Orthopedics 2

  1. osteosynthesis indication
    fractures of bone
  2. osteosynthesis principle
    reduction and internal fixation of fracture to allow intramembranous healing
  3. kirschner wires
    • used in fractures around joints as adjuvent 
    • maintain alignement 
    • do not resist rotation or bending
  4. steinmman pins
    thicker than kirschner wires
  5. intramedullary nails
    • fractures of long bones
    • minimally invasive 
    • allows compressive forces to stimulate bone healing
  6. plates and screws
    • used in articular fractures 
    • maintain alignement 
    • transmit forces bypassing fracture site
  7. buttress plates
    • prevent axial displacement of fracture fragments 
    • e.g. malleuolus
  8. compression plates
    have oval shaped screw holes so that when screw in the ends are brought together
  9. neutralization plates
    transmit forces bypassing fracture site
  10. bridge plates
    used when there are multiple fragments in the fracture
  11. lag screw
    • placed perpendicular to a fracture
    • screws ends of fracture back together
  12. LiSS
    Less invasive stabilization system
  13. MiPPO
    minimally invasive percutaneous plate osteosynthesis
  14. Herbert's screw
    scaphoid fracture
  15. dynamic hip screw
    intertrochanter neck of femur
  16. proximal femoral nails
    pertrochanter neck of femur
  17. phillos
    proximal humerus
  18. dynamic condylar screw + distal femoral nail
    distal femur
  19. pilon plate
    distal tibia
  20. T plate
    condylar fracture of tibia
  21. SP nail plate
    intertrochanter
  22. condylar blade plate
    condylar fracture of femur
  23. spoon plate
    lower tibia
  24. stages of healing of fracture
    • 1. hematoma – fibrin clot
    • 2. inflammation – granulation tissue
    • 3. soft callus – within 2 weeks
    • 4. hard callus – type 2 collagen (cartilage) --> type 1 collagen (bone)
    • 5. remodelling
  25. primary bone healing
    • small amount of strain – internal fixation
    • intramembranous healing / haversian remodeling
  26. secondary bone healing
    • higher amount of strain – cast, rod, external fixation
    • endochondral ossification (healing through cartilage formation)
    • initial periosteal callus
    • later medullary callus
  27. healing with osteosynthesis
    • decreased strain on fracture site + healing tissue 
    • stability 
    • diminished fracture gap 
    • allows primary / direct bone healing (no callus)
  28. ORIF
    • open reduction internal fixation 
    • serious fractures
  29. CRIF
    • closed reduction internal fixation 
    • condylar fracture of humerus in children
  30. complications of osteosynthesis
    • infection 
    • stiffness / loss of range of motion
    • non union / mal union 
    • damage to muscles / nerves 
    • arthritis / tendonitis 
    • chronic pain 
    • compartment syndrome 
    • deformity
  31. external osteosynthesis principle
    • bone implants + external bearing frame 
    • load is transfered from bone to fixation frame 
    • when callus begins to consolidate transfer load back onto bone
  32. external osteosynthesis indications
    • open fractures 
    • soft tissue damage 
    • ustabel fractures 
    • pelvic fractures 
    • fractures complicated by infection / non union
    • arthrodesis
  33. arthrodesis
    • artificial induction of joint ossification so that it will no longer move 
    • used in untreatable joint pain
  34. Taylor Spatial frame
    • pins into bone
    • external rings stabilized between each other 
    • can also be used to lengthen by increasing distance between rings
    • use 3D computer modeling to determine placement of pins etc.
