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Textbook of Orthopedics and Trauma (4 Volumes)
GS Kulkarni
SECTION 1: INTRODUCTION AND CLINICAL EXAMINATION
1:
Introduction and Clinical Examination
INTRODUCTION
DOCUMENTATION
Examination of the Patient
Armamentarium Necessary for Examining an Orthopedic Patient
Certain Factors Essential for Examining an Orthopedic Case
History Taking
Chief Orthopedic Complaints
History of Present Illness
History of Past Illness
Examination
General Examination
Systemic Examination
Regional Examination
Local Examination
Palpation
Measurements
Types of Joint Stiffness (Table 2)
Power of Controlling Muscles (Table 3)
Heel Walking/Toe Walking
Peripheral Circulation
Peripheral Nerves (e.g. lateral popliteal nerve, ulnar nerve, etc.)
Investigations
General Investigations
Special Investigations
Electrical Investigations
Radiological and Allied Investigations
Clinical Diagnosis
2:
Damage Control Orthopedics
HISTORICAL PERSPECTIVES
THE CONCEPT OF DAMAGE CONTROL SURGERY
THE ALGORITHM OF DAMAGE CONTROL SEQUENCE
SECTION 2: BASIC SCIENCES
3:
Function and Anatomy of Joints
TYPES OF THE JOINTS
Synarthroses or Fibrous Joints
Sutura
Syndesmosis
Gomphosis
Amphiarthroses or Cartilaginous Joints
Symphyses
Synchondrosis
Diarthroses or Synovial Joints
Structure of a Typical Synovial Joint
Joint Capsule
Neurovascular Supply
Synovial Fluid
TYPES OF DIARTHRODIAL OR SYNOVIAL JOINTS
Uniaxial Joint
Ginglymus or Hinge Joint
Trochoid or Pivot Joint
Biaxial Diarthrodial Joints
Condyloid Joints
Saddle Joints
Triaxial or Multiaxial Joints
Plane or Gliding Joints
Ball and Socket Joints
Function of the Joints
BIBLIOGRAPHY
INTRODUCTION
Histology
Synovial Fluid
Joint Lubrication1
Boundary Lubrication
Fluid Film Lubrication
Elastohydrodynamic Lubrication
Boosted Lubrication
Mechanism of Joint Lubrication2
4:
Growth Factors and Fracture Healing
GROWTH FACTORS: GENERAL CONCEPTS
MOLECULAR ASPECTS OF FRACTURE HEALING (TABLE 1)
Acute Phase Reactants
Interleukin-1 (IL-1)
Interleukin-6 (IL-6)
Tumor Necrosis Factor-alpha (TNF-α)
Growth and Differentiating Factors
Bone Morphogenetic Proteins (BMPs)
Transforming Growth Factors (TGFs)
Fibroblast Growth Factors (FGFs)
Platelet Derived Growth Factor (PDGF)
Insulin like Growth Factors (IGFs)
Angiogenic Factors
THE HEALING CASCADE AND ROLE OF GROWTH FACTORS
INHIBITOR MOLECULES
CARRIERS AND DELIVERY SYSTEMS FOR GROWTH FACTORS
Gene Therapy as a Method of Growth Factor Delivery
CLINICAL APPLICATIONS
Fracture Healing
Spinal Fusion
FUTURE
5:
Metallurgy in Orthopedics
6:
Pathophysiology of Spinal Cord Injury and Strategies for Repair
PATHOPHYSIOLOGY OF SPINAL CORD INJURY
Primary and Secondary Injury
Vascular Events of Secondary Injury
Biochemical Events of Secondary Injury
Excitotoxicity
Formation of Free Radicals and Nitric Oxide
Mitochondrial Damage
Cellular Reaction of Secondary Injury
Invasion of Neutrophils
Microglia Activation and Invasion of Macrophages
Lymphocyte Infiltration
Astrocytic Activation
Apoptosis
Wallerian Degeneration and Demyelination
STRATEGIES FOR REPAIR
NEUROPROTECTION
STIMULATING AXONAL GROWTH
Inhibiting the Inhibitors
Myelin and Myelin Derived Molecules
Astrocytes and the Glial Scar
Growth Enhancers
BRIDGING THE SITE OF SCI
OVERCOMING CONDUCTION BLOCK
REHABILITATION AND CNS PLASTICITY
7:
The Stem Cells in Orthopedic Surgery
SOURCES OF STEM CELLS
Embryonic Stem Cells (ES Cells)
Adult Stem Cells
ORTHOPEDIC APPLICATIONS OF STEM CELL TECHNOLOGY
Cartilage Repair
Critical Bone Defects and Nonunion
Spinal Cord Regeneration
ACL Reconstruction Augmentation and Meniscal Tear Repairs
Muscular Dystrophies
Spinal Fusion
Osteogenesis Imperfecta
Intervertebral Disc Regeneration
Tendon and Ligament Repair
Challenges
8:
Bone: Structure and Function
INTRODUCTION
Functions
Macroscopic Structure
Arrangement of Bony Lamellae
Haversian System in Compact Bone
Periosteum
Structure of Periosteum
Blood Supply of Long Bone
Arterial Supply
Blood Supply of Other Bones
Venous Drainage
Nerve Supply
Marrow
Hemodynamic Regulation of Bone Blood Flow
Bone Cells
Osteoprogenitor Cells
Osteoblasts
Osteocytes
Osteoclasts
Other Cells
Chemical Composition of Bone3
Collagen
Noncollagenous Proteins of Bone
Chemical Nature
Location of the Mineral Phase of Bone
Mechanism of Calcification
Water Content of the Bone
Citrate
Bone Enzymes
Bone Remodeling
Phases of Remodeling5
Regulation of Bone Cell Function
Peptide Growth Factors
Cytokine Effects on Bone Resorption
Prostaglandins
Electrical Phenomena and their Effect on Bone Cell Function
Bone Growth and Development
Intramembranous Ossification
Endochondral Ossification
Epiphyseal Growth
Zones of Epiphysis
Remodeling the Structure of Bone
Skeletal Growth and Development
Maturity
Sex Differences
Prediction of Adult Height (Weech)
Factors Affecting Skeletal Growth
Local Factors Affecting on Bone Growth4
9:
Cartilage: Structure and Function
INTRODUCTION
Structure
Peculiarities of the Cartilage
Ossification of the Cartilage
Types of the Cartilages
Cellular Cartilage
Hyaline Cartilage (Fig. 2A)
White Fibrocartilage (Fig. 2B)
Elastic Fibrocartilage (Fig. 2C)
Articular Cartilage
10:
Structure and Function of Muscle, Ligaments and Tendon: Muscle: Structure and Function
VOLUNTARY MUSCLE
Parts of Voluntary Muscle3,4
Functions of Tendon1
Types of Insertion of Muscles
Classification of Voluntary Muscles
According to the Color
According to the Direction of the Muscle Fibers
According to the Force of Actions
Some Observations
Contraction of Muscles
Action of Muscles5,6
Prime Mover
Antagonists
Fixation Muscles
Synergists
Bones and Muscles as Body Lever Systems
Classes of Lever
First Class Lever
Second Class Lever
Third Class Lever
Structure of Voluntary Muscle
Cytology
Sarcolemma
Sarcoplasm
Nuclei
Myofibrils
Myofilaments
Mitochondria
Sarcoplasmic Reticulum
Functions of Sarcoplasmic Reticulum (Fig. 13)
Paraplasmic Granules
Organization of Skeletal Muscles (Fig. 14)
Histogenesis of Striated Muscle Fibers (Fig. 15)
Growth and Regeneration
Vascular Supply of Voluntary Muscles
Methods of Entrance of the Arteries
Lymphatic Supply
Nerve Supply of Voluntary Muscles
Motor Supply
Sensory Nerves
Response to Immobilization, Exercise and Resistance Training
11:
Tendons and Ligaments: Structure and Function
INTRODUCTION
Response to Injury and Mechanism of Repair1
LIGAMENTS
Transition from Ligament to Bone
Factors Affecting Failure of Ligament1
Mechanism of Repair
Factors Affecting Ligament Healing
Grafts for Reconstruction
SECTION 3: DIAGNOSTIC IMAGING IN ORTHOPEDICS
12:
MRI and CT in Orthopedics
INTRODUCTION
PRACTICAL CLINICAL APPLICATIONS
Applications in Spine
Normal MRI Appearance of the Spine
Common Clinical Indications for Spine Imaging
Degenerative Disk Disease
The Lumbar Intervertebral Disk Degeneration
The Lateral Recess
Peripheral Hyperintense Zones (PHZ)
ENDPLATE CHANGES
Spondylolysis and Spondylolisthesis (Figs 12A to 13B)
CERVICAL DEGENERATIVE DISK DISEASE (FIGS 14A TO C)
SPINAL CANAL STENOSIS
Ossified Posterior Longitudinal Ligament (OPLL)
IMAGING OF THE POSTOPERATIVE SPINE
DISK vs Epidural Scar (Figs 21 to 23)
Role of CT (Figs 24 to 26)
SPINAL INFECTIONS (FIGS 27 TO 33)
NON INFECTIVE INFLAMMATORY PATHOLOGIES OF THE SPINE
NONCOMPRESSIVE SPINAL CORD ABNORMALITIES
Spine Trauma
Cervical Spine Trauma (Figs 36 to 39)
Trauma to Specific Areas of Spine (Fig. 40 to 45)
CV Junction
Brachial Plexus Injuries (Figs 46A and B)
INJURIES TO THE THORACIC AND LUMBAR SPINE
Sacral Fractures (Figs 47 to 49)
MRI Evaluation of Congenital Anomalies of the Spine
Scoliosis
SPINAL NEOPLASMS
Normal and Abnormal Bone Marrow
THE ROLE OF CT AND MRI IN BONES AND JOINTS
Musculoskeletal Trauma
Trauma to the Appendicular Skeleton (Figs 63 and 64)
STRESS AND INSUFFICIENCY FRACTURES
Muscle and Tendon Tears (Figs 67 to 69)
Role of CT (Figs 70 to 73)
IMAGING OF INDIVIDUAL JOINTS (FIGS 74 TO 77)
Hip Joints
Pediatric Hip (Figs 78 to 80)
TRANSIENT OSTEOPOROSIS
KNEE JOINTS (FIGS 82 TO 95)
OSTEOARTHROSIS (FIG. 97)
ANKLE JOINT AND FOOT (FIGS 98 AND 99)
Role of CT
SHOULDER JOINT (FIGS 105 TO 114)
WRIST AND HAND (FIGS 115 TO 119)
ELBOW JOINT
TEMPOROMANDIBULAR JOINT
BONE AND SOFT TISSUE TUMORS
CT and MR Imaging of Bone Tumors
MRI Appearance of Various Common Bone Tumors
Unicameral Bone Cyst/Simple Bone Cyst
Aneurysmal Bone Cyst (Figs 121 to 123)
Osteochondroma (Figs 124 and 125)
Osteoid Osteoma (Fig. 126)
Giant Cell Tumor (Figs 127 and 128)
Osteosarcoma (Figs 129 to 131)
Ewing's Sarcoma
Metastatic Disease
Soft Tissue Tumor's
Hemangioma and Lymphangioma (Figs 132 to 140)
Postoperative Changes
Musculoskeletal Infection
Bone and Joint Infection (Figs 141 to 148)
VASCULAR IMAGING (FIGS 149 TO 151)
13:
Musculoskeletal Ultrasound
INTRODUCTION
SONOGRAPHIC APPEARANCE OF NORMAL ANATOMIC STRUCTURES
Muscles and Tendons
APPLICATIONS
Imaging of Joints
Hip Joint
Shoulder Joint (Figs 2 to 4)
ULTRASOUND OF HAND AND WRIST (FIGS 6 TO 7)
USG KNEE (FIGS 8 TO 10)
USG OF ANKLE AND FOOT (FIGS 11 TO 13)
ULTRASOUND OF THE SOFT TISSUES (FIGS 14 TO 17)
Evaluation of Muscles and Tendons
Vessels (Figs 18 to 23)
Soft Tissue Tumors (Figs 24 to 28)
MISCELLANEOUS (FIGS 29 TO 33)
14:
Nuclear Medicine in Orthopedics
INTRODUCTION
OCCULT FRACTURES
Delayed Union, Nonunion
Insufficiency Fractures
Nonaccidental Trauma
SPORTS INJURIES
Stress Fractures
Periostitis
Shin Splints
Avulsion Injuries
Myositis Ossificans
Rhabdomyolysis
Compartment Syndrome
Complex Regional Pain Syndrome
BONE GRAFT VIABILITY
ENTHESOPATHIES3
OSTEOMYELITIS
Periprosthetic Infection
Avascular Necrosis (AVN)5
JOINT PATHOLOGIES
RHEUMATOID ARTHRITIS
Ankylosing Spondylitis
Osteoarthritis
BONE TUMORS AND METASTATIC BONE DISEASE
METABOLIC BONE DISEASE
THERAPEUTIC APPLICATIONS
SECTION 4: METABOLIC BONE DISEASES
15:
Osteoporosis and Internal Fixation in Osteoporotic Bones
INDIAN STATISTICS
WORLD STATISTICS
DEFINITION
WHO DEFINITION
GRADING: (WHO)
GENERALISED OSTEOPOROSIS
Primary
Secondary (Table 1)
Idiopathic Juvenile Osteoporosis
Localised Secondary Osteoporosis
BIOLOGY AND BIOMECHANICS
Changes in Cortical Bone
Changes in the Cancellous Bone
Bone Cells and Bone Remodeling
DISABILITY DUE TO OSTEOPOROSIS
SEQUELAE OF OSTEOPOROSIS
Assessment of Osteoporosis
Radiographic Photodensitometry
Dual-energy X-ray Absorptiometry
CONVENTIONAL SKELETAL RADIOGRAPHY
Radiogrammetry—Bone Desitometry
ASSESSMENT OF VERTEBRAL FRACTURE AND DEFORMITIES
Bone Mineral Densitometry
DENSITOMETRY
Indications for BMD
PREVENTION OF OSTEOPOROSIS AND FALLS PREVENTION OF REFRACTURE
Orthogeriatric Unit
Prevention of Osteoporosis
Prevention of Fall
MARKERS
Biochemical Markers of Bone-turnover
Markers of Bone Formation
Markers of Bone Resorption
PATHOGENESIS
Peak Bone Mass
The Effect of Osteoporosis on Fixation
Medical Treatment of Osteoporosis
Hormonal Replacement Therapy (HRT)
Selective Estrogen Receptor Modulators (SERMs)
Raloxifene
Antiresorptive Drugs
Biphosphonates
Complication of Biphosphonate
Gorham-Stout Syndrome
Calcium and Vitamin D
Fastest way to Reduce Fragility
Calcitonin
Fluoride
Strontium
Osteoporosis in Men
Treatment
Testosterone
Anabolic Steroids
Lifestyle
Smoking
Alcohol
Nutrition
Principles of Internal Fixation of Osteoporotic Bone
Load Sharing Device
Biologic Fixation
Impaction and Compression
Wide Buttress
Long Splintage
Replacement
Internal Fixation Using Plates
AUGMENTATION
CEMENT
Use of Cement
PMMA Bone Cement
Norian SRS for Distal Radius
HA GRANULES
Indications
HA Coated Pins and Screws (Fig. 9)
RESORBABLE POLYMERS
BONE GRAFTING (BG)
Cancellous Bone Graft
Corticocancellous BG Indications
Disadvantages
Quantity Less
Fibular Strut Graft
Tricortical Graft (Fig. 11)
Indications Similar to Fibular Strut Graft
Internal Fixation by Screws
K-Wires
Plating
Interlocking Intramedullary Nail
Advantages of Intramedullary Nail
Problems of Nailing in Osteoporotic Bone
Problem of Distal Locking is Loosening
EXTERNAL FIXATION IN OSTEOPOROTIC BONE IMPLANTS (FIG. 15)
ILIZAROV METHOD IN OSTEOPOROTIC BONE
FRACTURE PROXIMAL HUMERUS
DISTAL RADIUS (FIG. 16)
FRACTURE NECK FEMUR (FIGS 17 TO 19)
FRACTURE SUBTROCHANTER (FIG. 20)
Analgesia (Gary Heyburn)
Inter-trochanteric Fracture
Treatment
INTERNAL FIXATION OF VERTEBRAL FRACTURES
TIBIAL PLATEAU FRACTURE IN OSTEOPOROSIS BONES
16:
Vertebroplasty for Osteoporotic Fractures
INTRODUCTION
DIAGNOSTIC TOOLS
MRI
Kyphoplasty
Indications for Vertebral Augmentation (Vertebroplasty or Kyphoplasty)
Contraindications for the Vertebroplasty and Kyphoplasty Procedures
Relative Contraindications for the Vertebral body Augmentation (Vertebroplasty or Kyphoplasty)
MATERIAL
METHODS
Approach
Anesthesia
RESULTS
CASES
Case 1
Case 2
Case 3:
CONCLUSION
DISCUSSION
FUTURE OF VERTEBROPLASTY AND VCF TREATMENT
17:
Ochronosis
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL FEATURES
RADIOLOGIC FEATURES
Spinal Abnormalities
EXTRASPINAL ABNORMALITIES
LABORATORY INVESTIGATIONS
MANAGEMENT
18:
Gout
DEFINITION
INCIDENCE
ETIOLOGY
PATHOLOGY
OVERPRODUCTION OF URIC ACID (TABLE 1)
UNDEREXCRETION OF URIC ACID (TABLE 1)
CLINICAL PRESENTATION
ACUTE GOUTY ARTHRITIS
INTERVAL GOUT
CHRONIC TOPHACEOUS GOUT
RENAL MANIFESTATIONS16,17
DIAGNOSTIC EVALUATION
TREATMENT
ACUTE GOUTY ARTHRITIS
PREVENTION OF RECURRENT ATTACKS
19:
Crystal Synovitis
INTRODUCTION
GOUT AND PSEUDOGOUT
Etiopathogenesis
Diagnosis
CPPD DISORDER1
Treatment2
ACUTE SYNOVITIS
Treatment
20:
Rickets
INTRODUCTION
Action of Vitamin D
Intestine
Bone
Kidneys and Parathyroid Glands
REGULATORS OF 1,25-DIHYDROXY D3 PRODUCTION
RICKETS
PHYSIOLOGICAL CONSIDERATIONS
Clinical Diagnosis of Rickets
PATHOANATOMY OF RICKETS
Etiology
Pathogenesis
TREATMENT
Renal Rickets
Familial Hypophosphatemic Rickets
Vitamin D-Dependent Rickets (Type 1 pseudodeficiency rickets)
Vitamin D–Resistant Rickets (Type 2 Pseudodeficiency Rickets)
Renal Fanconi's Syndrome
Cystinosis
Oculocerebrorenal Dystrophy
Renal Tubular Acidosis
Renal Osteodystrophy
Aluminium Toxicity
Other Causes of Rickets
Rickets due to Malabsorption Syndromes
Rickets in Liver Disorders
Rickets Associated with Prematurity
Neonatal Rickets
Oncogenic Rickets
Ricket Simulating States
Metaphyseal Dysplasia
Idiopathic Alkaline Hypophosphatasia
Various Clinical Presentations
Laboratory Diagnosis
21:
Scurvy and Other Vitamin Related Disorders
INTRODUCTION
Metaphyseal Changes
ADULT SCURVY
Laboratory Tests
Differential Diagnosis
Treatment
22:
Mucopolysaccharidosis
INTRODUCTION
CLINICAL AND RADIOGRAPHIC FEATURES
Mucopolysaccharidosis I-H (Hurler's syndrome, gargoylism)
Mucopolysaccharidosis II (Hunter Syndrome)
Mucopolysaccharidosis III (Sanfilippo26 Syndrome)
Mucopolysaccharidosis IV (Morquio21 Syndrome)
Treatment
Mucopolysaccharidosis V (Scheie Syndrome)
Mucopolysaccharidosis VI (Maroteaux-Lamy18 Syndrome)
MPS VII (Sly's Syndrome)
ASPARTYLGLUCOSAMINURIA
MANNOSIDOSIS
FUCOSIDOSIS
GM1 GANGLIOSIDOSIS28
23:
Fluorosis
INTRODUCTION
ETIOLOGY
INCIDENCE
PATHOLOGY
HISTOLOGY
CLINICAL FEATURES
Skeletal Fluorosis
Dental Fluorosis
Neurological Fluorosis
RADIOLOGICAL FEATURES (FIG. 8)
INVESTIGATIONS
TREATMENT
PREVENTION
24:
Osteopetrosis
INTRODUCTION
Etiology7
Pathology
Clinical Features5
Prognosis
TREATMENT
Orthopedic Problem
SECTION 5: ENDOCRINE DISORDERS
25:
Endocrine Disorders
ACROMEGALY
CUSHING DISEASE, SYNDROMES AND STATES
THYROID DYSFUNCTION AND BONES
MYXEDEMA
Thyrotoxicosis and Bone
DIABETES MELLITUS1–3
GROWTH RETARDATION (GR)1–5
Pregnancy and Bone
REFERENCES
Thyrotoxicosis and Bone
Pregnancy and Bone
Growth Retardation
Diabetes Mellitus
26:
Hyperparathyroidism and Bone
PARATHYROID GLANDS AND PARATHYROID HORMONE ANATOMY
PRIMARY HYPERPARATHYROIDISM (OSTEITIS FIBROSA CYSTICA, VON RECKLINGHAUSEN'S DISEASE)
Pathology
Skeletal Changes
Clinical Presentations of Primary Hyperparathyroidism
Laboratory Diagnosis of Primary Hyperparathyroidism
Radiological Diagnosis
Subperiosteal Resorption (Figs 1A and B)
Brown Tumours
CPPD Deposition
Management (Figs 4A to C)
Differential Diagnosis of Hypercalcemia
SECONDARY HYPERPARATHYROIDISM
TERTIARY HYPERPARATHYROIDISM
Hypoparathyroidism
SECTION 6: BONE AND JOINT INFECTIONS
27:
Pyogenic Hematogenous Osteomyelitis: Acute and Chronic
INTRODUCTION
Etiology
PATHOPHYSIOLOGY
MICROORGANISMS
OSTEOMYELITIS OF NEONATES AND EARLY INFANCY
PATHOPHYSIOLOGY
Signs and Symptoms
INVESTIGATIONS
TREATMENT
COMPLICATIONS
ACUTE HEMATOGENOUS OSTEOMYELITIS OF CHILDHOOD: CLINICAL MANIFESTATIONS
SIGNS AND SYMPTOMS
INVESTIGATIONS
TREATMENT
Surgery
OTHER COMPLICATIONS
ACUTE SEPTICEMIC SHOCK
CHRONIC HEMATOGENOUS OSTEOMYELITIS
DIAGNOSIS
INVESTIGATIONS
RADIOGRAPHIC APPEARANCE
RADIONUCLIDE STUDIES
TREATMENT
General Treatment
LOCAL TREATMENT
WOUND CLOSURE AFTER OPERATION
HEMATOGENOUS OSTEOMYELITIS OF ADULTS
HEMATOGENOUS OSTEOMYELITIS (DE NOVO) OF ADULTS
INVESTIGATIONS
TREATMENT
Vertebral Osteomyelitis
INVESTIGATIONS
Blood Culture
RADIOLOGICAL FINDINGS
DIAGNOSIS
TREATMENT
28:
Septic Arthritis in Adults
INTRODUCTION
Indirect Spread (Hematogenous)
Direct Spread
Contiguous Spread
PATHOLOGY
INVESTIGATIONS
TREATMENT (FIG.3)
29:
Fungal Infections
INTRODUCTION
MYCETOMA
Historical Account
Etiology
Pathogenesis and Pathology
Clinical Features
Site of Lesion
Symptoms
Physical Signs
Radiographic Findings
Laboratory Investigations
Differential Diagnosis
Treatment
CANDIDIASIS
Site of Lesion
Diagnosis
Treatment
CRYPTOCOCCOSIS
Pathology
Signs and Symptoms
Diagnosis
Treatment
HISTOPLASMOSIS
Diagnosis
Treatment
BLASTOMYCOSIS
Diagnosis
Treatment
COCCIDIOIDOMYCOSIS
Diagnosis
Treatment
SPOROTRICHOSIS
Diagnosis
Treatment
Aspergillosis
Diagnosis
Treatment
FUNGAL OSTEOMYELITIS
30:
Miscellaneous Types of Infections
INTRODUCTION
PATHOGENESIS
CLINICAL FEATURES1
DIAGNOSIS2
MANAGEMENT
REFERENCES
INTRODUCTION
Causative Agent
Susceptible Animals
Mode of Infection
Acute Infection
Chronic Infection
Pathology at the Lesion5–7
Clinical Manifestations
Diagnosis
Treatment
BIBLIOGRAPHY
INTRODUCTION
CLINICAL FEATURES
RADIOLOGICAL FEATURES
Metaphyseal
Periosteal
Diaphyseal
PATHOLOGY
DIFFERENTIAL DIAGNOSIS
TREATMENT
BIBLIOGRAPHY
INTRODUCTION
PATHOLOGY
CLINICAL FEATURES
RADIOGRAPHIC FINDINGS
TREATMENT
BIBLIOGRAPHY
31:
PREVENTION OF INFECTION: Surgical Site Infection
INTRODUCTION
Historical Aspects
Methods of Cleaning Air2,20
Laminar Flow
Ultraviolet Light System
Garment Barrier9
Host Defense Mechanism14
Organisms16
Susceptibility of Bone to Infection
Topical use of Antibiotics22,23
Clinical Presentation of Postoperative Infection10
Diagnosis of Infection
Treatment of Postoperative Infection17
SUMMARY
32:
Prevention of Surgical Site Infection in India
INTRODUCTION
Layout and Design of the Operation Room (OR) Complex of a Proposed Hospital Building
The Surgical Scrub Basin
Cleaning and Sterilization of Surgical Equipment
Ventilation
Surface Cleaning and Disinfection
Use of Other Chemical Disinfectants
Fumigation Practices
Work Related Issues
Preoperative Preparation of the Patient and the Surgical Site
