What is bone?
Bone is a highly vascular,constantly changing living mineralized special form of
connective tissue.
Minor indication
a) Cosmetic problem-clavicle fracture
b) Earlier rehabilitation
Width mm
10
12
16
Thickness mm
3
3.6
4.5
Datta 15
Middle of the shaft in the anterior surface from ant interosseous artery
For ulna NF on the anterior surface about 7 cm from Ulnar tuberosity.
Q16.Tell the anatomy of radius and ulna
Datta 16
Q17. Tell the development of radius and ulna
Datta 18
Q18.Describe supinator muscle
Datta 81
Q.19How many cortex should be fixed with screw?
Ao asif 110
Forearm bone 6 cortex
Humerus 7 cortex
Tibia 7 cortex
Femur 8 cortex
Q20.Which surface plate should be fixed?
Q21.What is role of DCP?
To provide compression at fracture site
Provide stability at fracture site
Hold the bone
Bears the load
Q 22. How compression helps in union?
Thakur 79
1. What is AO type?
Ao surgery ref , apley 752-mason classification
2. What is the force caused this fracture?
Apley 752
3. What is the complication?
Apley 752
4. What is your plan?
Apley 752
5. What are the treatment options?
Apley 752
Ibnezar 162
6. What is the optimum time for operation?
2 to 3 wks after injury. Early excision of the head of the radius is asso
with high incidence of subluxation of inferior radioulnar joint.
(watsonzones 578)
7. What is your approach?
Campbell 116
8. Tell about postoperative care?
Campbell 2872
Monteggia fracture dislocation
1. what is monteggia fracture dislocation
Ebnezar 173
2. why it is called treacherous?
Ebnezar 173
3. what is Mclaughlins line?
In order to assess the radiocapitellar joint, a line should be drawn parallel to the long axis of the radius. This line
should point directly at the capitellum on any projection of the elbow.
4.
5. classify it?
Ebnezar 174
6. tell the clinical feature?
Ebnezar 174
7. what are the monteggia equivalent?
Ebnezar 174
8. tell the treatment option?
In case of children, close reduction, if fail open reduction
Postoperatively, patients were immobilised in an above elbow slab for 5 -7 days following which gentle active
mobilization was started. None of the patients were subjected to passive mobilization. Patients were followed up
regularly for a minimum of 6 months to assess the functional (MEPI) and radiological outcome.
9.
Lateral approach AO surgery ref
10.
Tell the open reduction procedure?
Ao surgery ref
11.
12.
13.
What is ur implant?
Tell the postoperative care?
Tell the complication of this fracture?
Type II: Major fracture line along the intertrochanteric line with
comminution in the coronal plane.
Type III: Fracture at the level of the lesser trochanter with
variable comminution and extension into the subtrochanteric
region (reverse obliquity).
Type IV: Fracture extending into the proximal femoral shaft in
at least two planes.
46 FRACTURE CLASSIFICATIONS IN CLINICAL PRACTICE
FIGURE
Type I:
Stable:
_ Undisplaced fractures.
_ Displaced but after reduction overlap of the medial
cortical buttress make the fracture stable.
Unstable:
_ Displaced and the medial cortical buttress is not
restored by reduction of fracture.
_ Displaced and comminuted fractures in which the
medial cortical buttress is not restored by reduction
of the fracture.
Type II: Reverse obliquity fractures.
FIGURE 3.9. Trochanteric fractures. (Reproduced with permission andcopyright of the British Editorial Society of Bone and Joint
Surgery.
Ewans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg 1949;31-B:190203.)
Ao asif 140
11.
Tell the entry point of DCS?
Ao asif implant 150,sura 7:131
12.
What is the TAD for DCS?
<20 mm
13.
Tell the difference between DCS and DHS?
Sura 7:132
14.
Why it is called Dynamic condylar screw?
15.
Tell about postoperative care
Non wt bearing walk 06 wk(but 2-3 days afer can be) then full weight
bearing
What is wards triangle?
Triangular area in betwn primary compressive, 2ndary compressive and
primary tensile trabeculae. Here purchase will not be good.
16.
Tell the treatment options
Apley 856
17.