  35. Ilizarov's technique
    • pins into bone
    • external rings stabilized between each other 
    • can also be used to lengthen by increasing distance between rings
  36. external osteosynthesis complications
    • pin tract infections 
    • pin lossening / breakage 
    • poor placement of fixator
  37. advantages of external osteosynthesis
    • no casting - inspection 
    • miantains length 
    • stabilized distantly from fracture
  38. rheumatoid disease
    • chronic, intermittent pain affecting joints and connective tissue 
    • systemic inflammatory disorders
  39. osteoarthritis
    occurs when articular cartilage is worn down / damaged
  40. rheumatoid arthritis
    • autoimmune disease of the joints
    • RF
  41. ankylosing spondylitis
    • bamboo spine - ossification of intervertebral discs 
    • ANCA
  42. systemic lupus erythematoides
    • multiorgan autoimmune disease
    • ANA
  43. treatment for rheumatoid diseases
    • remission + maintenance - steroids + NSAIDs
    • preserve joint function + prevent deformities - physiotherapy + splinting 
    • repair damage - surgery
  44. preventative surgery in rheumatoid disease
    synovectomy - pain releif + decreases inflammation
  45. palliative surgery in rheumatoid disease
    • tendon lengthening 
    • tendon repair 
    • arthrodesis
  46. reconstructive surgery in rheumatoid disease
    arthroplasty - reconstruction / replacement of joint
  47. Girdleston arthroplasty
    • extensive debridement of femoral head 
    • complications - bone shortening + disturbances in gait
  48. interposition arthroplasty
    reshape joint + add prosthetic disc
  49. total joint replacement
    replace with prosthetic
  50. perioperative care
    • routine blood tests 
    • X ray 
    • ECG
    • prophylaxis of venous thrombosis 
    • antibiotics 
    • autologous blood transfusions
  51. indications for prosthetics
    • cosmetic or functional
    • dental 
    • facial 
    • larynx / trachea 
    • breast 
    • amputation 
    • disarticulation
  52. principle of prosthetic
    artificial device that replaces a missing body part from trauma, infection, congenital or surgery
  53. sabolich sockets prosthesis
    hold patients limb like glove
  54. C leg prosthesis
    • hydraulic cylinders control knee flexion 
    • microprocessors measure speed psoition etc.
  55. Osseo-integration
    direct structural and functional connection to existing bone
  56. principle of orthosis
    • device that supports / corrects function of a limb or torso
    • cannot correct deformity - joint must be able to be positioned passively
  57. principle of braces
    device used to control, limit or immobilize a body segment
  58. functions of braces
    • restrict movement 
    • assist movement 
    • decrease weight bearing
    • protect from injury
  59. unloading brace
    • decrease weight bearing 
    • knee arthritis
  60. prophylactic braces
    restrict movement to prevent injury
  61. knee braces
    severe arthritis / osteoarthritis
  62. halo braces
    cervical brace
  63. milwaukee brace
    • back brace - scoliosis, kyphosis 
    • cervico - thoraco - lumbo - sacral
  64. boston brace
    • back brace - scoliosis, kyphosis
    • thoraco - lumbo - sacral
  65. cast of wrist
    • 15-30° dorsiflexion 
    • except in carpal tunnel syndrome - neutral
  66. cast of elbow
    90° ventro-medial flexion
  67. cast of thumb
    • abduction 
    • 15-30° dorsiflexion
    • thumbs up kind of position
  68. function of cast
    • static brace
    • prevent / correct contractures 
    • promote soft tissue stretching 
    • passive ROM
  69. function of sling
    • static brace
    • immobilization
  70. function of splint
    • static brace 
    • immobilization
    • recent surgery / inflammation
  71. flexion orthosis
    • maintain joint in semiflexion 
    • allows more flexion but not extension
    • contractures, burns, fractures
  72. functional arm orthosis
    • shoulder straddle suspends forearm 
    • arm weakness (SCL etc.)
  73. tone reduction orthosis
    • prevents flexion 
    • spasticity
  74. dynamic hand orthosis
    system of springs that assist in finger extension but allow finger flexion (against spring force)
  75. BiCAAL
    • bichannel adjustable ankle locking 
    • like a sock that has artifical ankle joint that can be set to certain flexion
    • stroke, head trauma, spinal injury etc.
