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Practical Orthopaedics
Subhash Kakkad
1:
Heart-Lung Resuscitation
MODIFIED AFTER SAFAR
Phase I: First Aid (Emergency Oxygenation of the Brain)
If Victim is not Breathing
Phase II: Restoration of Spontaneous Circulation
Instruction for Use of Manual Resuscitator
Phase III: Follow-up Measures
Use of Manual Resuscitator (Fig. 1.5)
2:
Shock
DEFINITION
SIGN AND SYMPTOMS
CLASSIFICATION (Table 2.1)
I. Hypovolaemic (> 40% Loss of Intravascular Volume)
II. Cardiogenic
III. Obstructive Shock
Distributive (Septic)
Neurogenic
Others
Metabolic Shock
Allergic Shock
I. Hypovolaemic Shock
II. Cardiogenic Shock
Pathophysiology
Irreversible Shock
Endocrinal Response
Adrenal Medulla
Pituitory Adrenal Renal Stimulation
Postpituitary Stimulation
Renal Response
Changes in Blood
MANAGEMENT
Aims
Treatment
Ventilation
Arrest Bleeding
Fluid Therapy (accelarate to CVP)
Adjuvents Drugs
3:
Classification of Fractures of Long Bones
DEPENDING ON SEVERITY BY M.E. MULLER
Anatomic Location
Fracture Types (Fig. 3.3)
Example
Example
4:
Classification of Soft Tissue Injuries
GRADING OF SKIN INJURY
Scale
Skin Lesions
For Closed Fractures (Fig. 4.1)
Skin Lesion IO (Open Fractures) (Fig. 4.2)
Muscle/Tendon Injury (MT)
Neurovascular Injury (NG)
5:
Plaster of Paris Casts
SERIOUS COMPLICATIONS OF CASTS
Impairment of Circulation
To Prevent Vascular Complications
If Impairment of Circulation
Pressure Sores Develop under the Plaster due to:
Prevention
Diagnosis
Instructions to OPD Patient for Plaster Casts
Important
Removal of a Plaster Cast
How to Use Electric Power Saw
Precautions
Bivalve Cast
Cutting A Window
Replacement of a Window
Splitting a Plaster Cast
Wedging a Plaster Cast
6:
Management of Patients in Traction
PATIENT
Nursing Care
I. General Appearance
II. Observations and Charts
III. Bed and Bedding
IV. Food
V. Toilet
VI. Pain Relief
VII. Skin
VIII. Mental State
Communication
Medical Care
i. Blood loss
ii. Chest complications
iii. Urinary tract
iv. Bowels
v. Pre-existing conditions:
Care of the Injured Limb
THE TRACTION SUSPENSION SYSTEM
I. Bed and Balkan Beam
II. Splint
III. Slings and Paddings
IV. Skin Traction
V. Skeletal Traction
VI. Stirrups
VII. Cords
VIII. Pulleys
IX. Weights
RADIOGRAPHIC EXAMINATION
PHYSIOTHERAPY
REMOVAL OF TRACTION
7:
Limb's Traction
INDICATIONS
METHODS
SKIN TRACTION
Adhesive Skin Traction
Application
Lower Limb
Contraindications
Complications
SKELETAL TRACTION
Steinmann's Pin
Denham's Pin
Kirschner's Wire
Common Sites
Upper Limb
Lower Limb
Lower end of tibia
Application
Complications
FIXED TRACTION
SLIDING TRACTION
Buck's Traction
Indication
Application
Problems
Perkins Traction
Indication
Application
Hamilton Russel's Traction
Indication
Application
Tulloch Brown's Traction
Indications
Contraindication
Application
Ninety-Ninety Traction
Indication
Application
Complications
Sliding Traction in a Fisk Splint
Indication
Application
Sliding Traction with a Thomas’ Splint and Knee Flexion Piece