Tell the complication of trochanteric fracture
Apley 856
Subtrochanteric fracture
1. What is your diagnosis?
04 days old subtrochanteric fracture seinsheimer type 2 in a
70 yrs old male patient
2. Tell ur treatment plan
ORIF by long DHS
3. Classify this fracture
Ebnezar 226
4. What are the treatment options?
Conservative-traction
OperativeIntramedullary- prox femoral nail, gamma nail, russel taylor
nail
Extramedullay- prox femoral locking plate, DHS,blade plate
5. Tell about post operative care?
Knee bending and quadriceps from 1st POD
Non wt bearing walk for 06 wks
After seeing radiological evidence of union partial weight
bearing
6. What is trochanteric plate?
10.
How many screws are in prox femoral locking plate and
their function?
The proximal portion of the plate is precontoured for the proximal femur. The two proximal screw holes
are
designed for 7.3 mm cannulated locking screws and the third locking hole is designed for 5.0 mm
cannulated locking
screws.
The three proximal screw holes are at the following angles to the plate shaft:
First proximal hole (7.3 mm): 95 for derotation
Second proximal hole (7.3 mm): 120 for purchase
Third proximal hole (5.0 mm): 135 for weight bearing
11.
How will u enter guide pin in DCS?
-2 cm distal to tip of trochanter or 2 cm proximal to vastus
ridge
-At the junction of anterior 1/3rd and posterior 2/3rd of anteroposterior side of greater trochanter.
Kakkad 175
Version guide wire
Through the centre of neck and inferior part of head
In lateral view it should go through the centre of the head.
12.
Tell the operative procedure
13.
14.
18.
Fracture distal radius with intra articular extension
What is your diagnosis?
What is the mode of injury?
Tell the AO classification?
Ao surgery reference
What is your plan?
Open reduction and internal fixation by volar plating.
What is colless fracture?
Apley 772
What is volar burton and dorsal burton fracture?
Apley 776
What is smith fracture?
Apley 774
Tell about the approach?
Campbell 2899
Postoperative care?
Campbell 2900
Tell the anatomy of distal radius.
Datta 16
What implant u will use?
Volar plate
What is the drill bit, plate and screw size?
Campbell 2899
What is the plate size?
Campbell 2899
What is the function of plate?
Hold fragments
Stabilizes the fragments
Bears weight
Tension band
Neutralization
Protection
Compression
What is buttress plate?
Kakkad 145
What is the role of buttress plate?
Kakkad 145
19.
Fracture distal tibia
What is your diagnosis?
Ao surgery reference
What is your plan
Orif by distal tibial lateral metaphyseal plate
Tell the approach
Campbell 2648
What is the drill bit?
2.8 mm
What is the plate size?
Combihole plates
What is the screw size?
3.5 mm cortical screw/locking screw
4 mm cancellous screw
Tell the anatomy of tibia
datta 146
Tell the attachment of extensor retinaculum
Datta 216
Tell course of common peroneal nerve and superficial and deep
peroneal nerve?
Datta 218,221
Hold fragments
Stabilizes the fragments
Bears weight
Tension band
Neutralization
Protection
Compression
Buttressing
Antiglide
Types of plate?
Campbell 2597
Spine fracture
1. Tell the direction of pedicle screw
Campbell 1527
2. What is long segment and short segment fusion?
Short- 1 vertebra above and below
Long->1 vertebra above and below
3. What is the problem of long segment fusion/
Facet joint arthropathy
Disc prolapse
4. Tell the blood supply of spinal cord
Campbell 1528
5. Tell the development of spinal cord
Langman 63
6. Which spinal segment lies on which level
Ebnezar 314
7. What is complete and incomplete spinal cord injury
Asia grading
8. Tell the plan
Decompression and stabilization
9. Tell ur approach
Campbell 1612
10. What is the size of screw and rod
11. What is asia and frankel grading and tell their difference
Asia grading
Campbell 1568
12. What is the outcome of surgery
One grade improvement
13. Explain the findings with spinal cord compression
14. What is reflex?
Involuntary motor response to a sensory stimulus
15. What is superficial and deep reflex?
These are elicited by stimulating appropriate receptors of skin and
mucous membrane
Deep reflexes : these are stretch reflexes produced by tapping over
a tendon.