Antibiotic Prophylaxis
Surveillance Programs for Surgical Site Infection
Disposal of Biomedical Waste
HIV INFECTED CASES
Water Supply
Reprocessing of Single Use Items
SURGICAL ATTIRE AND DRAPES
MICROBIOLOGIC SAMPLING
INFECTED AND COLONIZED PERSONNEL
33:
AIDS and the Orthopedic Surgeon
INTRODUCTION
AIDS
Immunopathogenesis of AIDS
Clinical Spectrum of HIV Infection in AIDS
Referring Specimens for Laboratory Diagnosis
Laboratory Diagnosis of AIDS
Merits of ELISA
Demerits of ELISA
INVESTIGATIONS FOR A KNOWN HIV PATIENT
CD-4 Counts (600-1500 cells/ul)
VIRAL LOAD ASSAYS
Management
Basic Steps to Avoid Exposure to HIV in the Health Care Setting
Barrier Precautions for High Risk Procedures
In Case of Needle Stick Injury
Sterilization and Disinfection of Equipments
Precautions for Handling Spilled, Potentially Contaminated Fluids
Human Rights, Discrimination and Isolation
HIV AND THE ORTHOPEDIC SURGEON
Orthopedic Surgery and HIV
Trauma and the HIV Patient7,8
Polytrauma
Closed Fractures
Compound Fractures
Fracture Union
Implant Removal and Late Sepsis
Hemophiliacs and HIV13,14
Arthroplasty and HIV8,14
Cold Surgery10
Bone and Joint Tuberculosis
Other Musculoskeletal Infections
Tropical Pyomyositis10
Adult Long Bone Hematogenous Osteomyelitis
Reactive Arthritis and Other Rheumatological Conditions
Risks of Treating HIV-Positive Orthopedic Patients
SECTION 7: TUBERCULOSIS OF SKELETAL SYSTEM
34:
GENERAL CONSIDERATIONS: Epidemiology and Prevalence
INTRODUCTION
Prophylaxis Against Tuberculosis
Chemoprophylaxis
35:
Pathology and Pathogenesis
INTRODUCTION
Osteoarticular Disease
Spinal Disease
The Tubercle
Cold Abscess4
Tubercular Sequestra
Types of the Disease
The Future Course of the Tubercle
Tuberculosis as a Late Complication of “Implant-Surgery”5
36:
The Organism and its Sensitivity
MYCOBACTERIUM TUBERCULOSIS
Mycobacterium Cultures
Disease Caused by Non-typical Mycobacteria9,14
37:
Diagnosis and Investigations
INTRODUCTION
DIAGNOSIS
INVESTIGATIONS
Roentgenogram
Blood Investigation
Mantoux (Heaf) Test3
Biopsy14
Examination of Synovial Fluid
Guinea Pig Inoculation
Smear and Culture
Isotope Scintigraphy2,8
Serological Investigations
Modern Imaging Techniques
CT Scans
Magnetic Resonance Imaging (MRI)
Ultrasonography
Poncet's Disease or Tubercular Rheumatism
38:
MANAGEMENT OF TB OF SKELETAL SYSTEM: Evolution of Treatment of Skeletal Tuberculosis
INTRODUCTION
Postantitubercular Era
Sinuses and Ulcers
Immunodeficient Stage and Looming Tuberculosis Epidemic
39:
Antitubercular Drugs
THIOACETAZONE
Ethambutol
Rifampicin
Pyrazinamide
Alternative Regimens3
Corticosteroids
The Role of Antitubercular Drugs
Penetration of Antitubercular Drugs
40:
Principles of Management of Osteoarticular Tuberculosis
PROGNOSIS AND COURSE
CLASSIFICATION OF ARTICULAR TUBERCULOSIS
Stage I: Synovitis
Stage II: Early Arthritis
Stage III: Advanced Arthritis
Stage IV: Advanced Arthritis with Subluxation or Dislocation
Stage V: Terminal or Aftermath of Arthritis
PRINCIPLES OF MANAGEMENT7
General
Rest, Mobilization and Brace
Abscess, Effusion and Sinuses
Antitubercular Drugs
Relapse of Osteoarticular Tuberculosis or Recurrence of Complications
Surgery in Tuberculosis of Bones and Joints
Extent and type of Surgery
Healing of Disease
41:
REGIONAL TUBERCULOSIS: Tuberculosis of the Hip Joint
INTRODUCTION
CLINICAL FEATURES
Stage I: Tubercular Synovitis
Stage II: Early Arthritis
Stage III: Advanced Arthritis
Stage IV: Advanced Arithritis with Sublocation or Dislocation
CLASSIFICATION OF THE RADIOLOGICAL APPEARANCE
Prognosis
Management
Management in Children
Indications for Surgical Treatment
Stage of Disease and Operative Procedure'
42:
Tuberculosis of the Knee Joint
INTRODUCTION
PATHOLOGY2
CLINICAL FEATURES
DIFFERENTIAL DIAGNOSIS
PROGNOSIS
TREATMENT
Operative Treatment
43:
Tuberculosis of the Ankle and Foot
TUBERCULOSIS OF ANKLE
Clinical Features
Management
Operative Treatment
TUBERCULOSIS OF FOOT1
Diagnosis
Management
44:
Tuberculosis of the Shoulder
INTRODUCTION
Management
45:
Tuberculosis of the Elbow Joint
INTRODUCTION
Management
Role of Operative Treatment
46:
Tuberculosis of the Wrist
INTRODUCTION
Clinical Features
Management
47:
Tuberculosis of Short Tubular Bones
INTRODUCTION
Differential Diagnosis
TUBERCULOSIS OF THE JOINTS OF FINGERS AND TOES
Management
48:
Tuberculosis of the Sacroiliac Joints
INTRODUCTION
Clinical Features
Management
49:
Tuberculosis of Rare Sites, Girdle and Flat Bones
TUBERCULOSIS OF GIRDLE BONES AND JOINTS
Sternoclavicular Joint
Acromioclavicular Joint
Clavicle
Scapula
Symphysis Pubis
Skull and Facial Bones
Sternum and Ribs
50:
Tuberculous Osteomyelitis
INTRODUCTION
Tuberculous Osteomyelitis without Joint Involvement
Tuberculosis of Long Tubular Bones
Treatment
51:
Tuberculosis of Tendon Sheaths and Bursae
INTRODUCTION
Tuberculous Tenosynovitis
Tuberculous Bursitis
52:
Tuberculosis of Spine: Clinical Features
53:
Tuberculosis of Spine: Radiographic Appearances and Findings on Modern Imaging
NUMBER OF VERTEBRAE INVOLVED
PARADISKAL TYPE OF LESION
Paravertebral Shadow
Kyphotic Deformity
Central Type of Lesion
Skipped Lesions
Anterior Type of Lesion
Appendicial Type of Lesion
Lateral Shift and Scoliosis
Natural Course of the Disease
Modern Imaging Techniques
CAT Scan
Magnetic Resonance Imaging (MRI)
Ultrasound Echographs
Classification of Typical Tubercular Spondylitis
54:
Tuberculosis of Spine: Differential Diagnosis
INTRODUCTION
Consideration of Age in Diagnosis
INFECTIOUS CONDITIONS
Typhoid Spine
Brucella Spondylitis
Mycotic Spondylitis
Syphilitic Infection of the Spine
Tumorous Conditions
Hemangioma
Giant Cell Tumor and Aneurysmal Bone Cyst
Primary Malignant Tumor
Multiple Myeloma
Lymphomas
Secondary Neoplastic Deposits
Histiocytosis-X
Local Developmental Abnormalities of the Spine
Spinal Osteochondrosis
Traumatic Conditions
Osteoporotic Conditions
Spondylolisthesis
Hydatid Disease
Miscellaneous Conditions
55:
Tuberculosis of Spine: Neurological Deficit
INTRODUCTION
Pathology of Tuberculosis of Spine with Neurological Complications
In Active Disease
In Healed Disease
Pathophysiology of Tuberculous Para-quadriplegia as Understood by MRI Observations
Changes Observed in Spinal TB
Staging of Neural Deficit
March of Neural Deficit
Clinical Presentation of Tuberculous Affection of Spine
Intraspinal Tuberculous Granuloma
Atypical Locations of Lesion
Imaging of Tuberculous Spine
Plain Radiography
Myelography
Indications of myelography
Scintigraphy
Indication of Scintigraphy
Computed Tomography
Magnetic Resonance Imaging
Limitation of MRI
Ultrasonography
Treatment
Indications of Surgery in Tuberculous Paraquadriplegia
Surgical Decompression (Anterior or Posterior)
Radical Surgery vs Debridement Surgery
Surgical Approaches to Tuberculous Spine
Role of Instrumentation in Management of Tuberculosis of Spine
Prognosis in Tuberculous Para/Quadriplegia
CRANIOVERTEBRAL TUBERCULOSIS
Treatment
Indications of Decompression Surgery
CERVICAL SPINE TUBERCULOSIS WITH NEUROLOGICAL DEFICIT
Cervicodorsal Junction Up to D3
Spinal Tumor Syndrome
Intraspinal Tuberculoma
Extradural Granulo ma
Subdural Granuloma
Intramedullary Tuberculoma
NEUROLOGICAL COMPLICATION WITH HEALED DISEASE
Pathogenesis of Neurological Complications with Healed Disease
Management
Correction of Severe Kyphosis for Prevention of Late Onset Paraplegia
56:
Management and Results
57:
Surgery in Tuberculosis of Spine
INTRODUCTION
Clinical Features
Treatment
SURGERY IN TUBERCULOSIS OF THE SPINE23,24
Rationale of Surgery
Indirect Surgery
Direct Surgical Attack on the Tubercular Focus
Focal Debridement
Radical Surgery22
Modified Radical Surgery
Additional Procedures33
Indications for Surgery
Approach to the Spine
Posterior Approach
Transpedicular Approach
Posterolateral Approach
Anterolateral Approach
Anterior Approach3,13–20
Intraoperative Difficulties
Contraindications for Surgery
Surgery for Complications of Tuberculosis of the Spine
Results
Complications
Reoperation
Limitations of Surgery
CONCLUSION
58:
Operative Treatment
INTRODUCTION
COLD ABSCESS
Dorsal Spine
Cervical Spine
Atlantoaxial Region
Cervicodorsal Region
Thoracolumbar Region
Lumbar Spine
Lumbosacral Region (L5–S1)
OPERATIVE PROCEDURES1,2
Approach to Atlantooccipital and Atlantoaxial Region
Anterior Retropharyngeal Approach to the Upper Part of the Cervical Spine (Clivus to Cervical-3, McAfee et al 1987)
Anterior Approach to the Cervical Spine7
Transthoracic Transpleural Approach for Spine C7 to L1
Anterolateral Decompression (D1 to L1)5,9
Operative Complications and their Prevention4
POSTOPERATIVE CARE
OPERATIVE PROCEDURES FOR LUMBAR SPINE
Anterolateral Approach8 to the Lumbar Spine (Lumbovertebrotomy)
Extraperitoneal Anterior Approach to the Lumbar Spine
LUMBOSACRAL REGION
Extraperitoneal Approach
Transperitoneal Hypogastric Anterior Approach
After Exposing the Site of the Diseased Vertebrae
POSTERIOR SPINAL ARTHRODESIS
59:
Relevant Surgical Anatomy of Spine
60:
Atypical Spinal Tuberculosis
INTRODUCTION
Intraspinal Tuber culous Granuloma
Posterior Vertebral Disease (Neural Arch Disease)
Single Vertebral Disease7
Multiple Vertebral Lesions (Skipped Lesion) not in Continuity
Giant Tuberculous Abscess with Little or No Demonstrable Bony Focus9
Sclerotic Vertebra with Intervertebrae Bony Bridging
Panvertebral Disease (Circumferential Spine Involvement)
Other Atypical Lesions
61:
The Problem of Deformity in Spinal Tuberculosis
SECTION 8: POLIOMYELITIS
62:
POLIOMYELITIS: GENERAL CONSIDERATIONS: Acute Poliomyelitis and Prevention
INTRODUCTION
Wonders of Polio Vaccine1
Vaccines
Pathology
Neuronal Recovery
Clinical Manifestations3
Major Illness
Investigations
Diagnosis
Differential Diagnosis
Prognosis
Management of Acute Phase
63:
Convalescent Phase of Poliomyelitis
INTRODUCTION
Clinical Features
Muscle Charting
Role of Surgery in Recovery Phase2,3
64:
Residual Phase of Poliomyelitis
INTRODUCTION
PROGRESSIVE DEFORMITIES IN RESIDUAL PHASE
ADIP Scheme
Continued Activity
The Management of Progressive Paralysis Deformity3
Treatment of Residual Chronic Phase
Physical Therapy2
Orthosis
Surgery
65:
Patterns of Muscle Paralysis Following Poliomyelitis
INTRODUCTION
UPPER LIMB PARALYSIS
LOWER LIMB PARALYSIS
66:
Clinical Examination of a Polio Patient
INTRODUCTION
Ambulatory Status
Observation of Gait/Gait Analysis, Gait Pattern in Poliomyelitis
Abductor Lurch
Extensor Lurch
Hand to Knee Gait
The Calcaneus Gait1
Foot Drop Gait
Short Limb Gait
Examination of the Joint2
Muscle Charting4,6,7
Technique of Muscle Charting
Tensor Fasciae Latae Contracture
Anterior Abdominal Wall Muscles3
Lateral Abdominal Flexors
The Erector Spinae-Gravity Collapse
67:
Management of Shoulder
INTRODUCTION
Basic Biomechanics
Pattern of Upper Limb Paralysis
Selection of Cases
Surgical Management
Arthrodesis
Disadvantages of arthrodesis
Operations for Scapular Instability
For Cases belonging to Group I
Cases Belonging to Group II, III, IV and V
68:
Surgical Management of Postpolio Paralysis of Elbow and Forearm
FUNCTIONAL ANATOMY
MUSCULAR IMBALANCE AT THE ELBOW
Pectoralis Major Transfer to Biceps Brachii
Proximal Shift of Common Flexor Muscle Origin on the Humerus
Transfer of Triceps Tendon, Bunnell4
Sternomastoid Transfer
Latissimus Dorsi Transfer
THE FOREARM
69:
Affections of the Wrist and Hand in Poliomyelitis
INTRODUCTION
PARALYSIS AND DEFORMITIES IN THE HAND AND WRIST
Common Patterns of Residual Polio Paralysis
Pattern I (Paralysis Figs 2A and B)
Pattern II (Paralysis Figs 3 to 4B)
Pattern III (Paralysis Fig. 5)
Deformities
Reconstruction Considerations
Sequence of Management of Deformities and Paralysis
Thumb Web Contracture
Trapeziometacarpal Joint Contracture
MCP Joint Extension Contracture
Tendon Transfers and Stabilizing Procedures
Reconstruction for Pattern I Paralysis
Opponensplasty
Reconstruction for Pattern II, Paralysis
For Paralyzed Thenar Muscles5
For Paralyzed Finger Intrinsics (Claw Fingers)18
Reconstruction for Pattern III, Paralysis
1st Stage
2nd Stage (To improve flexion of the fingers and thumb)
3rd Stage (Drop Wrist)
70:
Polio Lower Limb and Spine: Surgical Management of Sequelae of Poliomyelitis of the Hip
INTRODUCTION
Muscles around the Hip Joint
Pathomechanics
Surgical Management1
Hip Deformities
Operative Procedure for Restoring Muscle Imbalance
Paralytic Dislocation or Subluxation
71:
Knee in Poliomyelitis
QUADRICEPS PARALYSIS
Hand to Knee Gait and Frequent Falls
Flexion Contracture of Knee
Double Pin Traction
External Fixator Systems9
Recurrences
SUPRACONDYLAR OSTEOTOMY11
Technique
Aftercare
TENDON TRANSFERS19
Transfer of Biceps Femoris and Semitendinosus Tendons to Quadriceps/Patella1,2
Technique
Aftercare
Transfer of Biceps Femoris Tendon
GENU RECURVATUM8
OSTEOTOMY OF TIBIA
TRIPLE TENODESIS
FLAIL KNEE
72:
Management of Paralysis around Ankle and Foot
INTRODUCTION
Indications for Tendon Transfer
Principles followed in Tendon Transfer
73:
Equinus Deformity of Foot in Polio and its Management
INTRODUCTION
Equinus following Muscular Imbalance
Equinovarus
Equinovalgus
Equinus Following Static Forces
Equinus as a Compensatory Mechanism
Limb Length Discrepancy
Quadriceps Deficient Lower Extremity
Pathophysiology of the Equinus Deformity
Impact of Equinus Deformity on Other Joints
Assessment of Poliomyelitis Patient with Equinus Deformity
Management of Equinus Deformity
No Intervention
Conservative Treatment
Surgical Treatment
Soft Tissue Procedures
By open methods
Tendon Transfers (Equinovarus Deformity)
Bony Procedures
Postoperative Care
Complications
74:
Valgus Deformity of Foot
INTRODUCTION
CLINICAL EVALUATION
MANAGEMENT12–16
75:
Varus Deformity of Foot in Poliomyelitis
INTRODUCTION
TERMINOLOGY
EVOLUTION AND PATHODYNAMICS OF HINDFOOT VARUS (AND EQUINOVARUS)
EFFECTS OF VARUS DEFORMITY OF FOOT ON THE ANKLE AND UPWARDS
CLINICAL DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS
INVESTIGATIONS
PREVENTION
TREATMENT OF VARUS (AND EQUINOVARUS)
Conservative
Operative Treatment
Dwyer's Calcaneal Osteotomy
T Osteotomy
Differential Distraction Technique
76:
Postpolio Calcaneus Deformity and its Management
INTRODUCTION
Pathomechanics
Clinical Manifestations
Investigations
Management15
Surgical Management
77:
Management of Flail Foot and Ankle in Poliomyelitis
INTRODUCTION
Definition
Clinical Features
Diagnosis
Investigations
Treatment
Correction of Deformity
Stabilization Procedures
78:
Spinal Deformities in Poliomyelitis
INTRODUCTION
Natural History
Patient Evaluation
Treatment
Principles of Surgical Treatment
The Indications
Operative Planning
Types of Instrumentation
Indications for Anterior Surgery8,9
Preoperative Considerations
Assessment of Respiratory Insufficiency10–11
Operative Consideration
Postoperative Management
Removal of Intercostal Drainage
Ambulation
Complications
Neurological Deficit
Pseudarthrosis
Loss of Spinal Balance
Severe Curves in Young Children
79:
MISCELLANEOUS METHODS OF MANAGEMENT OF POLIO: Comprehensive Rehabilitation
80:
Comprehensive Management of Poliomyelitis and Deformities of Foot and Ankle with the Ilizarov Technique
INTRODUCTION
ILIZAROV TECHNIQUE
Preoperative Evaluation
Knee Flexion Contracture
Mild Contracture
Moderate to Severe Contractures
Recurvatum Deformity
Hip Instability
Shortening
Foot Deformity Correction
Osteotomy Correction
Hindfoot Lengthening
Calcaneus Deformity
Triple Arthrodesis
Ankle Fusion
Fusion in Children
Ankle Fusion
CONCLUSION
81:
Correction of Foot, Ankle and Knee Deformities by the Methods of Ilizarov
INTRODUCTION
CORRECTION OF DEFORMITY BY ILIZAROV METHODS2
Knee Deformity
Ankle Deformity
Mechanics in Plaster Correction
Double Pin Traction
Ilizarov Method of Correction
82:
ADULT POLIOMYELITIS: Late Effects of Poliomyelitis Management of Neglected Cases
INTRODUCTION6
Historical Background1
Clinical Features
Symptoms
Onset of New Symptoms
Pathophysiology of Postpolio Syndrome (Figs 1 to 5)
Motor Unit Dysfunction
Musculoskeletal Disuse
Musculoskeletal Overuse
Diagnosis2,3
Investigations
Diagnostic Criteria
Differential Diagnosis
Management5
Psychological Aspects
Weakness
Exercises
Pain
Respiratory Failure
Prognosis1–5
THE FUTURE
THE INDIAN SCENE
83:
Management of Neglected Cases of Poliomyelitis Presenting for Treatment in Adult Life
INTRODUCTION
Causes of Late Presentation
Type of Neglected Cases Coming to Orthopedicians
Fixed Deformity
Bony Deformity
Multiple Deformity
Shortening
Inability to Propagate
The Postpolio Syndrome
Aims of Treatment
General
Local
Problems at an Adult Age
Shortening
Procedures
Foot Stabilization
Knee Deformities and “Q” Paralysis
Hip and Pelvic Obliquity
Paralytic Scoliosis
Paralysis of Upper Extremities
SECTION 9: LEPROSY
84:
General Considerations: Leprosy
INTRODUCTION
Etiology
Pathology/Immunopathology
Early Leprosy8
Established Forms of Leprosy8
Borderline Reactions8
Type II Reactions or Erythema Nodosum Leprosum (ENL)8
Clinical Features and Classification
IAL Classification
Classification into MB/PB Groups
Complications
Reactions
Neuritis
Trophic Ulceration
Eye Complications
Systemic Complications13
Relapses
Management
Early Diagnosis
Multidrug Treatment
Newer Drugs
Monitoring Therapy
Management of Complications
Reactions
Relapses
Adverse Reactions
National Leprosy Eradication Program (NLEP)
85:
Consequences of Leprosy and Role of Surgery
MODEL FOR CONSEQUENCES OF DISEASE
Consequences of Leprosy
Preventive Interventions
First-level Interventions
Second-level Interventions
Third-level Interventions
Fourth-level Interventions
Fifth-level Interventions
Sixth-level Interventions
Role of Surgery
86:
Deformities and Disabilities in Leprosy
INTRODUCTION
Risk Factors
Patient Factors
Disease Factors
Other Environmental Factors
Causes and Types of Deformities
Specific Deformities
Motor Paralytic Deformities
Anesthetic Deformities
Sites of Deformities
87:
Clinical and Surgical Aspects of Neuritis in Leprosy
INTRODUCTION
Stages of Nerve Involvement and Damage
Stage of Parasitization
Stage of Host Response
Stage of Clinical Involvement
Stage of Reversible Nerve Damage
Stage of Nerve Destruction
Pathology of Nerve Lesions in Leprosy
Nerve in Tuberculoid Leprosy
Nerve in Lepromatous Leprosy
Nerve in Borderline Leprosy
Patterns of Involvement, Damage and Recovery
Modes of Onset and Progress of Nerve Damage
Insidious Onset: Quiet Nerve Paralysis7
Episodic Onset and Saltatory Progress
Sudden Onset
Nerve Damage of Late Onset
Diagnosis
Management of Neuritis and Nerve Damage
Nerve Damage
Acute Neuritis
Early Paralysis
Surgical Aspects of Neuritis in Leprosy
Decompression of Individual Nerves
SOME GENERAL REMARKS
Decompression for Relief of Pain
Nerve Abscess
Nerve Repair with Free Nerve and Muscle Grafts
88:
HAND AND WRIST IN LEPROSY: Hand in Leprosy
IMPAIRMENTS
DEFORMITIES
Specific Deformities
Paralytic Deformities
Anesthetic Deformities
DISABILITIES
Loss of Sensibility