  76. AFO
    • ankle foot orthosis 
    • plastic moulded sock like shell that maintains foot from plantarflexion (footdrop)
  77. KAFO
    • knee ankle foot orthosis 
    • like thigh length sock with adjustable knee and ankle joints 
    • maintains foot from plantarflexion 
    • quadriceps weakness, hamstring spasticity
  78. principles of arthroscopy
    • inject fluid into joint to allow better visualisation 
    • insertion of small camera through small incision 
    • insertion of small specialized equipment through separate small incision
  79. locations of arthroscopy
    • knee
    • hip 
    • shoulder
    • wrist
    • spine
  80. indications for knee arthroscopy
    • not osteoarthritis
    • meniscal repair
    • chondral defects
  81. indications for hip arthroscopy
    femoro-acetubular impingement
  82. indications for shoulder arthroscopy
    • subacromial decompression 
    • acromioclavicular osteoarthritis
    • rotator cuff tears
    • frozen shoulder (adhesive capsulitis)
    • chronic tendonitis
    • removal of loose bodies and partial tears of the long biceps tendon
    • SLAP lesions
    • shoulder instability
  83. indications for wrist arthroscopy
    • repetitive strain injury 
    • fracture of the wrist
  84. advantages of arthroscopy
    • best modality for joint visualization 
    • minimally invasive 
    • one day surgeries 
    • little time imbolised / in physiotherapy 
    • barely visible scars 
    • can be done under local anesthesia
  85. rotator cuff
    • teres minor
    • supraspinatus 
    • infraspinatus 
    • subscapularis
  86. range of motion of the shoulder
    • abduction - 180°
    • external rotation - 90°
    • internal rotation - 100-120°
  87. joints of the shoulder
    • gleno-humeral joint (scapula + humerus) - ball and socket 
    • sterno-clavicular joint - gliding joint 
    • acromio-clavicular joint (scapula + clavicle) - diathroidal joint 
    • scapulo-thoracic joint
  88. impingement syndrome of the shoulder
    irritation and pain when arm is raised over 90° (acromion rubs on tendon / bursa)
  89. Neer stages
    • stages of shoulder impingement 
    • stage 1 - under 25 years old, acute inflammation, reversible 
    • stage 2 - 25-40 ears old, tendon fibosis, operation 
    • stage 3 - over 40 years old, osteophytes on acromion, surgery
  90. SLAP lesion
    • superior labrum, anterior to posterior
    • tear of the shoulder joint above middle of socket
    • usually after dislocation
  91. bankart lesion
    • tear of the shoulder joint below middle of socket 
    • usually after dislocation
  92. snyder classification
    • SLAP classification I-IV
    • I - labrum + biceps frayed 
    • II - detached biceps 
    • III - bucket handle tear in labrum 
    • IV - bucket handle tear with detached biceps
  93. Maffet sub-classification
    • SLAP lesion types V-VII
    • V - bankart lesion 
    • VI - superior tear 
    • VII - capsular injury
  94. chronic shoulder instability
    • head of humerus forced out of shoulder socket 
    • once dislocation happens once, the shoulder is vulnerable to repeat
  95. meniscal regions
    • red-red - in highly vascularized area at periphery (meniscal suturing)
    • red-white - in less vascularized area 
    • white-white - no vessels in this area (meniscotomy)
  96. meniscal sutures
    • outside in 
    • inside out 
    • all inside (absorbable pins)
  97. osteochondritis dessecans
    cracks form in the articular cartilage and the underlying bone
  98. chondral repair
    • drilling / microfracturing - remove small defects 
    • autologous chondrocyte implantation 
    • mosaic plasty (take from non weight bearing parts)- not in children
  99. principle of alloplasty
    • repairing defects using allotransplants 
    • uses synthetic materials
  100. excision alloplasty
    • excision of joint surfaces --> gap formed 
    • place deep fascia / plastic lamina in gap for better mobility 
    • gap closes with fibrous tissue
  101. hemi-alloplasty
    only one joint surface is replaced with a synthetic material
  102. total alloplasty
    • completely replace both joint surfaces 
    • increased risk of sepsis
  103. indications of alloplasty
    • usually in hip and knee 
    • after fracture of head of femur 
    • for pain releif
  104. cementing principles
    • fills free space between prosthesis and bone 
    • absorbed forces so it doesnt detroy bone underneith it 
    • made from plexiglass powder + ATB + liquid --> dough --> solid in 24 hours
  105. timing of orthopedic neonatal screening