Indication
Application
Sliding Traction with Fixed Thomas’ Splint
Bryant's (or Gallows) Traction
Modified Bryant's Traction
Sliding Traction with Bohler Braun's Frame
Indications
Application
Disadvantages
Lateral Upper Femoral Traction
Indication
Application
Agnes Hunt's Traction for Correction of Flexion Deformity of Hip
Indication
Application
Dunlop Traction
Indications
Application
Circulatory Check Up
Olecranon Traction
Indication
Traction Force can be applied by:
Advantages
Application
Metacarpal Pin Traction
Indications
Applications
Complications
8:
Spinal Tractions and Tractions in Fracture Dislocations
NON-SKELETAL TRACTION HALTER
A Canvas or Chamois Leather Head Halter
Complication
Circle Head Halter
SKULL TRACTION OR SKELETAL TRACTION
Crutch Field Tongs
Application
Failure of Procedures
Cone (Barton) Tongs
Application
Halo Splint (Ace Cervical Traction Equipments)
Application
Pelvic Traction
Indication
Application
INTRODUCTION
Aims and Treatment
Management
Recommended Traction Weights
Important
Complication
9:
Functional Bracing
FUNCTIONAL BRACING
Contraindications
Material
BRACING OF FRACTURE TIBIA
Plaster of Paris Technique
Using Thermoplastic Material
BRACING FOR FRACTURES OF FEMUR
How to Apply Long Leg Cast Brace
General Preparation
Below Knee Cast
Thigh Cast
Hinges
Application
Polyethylene Hinges
Metal Hinges
Using Thermoplastic Material
When to Remove Brace
BRACING HUMERUS
Application
10:
Orthoses
PROSTHESIS
ORTHOSISM
TECHNICAL ANALYSIS FORMS
Terminology
Joint Movements
Diagnosis
Treatment
Checking an Orthoses
General
Foot-wear
Side-bars
Training to Use an Orthosis
Look After an Orthosis
11:
Spinal Orthoses
FUNCTIONAL ANATOMY OF SPINE
ORTHOSIS FOR THORACIC AND LUMBAR SPINES
FLEXIBLE—SUPPORTIVE SPINAL ORTHOSIS
Spinal Belts and Corset
Material Used
Reinforce with
Corsets
Extension
Sacroiliac Orthosis (SIO)
Lumbosacral Orthosis (LSO)
Thoracolumbosacral Orthosis (TLSO)
Fitting of Spinal Orthosis
Check the Orthosis
Introduction to Patient
RIGID SPINAL ORTHOSIS
Fitting of Rigid Spinal Orthosis
Moulded Spinal Orthosis
Fabric Spinal Orthosis
Rigid Spinal Orthosis
CORRECTIVE SPINAL ORTHOSIS
Milwaukee Brace (CTLSO)
Fitting and Checking
Advice to Patient and Parents
Boston Brace (CTLSO)
ORTHOSIS FOR CERVICAL SPINE
Temporary Felt or Foam Collar (CO)
Thomas's Collar (CO)
Moulded Cervical Orthosis (CO)
Plastazote
Polythene
Somi Brace (Sterno-occipital-mandibular-Immobilizer)
Four Postcervical Brace
Halo-Body Orthosis
MINERVA JACKET
12:
Lower Limb Orthosis
FUNCTIONS OF ORTHOSIS
WEIGHT-RELIEVING CALIPER (KAFO)
NON-WEIGHT RELIEVINGCALIPER (KAFO)
Basic Design
Upper End of a Caliper
Cuff Top
Block Leather Bucket Top
Pelvic Band and Hip Joint
Side Bar
Knee Joints
Heel Attachment of Side Bars
Heel socket
Stirrups
Ankle Joint
CONTROL OF ANKLE JOINT MOVEMENT (AFO)
Heel Stop
Toe Raising Devices
T-Straps
Retaining Straps and Bands
Ankle Strap
Calf Band and Anterior Thigh Pad
Knee Pad
Pattern–Ended Caliper (KAFO Weight-Relieving)