Motor Dysfunction
89:
Infections of the Hand
INTRODUCTION
SURGICAL ANATOMY
Surface Markings
Synovial Sheaths7
Spaces in the Palm
Midpalmar Space
Thenar Space
Other Spaces
Positions of Rest and Function
General Considerations7
Clinical Features
Anesthesia and Tourniquet
Incision and Drainage4
Postoperative Management
INFECTIONS OF TERMINAL SEGMENT OF FINGER1
INFECTIONS OF DIGITAL SYNOVIAL SHEATHS5
Clinical Features
Treatment
INFECTIONS OF SYNOVIAL SHEATHS IN PALM
Clinical Features
Treatment
INFECTION OF THE RADIAL BURSA (SHEATH OF FLEXOR POLLICIS LONGUS)
Clinical Features
Treatment
Midpalmar Space Infection
Thenar Space Infection
INFECTIONS OF OTHER SPACES
Infection of Deep Forearm Space9 (Parona's Space)
Web Space Infection
90:
Paralytic Claw Finger and its Management
INTRODUCTION
Clinical Features
Deformities
Disabilities
Complicating Features
Surgical Correction
Aim of Surgery
Active and Passive Correction
Procedures for Correction of Finger Clawing
To Restrict Extension and Prevent Hyperextension of MCP Joint
Intrinsic Substitution Procedures
Procedures to Provide an Independent Proximal Phalangeal Flexor
Timing of Surgery
Sequence of Operations in Combined Palsy
Operative Techniques of Some Commonly Performed Operations
Postoperative Care
Postoperative Physiotherapy
Results of Corrective Surgery (Figs 21A to 22D)
Failure in Postoperative Re-education
Inability to Unlearn Abnormal Movements
Overcorrection
Lateral Band Insertion
Superficialis Minus Deformity43–45
Check Rein Effect43
Adhesion of the Extensor Expansion
Too Loose a Tension in the Motor
Development of Adhesions
Reversal of Distal Transverse Metatarsal Arch29
CONCLUSION
91:
Surgical Correction of Thumb in Leprosy
MOVEMENTS OF THE THUMB
THUMB IN LEPROSY
Ulnar Paralysis
Combined Paralysis of Ulnar and Median Nerves
Surgical Correction of Intrinsic Minus Thumb
The Motor
The Fulcrum or Pulley
The Insertion
Objectives of Surgery
Evaluation of the Thumb
Checking the CMC Joint
Checking the MCP Joint
Checking the IP Joint
Assessment of Thumb Web
Tendon Transfer Procedures for Restoration of Opposition
Two-tailed Transfer of Flexor Superficialis Through a Window in the Flexor Retinaculum
Extensor Indicis Transfer56
Restoring Adduction of the Thumb
Procedure
Thumb Web Plasty
Arthrodesis of the Metacarpophalangeal Joint
Surgery of the Thumb in Ulnar Nerve Paralysis
Indications
Aims of Surgery
92:
Drop Wrist and Other Less Common Paralytic Problems in Leprosy
INTRODUCTION
Classification of Triple Nerve Paralysis
Assessment of Paralysis and Contractures
Muscle Assessment
Contractures
Preoperative Preparation
Reconstruction Considerations
Reconstruction after Triple Nerve Paralysis
First Stage
Second Stage
Other Less Common Problems
Pure Radial Nerve Paralysis
Radial and Ulnar Nerve Paralysis
High Median Paralysis
93:
Hand in Reaction
INTRODUCTION
Clinical Features
Natural History
Skin and Subcutaneous Tissue
Muscle
Bones
Management
Management of Frozen Hand
94:
Salvaging Severely Disabled Hands in Leprosy
INTRODUCTION
Causes of Severe Disability
Severe Impairments Involving the Fingers
Contracted Claw-hands
Proximal Interphalangeal Joint Flexion Contracture
MCP Joint Extension Contracture
Boutonniere Deformity (Hooding)
Swan-neck Deformity
Guttering Deformity
Severe Deformities of the Thumb
Severe Thumb Web Contracture
Fixed IP Joint Contracture
Severely Absorbed Thumb
Neuropathic Trapeziometacarpal Joint
Severe Deformities of the Wrist
Fixed Flexion Contracture
Neuropathic Wrist Joint
Mitten Hand
Extensive Motor Deficit
CONCLUSION
95:
Foot in Leprosy
IMPAIRMENTS INVOLVING FOOT
DEFORMITIES
Specific Deformities
Paralytic Deformities
Anesthetic Deformities
DISABILITIES
96:
Neuropathic Plantar Ulceration and its Management
INTRODUCTION
Sites of Ulceration
Etiology of Plantar Ulceration
Factors Influencing the Site of Ulceration
Clinical Features
Stages of Ulceration24
Natural History
Management of Plantar Ulcers
Acute Ulcers
Chronic Ulcers
Complicated Ulcers
Cauliflower Growths31,43–45
CONCLUSION
97:
Surgery for Prevention of Recurrent Plantar Ulceration
INTRODUCTION
Causes of Recurrence
Original Causes of Ulceration
Poor Quality of Scar
Excessive Loading of Scar
Flare up of Latent Infection
Prevention of Recurrence
Reducing Walking Stresses
Improving Quality of Scar
Reducing Load on Scar
Eradicating Infection
CONCLUSION
98:
Paralytic Deformities of the Foot in Leprosy
INTRODUCTION
DROP FOOT
Differential Diagnosis
Management of Drop Foot
Early Cases
Management of Established Drop Foot
Preoperative Evaluation and Physiotherapy
Operative Procedure (Fig. 3)
Orthoses for Drop Foot
Management of Neglected Drop Foot
CLAW TOES
Recognizing Damage to Posterior Tibial and Plantar Nerves
Mechanism of Claw Toes
Severity of Claw Toes Deformity
Differential Diagnosis of Claw Toe Deformity
Surgical Correction of Claw Toes
First Degree or Mild Clawing
Second Degree or Moderate Clawing
Third Degree or Severe Clawing
COMBINED DROP FOOT AND CLAW TOE DEFORMITY
99:
Neuropathic Disorganization of the Foot in Leprosy
INTRODUCTION
Anatomical Considerations
Etiopathogenesis
Predisposing Factors
Precipitating Factors
Clinical Features
Early Stage
Advanced Cases
More Advanced Cases
Late Cases
Management
Management of an Early Case
Management of Established Cases
Management of Advanced Cases
Prevention of Disorganization and its Recurrences
Prognosis
Septic or Secondary Disorganization
100:
Amputations and Prosthesis for Lower Extremities
INTRODUCTION
THE AMPUTATION
Types of Amputations
The Stump
Level of Amputation
Phalangeal Level/Disarticulation of the Toes
Transmetatarsal Level
Lisfranc-Cho part
Syme
Below-knee (BK)
Knee Disarticulation and Above-knee (AK)
General Remarks
Preoperative Care
Postoperative Care
CONCLUSION
101:
PHYSIOTHERAPY AND REHABILITATION: Physiotherapy and Occupational Therapy in Leprosy
INTRODUCTION
PHYSIOTHERAPY IN LEPROSY
Physical Therapy Modalities
Wax Therapy
Oil Massage
Active Exercises
Active Assisted Exercises
Passive Exercises
Splinting
Objectives of Physiotherapy in Leprosy
Assessment of Patient
Skin
Nerves
Muscles
Strength of the Muscles
Wasting of Muscles
Joints
DEFORMITIES
Physiotherapeutic Management to Prevent Deformity and Disability
Treatment of Hand and Foot during Reactional Episodes
To Provide Relief of Pain in Acute Neuritis
To Treat Established Paralytic Deformity
Preoperative Physiotherapy
Aims of Preoperative Physiotherapy
Training the Muscle to be Transferred
Postoperative Physiotherapy
Aims of Postoperative Physiotherapy
OCCUPATIONAL THERAPY IN LEPROSY
Early Treatment
Preoperative Treatment and Orientation to the Functional Possibilities of Reconstructive Surgery
Following Reconstructive Surgery
Functional Hand Splints
Adaptation for Utensils and Tools for Patients with Very Severe Deformities
Contribution of the Visiting Clinic Team
Rehabilitation
Disability Prevention
102:
Footwear for Anesthetic Feet
INTRODUCTION
General Principles: Manufacture
Covering
Avoidance of Nails
Padding
Moulding of Insole
Rigidity
Stability
“Mouldable” Uppers
General Principles: Prescription
Principles of Footwear Adaptations
Moulding
The Arch Support and Metatarsal Pad (ASMP)
The Prescription of Suitable Footwear
The Moulded Insole
The Taking of the Mould (Figs 3A to C)
Casting the Model
The Preparation of the Model
The Moulding of the Insole
Cork Build-up
The Uppers and Rigid Sole
Indicates for Prescribing of the Moulded Sole Rigid Rocker Shoe
SECTION 10: SYSTEMIC COMPLICATIONS IN ORTHOPEDICS
103:
Shock
INTRODUCTION
Classification
Hypovolemic Shock
Cardiogenic Shock
Obstructive Shock
Distribution Shock
Hemorrhagic (Hypovolemic) Shock
Diagnosis
Laboratory Studies
Treatment
Position
Oxygenation
Analgesics
Urine Flow
Monitoring of Central Venous Pressure (CVP) and/or Pulmonary Capillary Wedge Pressure (PCWP)
Volume Replacement
Colloids
Ionotropic Agents
Antibiotics
Corticosteroids
Prognosis
104:
Crush Syndrome
INTRODUCTION
Pathophysiology
Treatment
105:
Disseminated Intravascular Coagulation
INTRODUCTION
Pathogenesis
Diagnosis
Treatment
106:
Thromboembolism
DEEP VEIN THR OMBOSIS (DVT)
Pathogenesis
Investigations
Diagnosis
Treatment of DVT
Prevention
Complication
Antithrombic Agents
Anticoagulant
PULMONARY EMBOLISM
Treatment
107:
Fat Embolism Syndrome: Adult Respiratory Distress Syndrome (ARDS)
INTRODUCTION
Diagnostic Criteria
Investigations
Pathogenesis
Treatment
Role of Fracture Stabilization
Prognosis
ADULT RESPIRATORY SYNDROME
108:
Orthopedic Manifestations of Sickle Cell Hemoglobinopathy
INTRODUCTION
HISTORY
PATHOLOGY
SYMPTOMATOLOGY
INVESTIGATIONS
Hematology
Radiology
Early Osseous Changes
Late Osseous Changes
TREATMENT
Drug Therapy
Management of Sickle Cell Crisis
Management of Specific Problems
Anesthetic Care
Genetic Counseling
PROGNOSIS
109:
Systemic Infection
INTRODUCTION
Clinical Findings
Treatment
REFERENCES
INTRODUCTION
Clinical Findings
Prevention
Treatment
Use of Tetanus Toxoid1,2,4
Treatment7 of a Developed Case of Tetanus
SECTION 11: DISEASES OF JOINTS
110:
Synovial Fluid
111:
Synovial Disorders
INTRODUCTION
PIGMENTED VILLONODULAR SYNOVITIS
Pathogenesis
Classification and Features
Localized form of PVNS
Clinical Features
Pathology
Radiology
Differential Diagnosis
Behavior and Treatment
Diffuse form of PVNS
Clinical Features
Pathology
Radiology
Differential Diagnosis
Behavior and Treatment
SYNOVIAL CHONDROMATOSIS
Pathogenesis and Evolution
Clinical Features
Pathology
Investigations
Treatment and Behavior
Prognosis
SECONDARY SYNOVIAL CHONDROMATOSIS
SYNOVIAL HEMANGIOMA
Pathology
SYNOVIAL LIPOMATOSIS
SECTION 12: RHEUMATOID DISORDERS
112:
Rheumatoid Arthritis and Allied Disorders
INTRODUCTION
ETIOLOGY
Pathophysiology
The Initial Events
Organization of Inflammation
The Destruction Phase
Pathology of Rheumatoid Arthritis (RA)
Pathognomonic Features (True Rheumatoid Nodule)
Immunohistochemical Methods
Differential Diagnosis
Value of Synovial Biopsy
Conclusion
Clinical Features and Manifestations
Onset
Articular Involvement
Nonarticular Manifestations
Variants
Principles of Management of Rheumatoid Arthritis
Pharmacotherapy (Chemotherapy)
Splintage
Physiotherapy
Scope of Operative Treatment
RHEUMATOID HAND AND WRIST
Extra-articular Manifestations
Extensor Tenosynovial Cysts
Tendon Rupture
Flexor Tenosynovitis
“Swan Neck” Deformity
“Ulnar Drift”
“Boutonniere” or Buttonhole Deformity
Intraarticular Manifestations
Wrist Joint
Finger Joints
Other Joints
Knee Joint
Hip Joint
Elbow Joint
Shoulder Joint
Ankle and Foot
Spine
113:
Ankylosing Spondylitis
INTRODUCTION
ETIOLOGY
PATHOLOGICAL FEATURES
CLINICAL FEATURES
ROENTGENOGRAPHY
COMPLICATIONS
MANAGEMENT
ANKYLOSING SPONDYLITIS IN FEMALES
JUVENILE ANKYLOSING SPONDYLITIS
114:
Arthritis in Children
INTRODUCTION
Epidemiology5,7,9,10
Etiopathogenesis
Clinical Features (Table 4)
Polyarticular JCA5
Pauciarticular JCA
Systemic Onset JCA15
Differential Diagnosis3
Polyarticular JCA
Pauciarticular JCA14
Systemic Onset JCA
Investigations
Management2
Physiotherapy and Occupational Therapy
Medical Treatment
Orthopedic Surgery
Education and Counseling
Complications
Course and Prognosis
Childhood Spondyloarthropathies
Juvenile Ankylosing Spondylitis11,16
Psoriatic Arthritis
Reactive Arthritis
Neuropathic Joint Disease6
Pigmented Villonodular Synovitis
115:
Seronegative Spondyloarthropathies
REACTIVE ARTHRITIS
Clinical Features
Investigations
Differential Diagnosis
Prognosis
Management
PSORIATIC ARTHRITIS
Pathogenesis5
Pathology
Clinical Features
Investigations
Prognosis
Treatment5
SAPHO Syndrome
ENTEROPATHIC ARTHROPATHY
Treatment
WHIPPLE DISEASE
UNDIFFERENTIATED AND JUVENILE ONSET SPONDYLOARTHRITIS
BEHCET'S SYNDROME
SECTION 13: PERIPHERAL NERVE INJURIES
116:
Injuries of Peripheral Nerve
INTRODUCTION
Embryology
Anatomy
Histology
Epineurium
Perineurium
Endoneurium
Etiology of Nerve Palsies
Physiology of the Damaged Nerve and its Target Tissues
Muscle Cell Changes
Sensory End Organs
Classification of Injury
Technique of Nerve Repair
Timing of Repair
Primary Nerve Repair
Secondary Nerve Repair
Recent Advances
Nerve Graft
Sources of Grafts
117:
Electrodiagnostic Assessment of Peripheral Nerve Injuries
INTRODUCTION
Pathology of Nerve Damage
Neurapraxia
Axonotmesis
ELECTRODIAGNOSTIC TESTS ROUTINELY USED
Nerve Conduction Studies
Segmental supply to sensory nerves20 (Root value plexus peripheral nerve)
Following Partial Axonal Nerve Damage (Incomplete nerve damage)
Following Partial Axon Loss (e.g. Nerve Transection)
Nerve Conductions in Neurapraxis Lesions (Figs 1A to C)
Electromyography
Elecromyographic Pattern Following Partial Axonal Nerve Injury
Electromyographic Pattern in Pure Neurapraxic Lesions1,9
Electrophysiological correlates of a pure neurapraxic lesion1, 9
Electrophysiological correlates of axonal division1, 9, 10
SOME IMPORTANT CONSIDERATIONS
Severity of the Lesion and Prognosis
Late/follow-up Examination for Assessing Recovery
Postoperative Examination
Intraoperative Studies
Guidelines for Electrodiagnostic Evaluation and Referral
118:
Painful Neurological Conditions of Unknown Etiology
INTRODUCTION
CAUSALGIA
Treatment
Reflex Symphethetic Dystrophy
Phantom Limb
Sudeck's Atrophy
119:
Management of Adult Brachial Plexus Injuries
BRACHIAL PLEXUS INJURIES
Supraclavicular Injuries
Complete Supraclavicular Injuries
Incomplete Supraclavicular Injuries
Management of Supraclavicular Brachial Plexus Injuries
Diagnosis
Clinical Examination
Investigation
Treatment
Complete Palsies
Timing of Surgery
Operative Technique
Spinal Accessory Nerve
Intercostal Nerves (ICN)
Anterior Branches of the Cervical Plexus
Contralateral C7 Root
Surgical Strategies
Complete Palsies
Incomplete Palsies
Postoperative Care
Infraclavicular Injuries
Mechanisms of Injury
Clinical Picture
Associated Vascular Injuries
Iatrogenic Lesions
Therapeutic Indications
Supplementary Surgery
Incomplete Palsies
Overall Results of Surgery of the Brachial Plexus
Infraclavicular Palsies Alnot2 et al (1984, 1987)
Pain in Brachial Plexus Injuries
Mechanism of Causation of Pain
Changes in the Peripheral Nervous System
Changes in the Central Nervous System
Nonoperative Treatment of Pain
Surgical Treatment of Pain
Complications
CONCLUSION
120:
Obstetrical Palsy
HISTORICAL BACKGROUND
Etiopathogenesis
Obstetrical Factors
Development
Surgical Treatment
Lesions Found
Postoperative Treatment
Results
C5 C6 Lesions—65 Cases
C5 C6 C7 Lesions—59 patients
Total Palsies
Functional Limitations
Residual Deformity
Treatment
CONCLUSIONS
121:
Injection Neuritis
122:
Median, Ulnar and Radial Nerve Injuries
MEDIAN NERVE INJURIES
Introduction
Examination
Abductor Pollicis Brevis
Opponens Pollicis
Flexor Pollicis Longus
Low Lesions
High Lesions
Treatment
REFERENCES
ULNAR NERVE INJURIES
Anatomy
Etiology
Clinical Features and Examination
Treatment
Methods of Closing Gaps
Results of Sutures of Ulnar Nerve
Critical Limit of Delay of Suture
REFERENCES
RADIAL NERVE INJURIES
Anatomy
Etiology
Entrapment Syndromes
Examination
Palpation of the nerve
Method
Assessment of the Muscle Power According to MRC scale
Triceps
Brachioradialis
Extensor Muscles of Wrist Joint
Supinator
Extensor pollicis longus
Investigations
Electrodiagnosis
Principles of Treatment
Methods of Closing Gaps
Results of Suture
123:
Tendon Transfers
INTRODUCTION
Timing8
Selection of Muscles for Transfer2,6,7
Condition of the Extremity
Range of Motion
Ulnar Palsy5,18
The Claw Hand4
Radial Nerve Palsy
Etiology
Median Nerve Palsy5,9, 18,20,22
Disadvantages of FDS
Contraindications
Other Motors
Extensor Indicis Proprius (EIP) (Fig. 13)
124:
Entrapment Neuropathy in the Upper Extremity
INTRODUCTION
Blood Supply of a Nerve8,9
General Principles
Median Nerve1,7
Treatment
Ulnar Nerve
Signs and symptoms
Applied Anatomy
Treatment
Causes of compression
Radial Nerve
125:
Affections of Sciatic Nerve: Nerve Injuries in the Lower Limb
INTRODUCTION
Clinical Features
Examination
Treatment
126:
Peroneal Nerve Entrapment
INTRODUCTION
Etiology
Anatomy
Clinical Features
Investigations
Differential Diagnosis
Treatment
Acute Injury
Treatment of Slowly Progressive Lesion
Late Reconstruction Following Lateral Popliteal Nerve Injury
127:
Anterior Tarsal Tunnel Syndrome
INTRODUCTION
Clinical Features
Etiology
Electrophysiologic Evaluation
Differential Diagnosis
Treatment
128:
Lateral Femoral Cutaneous Nerve Entrapment
INTRODUCTION
Anatomy
Clinical Features
Etiology
Electrophysiologic Evaluation
Differential Diagnosis
Treatment
SECTION 14: BONE TUMORS
129:
Bone Tumors—Introduction, Classification and Assessment
INTRODUCTION
Age and Sex Distribution
Etiology
CLASSIFICATION OF TUMORS
Principles of Diagnosis
New Concepts in the Evaluation
130:
Bone Tumors—Diagnosis, Staging Treatment Planning
RADIOLOGY OF BONE TUMORS
IMAGING MODALITIES
Plain Radiographs
CT
MRI
Classification
Detection
Tumor Characterization
SPECIFIC FEATURES
Metastases
Osseous/Bone Forming Tumors
Osteosarcoma (Figs 7, 8, 16)
Osteoma
Osteoid Osteoma (Figs 5, 6)
Osteoblastoma
Chondroid/Cartilage Forming Tumors
Chondrosarcoma (Fig. 17)
Enchondroma (Fig. 18)
Osteochondroma (Figs 9, 19)
Chondroblastoma (Fig. 11)
Chondromyxoid Fibroma
Fibrous Neoplasms
Fibrosarcoma
Non-ossifying Fibroma/Fibrous Cortical Defect (Fig. 13)
Lesions Arising from the Marrow
Ewing's Sarcoma (Figs 15, 20)
Lymphoma
Plasma Cell Tumors
Other Bone Neoplasms
Giant Cell Tumor/Osteoclastoma (GCT) (Figs 3, 21)
Aneurysmal Bone Cyst (ABC) (Fig. 22)
Solitary Bone Cyst (SBC) (Fig. 12)
Eosinophil ic Granuloma (EG)
Fibrous Dysplasia (Fig. 10)
131:
The Role of Bone Scanning in Malignant
INTRODUCTION
WHAT IS BONE SCANNING?
WHO REQUIRES A BONE SCAN?
WHAT DOES A BONE SCAN INVOLVE?
HOW IS A BONE SCAN PERFORMED?
WHAT IS AN ABNORMAL SCAN?
HOW DOES AN ABNORMAL BONE SCAN CONTRIBUTE TO PATIENT MANAGEMENT?
DO DIFFERENT MALIGNANCIES HAVE DIFFERENT MANIFESTATIONS OF SKELETAL INVOLVEMENT AS WITNESSED ON A BONE SCAN?
DOES BONE SCANNING HAVE A ROLE IN THE EVALUATION OF PRIMARY BONE TUMORS?
THE ROLE OF PET SCANNING IN BONE TUMORS AND TUMORS METASTASING TO BONE
CONCLUSION
132:
Biopsy for Musculoskeletal Neoplasms
WHEN SHOULD THE BIOPSY BE DONE?
DO ALL RADIOLOGICAL LESIONS NEED A BIOPSY?
WHO SHOULD DO THE BIOPSY?
WHAT IS THE CORRECT SITE?
WHAT PART OF THE TUMOR SHOULD BE BIOPSIED?
NEEDLE BIOPSY AND OPEN BIOPSY— AN OVERVIEW
WHAT IS THE ACCURACY OF A NEEDLE BIOPSY?
What needle to use?
TECHNIQUE FOR NEEDLE BIOPSY
PRINCIPLES OF OPEN BIOPSY TECHNIQUE
THE PATHOLOGY REPORT … READ BETWEEN THE LINES
SOME MORE RULES
THE ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY
THE ROLE OF FROZEN SECTION
Drawbacks of Frozen Section
ADDITIONAL TESTS
SUMMARY
133:
Principles of Treatment of Bone Sarcomas and Current Role of Limb Salvage
THE BIOPSY
PRINCIPLES OF MANAGEMENT
Neoadjuvant Chemotherapy
Neoadjuvant Radiotherapy
Surgical Decision Making
LIMB SALVAGE OR AMPUTATION?