    • examine newborn at 
    • 0 minutes 
    • 3 minutes 
    • 6 minutes 
    • 1 week 
    • every 2 months for first year 
    • 12 months 
    • 18 months 
    • 3 years 
    • every 2 years afterwards
  106. clinical assesement in neonatal screening
    • passive and active movement 
    • neurological examination
    • spine 
    • legs 
    • feet 
    • arms
    • hands
  107. ultrasonogrophy in neonatal screening
    • confirmation of subluxation 
    • dysplasia of cartilagenous acetubulum
  108. congenital hip dysplasia screening
    • examine quiet and relaxed newborn 
    • subluxation or dislocation of hips 
    • asymmetry - skin fold, length, position of knee
  109. galaezzi test
    • congenital hip dysplasia 
    • sign of dislocation 
    • feet flat on table, knees and hips bent 
    • one knee looks higher than the other
  110. passive hip abduction test
    • congenital hip dysplasia 
    • dislocation of femur 
    • flex hips and slowly abduct
    • limited abduction / asymetry
  111. barlow test
    • congenital hip dysplasia 
    • unstable hips, NOT dislocated hips 
    • thumb on lesser trochanter and fingers on greater trochanter (grab head of femur), adduct and push backwards, slowly abduct 
    • feel subluxation
  112. ortolani test
    • congenital hip dysplasia 
    • dislocated hip 
    • flex knee and grab head of femur, abduct and lift femur
    • feel sliding in acetubulum
  113. neonatal screening of lower limbs
    • congenital hip dysplasia 
    • bowing of legs 
    • talipes equinovarus (club foot)
    • calcaneo-valgus 
    • metatarsus adductus
  114. neonatal screening of upper limb
    • Madelung deformity - deformity of radius + dislocation of ulna 
    • Clavicle fracture - birth trauma 
    • Brachial plexus injury
    • numerical abnormalitis in digits
  115. orthopedic examination of spine
    • hyper-kyphosis 
    • hyper-lordosis 
    • scoliosis 
    • free movement 
    • herniation of disc at L5 --> radiating pain
  116. Lasegue test
    • herniation of L5 intervertebral disc 
    • lie on back, passively lift straight leg 
    • pain
  117. orthopedic examination of gait
    • cation when walking - pain 
    • limping 
    • trendelenburg gait (hips)
  118. trendelenburg test
    • weakness of abductors of hip (gluteus medius + minimus)
    • stand on one foot 
    • see fall of opposite hip
  119. leg length measurement
    • anterior iliac spine + malleolus 
    • umbilicus + medial malleolus 
    • indirect - level of pelvis (use lift block)
  120. orthopedic examination of shoulder
    • inspection - flat / swollen / muscle wasting 
    • attitude - arm held to chest
    • palpation 
    • movement
  121. shoulder range of motion
    • abduction - 180°
    • extension - 45°
  122. apley's scratch test
    • shoulder examination 
    • 1. touch opposite shoulder 
    • 2. touch upper back + stretch 
    • 3. touch lower back + stretch
  123. orthopedic examination of knee
    • inspection 
    • attitude 
    • palpation
    • motion 
    • Pattelo-femoral examination
    • anterior cruciate ligament 
    • posterior cruciate ligament
    • collateral ligaments - valgus / varus
    • meniscus
  124. knee range of motion
    • flexion - 135°
    • extension - 10°
  125. Q angle
    • Quadriceps femoris muscle angle 
    • valgus or varus 
    • slight knee flexion (so not locked)
    • angle between anterior iliac spine to patella and tibial tubercle and patella
  126. ballotement test
    increased fluid in supra-patellar pouch
  127. lachman test
    • test anterior cruciate ligament 
    • push knee anteriorly and posteriorly (up and back)
  128. knee anterior drawer test
    • test anterior cruciate ligament
    • patient lies on back with knee half bent and foot flat on table 
    • pull knee towards self
  129. pivot shift test
    • test anterior cruciate ligament 
    • patient lies on back 
    • start with knee straight, internally rotate, then bend knee
  130. posterior drawer test
    • posterior cruciate ligament
    • patient lies on back with knee half bent and foot flat on table 
    • push knee towards patient
  131. Sag test
    • posterior cruciate ligament
    • patient lies on back, doctor lifts legs to 90° and compares tibial tuberocities of both knees
  132. McMurray's test
    • patient lies on back 
    • doctor lifts leg with bent knee and turns leg inwards (varus force - lateral meniscus) or outwards (valgus force - medial meniscus)
    • doctor extends knee slowly and feels for any popping etc.