The Cosmetic Long Leg: Caliper (KAFO)
Advantages
13:
Foot-wear
THE NORMAL SHOE
The Upper
Sole
Heel
Linnings
Re-inforcements
CHECKING FOR CORRECT FOOT-WEAR
MODIFICATION
Ankle and Subtalar Joint
Ankle Stiffner
Rocker Bar
Outside Heel Float
Heel
Medial-longitudinal Arch
Insole
Shoe Alteration
Toes
14:
Short Lower Limb Compensation
FACTORS FOR SHORT LOWER LIMB COMPENSATION
CALCULATION
TYPES OF RAISED
15:
Walking Aids
WALKING AIDS USE
PARALLEL BARS
WALKING FRAMES
Standard Walking Frame
Gutter Frame (Forearm Walker)
Pulpit Frame (Atlas Adjustable Standing Aid)
Reciprocal Walking Frame
Rollator
CRUTCHES
Axillary Crutches
Elbow Crutches
Gutter Crutches
Crutch Walking
Swinging Crutch Gaits
Four Point Crutch Gait
Two Point Crutch Gait
Three Point Crutch Gait
WALKING STICKS
Choosing the Correct Stick
Adjustment
TRIPOD AND QUADRUPED WALKING
Tripod
Quadruped Walking Aid
Indication
Adjustment
16:
Tourniquets
INTRODUCTION
Types
Non-pneumatic
Danger
Digital Tourniquets
Pneumatic
Non-automatic
Automatic
Contraindications to Exsanguination
Contraindications to use of a Tourniquet
Sites for Applications
Width of Pneumatic Cuffs
Exsanguination
Application of an Esmarch Bandage
For Exsanguination
As a Tourniquet
Application of a Digital Tourniquet
Fingers and Toes
Finger by Using Surgical Glove Only
Application of Pneumatic Tourniquet
Tourniquet Time
Tourniquet Pressure
How and When Tourniquet is used
Danger of Tourniquet
Danger from Exsanguination
Dangers from the Pressure in the Cuff
Tourniquet Paralysis Syndrome
Dangers from Ischaemia
Post-tourniquet Syndrome
Prevention
Dangers from Bleeding after Closure of Wound
Dangers from Failing to Remove Tourniquet
Tourniquet Equipment Checkup
Records of Use of a Tourniquet
17:
Suture Materials
BLACK SILK
MERSILK
SUTUPACK
PROLENE
VICRYL
CHROMIC CATGUT
PLAIN CATGUT
18:
Basic Orthopaedic Techniques
USE OF CHISELS, OSTEOTOMES AND GOUGES
Osteotome
Chisels: Bevelled only on One Side
Gouges
OSTEOTOMY
Children
Osteotomy of Long Bone
Cancellous Bones
Adult
Osteotomy of Long Bones
Cancellous Bone
Wedge Osteotomy
Pre-operative Planning
Post-operative Care
DRILLING BONE
By Hand
Disadvantage
Technique
Power Drilling
Technique
Retrieval of a Broken off Drill Point
MEASURING THE DEPTH OF A DRILL HOLE
SAWING BONE
Sawing Bone by Hand
Amputation Saw
Gigli Saw
Machine Saw
Using the Circular Saw
Technique
Using Oscillating Saw
Using Reciprocating Saw
Cutting Bone with High Speed Burr
USE OF STAPLES
Applications
EPIPHYSIODESIS
Indications
Pre-requisite
Techniques
Post-operative
19:
Tendon Suturing
INDICATIONS
METHODS
End to End Suturing
Tension Adjustment
Preparing the Ends for Suture
Suture
Suture with Overlap and Interlacing
Techniques
Burying the Ends
Side-to-Side Suture
Considerations
ATTACHING TENDON TO BONE
Applications
Three Basic Methods
Suture to Adjacent Soft Tissues
Looping through Tunnel
Anchorage within Tunnel
20:
Suture of Divided Nerve
PRIMARY NERVE SUTURING
Pre-requisite
Techniques
Mobilization