Types of Limb Salvage
Autografts
Allografts
Bone Lengthening
Endoprosthetic Replacement
Rotationplasty
Arthrodesis
CONCLUSION
134:
Systemic Theraphy and Radiotherapy
SYSTEMIC THERAPY OF OSTEOGENIC SARCOMA (OGS)—PRINCIPLES
Chemotherapeutic Agents and their Scheduling
SYSTEMIC THERAPY OF EWING'S FAMILY OF TUMORS-PRINCIPLES
ROLE OF CHEMOTHERAPY IN SOFT TISSUE SARCOMAS
OTHER APPROACHES IN THE MANAGEMENT OF SOFT TISSUE SARCOMA
CONCLUSION
BIBLIOGRAPHY
RADIATION THERAPY
Mechanism of Action of Radiation
Radiosensitivity
Types of Radiation Therapy
RADIOTHERAPY FOR SOFT TISSUE SARCOMAS (STS)
Radiotherapy can be used in the following Manner
Preoperative Radiotherapy
Postoperative Radiotherapy
RADIOTHERAPY FOR EWING'S SARCOMA/PNET
Lung Bath (Whole Lung Irradiation)
RADIOTHERAPY FOR OTHER BONE TUMORS
Primary Bone Lymphoma
Plasmacytoma and Multiple Myeloma
Skeletal Metastasis
Extracorporeal Radiotherapy
RADIOTHERAPY RELATED SEQUELAE
Acute Effects
Late Effects
CONCLUSION
135:
Benign Skeletal Tumors
OSTEOCHONDROMA (SOLITARY OSTEOCARTILAGINOUS EXOSTOSIS)
Incidence
Age and Sex
Site
Clinical features
Radiographic Features
Role of Ultrasound
Pathology
Pathogenesis
Differential Diagnosis
Treatment
Sarcomatous Changes
HEREDITARY MULTIPLE EXOSTOSES (MULTIPLE OSTEOCARTILAGINOUS EXOSTOSIS, DIAPHYSEAL ACLASIS)
Frequency
Age and Sex
Heredity
Clinical Features
Radiological Features
Pathology
Differential Diagnosis
Treatment
ENCHONDROMA
Incidence
Age and Sex
Site
Clinical Features
Radiographic Features
Radiographic Differential Diagnosis
Pathology
Gross
Microscopy
Features Favouring Malignancy are
Pathogenesis
Course
Treatment
MULTIPLE ENCHONDROMATOSIS
PERIOSTEAL (JUXTACORTICAL) CHONDROMA
Incidence
Site
Age and Sex
Clinical Features
Radiographic Features
Radiographic Differential Diagnosis
Pathology
Treatment
CHONDROBLASTOMA
Incidence
Age and Sex
Site
Clinical Features
Radiographic Features
Radiographic Differential Diagnosis
Pathology
Treatment
Aggressive Behavior and Metastasis
CHONDROMYXOID FIBROMA
Incidence
Age and Sex
Site
Clinical Features
Radiographic Features
Radiographic Differential Diagnosis
Pathology
Treatment
BIBLIOGRAPHY
BENIGN FIBROUS HISTOCYTIC
Incidence
Age and Sex
Site
Clinical Features
Radiographic Features
Pathology
Treatment
BIBLIOGRAPHY
OSTEOID OSTEOMA
Incidence
Age and Sex
Site
Clinical Features
Radiological Features
Pathology
Course
Treatment
OSTEOBLASTOMA
Age and Sex
Site
Clinical Features
Radiographic Features
Pathology
Differential Diagnosis
Treatment and Prognosis
“Malignant” Osteoblastoma
136:
Giant Cell Tumor of Bone
INTRODUCTION
EPIDEMIOLOGY
PATHOLOGY
CLINICAL PRESENTATION
IMAGING STUDIES
Conventional Radiography
Magnetic Resonance Imaging (MRI)
CLASSIFICATION
TREATMENT
Reconstruction After Marginal/Wide Excision
The Role of Chemotherapy and Radiotherapy
The Role of Embolisation and Biphosphonates
Evaluation of Local Recurrence
Metastasis in Giant Cell Tumors
137:
Osteogenic Sarcoma
INTRODUCTION
CLASSIFICATION
ETIOLOGY
CLINICAL MANIFESTATIONS
DIAGNOSIS
HISTOLOGY
STAGING
TREATMENT
Surgery
Reconstruction
Allogeneic Bone Graft
Autogenous Bone Graft
Endoprosthesis
Composite Reconstruction
Radiation
Adjuvant Therapy
138:
Chondrosarcoma
WHO CLASSIFICATION OF MALIGNANT CARTILAGINOUS TUMORS
Bone
Soft Tissue
PRIMARY CHONDROSARCOMA
Introduction
Age
Sex Distribution
Sites of Involvement
Clinical Features
Radiologic Findings
Low Grade Features
High Grade Features
Bone Scan
CT/MRI
Biopsy
Clinicopathologic Grading
Gross Findings
Histopathology
Grade 1 Chondrosarcoma
Grade 2 Chondrosarcoma
Grade 3 Chondrosarcoma
Treatment
Prognostic Factors
Prognosis
SECONDARY CHONDROSARCOMA
Introduction
Sites of Involvement
Clinical Features
Imaging
Gross
Histopathology
Treatment
Prognostic Factors
PERIOSTEAL CHONDROSARCOMA
Introduction
Age
Sex
Sites of Involvement
Clinical Features
Imaging
Gross
Histopathology
Differential Diagnosis
Prognosis
DEDIFFERENTIATED CHONDROSARCOMA
Introduction
Age
Sex
Sites of Involvement
Clinical Features
Imaging
Gross
Histopathology
Prognostic Factors
MESENCHYMAL CHONDROSARCOMA
Introduction
Age
Sex
Sites of Involvement
Clinical Features
Imaging
Histopathology
Prognostic Factors
CLEAR CELL CHONDROSARCOMA
Introduction
Age
Sex
Sites of Involvement
Clinical Features
Imaging
Histopathology
Treatment
Prognostic Factors
EXTRASKELETAL MYXOID CHONDROSARCOMA
Introduction
Age
Sex Ratio
Sites of Involvement
Clinical Features
Histopathology
Prognosis
139:
Ewing Sarcoma Bone
INTRODUCTION
RADIOGRAPHIC EVALUATION
Bone Scintigraphy
COMPUTED TOMOGRAPHY (CT)
MAGNETIC RESONANCE IMAGING (MRI)
GROSS PATHOLOGY
HISTOPATHOLOGY
PROGNOSTIC FACTORS
BIOPSY AND TREATMENT
CHEMOTHERAPY
LOCAL THERAPY
APPENDICULAR
PELVIS
SPINE
METASTATIC DISEASE
SECONDARY MALIGNANCIES
SURVEILLANCE
TARGETED THERAPY
SUMMARY
140:
Miscellaneous Tumors of Bone
UNICAMERAL BONE CYST (UBC)
Epidemiology
Location
Pathogenesis
Pathology
Clinical Features
Radiographic Features
Indications for Treatment
Treatment
FIBROUS DYSPLASIA
Location
Clinical Features
Radiographic Features
Microscopic Pathology
Treatment
Role of Biphosphonates
FIBROUS CORTICAL DEFECT / NON-OSSIFYING FIBROMA / FIBROXANTHOMA
Epidemiology
Location
Clinical Features
Radiographic Features
Histopathology
Treatment
OSSIFYING FIBROMA/ADAMANTINOMA
Epidemiology
Location
Clinical Features
Radiographic Features
Pathology
Microscopic Pathology
Treatment
ANEURYSMAL BONE CYST (ABC)
Radiographic Features
Pathology
Treatment
BIBLIOGRAPHY
141:
Evaluation of Treatment of Bone Tumors of the Pelvis
INTRODUCTION
SACRO-PELVIC ANATOMY
PATIENT EVALUATION
Biopsy Techniques
SURGICAL CONSIDERATIONS
Indications for Surgery
Preoperative Considerations
Operative Planning
EXTERNAL HEMIPELVECTOMIES
Posterior Flap Hemipelvectomy
Anterior Flap Hemipelvectomy
INTERNAL HEMIPELVECTOMIES
Type I Pelvic Resection
Type II Pelvic Resection
Type III Pelvic Resection
PELVIC RECONSTRUCTION TECHNIQUES
Reconstruction of Type I Resections
Reconstruction of Type II Resections
Reconstruction of Type III Resections
SURGICAL APPROACH TO SACRAL TUMORS
Sacral Reconstruction Techniques
Techniques of Sacral Reconstruction
SUMMARY
142:
Metastatic and Primary Tumors of the Spine
INTRODUCTION
Incidence and Frequency
Pathophysiology
Clinical Features
Evaluation and Diagnosis of Spinal Metastasis
Role of PET Studies
CT Scan/CT Myelography
Magnetic Resonance Imaging (MRI)
Biopsy in Suspected Metastasis
Differential Diagnosis of Spinal Metastasis
Management Strategies in Spinal Metastatic Disease
Chemotherapy and Hormonal Manipulation
Radiotherapy
Surgical Management of Spinal Metastasis
Contraindications to Surgery
Indications for Surgery
Role of Angiography
Role of Open Biopsy
SURGICAL PRINCIPLES
Approach
Disease Clearance
Reconstruction
Instrumentation
Role of Vertebroplasty
Authors’ Experience
BIBLIOGRAPHY
INTRODUCTION
Authors’ Experience with Primary Spine Tumors
CLINICAL EVALUATION OF SPINAL TUMORS
BIOPSY IN SPINAL TUMORS
Problems with Spinal “Needle” Biopsy
Differential Diagnosis of Spinal Tumors
PRINCIPLES OF TREATMENT OF PRIMARY SPINAL TUMORS
Treatment Oriented Classification of Spinal Tumors
Surgical Alternatives in Primary Spinal Tumors
BENIGN PRIMARY TUMORS OF THE SPINE
Osteoid Osteoma and Osteoblastoma
Aneurysmal Bone Cyst (ABC)
Giant Cell Tumor (GCT)
Hemangioma
Osteochondroma
Eosinophilic Granuloma (EG)
PRIMARY MALIGNANT TUMORS OF THE SPINE
Solitary Plasmacytoma and Multiple Myeloma
Clinical Presentation
Diagnosis
Treatment
OSTEOSARCOMA
EWING'S SARCOMA
CHORDOMA
CHONDROSARCOMA
LYMPHOMA
Author's Experience
Newer Trends in Surgery for Spinal Tumors
143:
Metastatic Bone Disease
INTRODUCTION
INCIDENCE AND EXTENT OF DISEASE
MECHANISM OF METASTASIS
Clinical Manifestation of Metastatic Bone Disease
Bone Pain
Hypercalcemia
Pathological Fractures
Patient Factors
Lesion Factors
Spinal Cord Compression
Radiological Diagnosis of Bone Metastasis
NON-OPERATIVE TREATMENT OF SKELETAL METASTASIS
PRINCIPLES OF SURGICAL TREATMENT
PROGNOSTIC FACTORS IN SKELETAL METASTASIS
144:
Role of Custom Mega Prosthetic Arthroplasty in Limb Salvage Surgery of Bone Tumors
SKELETAL RECONSTRUCTION
MEGAPROSTHESIS
CUSTOM MEGAPROSTHESES
ROLE IN ORTHOPEDICS
LIMB SALVAGE BY CUSTOM-MADE ENDOPROSTHESIS
Indications and Contraindications
INVESTIGATIONS
BIOPSY
PREOPERATIVE CHEMOTHERAPY
DESIGNING OF CUSTOM PROSTHESIS
Distal Femur/Proximal Tibia
Proximal Humerus
Prosthesis Design
PATHOMECHANICS OF IMPLANT FIXATION TO BONE
TREATMENT PROTOCOL
COMPLICATIONS
THE CHENNAI EXPERIENCE
The Work
Patient Profile
Histopathological Diagnosis
Anatomical Location
Staging
Biopsy Details
Custom Megaprostheses
Treatment Modality
Results
CONCLUSION
145:
Bone Banking and Allografts
INTRODUCTION
HISTORY
BONE BANKING IN INDIA
TATA MEMORIAL HOSPITAL TISSUE BANK
BONE DONATION
ETHICAL ASPECTS
DONOR SELECTION
Exclusion Criteria
Age Criteria
LABORATORY TESTS
TYPES OF GRAFTS
TISSUE PROCESSING
REDUCING IMMUNOGENECITY
Sterilization
Ethylene Oxide (EtO)
Gamma Radiation
Use of Allografts
Biology of Incorporation
Effect of Processing on Biomechanical Strength
Clinical Use of Allografts
Combining Allograft with a Prosthesis
Allograft with a Live Fibula
Indications for Allografts
Complications with Allografts
CONCLUSION
146:
Palliative Care in Advanced Cancer and Cancer Pain Management
147:
The Management of Soft Tissue Sarcomas
INCIDENCE
ETIOLOGY
PRESENTATION
The Virgin Tumor
The Unexpected Diagnosis
Tumors Presenting as Local Recurrence
Tumors Presenting Late
INVESTIGATIONS
Plain Film Radiography
Magnetic Resonance Imaging
Computed Tomography
Nuclear Medicine
Ultrasound
BIOPSY
CHEMOTHERAPY
RADIOTHERAPY
SURGERY
Limb Sparing Surgery
LONG-TERM SEQUELAE
Local Recurrence
Pulmonary Metastases
Multidisciplinary Team Approach
148:
Multiple Myeloma
INCIDENCE
ETIOLOGY AND PATHOPHYSIOLOGY
CLINICAL FEATURES
Diagnostic Evaluation
Diagnostic Criteria
Staging of Multiple Myeloma
Differential Diagnosis
Prognostic Factors
Management of Multiple Myeloma
Chemotherapy
Supportive Care
Radiotherapy
CONCLUSION
149:
The Future of Orthopedic Oncology
INTRODUCTION
BASIC SCIENCE
SARCOMAS OF BONE
SOFT TISSUE SARCOMA
CONCLUSION
SECTION 15: BIOMATERIAL
150:
Biomechanics and Biomaterials in Orthopedics
BIOMATERIALS USED IN ORTHOPEDICS
Ceramics and Ceramometallic Materials
Bioinert Ceramics
Bioactive Ceramics
Bioresorbable ceramics
Tissue Adhesives in Orthopedic Surgery
Types of Tissue Sealant
Bone Substitutes
Classification
Others
CARBON COMPOUNDS AND POLYMERS
Biomaterials Produced by Human Cellular and Tissue Engineering8
151:
Implants in Orthopedics
HISTORY
IMPLANTS FOR FRACTURE FIXATION: EVOLUTION
PHYSICAL PROPERTIES
TESTING OF IMPLANTS
Physical Tests
Chemical Tests
Structural Characteristics
Biological Compatibility
Nonmetallic Implants
Biomaterials used in Orthopedics
CERAMICS AND CERAMOMETALLIC MATERIALS
Bioinert Ceramics
Bioactive Ceramics
Bioresorbable Ceramics
TISSUE ADHESIVES IN ORTHOPEDIC SURGERY
Types of Tissue Sealant
BONE SUBSTITUTES
CARBON COMPOUNDS AND POLYMERS
Carbon Compounds
Polymers
BIBLIOGRAPHY
INTRODUCTION
HISTORY
ADVANTAGES
Current Uses
Degradation
DISADVANTAGES
FUTURE
SECTION 16: FRACTURES AND FRACTURE DISLOCATION: GENERAL CONSIDERATIONS
152:
Fractures Healing
INTRODUCTION
Types of Bone Formation
Inflammatory Phase
Stage of Callus Formation or Reparative Phase
Phase of Hard Callus or Woven Bone Formation
Osteoinduction and Osteoconduction
Factors that Influence the Fracture Healing
Severity of Injury
Intra-articular Fractures
Segmental Fracture
Factors Concerned with Patient (Table 3)
Tissue Variables
Osteoporosis
Treatment Variable
Principles of Treatment of Fracture
Healing of Injuries of Cartilage15
Variables15 that Influence Cartilage Healing
153:
Principles of Fractures and Fracture Dislocations
INTRODUCTION
Biomechanics
Intrinsic Factors
Young's Modulus and Stress-strain Curves
Fatigue Strength
Biomechanical Properties of Bone
Biomechanics of Fractures
Classification of Fractures by Mechanism of Injury
Indirect Forces
Indirect Trauma
Angulation Fractures
Rotational Fractures
Compression Fracture
Direct Trauma
Clinical Features of Fractures
Radiological Investigations
GENERAL PRINCIPLES: CLINICAL FEATURES OF DISLOCATIONS
Radiographic Findings
Emergency Management of Fractures
Special Splints
Definitive Treatment of Fracture
Immobilization
Principles of Internal Fixation
Plating
Compression
Documentation
Classification of Fractures1 (Comprehensive Classification of Fractures of Long Bones)
Soft Tissue Injuries
Preoperative Planning and Principles of Reduction
The Pinless External Fixator
154:
Stress Fractures
PATHOMECHANICS
RISK FACTORS
CLINICAL PRESENTATION
RADIOLOGICAL INVESTIGATIONS
X-RAYS
SCINTIGRAPHY
MRI
CT
TREATMENT
Rationale
Femoral Neck3,12–14,16,18,21,23
Femoral Shaft6
Tibia
MEDIAL MALLEOLUS
Navicular Fracture
METATARSALS
OTHER SITES
UPPER EXTREMITY
Pelvis
SUMMARY
155:
Principles of Two Systems of Fracture Fixation—Compression System and Splinting System
1. TWO SYSTEMS OF FRACTURE FIXATION
AO Principles: Classic and Current Approaches
DEFINITIONS (TABLE 1)
Absolute Stability
Relative Stability
Compression System (Table 2) (Fig. 2)
Compression Produces
Tension Band Fixation (Fig. 3)
Advantages of Compression System
Advantages of Splinting System
Requirements for Compression System
Methods of Compression
Disadvantages of Compression System
Splinting System (Table 2) (Fig. 5)
Splinting with Standard Plates and Cortex Screws
Disadvantages of Splinting Method
Fragment Mobility
Stiffness of Implant
Biomechanics of Flexible Fixation
Intramedullary Nail
Flexible Fixation
Flexible Methods of Fixation
Indications
Flexible System in Simple Fracture
Flexibility
Working Length
Number of Screws and Flexibility
Torsional Strength
2. PREOPERATIVE PLANNING
3. REDUCTION OF FRACTURE INDICATIONS AND TECHNIQUES
Reduction Techniques2
Types of Reduction
Indications for Direct Reduction
Types of Indirect Reduction
The Advantages of Indirect Reduction
Principles of Surgical Exposure of the Fracture
Methods of Indirect Reduction
Traction for Indirect Reduction
1. Use of Fracture Table (Fig. 11)
2. Pin Traction
3. Large Distractor (Fig. 12 and Fig. 13)
4. Forceps (Fig. 14 to Fig. 17)
5. Reduction Clamps (Fig. 18)
6. Implant used for Indirect Reduction (Fig. 19 to Fig. 21)
7. Liss Distractor
8. External Fixator
9. Joystick Reduction (Figs 22 and 23)
10. Kapandji Reduction for Distal End Radius
K Wire Technique
Techniques
Procedure
Assessment of Reduction
Intraoperative Techniques of Checking for Assessing Reduction
Assessment of Rotation of the Limb
Assessment of Femoral Rotation
CONCLUSION
4. BIOLOGICAL FIXATION
Mechanical and Biological Effects of Fractures
1. Mechanical Effects
2. Biological Effects
Methods of Dynamization
Biological Fixation Works on Three Principles
Perquisites for Biological Plating
Methods of Biological Fixation
Requirements of Biological Fixation
5. MINIMALLY INVASIVE SURGERY
Indications for MIPO
MIPO in Specific Segments
Femur
Tibia
Procedure for Plating
Indication
6. GENERAL PRINCIPLES OF FIXATION OF FRACTURES OF PART OF A LONG BONE
Intra-articular Fracture
Metaphyseal Fractures
Meta-diaphyseal Fracture
Diaphyseal Fracture (Fig. 26)
7. TIMING OF SURGERY
Timing of Internal Fixation
Tourniquet
Disadvantages of Tourniquet
8. POSTOPERATIVE CARE
BIBLIOGRAPHY
Two Systems of Fracture Fixation
Reduction of Fracture Indications and Techniques
Biological Fixation
Minimally Invasive Surgery
156:
Recent Advances in Internal Fixation of Fractures
INTRODUCTION
BIOLOGICAL OSTEOSYNTHESIS
LIMITED CONTACT-DYNAMIC COMPRESSION PLATE (LC-DCP)
POINT CONTACT FIXATOR (PC-FIX)
UNIVERSAL SPINE SYSTEM
INTRAMEDULLARY NAILING
Unreamed Tibia Nail (UTN)
Unreamed Femur Nail (UFN)
MINIMAL INVASIVE OSTEOSYNTHESIS OF ARTICULAR FRACTURES
CALCANEUS FRACTURES
BIODEGRADABLE MATERIAL
157:
Nonoperative Treatment of Fractures of Long Bones
INTRODUCTION
Mechanism of Action10–12
When to Apply
Contraindications
Time of Brace Application1,4
Fractures that Can be Well Treated by Cast Bracing
Functional Cast Bracing for Knee Joint6
Indications
Material
Technique
Ankle Brace
Indications
Technique
Follow-up
Functional Thigh Sleeve6
Indications
Contraindications
Technique
Postapplication Management
Hip Brace
Indications
Technique
Humeral Sleeve
Indications
Technique
Follow-up
Wrist Brace
Indications
Metallic Wrist Brace
Procedure
Olecrano Condylar Brace (OCB)
Indications
Method
After Treatment
Elbow Cast Brace
Indications
Technique
Results14
Complications
REFERNCES
INTRODUCTION
Basic Principles of Functional Treatment7
Motion
Complications Preventable
Role of Soft Tissue
Vascularity
Mechanical Stimulation in the Treatment of Tibial Fractures
Subsequent Management
Acceptance of Reduction
Angulation
Complication of Functional Cast (Table 1)
Disadvantages of Functional Cast
Fractures of the Humerus Treated by Functional Cast
158:
Open Fractures
HISTORY OF MANAGEMENT
PATHOPHYSIOLOGY OF OPEN INJURIES
INITIAL EVALUATION AND MANAGEMENT
EVALUATION AND CLASSIFICATIONS
OTHER OPEN INJURY SCORES
MANGLED EXTREMITY SEVERITY SCORE (MESS)
GANGA HOSPITAL OPEN INJURY SEVERITY SCORE (GHS)
MICROBIOLOGY
THE PROBLEM OF INFECTION IN OPEN INJURIES
THE ROLE OF ANTIBIOTICS
DEFINITIVE MANAGEMENT
The Question of Salvage
DEBRIDEMENT
BONE STABILIZATION
CHOICE OF BONE STABILIZATION
EXTERNAL FIXATION
Interlocking Nails
PLATE STABILIZATION
SKIN AND SOFT TISSUE RECONSTRUCTION
THE PROBLEM OF BONE LOSS
SEQUENCING THE RECONSTRUCTION IN OPEN INJURIES—AN ‘ORTHOPLASTIC APPROACH’
RECONSTRUCTION OPTIONS
‘Fix and Close’ Protocol
‘Fix, Bone Graft and Close’ Protocol
‘Fix and Flap’ Protocol
‘STABILIZE, WATCH, ASSESS AND RECONSTRUCT’ PROTOCOL
CONCLUSION
159:
Soft Tissue Coverage for Lower Extremity
INTRODUCTION
BACTERIOLOGY OF THE WOUND IN OPEN FRACTURES—ROLE OF WOUND CULTURES
DEBRIDEMENT—IMPORTANCE AND TECHNIQUE
DEBRIDEMENT OF CHRONIC AND NEGLECTED WOUNDS
TIMING OF DEBRIDEMENT
TIMING OF SOFT TISSUE COVER
FLAP COVER AND TYPE OF SKELETAL FIXATION
TYPE OF SOFT TISSUE COVER—DOES IT MAKE A DIFFERENCE?
DEGLOVING INJURIES ASSOCIATED WITH FRACTURES
160:
Bone Grafting and Bone Substitutes
CLASSIFICATION
Nonvascularized Autografts
Bone Marrow Concentrate25
Vascularized Autografts
Fresh Allografts
Frozen Allografts
Freeze Dried Allografts
Demineralized Bone Matrix
Processing
Clinical Experience
Synthetic Bone Grafts
Ideal Bone Substitutes
Tricalcium Phosphate
Collagraft
CALCIUM PHOSPHATE CEMENTS (NORIAN SRS)
CALCIUM SULFATE
LOCAL GROWTH FACTORS
BONE MORPHOGENETIC PROTEIN-2
BONE MORPHOGENETIC PROTEIN-7 (OSTEOGENIC PROTEIN-1)
GENE THEORY
BONE BANKING
161:
Polytrauma
INTRODUCTION
DEFINITION OF DAMAGE CONTROL ORTHOPEDICS
HISTORICAL BACKGROUND
HISTORY OF ABDOMINAL DAMAGE CONTROL
PHYSIOLOGY OF DAMAGE CONTROL
MARKERS OF INFLAMMATION
Genetic Predisposition and Adverse Outcomes
INDICATION FOR DAMAGE CONTROL PRINCIPLE IN ORTHOPEDICS
FEMORAL FRACTURES
PELVIC RING INJURIES
GERIATRIC TRAUMA
When it is safe to carry out secondary procedures?