  133. Apley's tests
    • patient lies on stomach with knee up at 90°
    • compression test - doctor pushes down on foot and rotates leg 
    • distraction test - doctor pulls on foot and rotates leg
  134. orthopedic examination of the hip
    • inspection - length, symmetry, allignement, swlling 
    • movements
  135. range of motion of the hip
    • flexion 
    • extension 
    • abduction 
    • adduction 
    • internal rotation
    • external rotation
  136. trendelenburg test
    • weakness of abductors of hip (gluteus medius + minimus)
    • stand on one foot 
    • see fall of opposite hip
  137. thomas test
    • psoas syndrome / hip flexion contractures 
    • patient lies on back and brings one knee to chest while keeping other leg straight 
    • other hip flexes without straight leg - iliopsoas 
    • hip comes into abduction - tensor fasciae latae 
    • knee extension - rectus femoris 
    • lateral rotation of tibia - biceps femoris
  138. obers test
    • iliotibial band tightness
    • patient lies on side, support knee and bring hip into extension with knee still bent 
    • let go of knee, it should drop
  139. patrick's test
    • sacroiliac joint 
    • patient lies on back then bring leg into FABER - flexion, abduction, external rotation (like ballet stand)
  140. causes of congenital malformations
    • genetic 
    • drugs during pregnancy and early development 
    • infections during pregnancy and early development 
    • trauma during birth and afterwards 
    • anoxia / compresion in utero
  141. numeric deformities of the digits
    • oligodactyly - fewer digits 
    • polydactyly - more digits
    • polysyndactyly - when digits are fused
  142. embryonic limb formation
    24-36 days
  143. amelia
    • lacking / shrunken limbs
    • thalidomide famous for it
  144. hemimelia
    • partial / total absence of a bone 
    • fibular - short deformed leg + club foot 
    • tibial - short extremity in supination + dislocation of femur 
    • radial - shorter forearm + deviated wrist
  145. focomelia
    • hands + feet attached to abbreviated arms + legs 
    • caused by thalidomide
  146. shortening of limbs
    • rhizomelia - proximal shortening 
    • mesomelia - central shortening 
    • acromelia - distal shortening
  147. amniotic band syndrome
    complete / partial amputation due to constriction by amniotic sac
  148. arthrogryphosis multiplex congenital
    • multiple contractures + muscle fibrosis 
    • unable to perform flexion / extension
  149. marfan syndrome
    • long fingers, toes and limbs 
    • abnormal spine curvature + protrusion of sternum 
    • increased flexibility 
    • early osteoarthritis
  150. pes calcaneo-valgus congenitus
    • severe dorsiflexion of foot (upwards) 
    • forefoot abducted (outwards)
    • common
  151. pes calcaneo-valgus congenitus causes
    • intrauterine positioning 
    • muscle imbalance (meningocele)
  152. pes calcaneo-valgus congenitus therapy
    • stretching 
    • casting 8-10 weeks
  153. pes planus congenitus
    • flexible flat foot 
    • seen when child first starts to walk (14-18 months)
  154. pes planus congenitus complications
    • compensation in posture for flat foot 
    • scoliosis
    • valgus knees (+ osteoarthritis)
  155. pes planus congenitus therapy
    • within first decade spontaneously develop normal arch 
    • casting 
    • Grice procedure
  156. Grice procedure
    allows arthrodesis (fusion) of subtalar joint
  157. vertical talus
    • rigid flat foot - neonate with foot almost turned inwards 
    • dorsiflexion of forefoot (up)
    • equinus position of hindfoot (like horse) 
    • abduction of foot (outwards)
  158. vertical talus treatment
    • surgery before child starts to walk 
    • soft tissue release
    • tendon lengthening 
    • reduction of talo-navicular joint
  159. tarsal coalition
    • rigid and painful flat foot in older children 
    • fusion of tarsal bones 
    • talo-calcaneal 
    • calcaneo-navicular
  160. tarsal coalition therapy
    triple arthrodesis
  161. triple arthrodesis
    • fusion of joints 
    • talo-calcaneal
    • talo-navicular
    • calcaneo-cuboid
  162. pes cavus, pes excavatus
    increased arch in foot
  163. pes cavus, pes excavatus therapy
    • plantar release 
    • osteotomy - cutting bones 
    • tendon transfers 
    • triple arthrodesis - fusing bones
  164. coleman test
    • diagnosis of pes cavus 
    • mark angle of foot to ankle 
