Thursday, 9 April 2015

Orthopedics high yield

Orthopaedic imp II
From newer edition f maheshwari

-inferior capsule is weakest portion of shoulder joint
-tests for anterior glenohumeral instability are apprehension test,fulcrum test,crank test,jobe's relocation test and surprise test
-test for posterior glenohumeral instability is jerk test
-sulcus test done for multi-directional and inferior stability
-lift off test evaluates subscapularis muscle activity.
-anconeus triangle formed by radial head,lateral epicondyle, and tip of olecranon
-mc cause f volkman's ischaemic contracture (VIC) in a child is supracondylar fracture f humerus n mc muscle involved in VIC is flexor digitorum profundus
-head f radius excision leads to valgus deformity at elbow.
-fracture of both bones f forearm abv insertion of pronator teres is immobilised in supination below insertion of pronator teres is immobilised in mid-neutral position.
-the proximal fragment of scaphoid fracture is more prone to avascular necrosis due to retrograde blood blow to proximal fragment
-lunate dislocation cn lead to medial nerve injury.
-incidence f injury in carpal bones is scaphoid>triquentral>trapezium>lunate.
-bennett:'s fracture is difficult to maintain in a reduced position due to pull of abductor pollicis longus.
-skiers thumb/gamekeepers thumb is n injury to ulnar collateral ligament of the metacarpo-pharyngeal joint.it is injured during skiing,holding a catch and twisting the neck of small animals.an incomplete rupture is treated conservatively with a thumbs spica or functional cast brace.a complete rupture is treated by surgical repair
-stener lesion occurs whn the adductor pollicis aponeurosis becomes interposed BTW the retracted ligament and this hinders healing.
-in pelvis fracture blood loss is 4-8units.
-jumpers fracture is a type f pelvic fracture
-kocher langenbeck approach is for posterior caudal exposure
-ilioinguinal approach is for internal or anterior approach.
-extended iliofemoral approach is to expose both the anterior and posterior columns.
-main blood supply to head f femur in adults is the lateral ascending cervical or retinacular and epiphyseal branches f medial circumflex femoral artery
-the commonest hip injury in the elderly patient is intertrochanteric (extra capsular fractures)
-occult fracture neck f femur best diagnosed by MRI
-maximum chances f avascular necrosis is subcapital fracture.
-fracture head f femur classified by Pipkin classification.
-femoral head palpable on per rectal examination in central dislocation f hip.
-paralysisf gluteus medius/minimus supplied by superior gluteal nerve causes trendelenburgs gait.
-upper 1/3rd shaft f femur mc fracture at birth
-maximum shortening f lower limb is seen in fracture shaft f femur and posterior dislocation f hip.
-in 90° flexion f knee the tibial tuberosity is in line with centre f patella on extension it moves towards the lateral border due to screw home mechanism
-people with anterior cruciate deficient knees have problem climbing downhill.
-dial test,tests posterolateral corner and positive cruciate ligaments
1)posterolateral corner deficiency positive at 30° flexion.
2)posterior cruciate ligament positive at both 30° and 90° flexion.
-physiological locking occurs with internal rotation f femur over fixed tibia by the quadriceps,unlocking refers to lateral rotation f femur over a stabilized tibia by the popliteus
-rotation force is most imp in causing meniscal injury.

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