Trimming of Cut Ends
Suturing
Closure
SECONDARY NERVE SUTURE
Technique
Mobilization
Resection of Ends Bulbs
Suturing
Application of Radioopaque Markers
Post-operative Management
21:
Minor Procedures
ANTERIOR TRANSPOSITION OF ULNAR NERVE
Technique
Position of Patient
Incision
Isolation of Nerve
Division of Flexor Muscle Origin
Division of Medial Intermuscular Septum
Resitting of Nerve
Closure
Post-operative
DECOMPRESSIONS
Sheath of Extensor Pollicis Brevis and Abductor Pollicis Longus (De-Quervain’ Syndrome)
Technique
Position of limb
Exposure and Division of Sheath
Closure
Post-operative
Carpal Tunnel at Wrist
Technqiue
Position of hand
INCISION-DRAINAGE
Fascial Spaces of Hand
Classification
Nail Fold and Sublingual Space Infection
Drainage
Pulp space (Whit-low)
Drainage
Other Subcutaneous Spaces
Drainage
Thenar Space
Medially
Forwards
Drainage
Mid-Palmar Space
Flexor Tendon Sheaths
Drainage
ACUTE (SUPPURATIVE) ARTHRITIS
Joints of Upper Limb
Shoulder
Aspiration (Fig. 21.11)
Drainage
Techniques
Posterior Drainage
After Treatment
Elbow
Aspiration (Fig. 21.12)
Drainage
Medial Drainage
Lateral Drainage
Posterior Drainage
After Treatment
Wrist
Aspiration (Fig. 21.13)
Drainage
Lateral
Medial
After Treatment
Joints of Lower Limb
Hip
Aspiration
Approach
Lateral
Anterior
Posterior
Drainage
Posterior (Ober) Drainage
Anterior Drainage
Lateral Drainage
Medial (Lud loff) Drainage
After Treatment
Complications
Knee
Aspiration (Fig. 21.15)
Drainage
Anterior
Posterolateral and Posteromedial (Henderson)
Posteromedial (Klein) Drainage
After Treatment
Ankle
Aspiration (Fig. 21.16)
Drainage – Approaches
Anterolateral
Posterolateral (David)
Anteromedial
Posteromedial
After Treatment
22:
Bone Screws
ANATOMY
Screw Head (Fig. 22.2)
A. Recess
B. Counter Sink
Under Surface of Head
Functions
Shaft
RUN-OUT
Thread
A. Core Diameter
B. Pitch
C. Lead
D. Outside Diameter (Thread diameter)
E. Thread Design
Tip: Four Common Types (Fig. 22.3)
A. Self-tapping
B. Non Self-tapping Tip
C. Cork Screw Tip
D. Trochar Tip
FULLY AND PARTIALLY-THREADED SCREWS
PARTIALLY-THREAD CORTICAL SCREW
CANCELLOUS SCREW
CANNULATED SCREWS
Large Used
Small Used
HERBERT SCREW (Fig. 22.4)
SCREW INSERTION
Drill Bit
Drilling
Drill size
Heat Generation in Drilling
Technique to Minimize Heat Production
Mechanics in Drilling
a. When Commencing the Drilling
b. Once Drilling Angle is Established
c. Drill Bit Failure
d. During drilling
e. Power Drill
PILOT HOLE
DRILL SLEEVE (DRILL GUIDE)
DRILLING DEPTH
LENGTH MEASUREMENT
COUNTER SINK
TAPPING
WASHERS
INSERTION OF SCREW
SCREW REMOVAL
SCREW FAILURE
LAG SCREW (Fig. 22.5)
23:
Bone Plates
CLASSIFCATION
NEUTRILIZATION PLATE (Fig. 23.1)
Clinical Application
COMPRESSION PLATE
Role of Compression
Type of Compression
Static Compression
Dynamic Compressor
Methods for Achieving Compression
Three Ways
Tension Device
Eccentric Screw Placement (Fig. 23.3)
BUTTRESS PLATE (Fig. 23.4)
CONDYLAR PLATE (Fig. 23.5)
PRINCIPLES OF PLATE FIXATION
Plate-Related