    • place a block on lateral aspect of foot to see if the angle becomes more straight
  165. pes equinovarus congenitus
    congenital club foot
  166. pes equinovarus congenitus etiology
    • more common in boys 
    • mechanical theory - increased intrauterine pressure 
    • ischemic theory - ishcemia of calf muscle 
    • genetic theory 
    • secondary causes - polio, spina bifida, muscle imbalance
  167. pes equinovarus congenitus signs
    • 1. plantar flexion of ankle - equines 
    • 2. subtalar joint inverted inwards - varus 
    • 3. forefoot adduction - inwards 
    • 4. internal rotation of tibia 
    • 5. pes cavus - increased arch
  168. pes equinovarus congenitus X ray appearance
    • lateral view - talocalcaneal angles <35°
    • anterior posterior view - talocalcaneal angle <20°
  169. pes equinovarus congenitus conservative therapy
    • splinting 2-3 days after birth 
    • 1. forefoot adduction 
    • 2. forefoot suppination 
    • 3. equinus
  170. ponseti method
    • method of correcting club foot 
    • series of long term leg plasters 
    • achilles tendon release 
    • external rotation of feet ins pecial boots for 2-3 years 
    • 1. cavus 
    • 2. adductus 
    • 3. varus 
    • 4. equinus
  171. pes equinovarus congenitus surgical therapy
    • soft tissues release 
    • tendon lengthening at 6-9 months 
    • talectomy - remove 
    • calcaneal osteotomy - split 
    • triple arthrodesis
  172. pes planum
    • flat foot - abducted forefoot + valgus hindfoot 
    • congenital / aquired 
    • flexible / rigid
  173. pes planum etiology
    • posterior tibial tendon dysfunction 
    • hypovascularity 
    • overload (obesity) 
    • inflammatory disorders 
    • trauma 
    • neuropathy 
    • tindinosis
  174. pes planum stages
    • assesed with single limb heel rise 
    • 1. pain with minimal / no loss of tendon strength 
    • 2. dynamic deformity visible 
    • 3. chronic dysfunction + lengthening of posterior tibial tendon + calcaneal subluxation 
    • 4. fibro-talar arthrosis
  175. plantigram
    use light box to asses points of load bearing on foot
  176. pes planum conservative therapy
    • casting / orthosis - corrective shoes with arch support 
    • NSAIDs 
    • physio
  177. pes planum surgical therapy
    • arthrodesis - subtalar / triple 
    • osteotomy - calcaneal 
    • soft tissue procedures - lengthen achilles tendon / lateral collumn
  178. pes planovalgus
    long standing pes planus
  179. subtallar dislocation
    • caused by high energy mechanism 
    • medial (75%) - locked in supination 
    • lateral (25%) - locked in pronation
  180. subtallar dislocation therapy
    • closed reduction 
    • non weight bearing caste 4-6 weeks
  181. leg length discrepancy
    • actual - different bone lengths (after fracture, damage, growth plate, congenital)
    • virtual - problem in pelvis / upper leg means it looks a different length
  182. leg length discrepancy therapy
    • prosthetics - heel / shoe 
    • surgical prolongation (calo-taxis prolonges at a healing callus)
    • surgical abbreviation
  183. axial deformities of hip
    • coxa vara 
    • coxa valga
  184. coxa vara
    • neck of femur angle smaller than 120°
    • leg appears shorter 
    • brings legs inwards together 
    • trendelenburg gait + increased lumbar lordosis 
    • therapy - osteotomy
  185. coxa valga
    • neck of femur angle greater than 135°
    • usually slipped epiphyesis of femoral head
  186. axial deformities of knee
    • varus - bow leg (boys)
    • valgus - knock-knee (girls)
  187. varus knees
    • bow legged (boys)
    • also see internal rotation + pes planus 
    • premature arthritis in medial compartment 
    • surgical therapy
  188. tibia vara epiphysera
    • dysarthosis + growth impairment of proximal tibia 
    • rare
  189. valgus knees
    • knock-knee (girls) 
    • physiological until age 10 
    • lateral compartment osteoarthritis 
    • surgical therapy
  190. congenital hip dysplasia
    • disease of hip joint causing instability 
    • present at birth 
    • due to excess stretching of posterior hip capsule 
    • usually on left 
    • more common in breach births
  191. congenital hip dysplasia diagnosis
    • galaezzi test - feet flat on tabel knees bent 
    • passive hip abduction test 
    • barlow test - hold hips and push backwards (subluxation) 
    • ortolani test - hold hip and lift (luxation)