Concept of Occult Hypoperfusion
Evidence Suggesting Efficacy of Damage Control in Orthopedics
Practical Considerations for Damage Control Orthopedics
FUTURE
OVERVIEW
162:
Abdominal Trauma
PREVENTION
GEOGRAPHY AND DEMOGRAPHY
PREHOSPITAL TREATMENT
CLASSIFICATION OF INJURIES AND MECHANISMS
PATHOPHYSIOLOGY
CLINICAL EXAMINATION
MANAGEMENT RESUSCITATION AND EVALUATION
INVESTIGATIONS
TREATMENT
Damage Control Surgery
Laparotomy
163:
Chest Trauma
INTRODUCTION
Emergency Room Evaluation and Treatment
Diagnosis
Initial Resuscitation
Indications for Early Thoracotomy4
Specific Injuries
Thoracic Cage: Soft Tissue
Clavicular Fractures
Rib Fractures
Flail Chest
Sternal Fractures
Open Pneumothorax
Pleural Space
Tension Pneumothorax
Hemothorax
Lungs
Pulmonary Contusion
Lung Laceration
Tracheobronchial Injuries
Heart and Heart Vessels
Diaphragm
164:
Trauma to the Urinary Tract
INTRODUCTI ON
INJURIES TO THE KIDNEY
SURGICAL PATHOLOGY3,6
Clinical Features3,4,6
Diagnostic Procedures1,3,6
Principles of Management4,6
Prognosis
RUPTURE OF THE URINARY BLADDER
Surgical Pathology2,5
Clinical Features1,5,6
Intraperitoneal Rupture
Extraperitoneal Rupture
Diagnosis1,5
Management Principles3,5,6
Emergency Measures
Specific Measures
Prognosis
INJURIES TO THE URETHRA
Surgical Pathology1,5,6
Clinical Features1,5,6
Injuries to the Bulbar Urethra
Injuries to the Membranous Urethra
Diagnosis1,2,5,6
Management Principles3,5,6
Prognosis
165:
Head Injury
INTRODUCTION
Treatment
Surgical
Medical
Prognosis
Glasgow Outcome Scale (GOS)
166:
Fractures of the Mandible
INTRODUCTION
Classification
Signs and Symptoms of Mandibular Fractures
Radiographs
Management
Methods of Immobilization
Intermaxillary Fixation
Intermaxillary Fixation with Nonrigid Osteosynthesis
Rigid/Semirigid Osteosynthesis without Intermaxillary Fixation
Locking Miniplates
167:
Temporomandibular Joint Disorders
INTRODUCTION
Etiology of Temporomandibular Disorders
Local Factors
Systemic Factors
Trauma
Classification
Signs, Symptoms and Management
Masticatory Muscle Disorders
Disk Interference Disorders
Inflammatory Disorders of the Joint
Hypermobility of the Joint
Methods to Restrain the Condylar Movement
Temporomandibular Joint Imaging14
Radiography
Tomography
Computed Tomography
MRI
Arthroscopy
Surgical Approaches to the Temporomandibular Joint10,11
Postauricular Approach
Endaural Approach
Preauricular Approach
Submandibular Approach
168:
Compartment Syndrome
DEFINITION
INTRODUCTION
Etiology
Decreased Compartment Size
Increased Compartment Content
Commonest Underlying Causes
Commonest Fracture
Risk Factors for Development of or Late Diagnosis of Acute Compartment Syndrome
Pathophysiology
Theories for Acute Compartment Syndrome Pathogenesis
Clinical Features
Diagnosis: Pressure Studies
FOREARM SYNDROME
Deep Forearm Compartment Syndrome (Volkmann's Ischemia)
Clinical Picture
Treatment in the Acute Stage
Treatment of Established Contracture
Compression Ischemia of Tight Splintage
Treatment
ANTERIOR COMPARTMENT SYNDROME OF LEG (ANTERIOR TIBIAL SYNDROME)
PERONEAL COMPARTMENT SYNDROME
SUPERFICIAL POSTERIOR COMPARTMENT SYNDROME
DEEP POSTERIOR COMPARTMENT
Surgical Treatment
Management of Associated Fracture
Complication of Acute Compartment Syndrome
CHRONIC COMPARTMENT SYNDROME
169:
Anesthesia in Orthopedics
INTRODUCTION
Pediatric Anesthesia1,2
SPECIFIC PROBLEMS OF THE ORTHOPEDIC PATIENT
Rheumatoid Arthritis3
Ankylosing Spondylitis3
Geriatric Patients4,19
Trauma Patients10
Patient Assessment
Oral Intake Precautions
Hemodynamic Status
Coexisting Head Injury
Spinal Fractures10,11
Hip Fractures
Positioning for Orthopedic Surgery (Table 4)
Choice of Anesthetic Technique13
Local Anesthesia
Regional Anesthesia
Upper Extremity
Lower Extremity
MAJOR ORTHOPEDIC PROCEDURES
Total Hip Replacement (THR)
Anesthetic Management
Intraoperative Hypotension
Total Knee Replacement (TKR)
Anesthetic Management
Postoperative Pain Management
SPINAL SURGERY3, 10
Monitoring
Somatosensory Evoked Potentials (SSEPs)
Wake-up Test
Conservation of Blood Resources
Hemodynamics
Postoperative Care
Major Allo- or Autograft Transplantation Surgery3
Anesthetic Management
Pelvic and Sacral Resections/Fractures
Anesthetic Management
BLOOD LOSS IN ORTHOPEDIC SURGERY
Management of Blood Loss
Monitoring in Orthopedic Surgery
Special Consideration during Orthopedic Surgery
Tourniquets3, 20
Summary of Effects of Tourniquets
Fat Embolism3
Treatment
Deep Vein Thrombosis and Pulmonary Embolism
Measures to Prevent Infection21
Postoperative Analgesia in Orthopedics22–25
Pre-emptive Analgesia23
Methods of Pain Relief9
Local Anesthetic Techniques
Epidural Analgesia3
Chronic Pain
Postoperative Nausea and Vomiting
Cardiac and Respiratory Arrest11,13
Causes of Cardiac Arrest
Prevention of Cardiac Arrest
REFERENCES
170:
Medicolegal Aspects
INTRODUCTION
Consent
Documentation
Certificates
INTRODUCTION
Doctor-patient Relation
Right to Refuse a Patient
Right to Restrict the Practice
Consent
Due Care
Locality Rule
Negligence
Duty
Dereliction
Direct Causation
Damage
Diagnosis
Treatment and Results
Duty to Refer and Consult
Medical Records
Medical Fees
Medical Certificates
Police Repo rts
Court Attendance
Defensive Medicine
SECTION 17: INTRAMEDULLARY NAILING
171:
Intramedullary Nailing of Fractures
INTRODUCTION
EVOLUTION
TIBIA
Interlocking Nail
Indications for Nailing
Preoperative Assessment for Interlocking Nail
Bone Quality
Closed Nailing of the Tibia
Distal Locking
Standard Technique with Aiming Device
Operative Technique: Indian Experience with C-Arm Modified Nail by Dr. Tanna Nail
Procedure
Method to Negotiate Guide Wire in Distal Fragment without C– Arm, without Fracture Table
DISTAL LOCKING
PROXIMAL TIBIAL FRACTURES8,9
MODIFICATION IN DESIGN
PROXIMAL LOCKING
PATIENT POSITIONING
ENTRY POINT
POLLER (BLOCKING) SCREWS10
FEMUR
Unlocked Nails
Locked Nails
Closed Nailing of the Femur
COMPLICATIONS
Late Complication due to Faulty Surgery
Tips
Biomechanics
Biology
Fracture Healing following Intramedullary Nailing
THE EFFECTS OF REAMING AND INTRAMEDULLARY NAILING ON FRACTURE HEALING
Reaming
Dynamization
Management of Open Fracture
COATING OF NAILS9,11
172:
Plate Fixation of Fractures
BONE SCREWS3 (AGASHE VM)
Countersink
THE SHAFT
Run Out
THE THREAD
Core Diameter
Pitch
Lead
Outside Diameter (Thread Diameter)
Thread Design
THE TIP
Self-tapping Tip
Nonself-tapping Tip
Corkscrew Tip
Trocar Tip
Self-drilling Self-tapping Tip
SELF-TAPPING SCREW
NONSELF-TAPPING SCREW
Types of Screws
Screws in Bone: Elastic Force from Bone
Screw Insertion
Holding Power
Interfragmentary Lag Screw (PS Bhide)
Types of Screws
Cortical vs. Cancellous
Self-Tapping vs. NonSelf-Tapping
Solid vs. Cannulated Screws
CANNULATED SCREW
Cerclage
Screw Failure
Method of Applying Compression Plate
DCP versus—Bridge Plating
Important Rules for Plate Fixation
History of Fixation of Fractures by Plate
Development of Locking Plate (Figs 21A to F)
Types of Locking Screws
Monocortical Screws
Advantages of Monocortical Screws
Bicortical Screws
Biomechanics of Conventional Plates
Biomechanics of Locking Head Plate
Mono block Concept
a. En block Failure or Simultaneous Failure
b. Sequential Failure
LHP in Flexible System
No Contact Plate
Contouring
LHP and MIPO
LHP and Osteoporosis
Primary Displacement
Toggling
Periprosthetic Fracture
LHP and Infection Rate
Bridge and Wave Plating (Fig. 37)
Bridge Plating has Four Advantages
Types of Bridge Plate
Requirement of Bridge Plating
Persistent Poor Reduction
Indications
LCP IN HYBRID FIXATION (FIGS 39 TO 42)
Axial Compression
Transverse Fracture
Transverse Fractures in Osteoporotic Bone
Oblique Diaphyseal Fracture
Oblique Fracture
LCP as a Splint (Splinting System)
Advantages of Internal Fixator (LCP) (Figs 45 to 50)
Indications for LCP as a Splinting Method Using MIPO Technique (internal fixator)
Combinations of Two Systems
Combination of Different Screws
Rules of Screw Placement of Locked Plating1 (Table 2)
Complications and Disadvantages of Locking Head Screw and Plate
AIDS in Reduction and LISS Fixation
Effect of Length and Position of Screws
Ideal Length and Number and Position of Screws
Hybrid Fixation
Indications for Hybrid Fixation
LCP in Compression Plating
Advantages of Precontoured Plates
Precontoured Plates
Clavicle Plate
Proximal Humerus Plate (Fig. 57)
Diaphyseal Humerus Plate (Figs 58A to D)
Distal Humerus Plate
Olecranon Plates
Coronoid Plate
Radial Head Plate
Distal Volar Radius Plate (Hand innovations, Miami, Florida USA)
Dorsal Nail Plate for Distal Radius Fractures
Proximal Femur
Distal Femur Plates
The Condylar Buttress Plate
Tibial LIF Plate
REFERENCES FOR BONE SCREWS
REFERENCES FOR PLATES
REFERENCES FOR LOCKING PLATE
REFERENCES FOR RULES OF SCREW PLACEMENT OF LOCKED PLATING
REFERENCES FOR LISS
REFERNCES FOR LISS FEMUR
REFERENCES FOR LISS TIBIA
REFERENCES FOR DISTAL FEMUR
REFERENCE FOR PRECONTOURED SPECIAL PLATES
SECTION 18: EXTERNAL FIXATOR
173:
External Fixation
INTRODUCTION
History
Indications for Application of External Fixator
Classification
Unilateral Pin Frames
Ring or Circular Frames10
Instrumentation
External Fixator Pin1
Clamp
The Rod
Frames
Mechanical Properties of External Fixator
The Number of Pins Used
The Pin Diameter/Pin Configuration
Distance from the Bone to the Support Column
Pin-bone Interface
Preloading2
Fracture Healing with External Fixation8
Unilateral Versus Bilateral, Two-Plane External Fixation
Unilateral External Fixation with Different Rigidity
Compression Versus No Compression Under External Fixation
Constant Rigid Versus Dynamic Compression Under External Fixation
Effect of Fracture Type on Fracture Healing in External Fixation16
Use of Minimal Internal Fixation
Bone Grafting in External Fixation
Method of Application of External Fixation
Timing of Removal of External Fixation
Regional Applications
Tibia
Femur
Radius and Ulna
Humerus
Bone Segment Transport
Pelvis
Use of External Fixation in Children
Complications
Infection and Pin Loosening14
External Fixator, What Next12
The Patient's Perception of the Fixator
Positive Body Images
Negative Body Images
The Developing Countries, Natural Calamities, War and External Fixation
External Fixation in Natural Calamities and War
174:
The Dynamic Axial Fixator
INTRODUCTION
SCREWS
FIXATOR
DYNAMIZATION
INDICATIONS
175:
Management of Trauma by Joshi's External Stabilization System (JESS)
FRAME CONSTRUCTION
Frames for Terminal Phalanges
“U” Frame
“L” Frame
Frames for Middle Phalanx
Collateral Frame
Angled “J” Frame
Delta Frame
Frames for Proximal Phalanx
Unilateral Frame
Dorsal-oblique Frame
Delta Frame
Collateral Frame
Frames for Metacarpal Fractures
Unilateral Frame
Dorsal-oblique Frame
Delta Frame
Angled “J” Frame
FRAMES FOR INTRA-ARTICULAR FRACTURES
Frames for Distal Interphalangeal Joint
Collateral Frame
Hinged Collateral Frame
Frames for Proximal Interphalangeal Joint
Collateral Frame
Hinged Collateral Frame
Frames for Peripheral Finger Metacarpophalangeal Joint (2nd and 5th)
Ray Frame
First Carpometacarpal Joint Arthrodiastasis Frame
Hinged Ray Frame
Intra-articular Fractures of the Metacarpophalangeal Joint of the Middle and Ring Fingers
Intra-articular Fractures of Bases of Metacarpals and Carpo-metacarpal Joint Injury
CLINICAL APPLICATIONS
CASE 1
Fracture Shaft of Distal Phalanx with Soft Tissue Loss
CASE 2
Fracture Neck of Middle Phalanx
CASE 3
Proximal Metaphyseal Fractures
CASE 4
Comminuted Fracture Proximal Third of Proximal Phalanx of Right Index Finger
CASE 5
Fracture Distal Third Shaft of Fifth Metacarpal
CASE 6
Comminuted Fracture of Right First Metacarpal Involving Proximal Two-third of Shaft
Perilunate Trans-scaphoid Fracture — Dislocation of Left Wrist
SECTION 19: ILIZAROV METHODOLOGY
176:
ILIZAROV METHOD—BASICS: The Magician of Kurgan: Prof GA Ilizarov
177:
Biomechanics of Ilizarov Ring Fixator
INTRODUCTION
Cantilever Type
Ilizarov Type8,9
Biomechanics of The Wire5
Tensioning of the Wire
Number of Wires
Wire Spread
Off-centering
Self-stiffening Effects of Wires
Olive Wires
Wire Diameter
Biomechanics of Rings
Carbon Fiber Rings11
Intrinsic Biomechanical Effects
Biomechanics of Fulcrums
Biomechanics of Hinges7
The Rule of Thumbs
Biomechanics of the Ilizarov Fixator for Fracture Fixation
USE OF HALF PINS
TITANIUM PINS
HYBRID MOUNTINGS
178:
Biology of Distraction Osteogenesis
TYPES OF OSTEOGENESIS
Histology
Physiology
Pathophysiology
Radiological Appearance
Mode of Ossification
Angiogenesis
Collagen and Osteogenetic Markers
Growth Factor and Cytokine
Factors Affecting Angiogenesis and Mineralization (Fig. 3)
Stimulation of Regenerate Formation and Maturation
Complications of Distraction Osteogenesis
The Effect of Excessive Distraction on Articular Cartilage39 (Fig. 6)
Knee Range of Motion in Isolated Femoral Lengthening
Future
179:
Operative Technique of Ilizarov Method
180:
Advances in Ilizarov Surgery
INTRODUCTION
ILIZAROV'S METHODS
ADVANCES IN ITALY
ADVANCES IN NORTH AMERICA
TITANIUM PINS
JUXTA-ARTICULAR MOUNTINGS
HYBRID MOUNTINGS
LENGTHENING OVER AN INTRAMEDULLARY NAIL
SELF-LENGTHENING NAIL
THE DANGERS OF LIMB ELONGATION
COMPUTERIZED DISTRACTION
GROWTH FACTORS
CONCLUSION
181:
Bone Transport
INTRODUCTION
Problems of Acute Docking
Problems of Gradual Docking
Bony Problems
Soft Tissue Problems
182:
Fracture Management
INTRA-ARTICULAR FRACTURE
Indications for Fracture Management by Ilizarov Method
Operative Treatment
Postoperative Management
Complications
183:
Nonunion of Fractures of Long Bones
INTRODUCTION
Causes of Nonunion
Classification of Aseptic Nonunion
AO Classification (Weber)23
Paley's15 Modification of Ilizarov's Classification
Clinical Feature
Treatment of Nonunions
Objective of Nonunion Therapy
Treatment of Uninfected Nonunion
Reducing the Fragments3
Treatment of Hypertrophic Nonunion
Treatment of Atrophic Nonunion
Metaphyseal Articular Nonunion9,11
Treatment of Synovial Pseudarthrosis23
Management of Nonunion of Fractures by Ilizarov Method4
Management of Various Types of Nonunions
Treatment of Stiff Hypertrophic Nonunion
Treatment of Atrophic Nonunion15
Oblique Nonunions
Nonunion of Femoral Shaft
Nonunion of Supracondylar Fracture of Femur
Nonunion of Tibia
Uninfected atrophic type
Hypertrophic Type (Fig. 4)
INFECTED NONUNION
Problems Associated with Long Standing Infected Nonunion
Classification of Infected Nonunion
Infected Nondraining Nonunion
Author's Classification9
Principles of Treatment1,2,8
Treatment of Infect ed Nonunion
Step I (a) Radical Debridement
Step I (b) Reaming of Medullary Canal
Infected Nonunion Secondary to Chronic Osteomylities16,22
Treatment of Wound
Technique of Preparing the AB Rod and Beads
Step III Stabilization of Fracture
Intramedullary Nailing with Interlocking
Bone Graft
Technique of Preparing Rods and Beads
Treatment of Infected Nonunion Type I (Figs 5 and 6)
Management of Type II Infected Nonunion
Posterolateral Bone Grafting (Harmon's Procedure)
Therapy
Local Beads
PLATING
Management of Infected Nonunion of Fractures by Ilizarov Method4
Management of Various Types of Nonunions
Treatment of Stiff Hypertrophic Nonunion
Treatment of Atrophic Nonunion15
Oblique Nonunions
Infected Nonunion of the Humerus
Nonunion of Femoral Shaft
Infected Nonunion of Femur (3 or 4 stage-procedure)
Nonunion Medial Malleolus3 (Fig. 12)
NONUNION OF THE FRACTURES OF THE TIBIA
PATELLA
FEMUR
PELVIS AND ACETABULUM
SHAFT OF HUMERUS
HIP JOINT
Chronic Infection and Infected Nonunion
184:
Correction of Deformity of Limbs
MECHANICAL AND ANATOMIC BONE AXES
Joint Orientation Anlges and Nomenclature (Fig. 4)
Mechanical Axis and Mechanical Axis Deviation (MAD)3
REFERENCES
REFERENCES
REFERENCES
TRANSLATION DEFORMITY
Two Angulations Equal One Translation
Translation Effects on MAD
OSTOTOMY CONSIDERATION
Translation Deformity Treatment
Translation Deformity Treatment
Order of Deformity Correction
COMBINING ANGULATION AND TRANSLATION
ANGULATION-TRANSLATIONAL DEFORMITIES AND MAD
Graphic Analysis of Angulation-translational Deformities
Osteotomy Correction of Angulation-translational Deformities
Osteotomy Correction of Angulation and Translation in the same Plane
Correction of Angulation and Translation in Different Planes
Strategy 1
Strategies 2 and 3
Strategy 4
Strategy 5
MULTILEVEL FRACTURE DEFORMITIES
Bowing Deformities
REFERENCES
GRAPHIC METHOD ERROR
AXIS OF CORRECTION OF ANGULAR DEFORMITIES
SUMMARY
REFERENCES
SAGITTAL PLANE ANATOMIC AXIS PLANNIN FOR TIBIAL DEFORMITY CORRECTION (FIG. 7)
Sagittal Plane Anatomic Axis Planning of Femoral Deformity Correction (Fig. 8)
Correction of Sagittal Plane Deformities by Osteotomy
Osteotomies for FFD Knee
HE and Recurvatum Knee Deformity (Figs 17 and 18)
Other Joint Considerations for Frontal and Sagittal Plane Deformities (Fig. 20)
Center of Rotation Hinge Technique
Push/Pull Constructs
Construct Considerations
For Rotational Deformities
185:
Calculating Rate and Duration of Distraction for Deformity Correction
186:
Bowing Deformities
INTRODUCTION
Causes of Bowing5
Preoperative Planning of Bowing Deformity5
Steps of Planning
Case Studies (Figs 3 to 5)
Anterolateral Bowing1–3
The New Approach to Anterolateral Bowing1,2
Case Studies (Figs 6 and 7)
The Rationale of this Approach
Treatment4,5
CONCLUSION
187:
Osteotomy Consideration
OSTEOTOMY CONSIDERATIONS
Osteotomy Consideration, Rules of Osteotomy and Hinge Placement
Other Factors in Determining the Level of the Osteotomy
Osteotomy Consideration
Determining the True Plane of the Deformity
METHOD OF OSTEOTOMY
Low Energy Method with only Osteotome (Figs 11A to M)
Multiple Drill Hole and Osteotomy (Figs 12A to C)
Gigli Saw Osteotomy (Figs 13A to K)
188:
Taylor Spatial Frame
INTRODUCTION
Hardware
The Software
Measurements and the Software
Frame Parameters
Structure at Risk
Postoperative Management
Difficulties with the Ilizarov Fixator
Advantages of the Taylor's Spatial Frame
SUMMARY
Patients and Methods
Results
189:
Congenital Pseudarthrosis of the Tibia
INTRODUCTION
Treatment
Case 1
The New Approach to Anterolateral Bowing
Case 2
Case 3
The Rationale of this Approach
CONCLUSION
REFERENCES
REFERENCES FOR WILLIAMS ROD
190:
Management of Fibular Hemimelia Using the Ilizarov Method
AMPUTATION
Complications
AMPUTATION
Acquired Fibular Hemimelia
Results
191:
Foot Deformities
INTRODUCTION
Principle of Deformity Correction
Evaluation Method of Paley
Frontal Plane Ankle Deformities (Paley)
SAGITTAL PLANE ANKLE DEFORMITIES
Conventional Surgery
The Advantages of Ilizarov Method
Disadvantages of Ilizarov Method
Strategies
Indications for Soft Tissue and Osteotomy Distraction
Constrained System
Unconstrained System
Treatment of Equinus Deformity13,15
Constrained Method: Technique13
Treatment of Equinus Deformity
Unconstrained Method (Technique—Paley13)
Varus Deformity: (Technique-Paley)13
CORRECTION OF FOOT DEFORMITY BY SOFT TISSUE DISTRACTION
The Standard Frame
CORRECTION OF FOOT DEFORMITIES BY DISTRACTION OF OSTEOTOMY
U-Osteotomy
V-Osteotomy
Supramalleolar Osteotomy (Paley)
Indication
Advantages
Disadvantages
Equinus Deformity Associated with Supination or Pronation
Equinus with Cavus Deformity with Supination or Pronation
Supramalleolar Osteotomy for varus and Valgus Deformities of Tibial Plafond
Supramalleolar Osteotomy for Recurvatum and Procurvatum Deformities of Tibial Plafond
Pes Cavus or Pes Planus Deformity
Enlarging the Girth of Lower Limb
Cavus with Associated Other Deformities
An Alternative Assembly
Second Alternative Method
Soft Tissue Release
Associated Soft Tissue Release
192:
Multiple Hereditary Exostosis
INTRODUCTION
Radiography
Malignant Transformation3
Treatment
Case History1 (Figs 1A to D)
Case History2 (Figs 2A to C)
193:
Stiff Elbow
INTRODUCTION
ETIOLOGY
CLASSIFICATION
Congenital Contractures
Acquired Contractures
PATHOPHYSIOLOGY
Indication for Surgery
Evaluation
MANAGEMENT OF STIFF ELBOW
Prevention
Management in Established Stiffness
Surgery for Post-traumatic Stiff Elbow
Approach
Operative Technique
Postoperative Management
Hinged External Fixator After Contracture Release
ROLE OF CPM
ARTHROSCOPIC RELEASE
Stiff Elbow in Distal Humerus Fracture
Stiff Elbow in Head Injury
Stiff Elbow and Articular Damage
Elbow Stiffness Associated with Malunion or Nonunion5
Complications of Surgical Intervention in Stiff Elbow
SUMMARY
194:
Limb Length Discrepancy
INTRODUCTION
Causes of Inequality
Assessment
True and Apparent Shortening
Measurement
Assessment of Associated Abnormality
Radiological Assessment
Prediction of Discrepancy
Assessment of the Patient and Predicting Discrepancy
Treatment of Limb Length Discrepancy
General Principles
Stimulation of Bone Growth
Retardation of Growth
Limb Shortening
Orthofix Device for Limb Lengthening
Lengthening over an Intramedullary Nail
Complications
CASE AND X-RAYS OF SUPRIYA GHULE LENGTHENING OVER NAIL
Self-Lengthening Nail
Limb Length Deformity Classification
Tibial Lengthening in Children
Femoral and Tibial Lengthening
Femoral Lengthening
Humeral Lengthening
Paley's Classification of Limb Length Discrepancy in the Forearm
Technique of Forearm Lengthening (Paley Technique)
Advantages of Ultrasonography
Choice of Treatment
Metacarpal Lengthening
195:
Limb Lengthening in Achondroplasia and Other Dwarfism
INTRODUCTION
Etiology
Pathology
Clinical Features
Radiographic Findings
PSEUDOACHONDROPLASIA
Clinical Features
Radiographic Features
Treatment
Whether to Lengthen
When to Lengthen
How Much to Lengthen
How to Lengthen
Complications
196:
Postoperative Care and Complications in Ilizarov Method: Postoperative Care in the Ilizarov Method
INTRODUCTION
In the Operation Room (OR)
After Surgery
Postoperative Day 1
Postoperative Days 2 through 4
Postoperative Days 8 through 10
Pain Relief
Limb Positioning
The Distraction Phase
Follow-up Checklist (Clinical)
Distance Moved on the Threaded Rods Compared to Previous Visit
ROM of Adjacent Joints
Neurological Examination
Pin-sites for Signs of Inflammation/Infection
Stability of Frame and Components
Ambulation
Follow-up Checklist (Radiographs)
Distraction Gap Increasing as Desired and Progressive Correction of Deformity
Quality of Regenerate
Physiotherapy
The Consolidation Phase
Removal of the Fixator
Postfixator Removal
197:
Problems, Obstacles, and Complications of Limb Lengthening by the Ilizarov Technique
INTRODUCTION
CLASSIFICATION
Muscle Contractures
Joint Luxation
Axial Deviation
Neurologic Injury
Vascular Injury
Premature Consolidation
Delayed Consolidation
Pin-Site Problems
Refracture
Joint Stiffness
Other Problems
Materials and Methods
Results
Discussion
198:
Complications of Limb Lengthening: Role of Physical Therapy
INTRODUCTION
Muscle Contractures
Joint Stiffness
Muscle Weakness
Weight Bearing
Joint Subluxation
Nerve Injury
Refracture
CONCLUSION
199:
Aggressive Treatment of Chronic Osteomyelitis
INTRODUCTION
Causes of Recurrence (Failure of Surgery)
Why Radical Resection?