Length of Plate
Screw-related
Bone-related
Construct-related
Effect of Compression
Tension Band Plate
Prebending of Plate
Success of Bone Plate Fixation
Depends on
“Prebending Plates” (Fig. 23.6)
Plate-bending
How Many Screws
Double Plating
PLATE REMOVAL
24:
Medullary Nailing
INTRODUCTION
BONE REACTION
On Circulation
Effects of Reaming
Shape has Important Role
Diameter
Curves
Femur
Tibial Nail
Length and Working Length
Total Nail Length
Length of Nail Bone Contact
Working Length
Ends of Nails
Fixation Devices
Reamed and Non-reamed Nails
Reaming of Medullary Canal
Slotted and Solid Nail
Comparison of Slotted and Non-slotted Nail
For Distal Locking Screws Methods
Interlocking
Static Locking
Dynamic Locking
Dynamization
Open Nailing
Nail Removal
Difficult situations in nail removal
Extraction hook fails to hold
Bone growth along the tract of locking screw removed some time ago
Broken nail in a united fracture
Broken solid nail in united fracture
Protruding nail in healed-fracture and nail does not move
Impacted Nail
Stuck Nail can not be Removed
The Femur
Tibia
Humerus
Radius and Ulna
INTRA-MEDULLARY NAILING (FOR FEMUR AND TIBIA)
Indications
Instrumentation
Reaming the Canal
Nail Insertion
Locking Instrumentation
TECHNIQUE—FEMUR FOR CLOSED METHOD
Prerequisite
On fracture table (Fig. 24.6)
Lateral position
Supine Position (Fig. 24.7)
Without fracture table
Lateral position (Fig. 24.8)
Supine Position (Fig. 24.9)
Measurement of the length of nail
On Uninjured Leg
Comparative measurement
Incision
Make opening at piriformis fossa
Threading of Fragments
Reaming the Medullary Canal
Locking
Proximal
Distal
Techniques
Standard Technique with Aiming Device
Free-Hand Method
Other method
INTERLOCKING NAIL FOR FEMUR
TIBIAL NAILING
Indications
For Closed Method
Incision
Making an Opening
Insertion of Reaming Rod
Reaming
Length Determination
Nail Insertion
Locking (Fig. 24.22)
Post-operative Care
25:
The DHS/DCS System
INTRODUCTION
INSTRUMENTATIONS (Fig. 25.1)
DCS
Implant
Indication
Operative Technique
1. Fracture Reduction
Incision
Point of Entry of Pin
Angle of Version
Insertion of Final Guide Wire
Deciding Depth of Reaming
Reaming
Tapping
Selection of Lag–Screw
Insertion of Screw
Insertion of Barrel Plate
Fixation of Plate to Femur
Insertion of top screw
Extraction
DCS
Indication
UPPER FEMUR
Instrumentations
Implant
Technique
Fracture is Reduced and Held in Position
Point of Entry
Angle of Version
Insertion of Final Guide Wire
Deciding Depth of Reaming
Reaming
Tapping
Selection of Lag Screw
Insertion of DCS Screw
Insertion of Barrel Plate
Fixation of Plate to femur
Insertion of Top Screw
LOWER END OF FEMUR
Operative Technique
Removal of Implant
26:
The Angled Blade Plate System
INTRODUCTION
Indications
Implant
Single Angle
Double Angle
INSTRUMENTATION
Condylar Plate Instrument Set
Condylar Plating
Point of Entery
Lower end of femur
The Version Wire
Placement of Final Positioning Guide Wire
Preparation of Entry Tract
Insertion of Plate