16. What is clonus?
Alternate contraction and relaxation of skeletal muscle in rapid
succession
17. Tell the various cord compression syndrome.
Apley 826
18. What is cauda equina syndrome?
Bowel bladder incontinence
Perineal numbness
Bil sciatica
Lower limb weakness
Cross SLR positive
19. What is spinal shock and neurogenic shock
Campbel 1570
20. How long u will give tong traction?
Atleast 06 wks
Classification
Type A: Compression injuries of the body (compressive forces)
Explanation
d)Rotation 110
e) 50% translation of body
8. What is the goal of treatment?
To improve neurological status
To prevent further progression of neurological deficit
For improve nursing care and rehabilitation
9. Tell the measurement of tricortical graft?
Height=body height+disc height, anteriorly more than posterior
to maintain cervical lordosis.
Fracture patella
Q1. Tell ur diagnosis
Q2. Classify patellar fracture
Fracture Classification 55
Ao surgery reference
Q3. What is your treatment plan?
Magnuson wiring
Q4. Why
As the distal fragment is small
Q5. Tell the principals of tension band wiring
By placing circlage wire in tensile surface we are converting distracting
force into compressive force
Sura 7: 126
Q6. Tell the anatomy of patella
Datta 145, sura 7:124
What is Q angle?
Sura 7:124
What is the percentage of patella fracture?
1%
Q7. What injury caused this?
Apley 887
Q8. What are the treatment options?
Ebnezar 260
Q. problems of k wire
Ebnezar 261
Sura 7:124
Knee Xray
Weight-Bearing
P/A (Rosenberg)
Demonstrate
s: femorotibial
articulation
Helpful
for: Knee
Arthritis, Tibial
Plateau
Fracture, Distal
Femur Fracture,
Position: Standing
with knees flexed
45 with grid in
front of knees
Beam directed 10
caudal from the
horizontal plane
through the knee
joint.
Demonstrate
s: femorotibial
articulation.
Helpful
for:Knee
Arthritis, Tibial
Plateau
Fracture, Distal
Femur Fracture,
Position: supine
with cassette
under knee and
femoral condyles
parelll to cassette.
Beam directed to
point 1-2cm distal
to the patella.
Lateral Knee
View
Demonstrate
s: femorotibial
articulation,
patellofemoral
articulation.
Femoral condyles
should be
superimposed.
Helpful
for:Knee
Arthritis, Tibial
Plateau
Fracture, Distal
Femur
Fracture, Patellar
Fracture, Patellofe
moral Arthritis
Position: lateral
with affected side
down and flexed
30 at the knee.
The contralateral
leg is shifted
posteriorly out of
the way.
Beam directed at
knee joint with
5cephalad
angulation.
Tunnel View
(Intercondylar
notch view)
Demonstrate
s: posterior aspect
of femoral
condyles,
intercondylar
notch,
intercondylar
eminence of tibia
Helpful
for:Tibial
Eminence
Fx, Tibial Spine
Fx, Distal Femur
Fracture,
Position: prone,
knee flexed 40
Beam directed
caudally toward
the knee joint at a
40 angle from
vertical.
Sunrise View
Demonstrate
s: tangential view
of patella;
femoropatellar
articulation
Helpful
for: Patellofemoral
Arthritis, Patellar
Fracture,Patellofe
moral Pain.
Position: Prone;
knee flexed 115
Beam directed
toward patella with
15 cephalad
angulation
Merchant View
Demonstrate
s: patellofemoral
articulation.
Centrial ridge of
patella should lie
at or medial to the
bisector of the
trochlear angle.
Helpful for:
Evaluating patellar
tilt. Not very
sensitive,Patellofe
moral
Arthritis, Patellar
Fracture, Patellofe
moral Pain.
Position:supine
knee flexed 45;
Beam directed
caudally toward
patella at a 60
angle (30 from
the horixontal
plane).
(Merchant A,
JBJS 1974;
56A:1391)
Patellar Alta,
Patllar Baja
Insall-Salvati
Ratio
BlackburnePeel Ratio:
<0.8=patella baja,
>1.2=patella alta.
Image= lateral
view of patient
with patellar
tendon rupture
demonstrating
patella alta.
Radiology
References
Frank ED,
Merrill's Atlas of
Radiographic
Positioning and
Procedures,
2007(link is
external)
Galeazzi fracture
Tell ur diagnosis
What is galeazzi fracture?
Fracture radial shaft with distal radioulnar joint dislocation
Apley 25
Classification ?
AO surgery ref
Tell the anatomy of radius
Datta 14
Tell the development of radius
Datta 17
Course of radial nerve?
Datta 106
Course of radial artery
Datta 73
Leash of blood vessel?
Branch from radial artery which supplies brachioradialis,
which should be ligated.