Cierny-Mader Classification
Physiologic Classification (Host)
Anatomic Classification (Fig.1)
Treatment
Radical Resections
Glycocalyx Biofilm
Antibiotic Imprignated Beads
Treatment of Cavity
Circumferential Gap and Bone Transport
Indications
Procedure
Problems of Acute Docking
Problems of Gradual Docking
Bony Problems
Soft Tissue Problems
Bone Graft
Calcium Sulfate Beads
Nutrition Status
Conclusion
200:
Use of Ilizarov Methods in Treatment of Residual Poliomyelitis
INTRODUCTION
Correction of Deformities4,12
Stabilization of Joints2
Limb Lengthening
201:
Arthrodiatasis
INTRODUCTION
RATIONALE
BIOMECHANICS
Rotational Axis of Joint
Center of Rotation of Hip
Center of Rotation of Elbow
Center of Rotation of Knee Joint
Indications for Arthrodiatasis
Techniques of Elbow Hinge Distraction
Technique Aldeghere
Technique Herzenb erg
Intra-articular Fractures
Intra-articular Fractures of the Elbow
Ligamentous Injury
Intra-articular Comminuted Fractures of the Distal Radius
Acetabular Fractures
Intra-articular Fractures of the Knee
Fractures of the Tibial Plateau
Pilon Fractures
Hip Joints
Tuberculosis of the Hip
Rheumatoid Arthritis
Burn's Contracture
Flexion Contractures of the Knee
POSTOPERATIVE CARE
202:
Thromboangiitis Obliterans
INTRODUCTION
Material and Methods
Symptoms
Technique
Postoperative Care
Results and Complications
Results
DISCUSSION
Incidence
Clinical Features
Differential Diagnosis
Etiopathology
Etiology
Treatment
Omento Plasty
Conclusion
Corticotomy and Periosteum Elevation
SECTION 20: ARTHROSCOPY
203:
Arthroscopy
INTRODUCTION
PATIENT POSITIONING FOR ARTHROSCOPIC SURGERY
PORTALS
Standard Portals
Accessory Portals
TRIANGULATION
ARTHROSCOPIC ANATOMY AND DIAGNOSTIC VIEWING
Systematic Viewing of the Knee Joint
Probing of the Joint
ETIOLOGY
CLINICAL PRESENTATION
INVESTIGATIONS
APPROACH TO A PATIENT
SURGICAL TREATMENT
SUMMARY
WHICH PATIENT WILL BENEFIT?
WHERE NOT TO DO ARTHROSCOPY?
TECHNICAL PROBLEM IN DOING ARTHROSCOPY IN OA KNEE
ARTHROSCOPIC PROCEDURES USED IN AN OA KNEE
ANATOMICAL CONSIDERATIONS
CLINICAL SIGNS AND SYMPTOMS
Lachman Test
Pivot Shift Test
Anterior Drawer Test
IMAGING THE ACL INJURED KNEE
Plain Radiography
MR Imaging
Instrumented Ligament Testing
Examination under Anesthesia and Arthroscopy
TREATMENT SELECTION
PATIENT SELECTION
NONOPERATIVE MANAGEMENT
OPERATIVE MANAGEMENT
Graft Selection
Graft Fixation
Graft-Site Morbidity
Surgical Technique
REHABILITATION
COMPLICATIONS OF ACL SURGERY
Joint Stiffness
Graft Donor-Site Complications
CAUSES OF RECURRENT INSTABILITY
Technical Errors
Nonanatomic Tunnel Placement
Inadequate Notchplasty
Improper Tensioning
Graft Fixation Failure
Biologic Failure
Infection
Arthrofibrosis and Infrapatella Contracture Syndrome
Traumatic Failure
Failures Due to Secondary Instability
CONSIDERATIONS IN REVISION ACL RECONSTRUCTION SURGERY
Graft Selection
Staging
Skin Incisions
Hardware Removal
Revision Notchplasty
Bone Tunnel Placement
Graft Fixation
Associated Instability Patterns
Rehabilitation
RESULTS OF REVISION ACL RECONSTRUCTION
PCLANATOMY
PCLBIOMECHANICS
INCIDENCE
MECHANISM OF INJURY
DIAGNOSIS
Presenting Complaints and History
Physical Examination
Imaging Studies
NATURAL HISTORY
TECHNIQUES OF ARTHROSCOPIC RECONSTRUCTION
PCLTREATMENT RESULTS
REHABILITATION OF THE PCL
Nonoperative Rehabilitation Program of the PCL
Postoperative PCL Rehabilitation
ANATOMY
MECHANISM OF INJURY
BIOMECHANICS
HEALING RESPONSE OF MCL
CLINICAL EXAMINATION
History
Stress Testing
Lachman Test
Anterior Drawer Test
Pivot Shift
RADIOGRAPHY
MAGNETIC RESONANCE IMAGING
ARTHROSCOPY
TREATMENT OPTIONS
ISOLATED MCL INJURIES
SURGICAL REPAIR OF MCL
COMBINED INJURIES
Combined MCL and Anterior Cruciate Ligament Injury
MCL Injury in Multi-ligament Injured Knee (Knee Dislocation)
Repair of Medial Collateral Ligament
Neglected MCL Injuries
CONCLUSION
ANATOMY
BIOMECHANICS
Primary Function
Secondary Function
Clinical Application of Biomechanical Studies
MECHANISM OF INJURY
CLASSIFICATION
CLINICAL PRESENTATION
EXAMINATION FINDINGS
PREOPERATIVE PLANNING
TREATMENT
ACUTE RECONSTRUCTION
CHRONIC RECONSTRUCTION
Valgus High Tibial Osteotomy
Popliteus Tendon, Popliteofibular Ligament, and LCL
POSTOPERATIVE REHABILITATION
COMPLICATIONS
Common Peroneal Nerve Palsy
Reconstruction Failure
Stiffness
Hamstring Weakness
Irritation of Hardware
PROCUREMENT, STERILIZATION AND STORAGE
PHYSIOLOGY
ARTICULAR CARTILAGE ALLOGRAFTS
Indications
Surgical Considerations
Results
SUMMARY
LIGAMENT ALLOGRAFTS
Indications
Surgical Considerations
Results
SUMMARY
MENISCAL ALLOGRAFT TRANSPLANTATION
Indications
Surgical Considerations
Results
Pre-requisites for Shoulder Arthroscopy
ANESTHESIA FOR SHOULDER ARTHROSCOPY
Operating Room Set up
Patient Positioning
Beach Chair Position
Lateral Decubitus Position
Examination under Anesthesia
Arthroscopic Portals
Cannulae
Joint Distention and Fluid Management
Diagnostic Arthroscopy
Biceps-superior Labrum Complex
Supraspinatus
Head of Humerus
Labrum
Glenohumeral Ligaments
Glenoid
Subscapularis
Rotator Interval
Bursal Scopy
Complications
CONCLUSION
GLENOID LABRUM ANATOMY AND BIOMECHANICS
MECHANISMS OF INJURY
CLASSIFICATION OF SLAP TEARS
SLAP Type I
SLAP Type II
SLAP Type III
SLAP Type IV
SLAP Type V
SLAP Type VI
SLAP Type VII
SLAC Lesion
CLINICAL PRESENTATION
History
Examination
MR IMAGING
DIAGNOSTIC ARTHROSCOPY
TREATMENT OF SUPERIOR GLENOID LABRAL TEARS
SURGICAL STEPS IN REPAIRING THE TYPE II SLAP TEAR
POSTOPERATIVE REHABILITATION
SECTION 21: TRAUMA UPPER LIMB
204:
Fractures of the Clavicle
INTRODUCTION
Functions of the Clavicle
Mechanism of Injury
Classification
Craiges Classification
Robinsons Classification (Fig. 4)
Clinical Presentation
Investigations
Apical Oblique
Associated Injuries
Treatment
Operative Treatment
Operative Treatment
Complications
Post-traumatic Arthritis
BIBLIOGRAPHY
INTRODUCTION
Clinical Features
Investigations
Classification
Treatment
Operative Technique
Complications
205:
Injuries of the Shoulder Girdle
INTRODUCTION
SPRAINS
SUBLUXATION AND DISLOCATION
Diagnosis
Treatment of Acute Dislocation of Shoulder
Closed Reduction
Hippocratic Technique
Stimson's Techniques
Kocher's Leverage Technique
Postoperative Care
Complications
ACUTE POSTERIOR DISLOCATION OF THE SHOULDER
Mechanism of Injury
Treatment
REFERENCES
CLINICAL EVALUATION
Physical Examination
Radiographic Examination
CT Scan
Other Tests
Classification
Treatment
Non-operative
Operative
Two-part Surgical Neck Fractures51,52
Percutaneous Pin Fixation43,44
Open Reduction and Internal Fixation
Two-part Isolated Tuberosity Fractures
Three-part Fractures
Four-part Fractures
Fractures of Special Importance
COMPLICATIONS
Neurovascular Injuries
Stiffness or Frozen Shoulder
Avascular Necrosis (Figs 14 and 15)
Malunions and Nonunions
Locked Compression Plate
SUMMARY
REFERENCES
FRACTURES OF THE GLENOID PROCESS
Fractures of the Glenoid Neck With Another Disruption of the SSSC
Fractures of the Glenoid Cavity With Another Disruption of the SSSC
Fracture s of the Acromial or Coracoid Process With Another Disruption of the SSSC
Postoperative Management and Rehabilitation
Summary
206:
Fractures of the Shaft Humerus
INTRODUCTION
Epidemiology
Surgical Anatomy of the Brachium as it Applies to Management of Fractures of the Humeral Shaft
Compartments
Mechanism of Injury
Clinical Examination
Radiological Examination
Management
Conservative Management
Functional Bracing
Technique
Intramedullary Nailing
TIPS AND TRICKS
Expandable Nails
Compression Plates (Figs 6 to 8)
TIPS AND TRICKS
Complications
Nonunions
Clinical Examination
Radial Nerve Paralysis
Secondary Nerve Injury
Secondary Repair
SECTION 22: INJURIES OF ELBOW
207:
Fractures of Distal Humerus
INTRODUCTION
Classification of Fractures4
High T Fracture
Low T Fracture
Y Fracture
H Fracture
Medial Lambda Fracture
Lateral Lambda Fracture
AO Classification
Groups
Operative Treatment: Principles of Internal Fixation
Preoperative Planning
Approaches
Position
Incision
Olecranon Osteotomy3
Fracture Fixation5
The Condyles and Humeral Shaft: Anatomic Reduction and Stable Fixation11
Fixation of Olecranon Osteotomy
Closure
Postoperative Management
ELBOW ARTHROPLASTY
Complications
Nonunion and Malunion8
Ulnar Neuropathy7
Heterotopic Ossification7
208:
Injuries Around Elbow
MONTEGGIA FRACTURE DISLOCATION
Classification (Bado)1, 2(Fig. 1)
Monteggia Equivalent Fractures (Bado)
Diagnosis
Treatment
Old Injuries (6 Weeks or Older)
Compound Injuries
Treatment
Treatment of Old Unreduced Monteggia Fractures
Congenital Dislocation of Radial Head
ELBOW DISLOCATIONS
Mechanism of Injury
Classification (Wilkins KE)
Associated Injuries
Treatment
Reduction of Dislocation
Complications
Treatment of Persistent Subluxation of the Elbow
Treatment of Unstable Dislocation
Recurrent Dislocation of Elbow
Surgical Treatment of Recurrent Dislocation of Elbow
Elbow Dislocations in Children
RADIAL HEAD FRACTURES
Mechanism of Injury
Diagnosis
Classification (Fig. 4)
Treatment
Conservative
Surgery
Radial Head Fracture Associated with Elbow Dislocation
Essex-Lopresti Fracture Dislocation
Timing of Surgery
After Effects of Radial Head Excision
Complications
Radial Head and Neck Fractures in Children7
Mechanism of Injury
Classification According to Wilkins KE
Diagnosis
Treatment
BASEBALL PITCHER'S ELBOW
Clinical Features
Treatment
REFERENCES
‘LOCKING COMPRESSION PLATES’
Postoperative Regime
Prognosis
Complications
Nonunion
Arth ritis
Loss of Motion
Instability
Ulnar Nerve Palsy
REFERENCES
209:
Dislocations of Elbow and Recurrent Instability
TERRIBLE TRIAD
Complications of Terrible Triad
Recurrent Elbow Instability
Causes of Recurrent Elbow Instability
Assessment of Recurrent Instability
Apprehension and Pivot Shift Test4
The Anterior Band of MCL also may need to be Reconstructed
Intr aoperative Testing
FRACTURES OF THE CORONOID PROCESS
CLASSIFICATION
LARGER TIP FRACTURES (TYPE II INJURIES) AND POSTEROLATERAL ROTATORY INSTABILITY (O'DRISCOLL)
ANTEROMEDIAL FRACTURE
BASE FRACTURES (TYPE III INJURIES)
POSTOPERATIVE MANAGEMENT
Chronic Instability
HINGED ELBOW EXTERNAL FIXATOR
210:
Fractures of the Radius and Ulna
INTRODUCTION
Anatomy
Mechanism of Injury
Investigation
Classification8
AO Classification
Rationale of Treatment
Treatment
Undisplaced Fractures
Displaced Fractures
Open Reduction and Internal Fixation
Indications for Open Reduction6
Fixation Using Intramedullary Nails
Use of Plate and Screws1–3
Reduction Techniques
Open Fractures
External Fixation
Complications
Nonunion and Malunion
Infection
Nerve and Vascular Injury
Compartment Syndrome
Synostosis
Refracture
SECTION 23: TRAUMA LOWER LIMBS
211:
Fractures of Pelvic Ring
CONCLUSION
212:
Fractures of Acetabulum
INTRODUCTION
ANATOMY
Acetabular Columns (Figs 2 and 3)
MECHANISM OF INJURY
INVESTIGATIONS
Roentgenography
AP View (Fig. 5) (Chart 1)
Judet Views
CT Scan
MRI
CLASSIFICATION
Letournel and Judet Classification8
Elementary Fractures (Fig. 13)
Associated Fractures (Fig. 14)
AO Comprehensive Classification: Fractures of the Acetabulum9 (Fig. 15)
Type A: Partial articular fractures, one column involved
Type B: Partial articular fractures (transverse or T-type fracture, both columns involved)
Type C: Complete articular fracture (both-column fracture; floating acetabulum)
Radiographic Working Classification (Table 1)
INITIAL MANAGEMENT
NONOPERATIVE MANAGEMENT
OPERATIVE MANAGEMENT
Indications for Immediate Open Reduction
Unstable Hip
Incongruity
Retained Bone Fragments
Principles of Operative Management
Timing
Neurologic Monitoring
Surgical Approaches
Implants
Sites of Application
Intraoperative Assessment of Reduction
POSTOPERATIVE CARE
RESULTS
COMPLICATIONS
Heterotopic Ossification (HO)
Nerve Injuries
Vascular Injury
Infection
Avascular Necrosis
SPECIAL SITUATIONS
Elderly Patients
Delayed Presentation
RECENT ADVANCES
SUMMARY
213:
Fractures and Dislocations of the Hip
INTRODUCTION
Clinical Significance of Vascular Anatomy
MECHANISM OF INJURY
POSTERIOR DISLOCATIONS
Clinical Features
Radiological Findings
Treatment
Type I Posterior Dislocation without Fracture (Fig. 7)
Bigelow's Method of Reduction
Allis Method
Bass's Method (Modified Allis Method)
Classical Watson Jones Method (Fig. 9)
St imson's Gravity Method
Postoperative Management
Treatment of Posterior Fracture Dislocation
OPEN REDUCTION
Posterior Dislocation with Fracture of the Head of the Femur (type V)10
Fractures of the Head of the Femur with Dislocation
Treatment
Complications
Prognosis
Anterior Dislocation
Mechanism of Injury
Clinical Picture
Classification
Epstein’ Classification (Fig. 16)
TYPE I: Superior Dislocation (Includes pubic and subspinous dislocation)
TYPE II: Inferior Dislocation (includes obturator, thyroid and perineal dislocation)
Methods of Reduction
Central Fracture Dislocation of the Hip
Mechanism of Injury
Classification: Judet's Types
Clinical Diagnosis
Radiology (Fig. 19)
Treatment (Fig. 20)
Complications
Early Complications
Delayed Complications
Ilizarov Method
REFERENCES
INTRODUCTION
Treatment
REFERENCES
214:
Fractures of Neck of Femur
INTRODUCTION
Historical Aspects
Surgical Anatomy (Fig. 2)
Singh Index
Bone Quality
Healing Occurs by Two Sources
The Calcar Femorale (Fig. 6)
The Influence of the Muscles
Fixation Mechanics of Femoral Neck Fractures
REFERENCES
DIAGNOSIS AND INVESTIGATIONS
Computerized Tomography
Assessment of Femoral Head Vascularity2,4
Laboratory Investigations
Fracture Gap
Osteomalacia
REFERENCES
REFERENCES
CLASSIFICATION
Garden's Classification32–36, 39(Fig. 1A)
Disadvantages of Garden's Classification
AO Classification (Fig. 2)
Pauwels Classification97(Fig. 3)69
Simple and Working Classification
Initial Patient Management109
Decision Making
Impacted Fracture Neck Femur
Stress Fracture
Fullerton Classified Stress Fracture are:
Treatment of Impacted Fractures
Displaced Fracture Neck Femur
Choice of Treatment
Internal Fixation of the Fracture
Arthroplasty
Local Risk Factors for Arthroplasty103
Thromboprophylaxis107,108
Choice of Implant
The purposes of the fixation screws are to:109
Asnis Screws
Advantages of Sliding System are as follows:
Timing of Surgery
Techniques
Decision Making
Undisplaced Fracture
Displaced Femoral Neck Fractures in Young Adults97
Treatment in the Active Elderly Patient
Internal Fixation (IF) Versus Arthroplasty97
Advantages of IF97
Disadvantages of IF97
Technique of Internal Fixation97
Reduction
Anatomic Reduction is Crucial97
Methods
Types of Malreduction35,42
Open Reduction49
Methods of Open Reduction
Technique of Open Reduction—Schaztker78
Fourth Screw
Percutaneous Fixation
Quadratus Femoris Muscle Pedicle Graft (Meyer) (Fig. 19)
Advantages of Arthroplasty
Asepsis
Postoperative Care
Milch Batchler Operation (see Section-19)
Summary of Indications for Procedures for Fracture Neck of the Femur
Prognosis
Complications
Avascular Necrosis (AVN)
Complications of Femoral Neck Fracture58
Early
Late
Diagnosis of AVN75
Treatment
Infection
Mortality92
Thromboembolic Phenomenon
Nonunion (Fig. 23)
Factors beyond the Control of the Surgeon
Head Preserving Procedures
215:
Intertrochanteric Fractures of Femur
216:
Subtrochanteric Fractures of the Femur
INTRODUCTION
Anatomy
Classification
Comprehensive Classification by AO
SUBTROCHANTERIC HIP FRACTURE
Biomechanics10,25
Femur a Cantilever-Bending Moment
In Low Level Fracture
Biological Plating
Dynamic Condylar Screw (Figs 11A to C)
Biomechanics of Intramedullary (IM) Nailing (Figs 12A and B)
Zickel Nail (Fig. 13)29
Locked Intramedullary Nailing7,12,13,22,27
Evaluation
Treatment
Nonoperative Treatment
Operative Treatment
External Fixation
Pathologic Fractures
Preoperative Planning
Technique
Postoperative Care
Complications
CONCLUSION
217:
Diaphyseal Fractures of the Femur in Adults
INTRODUCTION
Relevant Anatomy
Mechanism of Injury
Classification
Diagnosis
Treatment
Nonoperative Treatment
Operative Treatment
Pathological Fractures
Complications1,2
218:
Fractures of the Distal Femur
INDIVIDUAL FRACTURES
Reduction of the Articular Segment to the Shaft
Minimally Invasive Reduction Techniques17
Type A Fracture (Extra-articular)
Type B Fracture (Unicondylar)
INDIVIDUAL FRACTURES
Postoperative Rehabilitation
Complications
Future Direct ions
219:
Extensor Apparatus Mechanism: Injuries and Treatments
EXTENSOR MECHANISM INJURIES
Cause of Tendon Rupture
Clinical Features
Investigations
Ultrasonography
MRI
Treatment
Postoperative Rehabilitation
Delayed Tears
Complications
220:
Intra-articular Fractures of the Tibial Plateau
SURGICAL TECHNIQUE9
Postoperative Management
Complications
LOCKING COMPRESSION PLATE FOR TIBIAL PLATEAU FRACTURE
Table of Clinical Assessment (X-ray, CT or MRI)
Assess9
Contraindications
4.5 mm LCP for Proximal Tibia Plate
Rules for Screw Placement in LCP
Conventional Screws are:
LESS INVASIVE STABILIZATION SYSTEM (LISS)3
221:
Diaphyseal Fractures of Tibia and Fibula in Adults
INTRODUCTION
HISTORY
SURGICAL ANATOMY
Blood Supply of Tibia
Mechanism of Injury
Classification
Orthopedic Trauma Association Classification (OTA) AO Classification of Tibial Diaphyseal Fractures
Type A: Unifocal fractures
Type B: Wedge Fractures
Type C: Complex Fractures (Multifragmentary, Segmental, or Comminuted Fractures)
CLINICAL EVALUATION13
History
Signs and Symptoms
COMPARTMENT SYNDROME
RADIOGRAPHIC STUDIES
1. Plain X-rays
2. CT Scan and MRI
3. Arteriography
Management
Goals of Treatment
Nonoperative Treatment
Functional Cast Brace
Operative Management
Plate Fixation53
Modifications of Plate Fixation
Biological Plating
Locking Plates
Extended Uses of Plating
Intra-articular Extension
Open Fractures
Nonunion
External Fixation
Interlocking Nail50
General Principles of Interlocking Nailing
Reamed Versus Non-reamed Nails4,31,32
TECHNIQUE
Anesthesia
Entry Site
Reaming and Nailing
Interlocking Screws
Proximal Third Fractures
Distal Third Fractures
Comminuted and Segmental Fractures
Nailing in Open Fractures43
Nailing in Polytrauma
Postoperative Care
Splinting
Weight Bearing
Dynamisation
Complications
Nonunion
Infection
Compartment Syndrome33
Knee Pain following Nailing20
CONCLUSION
222:
Pilon Fracture
CLASSIFICATION5
Clinical Assessment
Management
Nonoperative Treatment
Operative Management
Minimally Invasive Surgery
Reduction Technique
LOCKING COMPRESSION PLATE
Postoperative Management
Use of External Fixator4,6–8
External Fixator with Limited Internal Fixation
Types of Frames
Use of Ilizarov External Fixator with Limited Internal Fixation4,6–8
Pilon Fracture
Disadvantages of External Fixation
Prognosis
Complications
Pearls and Pitfalls for Pilon Fractures
SECTION 24: INJURIES OF THE SPINE
223:
Cervical Spine Injuries and their Management
RADIOLOGICAL EVALUATION
How to Obtain Radiographs
Interpretation of Radiographs
Flexion-Extension Radiographs, CT and MRI
Spinal Cord Injury without Radiological Abnormality (SCIWORA)
Steroids (Methylprednisolone) in Spinal Cord Injury
CLASSIFICATION AND TREATMENT OF SPECIFIC INJURIES
UPPER CERVICAL SPINE
Clinical Assessment
Occiput-C-1 Disruption
Occipital Condyle Fractures (Fig. 3)
Atlas Fractures
Craniocervical Dissociation
Harborview Classification of Craniocervical Injuries
Levine and Edwards26 Four Part Classification System for C1 Fractures
C1-2 Injuries (Atlanto- axial Subluxation, AAS) (Fig. 6)
C1-C2 Rotatory Subluxations (Figs 7A and B)
Odontoid Fractures (Fig. 9)
Odontoid Fractures (Fig. 10)
Traumatic Spondylolisthesis of the Axis
Effendi's Classification of Hangman's Fractures (Figs 12A to C)
SUBAXIAL FRACTURES
Compressive Flexion Injuries (Fig. 13)
Vertical Compression Injuries (Fig. 14)
Distractive Flexion Injuries (Fig. 15)
Compressive Extension Injuries (Fig. 16)
Distractive Extension Injuries (Fig. 17)
Lateral Flexion Injuries
Timing of Surgery
224:
Fractures and Dislocations of the Thoracolumbar Spine
INTRODUCTION
Classification
Mechanism of Injury
Treatment Options
Nonoperative Treatment
Indications of Nonoperative Treatment include
Nonoperative Treatment is not advisable in:
Nonoperative Treatment Options
Surgical Treatment
Goals
Indications
Approaches
Complications
With Nonoperative Treatment
With Operative Management
225:
Pressure Sores and its Surgical Management in Paraplegics
INTRODUCTION
History
Pathology
Presenting Features, Diagnosis and Preliminary Debridement
Complications
Management of Pressure Sores
Surgical Treatment
INTRODUCTION
Applied Anatomy of Tensor Fascia Lata Flap
Operative Technique
SECTION 25: NEGLECTED TRAUMA
226:
Neglected Trauma in Upper Limb
INTRODUCTION
Neglected Trauma in Orthopedics are of Three Types
Complications due to Negligence or Wrong Treatment of Fractures
MALUNITED FRACTURES
NEGLECTED DISLOCATIONS
Fracture Clavicle
Injuries Around the Shoulder Joint
Fracture Dislocation with Comminution of the Humeral Head
Fractures of the Proximal Humerus
Neglected Fracture Shaft Humerus with Radial Nerve Palsy
Neglected Nerve Injuries
Treatment of Nerve Injury
Fractures of the Distal Humerus
Injuries Around the Elbow
Intra-articular Fractures of the Elbow
Neglected Supracondylar Fracture of Humerus in Children
Old Fractures of the Capitellum
Malunited Fracture with Cubitus Valgus or Varus Deformity
Old Fractures of the Medial Epicondyle
Fractures of the Radial Head
Fractures of the Olecranon
Injuries of the Forearm
Neglected Fractures of the Radius and Ulna
Shaft Radius and Ulna in Adults
Fracture Distal Radius
Neglected Monte ggia Fracture
Post-traumatic Radioulnar Synostosis
Restriction of Rotation
Neglected Injuries of the Wrist
NEGLECTED HAND TRAUMA
NEGLECTED DISLOCATIONS OF JOINTS IN THE UPPER LIMB
Sternoclavicular Joint Dislocation
Acromioclavicular Joint
Unreduced Dislocations of the Shoulder
Dislocations of Several Months
Treatment
Posterior Dislocation of Shoulder
Neglected Dislocation of Elbow
REFERENCES
227:
Neglected Trauma in Lower Limb
REFERENCES
BIBLIOGRAPHY
INTRODUCTION
Treatment
Manipulation Under GA
Closed Reduction with Heavy Traction in Abduction (HTA)
Open Reduction17
Author's Preferred Method
Avascular Necrosis (AVN)
228:
Neglected Trauma in Spine and Pelvis
POSTERIOR NONUNION
SACRAL NONUNION
Limb Length Discrepancy
SECTION 26: HAND
229:
Functional Anatomy of the Hand, Basic Techniques and Rehabilitation
230:
Biomechanics of the Deformities of Hand
INTRODUCTION
Stability
Monarticular System
Biarticular Chain Model
Finger Deformities
Deformities Resulting from Disequilibrium in a Monarticular System
Deformities Resulting from Disequilibrium in the MCP-PIP Joints Biarticular System
Deformities Resulting from Disequilibrium of the PIP/DIP Joints Biarticular System
Deformities of Thumb
Articulated System of Thumb
Biarticular Chain Model
Patterns of Thumb Deformities
CONCLUSION
231:
Examination of the Hand
GROSS ASSESSMENT OF MOVEMENTS OF THE HAND
Movement of the Thumb (Table 1, Fig. 12)
Special Tests
INVESTIGATION
232:
Fractures of the Hand
FRACTURES OF DIGITAL BONES
Principles of Management
Modalities of Management of Hand Fractures
Conservative Treatment6–8
Postoperative Care
REFERENCES
PHALANGEAL FRACTURES
Distal Phalanx Fracture2
Mallet Finger
Of Tendon Origin7
Of Bony Origin
Fractures of the Proximal and Middle Phalanges
Fractures of the Base1,2
DIAPHYSEAL FRACTURES4
Closed Reduction
Closed Reduction and Percutaneous Fixation
Open Reduction and Internal Fixation (ORIF)
External Fixation
Complications of Phalangeal Fractures4
Metacarpal Fractures
Non-operative Treatment of Diaphyseal Fractures
ARTICULAR FRACTURES OF THE CMC JOINT (BENNETT'S6)
ROLANDO'S FRACTURE6
MUTILATING HAND INJURIES7
Evaluation
Physical Examination
Management
233:
Dislocations and Ligamentous Injuries of Hand
CARPOMETACARPAL (CMC) DISLOCATIONS10,11
METACARPOPHALANGEAL DISLOCATIONS
MCPJ Dislocations
INJURIES OF THE ULNAR COLLATERAL LIGAMENT
MECHANISM OF INJURY
PATHOLOGY (FIGS 3 AND 4)
CLINICAL FEATURES AND INVESTIGATIONS2
TREATMENT
Incomplete Acute Tears5
Complete Acute Tears1
Chronic Tears3,4
RADIAL COLLATERAL LIGAMENT INJURIES
DISLOCATIONS OF THE PROXIMAL INTERPHALANGEAL JOINT (PIPJ)1,6
Acute Dorsal PIPJ Dislocation8,9,14,18
Dray and Eaton's Classification
Type I (Hyperextension)
Type II (Dorsal Dislocation)
Type III (Fracture-Dislocation)15–17
REFERENCES
234:
Crush Injuries of the Hand
INTRODUCTION
Principles
Observations
JOSHI EXTERNAL STABILIZING SYSTEM (JESS): BASIC FRAME CONSTRUCTION (POSITIONAL)
Inverted U Frame (Figs 1A and B)
Indications
Unilateral Frame (Fig. 2)
Indication
Dorsolateral Frame (Fig. 3)
Collateral Frame (Fig. 4)
Ray Frame (Fig. 5)
Hand and Extended Hand Frame (Fig. 6)
BIBLIOGRAPHY
INTRODUCTION
Determining Factors
Priorities in Treatment
Essentials of Management Care
Phase I
Phase II
Phase III
Phase IV: 1 Week to 4 Weeks
Phase V: 4 Weeks to 12 Weeks
Phase VI
Treatment
Radiological Assessment
Phase I: Examination Wound Debridement
Treatment
Commonly Used Protocols
Postoperative Rehabilitation
Physiotherapy
Secondary Treatment
235:
Skin Cover in Upper Limb Injury
INTRODUCTION
Skin Approximation
Split Skin Graft
FTSG
Flap Cover
Random Pattern Flap
Axial Pattern Flap
Musculocutaneous Flap
Fasciocutaneous Perforators
Flap Selection
Skin of the Hand
Provision of Sensation
INTRODUCTION
Fingertip Injury
Local Flap-like Tissues
Atasoy-Kleinert V-Y
Volar Advancement Flap
Cross-Finger Flap
Dorsum of Hand
The Palm as Donor Site
Radial Artery Fasciocutaneous Flap: An Adjacent Large Flap
Distant Flaps
The User-Friendly Area Around the Inguinal Region
Microvascular Flaps
CONCLUSION
236:
Flexor Tendon Injuries
INTRODUCTION
Clinical Evaluation
Examination of Hand
ANATOMY OF THE TENDON SHEATH
Management
For Thumb (Fig. 4)
Suture Material
Timing of Repair
Timing of Flexor Tendon Repair
Indications for Primary Repair
Level of Injury
Retrieving Tendon Ends into the Wound
Basic Principles of Suturing Tendons17(Fig. 5)
Suturing Technique6–8,19, 21
Postoperative Care
Complications
Evaluation of Results of Tendon Repair
Evaluation by Boyes’ TPD Method (Tsuge's Modification)
Evaluation with White's Method
Secondary Repair of Flexor Tendons
Reconstruction of Finger Flexor by Two-Stage Tendon Graft
237:
Extensor Tendon Injuries
INTRODUCTION
Anatomy
Zone-I
Zone-II
Zone-III
Zone IV
Zone-V
Affections of Thumb
Zone I—IP Joint (Mallet Thumb)
Zone II
Zone III (MP Joint Level)
Zone IV (Metacarpal Level)
Zone V (CMC Joint Area)
Late Reconstruction
Postoperative Care
Complications
Operative Mana gement17
Complications
Management
Operative Management
Mallet Finger Deformity (DIP Joint Extensor Disorder)
Management
238:
Congenital Deformities of Upper Limbs
INTRODUCTION
Congenital Amputations (Figs 1A to D)
Phocomelia (Fig. 2)
Radial Club Hand (Figs 3A to D and 4A to D)
Syndactyly (Figs 5A to D)
Polydactyly
Duplicate Thumb (Figs 6A to C)
Postaxial Polydactyly (Figs 7A and B)
Macrodactyly (Figs 8A to D)
Congenital Ring Syndrome (Figs 9A to D)
Trigger Digits
Arthrogryposis (Figs 10A to C)
RECENT ADVANCES
Bone Lengthening
Deformity Correction
Microsurgical Reconstruction
BIBLIOGRAPHY
TORSIONAL DEFORMITIES
Congenital Torticollis
Pathology
Differential Diagnosis
Treatment
Clinical Features
Symphalangism
Cromptodactyly
Clinodactyly
239:
Complex Regional Pain Syndrome
COMPLEX REGIONAL PAIN SYNDROME (CRPS)
Importance of Objective Findings
Diagnosis of CRPS
Clinical Features of CRPS
Associated Movement Disorders
Case Report
Etiology
Microangiopathy
Persistent Minimal Distal Nerve Injury
Laboratory Diagnostic Aids
Thermogram and Bone Scan
Thermogram
Treatment
Treatment Protocol
Psychosocial Modalities a often Neglected aspect and must be considered in all Patients with CRPS
Urgent Sympathetic Blocks
Sequential Drug Trials
Medications used to Treat Chronic Pain
For Constant Pain associated with Inflammation
For Constant Pain not caused by Inflammation
For Constant Pain or Spontaneous (Paroxysmal) Jabs and S leep Disturbances
For Spontaneous (Paroxysmal) Jabs
For the Treatment of Sympathetically maintained Pain (SMP)
For Muscle Cramps (Spasms and Dystonia) which can be very Difficult to treat.
For Localized Pain related to Nerve Injury
Sympathetic Blocks
The Pros and Cons of Sympathetic Block
The Value of Sympathetic Block
THE GOAL IS ALWAYS TO TREAT, NOT OVER TREAT
Stellate Ganglia Block (Figs 5 and 6)
Technique
Axillary Sympathectomy
Technique
Sympathectomy of the Lower Limb (Figs 11 and 12)
Technique
Post-laminectomy Burning Foot Syndrome
Treatment
Post-pelvic Trauma CRPS
Treatment
Clinical
How to Assess an Effective Sympathetic Blockade
Complications of Sympathetic Block
Stellate Ganglion Block
Lumbar Sympathetic Block
The Myofascial Pain Syndrome in CRPS
Post-sympathectomy Pain
Sympathectomy: To Do or Not to Do
Laparoscopic Sympathectomy
Patients Variable Response
Spinal Cord Stim ulation (SCS)
The External Battery System Versus the Internal Battery System for Spinal Cord Stimulation
Opiates in CRPS
Morphine Pump
Intrathecal Baclofen
BIBLIOGRAPHY
240:
Infections of Hand
INTRODUCTION
Management
Examination
Operation
Tourniquet
Antibiotics
Incisions
Postoperative Care
Specific Infections
Paronychia
Felon
Deep Space Infection of the Palm
Web Space Infection
Palmar Space Infections
Midpalmar Space Infection
Thenar Space Infections
Pyogenic Flexor Tenosynovitis
Bite Wounds of the Hand
241:
Contractures of Hand and Forearm
INTRODUCTION
Etiopathogenesis1
Milestones in VIC
Anatomic Considerations8
Morbid Anatomy19
Nerve
Clinical Classification of Established VIC
Mild (Localized) Type
Moderate (Classic) Type
Severe Type
Management of Established VIC3,5
Conservative Methods
Operative Measures
Treatment of Mild VIC
Treatment of Moderate Type
Treatment of Severe VIC
Tendon Transfer for Severe VIC14
Free Muscle Transplant9
REFERENCES
PROGNOSIS
NONOPERATIVE TREATMENT
Surgical Managements
Things to Remember
Popular Skin Incision Patterns
Treatment of Joint Contracture
PIP Joint Contracture
Postoperative Rehabilitation
Complications
Recurrence
REFERENCES
PATHOPHYSIOLOGY
MANAGEMENT OF ACUTE BURNS
POSTBURN DEFORMITY
242:
Nail and its Disorders and Hypertrophic Pulmonary Arthropathy
INTRODUCTION
Anatomy
Indications and Contraindications
Types of Operations
Subungual Hematoma
LACERATIONS OF NAIL AND NAIL BED
Stellate Lacerations
AVULSIONS OF NAIL BED
COMPLEX INJURIES WITH PARTIAL LOSS OF N AIL BED
ASSOCIATED FRACTURES
Postoperative Management
243:
Stiff Hand and Finger Joints
ETIOLOGY
PATHOPHYSIOLOGY OF JOINT STIFFNESS
Clinical Features
History
Examination
Special Tests
Investigations
Treatment
Prevention
Nonoperative Interventions4
Operative Treatment
MP Joint Extension Contracture Release
PIP Joint Flexion Contracture Release
PIP Joint Extension Contracture Release
MP Joint Arthrodesis5
PIP Joint Arthrodesis5
MP and PIP Joint Arthroplasty7,8
244:
Ganglions, Swellings and Tumors of the Hand
INTRODUCTION
Incidence and Type
Age of Onset, Behavior and Significance
Patient Evaluation
Investigations
Plane Radiographs of the Hand Skeleton
Blood Tests
Isotope Bone Scan
CT Scan
Magnetic Resonance Imaging (MRI)
Angiography
Radiologic Examination of the Chest
Biopsy
GANGLIONS
Dorsal Wrist Ganglions
Management of Ganglions
Volar Wrist Ganglion
Flexor Tendon Sheath Ganglion
Mucous Cyst
GIANT CELL TUMOR OF TENDON SHEATH
DERMATOFIBROMA
LIPOMA
HEMANGIOMAS
GLOMUS TUMORS
NEURILEMMOMA (SCHWANNOMA)
BENIGN BONE TUMORS
Enchondroma
Osteochondroma
Aneurysmal Bone Cyst (ABC)
Osteoid Osteoma
GIANT CELL “TUMOR” OF BONE
MALIGNANT TUMORS IN THE HAND
General Surgical Plan
Synovial Sarcoma
Epithelioid Sarcoma (Squamous Cell Carcinoma)
Rhabdomyosarcoma
Fibrosarcoma
Chondrosarcoma
Osteosarcoma
Metastatic Tumors
245:
Hand Splinting
INTRODUCTION
Objectives of Splintage
Characteristics of a Good Splint
Need for Individualization of a Splint
Applied Anatomy of the Hand for Splinting
GENERAL PRINCIPLES OF FIT
Precautions
MECHANICAL PRINCIPLES
Angle of Pull
Ligamentous Structures
Pressure
Torque Effect
Contour
Resolution of Forces
Effect of Passive Mobility of a Multiarticular Segment
Straps
Rubber Bands
Splint Component Terminology
Classification of Splints
Material used in Fabrication of Splints
Material Used
Application of Motor Car Rubber Tube
Finger Slings
Lining material for metal splints
Straps for the Splint
Wrist Bands
Application of Rubber and Polythene Tubing
Low Temperature Thermoplastic Splints
Function
Instruments used in Fabrication of Splints
Jig for Construction of Spring or Helix
Stand
Disk
Nuts (Fig. 10)
Tool Bit
Handle
Preparation of a Coil (Fig. 11)
CLINICAL APPLICATIONS OF SPLINTS
Mallet Finger Splint (Fig. 12)
2. Cylinder Cast (Fig. 13)
3. Gutter Splint
4. Tip Protector Splint
5. Full Extension Resting Pan Splint
6. Capener Splint (Fig. 14)
7. Dorsal Outrigger (Fig. 15)
8. Wrist Cuff with MP Slings (Fig. 16)
9. Wrist Cuff with IP Hooks (Fig. 17)
10. Wrist Cuff with MP Slings and IP Hooks (Figs 18 and 19)
11. Wrist Immobilization with MP Slings and IP Hooks (Fig. 20)
12. Safe Position or Resting Pan Splint (Platform Splint) (Fig. 21)
13. Web Spacer Splint (Fig. 22)
14. Wrist Cuff with Slings a nd IP Hooks (Fig. 23)
15. Dorsal Wrist Extension Block Splint (Cock-up Splint) (Fig. 24)
16. Buddy Tapes (Fig. 25)
17. Boutonniere Splint
18. Glove Rubber Bands (GRBs)
19. Wide Rubber Bands (WRBs)
20. Static/Dynamic Elbow Splint (Fig. 26)
246:
Amputations in Hand
INTRODUCTION
General Principles
Emotional Response of the Amputee
Role of Family
Esthetic Considerations
Basic Functional Patterns of the Hand
Precision Manipulations
Power Grasp
Nonprehensile Functions
AMPUTATION OF FINGERTIP
Treatment
AMPUTATIONS OF SINGLE FINGER
Index Finger
Middle or Ring Finger
Little Finger
Ray Amputations
Index Ray Amputation
AMPUTATION THROUGH THE THUMB
AMPUTATIONS OF MULTIPLE DIGITS
Transmetacarpal Amputation
Disarticulation Wrist or Lower Forearm Amputations
Painful Stump
247:
Arthrodesis of the Hand
INTRODUCTION
ARTHRODESIS OF THE WRIST
Anatomy
Indications
Contraindications
Surgical Method
Complications of Wrist Arthrodesis
Intercarpal Arthrodesis
Triscape (STT) Arthrodesis
Techniques of Triscaphe Arthrodesis
SMALL JOINT ARTHRODESIS
Indications
Principles
Surgical Procedure
Fixation of Bone Ends
Complications
BIBLIOGRAPHY
SECTION 27: INJURIES OF WRIST
248:
Surgical Anatomy of the Wrist
INTRODUCTION
ANATOMICAL CONSIDERATION
249:
Examination of the Wrist
METHODOLOGY
History Taking
Regional Examination
Local Examination
Attitude
Inspection
Palpation
Common Swellings around the Wrist Joint
Egg Shell Crackling
Step Sign
Palpation of the Snuff-Box
Crepitus
Test for de Quervain's Disease
MOVEMENTS (TABLE 1)
Palmar-Flexion and Dorsiflexion (Fig. 7A)
Method of Demonstration
Radial and Ulnar Deviation (Fig. 7B)
Circumduction
Test for Function of Important Tendons
Extensor Pollicis Longus (Fig. 9A)
Extensor Digitorum (Fig. 9B)
Palmaris Longus (Fig. 9C)
Flexor Carpi Ulnaris
MEASUREMENTS
Linear Measurement
Investigations Required for Wrist Pathology
Positioning of the Part for Oblique Projection (Fig. 11)
250:
Fracture of the Distal End Radius
LOCKING PLATES FOR DISTAL END RADIUS17
Partial Articular Distal Radius Fractures (B3)
Extra-articular Multifragmentary Fractures (A3)
Extra-articular Dorsally Displaced Fractures (A2)
Fragment Specific Fixation (Fig. 19)
Associated Injuries
Complications
Treatment of Malunion and Radiocarpal Arthritis
Causes
251:
Distal Radioulnar Joint
INTRODUCTION
Biomechanics and Anatomy
Functions of Triangular Fibrocartilage Complex (TFCC)
Investigations
Radiography
Tomography
Magnetic Resonance Imaging (MRI)
Arthroscopy
Arthrography
Treatment of Distal Radioulnar Joint Disorders
Essex-Lopresti Injury7
Late or Chronic Joint Disruption (More than 2 Months) without Radiographic Arthritis
Isolated TFCC Damage without Instability
TFCC Disruption with Recurrent Dislocation or Instability
Bunnell-Boyes3 Reconstruction of DRUJ for Dorsal Dislocation
Impingement
Indications for Hemiresection Interposition Arthroplasty
Disadvantages of Bower's Arthroplasty
Contraindications for Bower's Arthroplasty8
Disadvantages
Modified Darrach's Procedures5
Radioulnar Arthrodesis
Snapping or Dislocating Extensor Carpi Ulnaris
252:
Fractures of the Scaphoid
INTRODUCTION
Diagnosis
Mechanism of Injury
Classification
Type A (Acute Stable Fractures)
Type B (Acute Unsta ble Fracture)
Type C (Delayed Union)
Type D (Established Nonunion)
Biomechanical Implications of Scaphoid Waist Fractures
Blood Supply of the Scaphoid
Treatment
Undisplaced Scaphoid Fractures
Displaced Scaphoid Fractures
Delayed Union
Nonunion
Bone Grafting (Fig. 3)
Avascular Necrosis
Revision of Failed Bone Graft
Complex Scaphoid Fractures
Degenerative Arthritis
Scaphoid Malunion
253:
Fracture of the Other Carpal Bones
INTRODUCTION
Triquetrum
Pisiform
Hamate
Trapezium
Trapezoid
Capitate
254:
Carpal Instability
255:
Kienbock's Disease
INTRODUCTION
Etiology31
Radiographic Findings6,39
Stahl-Lichtman Classification
Swanson's Classification
Treatment
Immobilization
Revascularization
Ulnar Lenghthening and Radial Shortening2
Excision of the Lunate
Implant Arthroplasty13
Intercarpal Arthrodesis
CAPITATE SHORTENING41
CAPITATE-HAMATE ARTHRODESIS11
Salvage Procedures
Authors’ Recommendations
SECTION 28: DISORDERS OF WRIST
256:
de Quervain's Stenosing Tenosynovitis
INTRODUCTION
Pathological Anatomy4
Etiology
Clinical Features
Treatment17
257:
Carpal Tunnel Syndrome
INTRODUCTION
Anatomy
Etiology
Pathogenesis
Clinical Features
PROVOCATIVE TEST
SENSORY TESTINGS
MOTOR EXAMINATION
INVESTIGATIONS
ELECTRO DIAGNOSTIC TESTS
DIFFERENTIAL DIAGNOSIS
Double Crush Syndrome
Pronator Syndrome
Treatment
Nonoperative Treatment
Operative Treatment
MINI OPEN CARPAL TUNNEL RELEASE (FIG. 3)
COMPARISON OF ENDOSCOPIC, MINI-INCISION AND CONVENTIONAL CARPAL TUNNEL RELEASE
ACUTE CARPAL TUNNEL SYNDROME
258:
Chronic Tenosynovitis
INTRODUCTION
TENOSYNOVITIS OF WRIST AND HAND
de Quervain's Disease
Compound Palmar Ganglion
Pathoanatomy
Clinical Features
Treatment
Technique of Tenosynovectomy
Trigger Fingers and Trigger Thumb
Pathoanatomy
Etiology
Clinical Features
Treatment
Extensor Pollicis Longus Tenosynovitis
Pathoanatomy
Clinical Feature
Treatment
Bicipital Tenosynovitis
Stenosing Tenosynovitis Around Ankle
Clinical Presentation
Treatment
SECTION 29: DISEASES OF ELBOW
259:
Clinical Examination and Radiological Assessment
METHODOLOGY
Inspection
Palpation
Palpation of Supracondylar Ridges
Three Point Relationship
Palpation of Epicondylar Region
Palpation of Joint Line
Fluid in the Joint
MOVEMENTS (TABLE 1)
Elbow Proper
Method of Assessing the Movements
Rotational Movements
MEASUREMENT
Linear
Circumferential
Measurement of Cubitus Varus and Cubitus Valgus
ASSESSMENT OF COMPLICATIONS DUE TO PATHOLOGY IN AND AROUND THE ELBOW
Test for Impending/Threatening Volkmann's Ischemic Contracture
Tests for Lateral Epicondylitis
Test for Medial Epicondylitis (Fig. 17)
Test for Cubital Tunnel Syndrome
INVESTIGATIONS REQUIRED FOR ELBOW PATHOLOGY
General Investigations
Radiological Investigation
Aspiration
260:
The Elbow
INTRODUCTION
ANATOMICAL CONSIDERATIONS
BIOMECHANICS OF THE ELBOW JOINT3
Stability of the Joint
CLINICAL EXAMINATION OF ELBOW JOINT
INVESTIGATIONS
Roentgenographic Examination
Tomography
Computed Tomography (CT)
3D CT Scan
Magnetic Resonance Imaging (MRI)
Scintigraphy
DIFFERENTIAL DIAGNOSIS
SURGICAL APPROACHES TO THE ELBOW
Lateral Approach
Medial Approach
Posterior Approach
Campbell's Posterolateral Approach
Transolecranon Posterior Approach (by MacAusland and Cassebaum)
Boyd's Approach
Anterior Approach
Henry's Approach
DISEASES AND DEFORMITIES OF ELBOW JOINT
PYOGENIC INFECTION OF BONES AND JOINT AROUND ELBOW
Diagnosis
Treatment
Antibiotics
RHEUMATOID ARTHRITIS1
Diagnosis
Treatment
Medicine
Surgery
MISCELLANEOUS AFFECTIONS OF ELBOW
Osteochond ritis Dissecans in Adults
Osteoarthritis of the Elbow
Osteochondritis Dissecans in Children
Treatment
DISEASES AND INJURIES OF SOFT TISSUE AROUND ELBOW
Extra-articular Conditions
Tennis Elbow (Lateral Epicondylitis)2
Management
Golfer's Elbow (Medial Epicondylitis)