CONDYLAR PLATE IN OSTEOTOMIES
27:
Fracture of Lower Humerus
FRACTURE ANALYSIS AND PLANNING
EXTRA-ARTICULAR FRACTURES
Avulsion Fractures of Epicondyles
Plan
Bending Fractures
Mechanism: Caused by
Fracture Pattern
Plan
ARTICULAR FRACTURES
Fracture of Lateral Condyle
Mechanism
Pattern
Plan
Technique
Fracture of the Capitullum
Mechanism
Pattern
Plan
Technique
T–Y Articular Fractures
Mechanism
Y Fracture
T Fracture
Variations
Approach: Posterior/Transolecranon Plan
Technique
28:
Fracture of Pelvis
MANAGEMENT
Depends on
Pelvic Stability
Principles
PLANNING OF TREATMENT
External Rotation Type (A–P, Compression)
Stable type
Unstable type
Internal Rotation Type (Lateral Compression)
Ipsilateral type
Contralateral Type
Vertical Shear
Unilateral
Bilateral
TECHNIQUE OF STABILIZATION
External Fixation
Indication
Schanz Screw Placement
FRAME CONSTRUCTION
INTERNAL FIXATION
Posterior Injury Complex
Indications
Technique
Iliac Fractures
Sacral Fracture
Internal Fixation
Anterior injury complex
Indication
Contraindic-ation
29:
Fracture of Acetabulum
INTRODUCTION
Assessment
ACETABULAR ARCHITECTURE
Classification
Decision Making and Principles
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Step 7
ANALYSIS OF INJURY PATTERNS
Anterior Instability
Anterior Lip Fracture
Anterior Column Fracture
Bicolumnar Fracture with Anterior Instability
Radiographic Assessment
Posterior Instability
Posterior Lip Fracture
Posterior Column Fracture—
Bicolumnar Fracture with Posterior Instability
Medial Instability
Low Transverse Fracture
NON-OPERATIVE TREATMENT
Indications
Methodology of Non-operative Treatment
Surgical Management
SURGICAL APPROACH
Kocher—Langenback
Ilioinguinal
Straight Lateral
Extended Iliofemoral
Standard Posterior Approach
Kocher-Langenbeck Approach
Ilioinguinal Approach
Iliofemoral Approach
Combined Approach
Extensile Approaches
Extended Iliofemoral Approach
Triradiate Approach
Postoperative Care
30:
External Fixation
TYPES OF FRAME
CHOICE OF FRAME
BIOMECHANICS
Mechanics of Bone Pin Interface
Mechanics of Bone-Fixator Composite
BASIC REQUIREMENT (Fig. 30.1)
Schanz Screws
Clamps
Tubes 11 mm (Outer Diameter)
Instruments
OPERATIVE TECHNIQUE
Unilateral Frame
Indications
Requirement
Procedure
Delta Frame
Indications
Requirement
Procedure
Three Tube Assembly
Indications
Requirement
Procedure
‘T’ Assembly using the Transverse Pin
Adjusting Clamp
Requirement
Procedures
31:
Hand Bones Fracture Frame
INTRODUCTION
It Provides
Indications
Basic Components
Link Joints
Connecting Rods
K-Wires
Hinges
Plates
Threaded Sleeves and Nuts
Link Joints
Mini Link Joint
Medium Link Joint
Large Link Joint
Modified Link Joints
Sliding link joint
Connecting Rods
K-Wires
Distraction/Compression External Fixators
Standard D/C External Fixator
Small D/C External Fixator
Large D/C External Fixator
Extralong D/C External Fixator
Swivel D/C External Fixator
vi. Open month D/C External Fixator
Turn Buckle D/C External Fixator
Modified D/C External Fixators
Hinges