    • ultrasound
  192. congenital hip dysplasia perinatal X ray
    • not before 3 months (femur not ossified yet) 
    • good after 6 months 
    • arthrogram - inject contrast into joint
  193. congenital hip dysplasia ultrasound
    • used before 6 months (before ossification) 
    • 2 weeks, 3 months, 6 months 
    • alpha angle - between acetubular roof line and mid femur 
    • beta angle - between inclination line (perpendicular to acetubular roof line) and mid femur
  194. congenital hip dysplasia types
    • acetubular dysplasia 
    • subluxation - incomplete contact between articular surfaces 
    • luxation / dislocation
  195. treatment protocol for congenital hip dysplasia
    • 1. normal hip - nothing 
    • 2. mild acetubular instability - treat if still present after 6 months 
    • 3. unstable with possible dislocation - pavlik's harness 
    • 4. reducible luxation of hip - Byrant's traction 
    • 5. non-reducible luxation of hip - fmeoral osteotomy + triangle acetubular osteotomy
  196. double nappies
    • forces abduction + flexion of hip 
    • not used anymore
  197. frejka mat
    special nappies causing abduction + flexion of hips
  198. pavlik straps
    • worn 2-3 weeks 
    • hip flexion at 100° + unable to adduct 
    • low risk of avascular necrosis
  199. overhead traction
    • method of closed reduction in luxation of hip 
    • gently stretches soft tissue around hip and decreases forces in joint
  200. Bryant's traction
    • method of closed reduction in luxation of hip 
    • 20 days 
    • 1. hips flexed with straight legs (up) 
    • 2. abduction to 50° (side)
    • 3. casting for 3 months
  201. manipulative reduction of hip luxation in congenital hip dysplasia
    • general anesthesia 
    • flexion over 90°
    • abduction 30-40°
    • slight internal rotation
  202. spica cast in child
    • immobilizes hips and thighs
    • changed every 6 weeks 
    • kept for 3-6 months
  203. congenital hip dysplasia indications for surgery
    • older children 
    • severe dysplasia with limping 
    • severe leg shortening 
    • high valgus of hip 
    • subluxation of femoral head
  204. congenital hip dysplasia surgery
    • open reduction 
    • femoral shortening osteotomy 
    • suturing capsule tears
  205. salter osteotomy surgery for congenital hip dysplasia
    • cut shaft of femur + rotate + plate --> reduction 
    • remove piece of iliac crest + place into pelvis above hip joint - salter osteotomy
  206. congenital hip dysplasia differential diagnosis
    • newborn coxitis --> pathological luxation 
    • epiphysiolysis of femur in delivery 
    • teratogenic luxation
  207. congenital hip dysplasia complications
    • spica cast --> atrophy of muscles 
    • pavlik harness --> skin irritation 
    • forceful reduction / tension in soft tissue --> avascular necrosis of femoral head
  208. aseptic necrosis
    • avascular necrosis 
    • osteo-necrosis 
    • bone infarction 
    • ischemic bone necrosis 
    • occurs in people under 50 years old
  209. aseptic necrosis etiology
    • trauma - femoral head 
    • embolism 
    • caisson disease - nitrogen bubbles in arteries 
    • metabolic disorders 
    • autoimmune 
    • smoking - hip 
    • alcohol
    • pregnancy 
    • idiopathic
  210. aseptic necrosis pathophysiology
    • decreased blood suply 
    • 12 hours - death of hematopoetic cells 
    • 12-48 hours - death of bone cells 
    • 5 days - death of fat cells 
    • reperfusion --> osteoblasts + fibroblasts 
    • causes bone collapse
  211. aspetic necrosis clinical features
    • slow onset 
    • limping / restriction of movement 
    • local pain eventually 
    • no outward visible signs
  212. aseptic necrosis X ray
    • I - demineralization + osteoporosis 
    • II - fragmentation (fracture) 
    • III - reparation - remodeling of necrotic area (in child)
    • IV - definitive changes - shape and structure of bone
  213. aseptic necrosis treatment
    debridement + joint replacement
  214. Hass disease
    • osteonecrosis of head of humerus (shoulder)
    • caused by corticosteroids, alcohol, radiotherapy
  215. Panner's disease
    • osteonecrosis of capitulum of humerus (elbow)
    • caused by trauma
  216. Kienbock's disease Preiser's disease
    • osteonecrosis of lunate (wrist) 
    • caused by repetitive microtrauma in manual labor
  217. Perthe's disease
    osteonecrosis of proximal femural epiphysis (thigh)
