of warm normal saline, potentially needing 6-12 liters for long bone injuries.

Pain and tenderness over the bicipital groove.

Clean skin and apply dressing if there is a wound.

90%.

If the fracture is unstable, the patient is obese, or there is prolonged discomfort.

Injury to the brachial artery or median and radial nerves.

Pain when the arm is flexed to 90 degrees and internally rotated.

Malunion leading to gunstock deformity.

Can move joints, allowing for muscle exercise, and is safe if not excessive.

Tenderness disappears.

Inspect again after 2-3 days; if there's significant skin loss, consider plastic surgery.

Anaesthesia, muscle relaxation, and X-rays before and after the procedure.

A fall on an outstretched hand with the shoulder abducted and externally rotated.

Shoulder stiffness.

A fall on the outstretched hand.

A direct force pushing the humerus head out of the glenoid cavity.

Iatrogenic infection leading to chronic osteomyelitis.

Excessive damage to soft tissues, inadequate blood supply, or rigid fixation.

Elevate and exercise; never dangle or force.

Early debridement and early antibiotics.

Bicep tendon lesions, including tendinitis and torn long head of the bicep.

Tissue damage and bleeding, leading to haematoma formation.

Fall on an outstretched hand or direct fall on the elbow.

Never move a broken bone; only relevant joints should be moved, especially in unconscious patients.

Arms at the sides with elbows flexed to 90 degrees.

Painful arc syndrome.

Popeye deformity.

When there is little or no displacement of the fracture.

Wound type III requiring more than one debridement and extensive skin loss over the fracture.

From distal to proximal.

Skin colour changes, temperature variation, pulse presence, and collagenosity.

For soft tissue injuries, acute management awaiting orthopedic intervention, or selected types of fractures.

Remodelling of the newly formed bone to resemble normal structure.

To reduce oedema (swelling) and preserve joint movement.

Open reduction and internal fixation (ORIF).

To evaluate support systems, lifestyle factors like smoking or alcohol use, and financial status.

Create a sterile field with limb exposed.

Pain, large bruise in the upper arm, signs of axillary nerve or brachial plexus injury.

Progressive fibrosis and disruption of the cuff.

It extends across the surgical neck and the greater tuberosity.

1 year, safer after 18-24 months.

It is usually impacted into the head in an abducted position.

Swelling, S-shaped deformity, distal humeral tenderness, and unusual posterior prominence at olecranon.

Pain, swelling, deformity, crepitus, and inability to raise the shoulder.

Anterior shoulder pain.

Spiral fractures of long bone shafts, such as the femur and tibia.

Swelling of soft tissues, which can complicate reduction.

Purplish color, failure to contract, and failure to bleed when cut.

Evenly, rapidly, and without intervention using the palm, not fingers.

Patient condition, doctor's skill, and facility standards.

Length from one joint above to one joint below, specific number of layers for upper and lower limbs, and specific width measurements.

Injecting local anesthetic into the subacromial space.

Soft tissue injuries to hand and wrist, acute carpal bone fractures (excluding scaphoid/trapezium), and childhood buckle fractures of the distal radius.

Vascular compression, leading to diffuse pain and bluish discoloration of digits.

Discard the collar and cuff.

Internal fixation.

40-50 years old.

Extensor tendon avulsion from the base of the distal phalanx.

It prevents joint stiffness while allowing fracture splintage and loading.

Pulse and capillary refill.

Fibroblast growth factors, transforming growth factors, and bone morphogenic protein.

5-6 mm.

A light cast with elbow flexed to just above 90 degrees.

A break in the structural continuity of bone, which may include cracks, crumpling, splinting, or complete breaks.

Higher risk of complications and more technically difficult to apply.

4th and 5th proximal/middle phalangeal shaft fractures and the 1st metacarpal fracture.

Repetitive stress of normal degree that persists to the point of mechanical fatigue.

Molding around tibia condyles to lock the tibia when the patient is able to partially weight bear.

The proximal end may be broken into several pieces.

Elbow in 90° flexion and wrist in 25° extension.

Active abduction is impossible.

To stabilize long bone fractures, especially in femur and tibia.

Any life-threatening conditions and wound inspection.

Type I: Puncture wound (<1cm); Type II: Skin damage (>1cm); Type III: Severe, big wound (>10cm).

Excessive stress at the fracture site before union occurs.

A closed fracture has intact overlying skin, while an open fracture has breached skin, increasing the risk of contamination and infection.

A type of fracture where the bone is buckled and bent, typically seen in children.

They burrow through debris at the fracture site.

To maintain proper joint function while providing immobilization.

Deep vein thrombosis (DVT) leading to pulmonary embolism.

Joint stiffness, skin abrasion, and plaster breakage.

Type I: >2%; Type III: >10%.

Shoulder stiffness.

It is used when fractures begin to unite, typically after 3-6 weeks of traction or restrictive splintage.

Anterior dislocation is more common than posterior dislocation.

Splinting the limb and covering the wound to reduce risk of further contamination.

Medial to lateral.

Through x-ray.

Injuries to scaphoid/trapezium and stable thumb fractures.

Always assume to be contaminated; aim to prevent infection.

It is characterized by the bone being broken into more than two fragments.