Uniaxial uniplanar hinge
Biaxial uniplanar hinge (Fig. 31.20)
Biaxial biplanar hinge (Fig. 31.21)
Threaded-nuts
Distraction nuts
Hex nut
SAFE ZONES FOR WIRE PENETRATION
Phalanges (Fig. 31.24)
Distal
Middle
Proximal
METACARPALS (Fig. 31.27)
Radius and Ulna (Fig. 31.28)
Thumb (Fig. 31.29)
FRAME CONSTRUCTION
Lateral Frame
Collateral (Bilateral) Frame
Ray Frame (Fig. 31.30)
Frame Constructions for
Modified Ray Frame (Fig. 31.31)
Multiple Ray Extensions to the Digits
U-Frame (Fig. 31.32)
L-Frame (Fig. 31.33)
Delta Frame (Double Dorsolateral Frame) (Fig. 31.34)
J-Frame (Fig. 31.35)
Syndactyly Frame (Fig. 31.36)
Web-Space Frame (Fig. 31.37)
32:
Therapies
HYDROTHERAPY (POOL THERAPY)
ELECTROTHERAPY
PARAFFIN WAX
INFRA-RED RADIATIONS
Heat Pad
Hot Moist Packs
Short Wave Diathemoy (SWD)
Microwave Diathermy
Cooling of Tissues—Ice Therapy
Ultrasound
Ultravoilet Rays (UVR)
Source
Physiological Effects
Local Effects
Desquamaton (Peeling)
Pigmentation
Thickening of epidermis
Antibiotic effect
General Effects
Formation of Vit D
Therapeutic Effects (Indications)
Contraindications
LASER
Medium Frequency Currents
Indications
Contraindications
Lower Frequency Current
Faradic Current
Direct Current
Use of Faradic Type of Current (Indications)
Muscle Testing
Transcutaneous Electrical Nerve Stimulation (TENS)
Uses (Indications)
Contraindications
33:
Guidelines for Evaluation of Permanent Physical Impairment
KESSLER'S METHOD
UPPER LIMB
ARM—COMPONENT
HAND COMPONENT
AT A GLANCE:
LOWER LIMB
Mobility Component (90%)
Evaluation of Range of Motion
Evaluation of Muscle Strength (90%)
Combining value for mobility component
Combining Values
Stability Component (90%)
Tested by Two Methods
Extra-Points
SPINE (TRUNK)
TRAUMATIC LESIONS
Cervical
Cervical Spine Fracture
Thoracic and Dorsolumbar Spine Fracture
Low Lumber
NON-TRAUMATIC LESIONS
Scoliosis
1. Kobb's method for measurement of angle of curve in standing position is used:
Miscellaneous
2. Kyphosis
For Dorsal Spine
Paralysis of Flexors and Extensors of Dorsal and Lumbar Spine
Paralysis of Muscles of Cervical Spine
Rating of Motor Power
AMPUTEES
Guidelines
Upper Limb Amputation
Lower Limb Amputations
NEUROLOGICAL CONDITIONS
Guidelines
BURNS
Split up of ten point formula for each component:
Trunk and Genitalia
Split up of Trunk and Genitalia
FACIAL INJURIES
POLIOMYELITIS
Example 1: Foot drop
Calculation of loss of range of motion at ankle
Calculation of loss of muscle strength at ankle
Stability Component
Example 2: Foot drop with gross equinus contracture
Mobility Component
Stability Component
Example 3: Total paralysis of one lower limb requiring one full caliper
Mobility Component
Example 4: Total paralysis of both lower limbs with flexion contractures hips and knees
Example 5: Paralysis of one upper limb flail from shoulder downwards
LEPROSY
Example 1:
Example 2:
Hand Component
Hand Component
ARTHRITIS
Example
CARDIOPULMONARY DISEASE
Basic Guidelines
INDEX
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