  218. Osgood schlatter
    • osteonecrosis of tibial tuberosity (shin) 
    • caused in sports by overload of insertion of patellar ligament
  219. blount disease
    • medial tibial condyl (knee)
    • common in sickle cell disease
  220. kohler disease
    osteonecrosis of tarsal navicular (foot)
  221. haglund sever disease
    • osteonecrosis of calcaneal apophysis (heel)
    • caused by overloading
  222. kummel disease
    • osteonecrosis of vertebral body 
    • caused by trauma (elderly)
  223. scheuermann's disease
    juvenile osteochondrosis of the spine
  224. M. perthes
    • morbus perthes / coxa plana 
    • osteonecrosis of epiphysis of femoral head
  225. Morbus perthes etiology
    • boys 4-10 years old 
    • multifactorial 
    • genetic influences 
    • second hand smoking 
    • low birth weight
  226. Morbus perthes diagnosis
    • X ray 
    • bone scan 
    • MRI 
    • arthrography
  227. morbus perthes clinical appearance
    • mild intermittent groin pain 
    • limp in child 
    • limited hip motion 
    • trendelenburg positive
  228. morbus perthes x ray
    • 1. non-specific effusion of joint + slight widening of joint space 
    • 2. metaphyseal demineralisation + periarticular swelling 
    • 3. dense necrotic ossification center 
    • 4. collapse of head + increased width of neck 

    varus deformity of head
  229. morbus perthes classification
    • waldenstrom staging 
    • catterall classification 
    • herring classification
  230. waldenstrom staging
    • initial 
    • fragmentation 
    • re-ossification 
    • healing + remodelling
  231. catterall classification
    • 1. anterior epiphysis only 
    • 2. anterior epiphysis + sclerosis 
    • 3. most of epiphysis affected + loss fo structural integrity of head 
    • 4. total head involvement + loss of structural integrity of head + socket
  232. herring classification / Pillar classification
    • height of lateral pillar of femoral head on AP x ray 
    • A - full height 
    • B - over 50% of height 
    • C - less than 50% of height
  233. morbus perthes treatment principle
    • prevent epiphyseal collapse + miantain spherical head 
    • 1. maintain femoral abduction 
    • 2. maintain internal rotation
  234. abduction orthosis atlanta
    • looks like pavlik straps for adults 
    • miantain hip in abduction
  235. thomas splint
    • can be with traction 
    • pulls leg straight outwards
  236. morbus perthes surgical treatment
    • performed when head of femur is at risk 
    • pelvic osteotomy 
    • femoral osteotomy 
    • abduction rotation femoral osteotomy 
    • cheilotomy - reshape femoral head
  237. coxa vara adolescentium
    • slip of proximal femoral epiphysis (hip) 
    • head of femur is held at more of an angle 
    • dorsal + medial dislocation
    • usually in left hip
  238. coxa vara adolescentium etiology
    • adolescent females 11-14 years old 
    • adolescent males 13-16 years old (more common)
    • mutlifactorial 
    • genetics 
    • testosterone --> epiphyseal closure 
    • estrogen --> hyperlax joints 
    • obesity - increased forces on femur
  239. coxa vara adolescentium clinical manifestation
    • prodromal symptoms - lower limb joint pain increased on walking, decreased range of motion
    • affected hip in external rotation
    • prefer legs crossed 
    • abnormal gait - external rotation / trendelenburg 
    • decreased hip motion 
    • loss of internal rotation
  240. coxa vara adolescentium x ray
    • 1. <30° angle of neck of femur 
    • 2. 30-60°
    • 3. >60°
  241. coxa vara adolescentium conservative treatment
    always surgical treatment
  242. coxa vara adolescentium surgical treatment
    • fix with kirschner wire to prevent farther slipping 
    • correction osteotomy - southwick, imhauser
  243. southwick surgery
    • correction osteotomy for coxa vara 
    • via small trochanter
  244. imhauser surgery
    • correction surgery for coxa vara 
    • via interhumeral area
  245. Scoliosis
    lateral curve of the spine
  246. types of scoliosis
    • congenital scoliosis - associated with malformation 
    • idiopathic - infantile, juvenile, adolescent
  247. scoliosis clinical examination
  248. scoliosis x ray
  249. scoliosis treatment
    • 0-10° - normal 
    • 10-20° - rehabilitation 
    • 20-40° - corset 
    • >40° - surgery
  250. scoliosis surgical treatment
Author
Marine
ID
340914
Card Set
Orthopedics 2
Description
ortho
Updated