Following stable fixation, with or without transfixion of the DRUJ, postoperative treatment
consists of immobilization in a long cast for 3 weeks in the position of forearm rotation that
at operation was determined to give maximal stability of the DRUJ (allowing the disrupted
ligaments to heal). The operated arm is elevated and active mobilization of the fingers is
started within the first week.
2.
In cases where the distal ulna is transfixed to the radius by a K-wire, the wire is to be
removed after 3 weeks.
3.
After cast and K-wire removal, elbow, forearm, and wrist mobilization exercises are
started.
Hrs: inflammation
Days: profibroblast
Wks: proosteoblast
Months:scaffolds-creeping substitution
Yrs: remodeling and incorporation of graft
Deltopectoral approach
Operative procedure
Campbell 2849
Appley 747
What is the complication of this operation?
Campbell 2483
What is Philos plate?
Proximal Humeral Internal Locking System plate
ur diagnosis
the treatment plan
the approach
the implant screw and drill bit
the postoperative care
Apley 762
10. What are the complication of treatment
Malunion, nonunion, delayed union, infection, haemorrhage.
11. Tell about the postoperative care
Campbell 1399
12. Tell the anatomy of distal humerus
Datta
13. Tell the development of distal humerus
Datta
19.
Prerequisite of Austin moore prosthesis:
At least 1.25 cm calcar must be present, if not then Thomson
20.
Tell the types of bipolar prosthesis
Fenestrated, nonfenestrated
Hydroxyapetite coated or not coated
Modular or nonmodular
21.
What will be ur approach?
Posterior moore approach Campbell 70
Lateral hardinge approach Campbell 64
Ao surgery ref
22.
Tell the approaches of hip and their indication?
Anterior: smith Peterson-femoral neck fracture repair
Somerville-congenital dislocation of hip
Lateral :hardinge-hemiarthroplasty
Posterior: Moore- hemiarthroplasty
Medial :Ferguson, hoppenfield, deboer-DDH
23.
Tell the surgical technique
Gustillo 812
Ao surgery ref
24.
Flex hip and knee to 900 and adduct and internally rotate25.
How will u maintain anteversion?
Putting the stem along the calcar or 10-15o anterior to lesser
trochanter
26.
What is 3 point fixation?
proximal stem laterally, and its distal tip close to the medial femoral
cortex and collar on medial cortex along calcar.
27.
Will u use cement?
No austin moore
28.
Why?
For better fitting
29.
Tell about postoperative care
st
1 pod-drain off, breathing exercise, quadriceps exercize,
2nd pod- walk with walker
Avoid squatting, adduction and internal rotation,
30.
Apley 852
31.
Sura 7: 157
32.
Apley 850
33.
What are the treatment options of fracture neck of
femur according to age?
Older patient >75-replacement hemiarthroplasty
Campbell 2733
49.
What are the treatment options for AVN?
Realignment or rotational osteotomy relatively small
necrotic fragment
Joint replacement
50.
Causes of nonunion?
Poor blood supply
Imperfect reduction
Inadequate fixation
Tardy healing of intra articular fracture
51.
Treatment option of nonunion?
Apley 852
52.
What is calcar?
Datta 144
53.
What is linea aspera?
Datta 141
54.
Tell the biomechanics of hip
Sura 7:154
55.
Muscle pedicle graft indication and procedure?
Post communation and nonunion
Gustillo 803
56.
Tell the complication of hemiarthroplasty
iiGustillo 813
57.
Tell the generation of cementing technique
Cementing techniques First generation Original technique of Charnley: Hand mixing of the
cement Finger packing of cement in an unplugged and uncleaned femoral canal and acetabulum
No cement restrictor, no cement gun and no reduction in porosity
Second generation Femoral canal plug Cement gun to allow retrograde filling Pulsatile lavage
Cement restrictor
Third generation Pressurization of cement after insertion Some form of cement porosity reduction
(vacuum or centrifugation) Stem centraliser
Cartridge mixing and delivery Latest advancement in bone cement mixing technique It is a simple,
universal power mixer that quickly mixes and then mechanically injects all types of bone cement.
This type of device reduces mix times, as it requires fewer steps to load, mix, and transfer the
cement. The rotary hand piece reduces variability, which results in consistent mix times and built-in
charcoal filter reduces harmful fumes.
58.
What are the technique of improved cemented femoral
fixation?
Injection of low viscosity cement
Occlusion of medullary canal
Reduction of porosity
Pressurization of cement
Centralization of stem
Replacement of conventional ultra-high molecular weight
polyethylene to highly cross linked polyethylene.
59.
Tell the monomer and dimer of cement
Monomer-liquid form
Dimer-powder form
60.
How much weight the total hip component to withstand?
At least 3 times the body weight.
61.
Biomechanics of hip
Campbell 159
62.
Classify proximal femur according to cortical thickness
and canal dimension
Campbell 161
63.
Types of femoral component
Campbell 170
64.
Tell the exposure and prep of acetabulum
Campbell 187
65.
Shoulder dislocation
In which disease shoulder may dislocate?
epilepsy
Type II
Type III
Type IV
Type V
Four-part fracture
13.
Postoperative care?
Campbell 2677
14.
Complication of this fracture?
Apley 895
15.
Complication of operation?
Injury to common peroneal nerve
16.
Course of common peroneal nerve?
Datta 219,221,198
17.
Tell the anastomosis around knee?
Netter 481
18.
What are the structures injured along with tibial plateau?
Sura 7: 164
19.
Tell the incidence of tibial plateau fracture?
Sura 7: 164
20.
Fate of bone graft?
Turek 68
21.
How will u do X ray?
o
15 caudal AP view, as there is 150 posterior tilt
22.
Tell the conservative protocol of tibial plateau fracture
Early wt bearing
Short hospital stay
Rapid return of motion in all joints
Prompt return to walking
Relatively short total disability time
Allows some movement at fracture site and ensures callus
formation
It shares load
Prevent angulation, translation and some rotatory movement
6) What is the complication of im nail?
Damage the nutrient artery
Damage to neck or shaft
Fat embolism
Loose fitting nail-delayed or non union
Infection
Implant failure
7) How will u measure the length of im nail?
a. Tip of greater trochanter to joint line, then subtract 20-30
mm
b. Length of reaming rod-exposed portion
c. With the help of guide wire of same length of reaming rod
and parallel to exposed rod
8) Tell about the generation of nail?
4 generation
a. Ist generation: prox locking bolts are directed downwards
and medially from greater trochanter to lesser trochanter.
Ex. Grosse-kempe, AO transverse
b. 2nd generation: prox locking bolts are directed from greater
trochanter below upwards and medially towards the head
of the femur. Russel Taylor nail
c. 3rd generation: distal and prox locking screw. Ex- trigen nail
system
d. 4th generation: slot for segmental fracture fragment
Nonunion:
1.What is non union?
Campbell 2982
2.Types of nonunion?
Campbell 2983
Types of nonunion
Septic and aseptic nonunion
Aseptic:
2 classification:
a) AO Classification
b) Paleys modification of ilizarovs classification
AO classification(Weber)
Hypertrophic(reactive, hypervascular):1)elephant foot 2)Horse hoof
3)oligotrophic
Atrophic : 1)torsion wedge 2)comminuted 3)defect 4)atrophic
Paleys classification:
Type A: nonunion with bone loss less than 1 cm. A1: nonunion with mobile
deformity A2: nonunion with fixed deformity. A2-1: stiff nonunion without
deformity. A2-2: stiff nonunion with a fixed deformity
Type B: bone loss more than 1 cm.
B1:nonunion with a bone defect
B2: loss of bone length(shortening)
B3: both
Point
Clinically
Pain
Radiograph shows
Change in treatment
Gap
Nonunion
Delayed union
Duration more than 08 Duration less than 6-8
months, mobility
months mobility
Slight
More
Sclerosed ends
No sclerosis of the
ends
Closed medullary
Open medullary cavity
cavity
Usually required
May unite without
change
Gap usually present
Gap usually present
Implant failure:
Causes of implant failure?
Surgeon factor1.
2.
3.
4.
5.
6.
Patient factor
1.
2.
3.
4.
5.
Anaemia
Poor nutritional status
DM
Tuberculosis
AIDS
6. Immunosuppressive agent
7. Steroid
8. Connective tissue disease
9. Renal failure
10.
Osteoporosis
Implant factor:
1. Dissimilar metal
2. Corrosive material
3. Faulty manufacturing
What is implant failure?
Giving way of implant before serving definitive purpose
Bone graft:
1. What is bone graft
2. Tell how to take bone graft
Campbell 21
3. Function of bone graft
Campbell 15
4.
Xray findings
Gap
Sclerosed margin
Obliteration of medullary cavity
Ilizarov :
1.
a.
b.
c.
d.
3 cm behind the artery is the safe zone in the medial surface. 2cm
above the undersurface of calcaneum and 2 cm in front of
tendoachilis insertion emerge 4-6 cm behind the posterior border of
post malleolus.
Calcaneal pins ideally should be inserted as far posterior as possible while still engaging sound bone.
The tendons and neurovascular bundle passing behind the malleoli and the subtalar joint are to be
avoided.
Halett et al suggests for a calcaneal pin place it 2 cm below and behind the lateral malleolus or 3 cm
below and behind the medial malleolus BEWARE Tornetta et al show no position is completely safe
when placing a medial calcaneal pin or transcalcaneal pin. Ensure you are as far posterior as
possible yet still engaging bone.
Calcaneal fracture
1. What is bohler angle?
Bhler angle (also written as Bohler angle or Boehler angle) is the angle between two lines tangent to
the calcaneus on the lateral radiograph. These lines are drawn tangent to the anterior and posterior
aspects of the superior calcaneus.
Bohler's angle
Severe injury may result in flattening of the calcaneus. This results in a reduction of 'Bohler's angle'.
On a lateral view this angle is formed by the intersection of two lines. The first line is drawn from (1) - the upper
edge of the calcaneal body posteriorly to (2) - the upper edge of the posterior articular facet of the calcaneus at
the subtalar joint. From this point another line is drawn to (3) - the upper edge of the anterior process of the
calcaneus.
Bohler's angle is normally between 28-40 degrees.
2. Present ur case
3. What is the type of this fracture
Apley 924
4. Tell the complication of this fracture
Apley 928
5. Tell the treatment option
Apley 926
6. Tell ur plan
7. Tell the operative procedure
8. Tell the postoperative care
Hip dislocation:
1. Present ur case:
2. What is ur diagnosis?
Posterior dislocation of lt hip
3. Classify hip dislocation?
Ebnezar 213
After 03 months close reduction and heavy traction usually fails, as the
acetabulum may fill with fibrous tissue.
11.
Dislocation of hip
12.
Campbell 2764
14.
Ebnezar 219
15.
Close reduction
Open reduction
Heavy traction and abduction
Subtrochanteric osteotomy
Excision arthroplasty
Replacement arthroplasty
THR
Arthrodesis
16.
Tell ur approach
Ebnezar 219
18.
10-15%
Gustillo 792
21.
Pelvic fracture
1. Present ur case?
2. Tell the classification
Campbell 2783
3. Tell the tiles classification?
Campbell 2803
4. Tell the mechanism of injury
Apley 837
5. What are the clinical features
Apley 839
6. What is ur plan
10.
Campbell 2784
11.
Tell ur approach
Posterior kocher langenbeck approach for post column and wall campbell 77
Anterior ilio-inguinal approach: hoppenfield
12.
13.
Recon plate 88, 108 dia, drill 2.5, screw 3.5 cortical screw
14.
15.
Campbell 2795
16.
Campbell 2783
18.
20.
Skin grafting
1. From where we can take full thickness skin graft?
Upper part of arm, supraclavicular fossa, back of the ear
2. Tell the process of graft take?
Imbibitions: within 24-48 hrs. adhesion of graft to bed by fibrin layer
Inosculation: alignment of graft-host vessels
Revascularization: connection of graft host vessels. Formation of new
blood vessels, combined old and new vessels.
3. Indication of skin grafting
Polytrauma:
1. Tell the priority of OT list
a.open fracture
b. fracture-dislocation
c. intraarticular fracture
d. polytrauma
2. If a patient with bleeding come to u and u get blood and fluid? What
will u give?
Fluid first to compensate the extravascular shift.
NERVE INJURY
1.what are the nerves can be used as graft?
Sural nerve
Medial cutaneous nerve of arm
Superficial radial nerve
Lateral cutaneous nerve of forearm
TENDON TRANSFER IN HAND
6. Why we dont choose FCU transfer?
FCU is the main wrist flexor. If FCU is transferred, power grip
will be lost.
Flap:
Q1. Tell the flap of different site of leg
-upper 1/3rd: gastrocnemius flap
-middle 1/3rd: soleal flap
-lower 1/3rd: distally based fasciocutaneous flap
2. what is island flap?
only based on blood vessel-all attachment should be freed
pedicle flap: some attachment remains
Talus fracture:
1. Tell the blood supply of talus?
Blood Supply of The Talus
Enters Tarsal Canal (only other structure present is the Interosseous Ligament)
2. Deltoid Branch
Important branch from the artery of the Tarsal Canal (occasionally directly from the Posterior
Tibial A)
Sends branches that enter via medial side of the talar body
Formed by anastomosis of branch of the Dorsalis Pedis that crosses the navicular (lateral
tarsal branch), the branch of the Perforating Peroneal A
Peroneal A
o
Unimportant
Contributes to plexus around the posterior talus around the posterior tubercle area
Intraosseous
Head of Talus
o
Body of talus
o
Middle part from branches of the anastomosis between the arteries of Tarsal Sinus & Tarsal Canal
AVN OF HIP:
TB
Septic
OA
Rheumatoi
d
AVN
Clinically
Constitutional
History of high
fever.
Usually in
children. In
aduld after a
procedure.
Occurs after
periods of
activity.
Internal
rotation,
abduction
and external
rotationusually
affected first
Activity
decreases
pain.
Increased
pain over a
period of 2
yrs.
Initially
Initially
Initially
Symptom
Initially flexed
and abducted
and in late
stage flexed,
adducted and
medially
rotated.
Radiologicall
Initially
Progressive
destruction Sectoral
on both
sign may
side of the
be positive
joint
without any
reactive
bone
formation.hall mark of
the
disease.
Early stage
general
rarefaction
but with
normal joint
line and
space. Bone
abscess.
Later
destruction of
acetabular
roof and
femoral head.
Bones
recalcify.
displacement
of femoral
head, vacuum
sign in the
joint.
Later bone
destruction,
bony ankylosis
decreased
joint space
specially in
superior
weight
bearing
zone. Later
subarticualr
sclerosis,
cyst
formation
and
osteophytes.
osteoporosi
s and
diminution
of joint
space.
plain xray
normal. 6-9
months
after bone
death
reactive
Later
changes in
acetabulum surrounding
and
bone
femoral
increased
head are
densityeroded.
sclerosis.
Protrusion
acetabuli is Later
common. If subchondra
patient on
l fracture
steroid
linegross bony crescent
destruction sigh, slight
and floor of flattening
acetabulum of the
may be
weight
perforated. bearing
zone,
increased
distortion
with
eventual
collapse of
the
articular
surface of
femoral
head.
Dense band
between
dead bone
and new
bone
formation.
Other inv
What is avn?
11.
Necrosis refers to a spectrum of morphologic changes that follow cell death in living tissue,
largely resulting from the progressive degradative action of enzymes on the lethally injured cell
12.
Apley 103
13.
Apley 104,105
14.
15.
Apley 109
16.
A frog leg lateral view is a special type radiographic view to evaluate the hip. Joints
and femoral necks are better visualised and can be compared. Technique
the patient is usually positioned supine on the x-ray table with the affected limb
flexed at the knee approximately 30 to 40 and the hip abducted 45.
the heel of the affected limb should rest against the medial aspect of the
contralateral knee
the cassette is placed so that the top of the film rests at the anterior superior
iliac spine.
the crosshairs of the beam are then directed at a point midway between the
anterior superior iliac spine and the pubic symphysis. the x-ray tube-to-film
distance should be approximately 40 in (102 cm)
Campbell 164
13.
Campbell 166
Femoral component:
a. Cemented: polished surface
Nonpolished
PMMA coated
Modular
Nonmodular
b. Noncemented
Titanium alloy
Cobalt-chromium alloy
Surface modification:
-porous coating
-grit blasting: pressurized spray of aluminium
-plasma spraying: high velocity application of molten metal
-hydroxyapatite coated
Stem type:
-single wedge: type 1
-double wedge: type 2
Type 3: double wedge and more fixation at metaphysiodiaphyseal junction
Type 4: extensively coated implant
Type5: modular
Type 6: anatomical
Acetabular component:
Cemented:
Thick walled polyethylene cup: vertical and horizontal groove
and spacer
Noncemented:
Campbell 182
15.
What will u think if femoral head is good but acetabulum
is diseasesed?
Neoplasm
TENDOACHILIS INJURY
1. What is modified tauffer technique and tauffer technique?
2. Tell the postoperative care
TORTICOLIS
1. What are the treatment options?
2. What is the complication of proximal release?
Injury to spinal accessory nerve
3.