Management
Olecranon and Radial Bursitis
NEUROLOGICAL DISORDERS
Cerebral Palsy
Stroke
Charcot's Joint
CONGENITAL AND DEVELOPMENTAL ANOMALIES (WADSWORTH)
POST-TRAUMATIC STIFFNESS OF THE ELBOW4,5
Soft Tissue Contractures
Capsular Contractures and Adhesions
Myositis Ossificans
Bone Blocks and Tilt in the Articular Surfaces
Incongruity of the Articular Surfaces
Management of the Stiff Elbow
Prevention
Management in Established Stiffness
Surgery for Post-traumatic Stiff Elbow
Operative Technique2
Postoperative Management
261:
Abnormal (Heterotropic) Calcification and Ossification
INTRODUCTION
HEREDITARY CONDITIONS
Tumoral Calcinosis2
Pathophysiology
Clinical Features
Macroscopic Appearance
Microscopic Appearance
Differential Diagnosis
Management
Dysplasia Epiphysialis Punctata (Stippled Epiphyses)7
Pathology
Clinical Features
Radiographic Picture
Differential Diagnosis
Metabolic Disorders
Clinical Features
Radiographic Picture
Pathology
Treatment3
Dystrophic Calcification5
Myositis Ossificans Progressive: (Fibrodysplasia Ossificans Progressive)4
Pathology
Treatment
REFERENCES
INTRODUCTION
Pathology
Clinical Features
Diagnosis
Radiography2
Differential Diagnosis
Treatment
REFERENCES
REFERENCES
SECTION 30: DISEASES OF SHOULDER
262:
Functional Anatomy of Shoulder Joint
263:
Biomechanics of the Shoulder
INTRODUCTION
Sternoclavicular Joint
Motion and Constraint
Acromioclavicular Joint
Motion and Constraint
Glenohumeral and Scapulothoracic Joint
Diseases of Shoulder Codman's Paradox
Description of Joint Motion
Shoulder Motion
Articular Surface and Orientation
Arm Elevation
External Rotation of the Humerus
Center of Rotation
Clinical Relevance
Constraints
Capsular and Ligamentous Contributions to Static Shoulder Stability
Dynamic Stabilizers
264:
Clinical Examination and X-ray Evaluation: History Taking, Fallacies of Tests and Comprehensive Examination of Shoulder
HISTORY MINUTIAE
EXAMINATION PROPER
Look
Feel
Move
Tests
Hawkins Sign (Fig. 6)
Neer's Sign
Neer's Test
TESTS FOR INSTABILITY
Anterior Instability Drawers Test (Fig. 7)
Crank Test for Anterior Instability (Fig. 8)
Jobes’ Relocation Test (Fig. 8)
FALLACIES
Sulcus Test
Ligament Laxity (Fig. 10)
Rotator Interval
CLINICAL APPLICATION
Posterior Instability (Fig. 11)
SLAP (Superior Labrum Anterior to Posterior) Tears
O'Brien Test (Fig. 12)
Anterior Slide Test for SLAP Tears
ROTATOR CUFF TESTS
Supraspinatus
Infraspinatus (Fig. 14)
Subscapularis
Napoleon or Belly Press Test (Fig. 17)
ACROMIOCLAVICULAR JOINT TESTS
Cross Adduction Test (Fig. 18)
Paxinos Sign
LONG HEAD OF BICEPS
Speed Test
Yergasson's Test (Fig. 19)
NERVE TESTS
Serratus Anterior
Wall Push Test
Trapezius
Compression Neuropathy of Suprascapular Nerve
265:
Anomalies of Shoulder
266:
Chronic Instability of Shoulder—Multidirectional Instability of Shoulder
INTRODUCTION
Normal Functional Anatomy
Etiology
PATHOLOGICAL ANATOMY OF THE ESSENTIAL LESION
BANKART'S LESION
HILL SACH'S LESION
Classification
CLINICAL DIAGNOSIS AND ASSESSMENT
Apprehension Test
Anterior Instability
Posterior Instability
Inferior Instability
LOSS OF MOVEMENTS
Investigations
MANAGEMENT
Arthroscopic Procedure (Mogiymn and Caspari)
Advantages
Postoperative Program
Postoperative Management
BANKART PROCEDURE
Surgery
Putti Platt Procedure
Eden-Hybbinette Operation
Bristow-Helfet Operation
Saha's Procedure
NON-OPERATIVE MANAGEMENT
Posterior Instability
Conservative Treatment
Rehabilitation of Shoulder Instability
FAILED SURGERIES
267:
Posterior Shoulder Instability
HISTORY
CLASSIFICATION OF ANTERIOR INSTABILITY
PATHOANATOMY
Ligaments
SGHL
MGHL
IGHL
LABRUM
Super ior Labrum Lesions
BONY LESIONS
MRI IN INSTABILITY
ARTHROSCOPI C TREATMENT MODALITIES
POSITIONING
Anterior Instability
OPEN BANKART REPAIR
Procedure in Brief
Bony Defects
POSTERIOR INSTABILITY
REHABILITATION
RESULTS
COMPLICATIONS OF ARTHROSCOPIC REPAIR
Nerve Lesions
Cartilage Damage
Metal Anchors Protruding
Infection
Stiffness
COMPLICATIONS OF OPEN REPAIR
TREATMENT IN FIRST TIME DISLOCATORS
CONCLUSION
268:
Superior Labral Anteroposterior Lesion
INTRODUCTION
History
Anatomy
Biomechanics of the SLAP Lesion
Peel Back Sign
Circle Concept
180° Rule
Classification of SLAP Tears (Figs 6 and 7)
Clinical Examination
Arthroscopic Evaluation and Treatment
Postoperative Rehabilitation Program
269:
Rotator Cuff Lesion and Impingement Syndrome
INTRODUCTION
History and Development
ETIOLOGY AND PATHOLOGY
Intrinsic Factors
Degeneration of the Cuff
Extrinsic Factors
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
Why Operate
When not to Operate
Surgery Open or Arthroscopic Repair
Arthroscopic Assisted Mini-Open Repair I
Arthroscopic Assisted Mini-Open Repair II
All Arthroscopic Repairs
DISCUSSION AND RESULTS
RECENT ADVANCES
ROLE OF STEROIDS
CONCLUSION
270:
Miscellaneous Affections of Shoulder
INTRODUCTION
Etiology
CLINICAL FEATURES
Treatment
CONCLUSION
REFERENCES
HISTORY
Anatomy5
Clinical Features1,4
Speed's Test or the Biceps Tension Test
Classification of Biceps Pathology
Secondary Biceps Tendinitis
Primary Biceps Tendinitis
Biceps Tendon Instability
Biceps Tendon Rupture
Differential Diagnosis
Imaging
Radiography
Ultrasonography
Arthrography
MRI
Arthroscopy
Treatment2,3
Secondary Biceps Tendinitis
Primary Biceps Tendinitis
Biceps Tendon Instability
REFERENCES
DEFINITION
Surgical Anatomy1
Etiology2–5
Signs
Radiography
Management6–8
271:
Adhesive Capsulitis
INTRODUCTION
Etiology
Pathology
Clinical Features
Differential Diagnosis
Imaging
Radiography
Arthrogram
Arthroscopy
Treatment
Surgery
272:
Shoulder Rehabilitation
INTRODUCTION
Scapular Principle—Ben Kibler's Contribution
Scapular Dyskinesia
Definition of Normal Scapulo-humeral Rhythm
It is a motor pattern learnt through practice and repetition
Golf Ball Concept
The Concept of Impingement
CONSERVATIVE SHOULDER REHABILITATION
Principles of Shoulder Rehabilitation—Do's & Dont's
Phasic Program
Phase I
Anterior Capsular Stretches (Fig. 1)
Inferior Capsule Stretches (Figs 2 and 3)
Caveats
Posterior Capsular Stretches (Figs 4 and 5)
Scapular Strengthening
Exercise Bands
The three cuff strengthening positions are:
Core Strengthening and Stability
Scapular Stabilizing Program
Scapular Proprioception Restoration/Scapular Setting
Setting in Neutral
Dynamic Control/Dissociation
DELTOID STRENGTHENING EXERCISES
Phase II
Phase III
MODALITIES—STEROIDS/IFT/SWD
Intra-articular Steroid Injections
Caveats
Therapeutic/Diagnostic/Assistive
Role of IFT/SWD
Surgical Protocols
Principles of Protected Phase and Rehab Phase
SPECIFIC SHOULDER PROCEDURES
Arthroscopic Subacromial Decompression
Start on 5th Postoperative Day
Caveats
2nd week
Caveats
Milestones
Arthroscopic Bankart Repair
First 6 Weeks
3rd Week
6th Week—Start 2 Weeks of Phase I
Milestones
Arthroscopic SLAP Repair
Excision of AC Joint
Rotator Cuff Repair—Start on 5th Day
6th Week
Milestones
273:
Thoracic Outlet Syndrome
INTRODUCTION
Etiology
Todd's Theory
Abnormal Ossification Theory of Platt
Jones Theory
Surgical Anatomy of the Outlet
Pathological Anatomy
Cervical Ribs
First Thoracic Rib
Clavicle
Congenital Malformations
Scalenus Anticus
Scalenus Medius
Pectoralis Minor
Hypertrophied Subclavius
Tight Omohyoid Muscle
Other Congenital Anomalies
Other Soft Tissue Structures
Precipitating Factors
Clinical Features
Neurological Features
Vascular Features
Diagnosis
Radiography
Electromyography (Huffman 1986)16
Differential Diagnosis
Treatment
Conservative
Operative
Advantages of Transaxillary Approach
Supraclavicular Approach: Advantages
CONCLUSION
SECTION 31: CERVICAL SPINE
274:
Functional Anatomy of the Cervical Spine
INTRODUCTION
Intervertebral Disk
Intervertebral Foramina
Uncoverte bral Joints
Apophyseal Joints
The Vertebral Artery
Vertebral Canal
Nerve Supply of Vertebral Column
BIBLIOGRAPHY
INTRODUCTION
Possible Movement
Clinical Stability of the AA Region
AO Joint
AA Joint
Biomechanics of the CV Region in Trauma
Biomechanics of Fusion of the CV Region
Biomechanics of Orthotics
Instability of the Cervical Spine
275:
Surgical Approaches to the Cervical Spine
SAFETY TIPS FOR SUPINE POSITIONING FOR ANTERIOR APPROACH
SAFETY TIPS FOR PRONE POSITIONING FOR THE POSTERIOR APPROACH
ANTERIOR APPROACH TO THE UPPER CERVICAL SPINE
Transoropharyngeal Approach
Indications
Preoperative Preparation
Positioning and Anesthesia
Incision
Dissection
Closure
Potential Complications and Relevant Precautions
Alternative Approaches to the Upper Cervical Spine
Anterior Approach to the Subaxial Spine
Indications
Patient Position
Side of Approach
Transverse or Longitudinal Incision
Dissection
Closure
Potential Complications and Relevant Precautions
Anterior Approach to the Cervicothoracic Junction
Modified Anterior Approach to the Cervicothoracic Junction
Position
Incision
Closure
Complication
Alternative Approaches to the Cervicothoracic Junction
Posterior Approach to the Cervical Spine
Indications
Position
Incision
Closure
276:
Craniovertebral Anomalies
ANATOMY1, 2, 12
The Radiological Parameters6
Basilar Invagination4–6, 9, 11
Syringomyelia3, 5, 7
Mobile and Reducible Atlantoaxial Dislocation8,10,11
Fixed Atlantoaxial Dislocation4,8
277:
Cervical Disc Degeneration
CERVICAL SPONDYLOTIC MYE LOPATHY (CSM)
Pathophysiology
Natural History
Clinical Features
Differential Diagnosis (Table 16)
Investigations
Pathological Spinal Factors
Evaluation of Compression and Deformity of the Spinal Cord
Evaluation of an Intramedullary Lesion
Treatment
Conservative Treatment
Operative Treatment
Anterior Cervical Discectomy and Fusion
Anterior Corpectomy and Fusion
Complications with Anterior Procedures
Laminectomy
Laminectomy and Fusion
Laminoplasty
Complications with Posterior Decompression Procedures
278:
The Inflammatory Diseases of the Cervical Spine
INTRODUCTION
Rheumatoid Arthritis of the Cervical Spine
Incidence
Pathophysiology
Clinical Presentation
Natural History of Cervical Instability
Radiographic Predictors of Paralysis (Boden, Dodge et al. 1993)
Atlanto-Axial Subluxation (AAS) (Figs 2A and B)
Superior Migration of Odontoid (SMO)
Subaxial Subluxation (SAS) (Fig. 6)
Predictors of Neurological Recovery
Goals for Management
Indications for Surgical Stabilization
SURGICAL STABILIZATION
General Considerations
Types of Surgical Stabilization
Atlantoaxial Subluxation (AAS)
Superior Migration of Odontoid (SMO)
Subaxial Subluxation (SAS)
Combined Subluxations
Outcome and Complications
Surgical Technique
JUVENILE RHEUMATOID ARTHRITIS
SERONEGATIVE SPONDYLOARTHROPATHIES
Pathophysiology
Deformity
Pathological Fracture
SUMMARY
279:
Cervical Canal Stenosis
INTRODUCTION
Clinical Features
Investigations
Management
280:
Ossification of the Posterior Longitudinal Ligament
INCIDENCE
ETIOLOGY
PATHOLOGY
Clinical Symptoms
Diagnosis
Treatment
SURGICAL
Indications
SECTION 32: LUMBAR SPINE DISORDERS
281:
Clinical Biomechanics of the Lumbar Spine
INTRODUCTION
HISTORY
INSTABILITY
The Anatomy
The Intervertebral Disk
The Pedicle
MECHANICS OF INSTRUMENTATION
Clinical Conditions and Instability
The Bone Grafts
CONCLUSION
282:
Examination of Spine
METHODOLOGY
History Taking
THORACIC AND LUMBAR SPINE
PHYSICAL EXAMINATION
Palpation
Percussion
Percussion Tenderness
MOVEMENTS (TABLE 3)
Dorsal spine
Lumbar Spine
Method (Fig. 14)
Fallacies
NEUROLOGICAL EXAMINATION
Motor Function (Tables 4 and 5)
Nerve Root Tensions Signs (Provocative Test)
Femoral Nerves Stretch Test
Special Tests
Stress Test of Spine
Sacroiliac Joint
Hip joint
Non-organic Physical signs
Multiply Operated Low Back
Measurements
Linear Measurement (Fig. 23)
Measurement of Chest Expansion
Auscultation
Search for Pressure Sore
Vasomotor Changes
Visceral Assessment
INVESTIGATIONS FOR SPINAL PATHOLOGY
Radiological Investigations
Anteroposterior view—look for
Lateral view—look for
Oblique Views
Tomography
Screening
Cine-radiography
Scanogram
Methods of Measuring the Scoliotic Curves
Contrast Radiography
Myelographic Study
Radioactive Scanning
Discography
Needle Biopsy
Modern Imaging Techniques
283:
Back Pain Phenomenon
INTRODUCTION
Anatomy
The Spinal Motion Segment
Contents of the Spinal Canal
Nerve Roots/Cauda Equina
Dorsal Root Ganglion
Nourishment to Nerve Root and Dorsal Root Ganglion
Innervation of the Lumbopelvic Tissues
Pain-sensitive Structures
Peripheral Sensory Fibers
Axoplasmic Transport and Nerve Root Function
Classification of Back Pain
Somatic Back Pain
Pathogenesis of Pain Production
Perception of Pain
Pain Apparatus
Peripheral Nociceptors
First Order Neurons
Second Order Neurons
Third Order Neurons
The Thalamic Dispersal System
Pain Modulation
Synaptic Transmission
Diffuse Noxious Inhibitory Control
Psychological Aspect of Back Pain
Pain Behavior30
Chronic Pain Syndrome
Pathophysiology of CPS
284:
Backache Evaluation
INTRODUCTION
Etiology
Musculoskeletal Evaluation
History
EXAMINATION
Other Tests (Fig. 1)
Spinal Percussion Test
Straight-Leg Raising (SLR) Test
Lasègue's Test
Buckling Test
Sicard's Test
Turyn's Test
Fajersztajn's Test
Bachterew's Test
Bowstring Sign
Bragard's Test
Linder's Sign
Milgrams Test
Naffziger's Test
Goldthwait's Test
Nachla's Test
Reverse SLR
Tests for Sacroiliac Joint
Yeoman's Test
Sacroiliac Stretch Test
Sacroiliac Resisted Abduction Test
Hibbs’ Test
Pelvic Rock Test
Lewin-Gaenslen's Test
Gaenslen's Test
Neurological Assessment
Investigations
285:
Rehabilitation of Low Back Pain
INTRODUCTION
EVALUATION
Observation
History and Interview
Physical Examination
Observations
Palpation
Nerve Stretch Tests
Functional Assessment
Examination of the Related Joints
TREATMENT PLAN
ELECTROTHERAPEUTIC MODALITIES
DANGERS AND C/I
Short Wave Diathermy
Ultrasound Waves
Flexibility and Fitness Evaluation
The Mechanism of Action
Lumbar Traction
Indications of Traction
Lumbar Traction Technique
Contraindication
Use Traction as a Flexible and Freely Adaptable Method of Manual Mobilization
Phase of Physical Reconditioning
Phase of Work Ablisation and Work Hardening
Patient Education
Ergonomic Care of the Spine
Obesity
Braces
SUMMARY
286:
Conservative Care of Backpain and Backschool Therapy
INTRODUCTION
DIAGNOSIS AND EVALUATION
RELEVANT ANATOMY
Intervertebral Disk
Zygapophyseal (Facet) Joint
ETIOLOGY
Degenerative Cascade
Phase of Dysfunction Kirkaldy Willis
Phase of Instability
Phase of Stabilization
Psychologic Cascade
Socioeconomic Cascade
TREATMENT
Treatment of Dysfunctional Phase
STABILIZATION AND NEUTRAL SPINE CONCEPTS
Skeletal Muscle
Types of Muscular Contraction
Flexibility
Exercise Program
Yog
General Rules for doing the Exercises and Yogasanas
Sun Salute [Suryanamaskar]
Yogasanas
Meditation, Pranayam or Vipashyana
Swedish Gym Ball Exercises
Shawasan Corpse Position
Aerobic Exercises
Postures
Minnesota Multiphase Personality Inventory
Waddel Signs
MEDICATION
Drugs Therapy
The Analgesics
Muscle Relaxant
Non-steroid Anti-inflammatory Drugs (NSAIDs)
Steroids
Physical Therapy
Traction Therapy
Braces
Special Furniture
Psychotherapy
287:
Psychological Aspects of Back Pain
INTRODUCTION
Psychological Factors
Illness Behavior
Treatment
288:
Degenerative Diseases of Disc
INTRODUCTION
Nucleus Pulposus
Clinical Relevance
The Vertebral End-plate
Innervation of the Disc
Functional Biomechanics of the Disc
Hydrodynamics of the Disc
Immune System and the Disc
Disc Degeneration
Trauma to the Disk
Healing of the Disc
Neural Involvement
Clinical Presentation
Straight Leg Raising Test (SLR)
Femoral Nerve Stretch Test
Motor Function Testing
Diagnosis of Disc Disorders
Radiological Examination
Discography
Spinal Fluid Examination
Management of Disk Disorders
Nonsurgical Management
Indications for Surgery
Contraindications of Surgical Intervention
SUMMARY
289:
Lumbar Disc Surgery
INTRODUCTION
Epidemiology
Prevalence of Associated Injuries
Pathophysiology of Spinal Cord Injury
Emergency Management of SCI
Management at the Injury Site
Transportation of the Spine Injured Patient
Clinical Assessment at Hospital
Neurological Assessment (SCI)—Frankel Classification
American Spinal Injury Association (ASIA) Grading Scale of SCI
ASIA SCORE
Radiological Assessment
Primary Treatment Measures
Recent Advances
Conclusion
REFERENCES
INTRODUCTION
Laminectomy and Discectomy
MINIMALLY INVASIVE TECHNIQUES FOR LDP
Microlumbar Discectomy
Microdiscectomy
History
RATIONALE
SUMMARY
290:
Surgery of Lumbar Canal Stenosis
INTRODUCTION
Conservative Care
History of Surgery
Preoperative Evaluation
Indications for Surgery
Surgical Technique
Degenerative Spondylolisthesis6
Developmental Stenosis
Degenerative Scoliosis and Kyphosis
Recurrent Stenosis or Junctional Stenosis
Spinal Fusion: Indications for Concomitant Arthrodesis
Goal of Fusion is Back Pain from a Degenerated Disc and Eliminate Instability
Indications for Spinal Instrumentations
Less Invasive Decompression Procedures
Multiple Laminotomies
Expansive Lumbar Laminoplasty
Distraction Laminoplasty
Decompression Through a “Port-hole” Approach
Spinous Process Distraction Devices
Treatment Algorithm
Results
291:
Spondylolisthesis
INTRODUCTION
CLASSIFICATION
Anatomical Classification
1. Congenital
2. Isthmic
3. Degenerative
4. Post-surgical
5. Post-traumatic
6. Pathological
Etiological Classification
Diagnosis
Clinical Features
Symptoms
Signs
Associated Conditions
Radiological Findings
X-rays
Radiographic Measurements
Bone Scan11
MRI
Myelogram
Treatment
I. No treatment
II. Bed Rest/activity Restrictions
III. Medication
IV. Corset/Brace
V. Surgery
Surgical Procedures
Posterior Fusion
Laminectomy or Laminectomy Combined with Fusion
Anterior Fusion
Isthmic Defect Repair
Anterior and Posterior Fusion
Reduction of Spondylolisthesis
Transforaminal Lumbar Interbody Fusion (TLIF) Back Surgery
Spinal Fusion Surgery for Back Conditions
Procedure for Spine Fusion Using TLIF Technique
Benefits of TLIF Back Surgery Technique
POSTERIOR LUMBAR INTERBODY FUSION (PLIF)
Introduction: PLIF
Minimal Access Spinal Technologies
Open Approach
Minimally Invasive Approach
Open PLIF Procedure
MAST PLIF Procedure
Cases
292:
Failed Back Surgery Syndrome (FBSS)
INTRODUCTION
Proper Selection
Late Presentation
Surgery
Crucial Operation
Surgeon's Outlook
Common Clinical Problems
Failure to Recognize the Instability
Iatrogenic Instability
Posterolateral Fusion
Disk Space Infection
Nerve Root Damage
Presenting Features
Criteria
Unhappy Patient
293:
Complications in Spinal Surgery
INTRODUCTION
Complications in Cervical Spinal Surgery
Neural Injury
Anterior Surgery
Posterior Surgery
CSF Leak
Recurrent Laryngeal Nerve Palsy
Horner's Syndrome
Bleeding
Complications Related to Bone Grafting and Fusion
Instability
Implant-related Complications
Respiratory Complications
Infection
Complications in Thoracic Spinal Surgery
Neural Injury
Instability
Visceral Structure Damage
Implant Related Complications
Complications in Lumbar Spinal Surgery
Neural Injury
Incidence of Dural Tear
Vascular and Visceral Injuries
Infection
Instability
Complications Related to Fusion
Implant Related Complications
Recurrence of Symptoms
Miscellaneous Complications
CONCLUSION
294:
Spinal Fusion
INTRODUCTION
History of Spinal Fusion
Bone Graft
Anterior Spinal Fusion
Indications
Absolute Indications
Relative Indications
Anterior Interbody Fixation Devices
Types of Devices Available
Complications
Anterior Approach to Cervical Spine
Anterior arthrodesis of cervical spine:
Postoperative Management
Anterior Arthrodesis of Dorsal and Lumbar Spine
Posterior Arthrodesis of Cervical Spine
Posterior Spinal Fusion
Combined Anterior and Posterior Fusion
Posterior Lumbar Interbody Fusion (PLIF)
Indications
Biomechanical Principles of PLIF
Circumferential (360) Fusion
295:
MISCELLANEOUS CONDITIONS OF PAIN IN THE BACK: Diffuse Idiopathic Skeletal Hyperostosis (DISH) Syndrome
INTRODUCTION
Stages
Etiology
Pathology
Clinical Features
Radiographic Evaluation
Differential Diagnosis
Sequelae
Treatment
296:
Postoperative Spinal Infection
INTRODUCTION
Incidence
Etiology
Risk Factors
Pathogenesis
PREVENTION
Following Care Should be Taken to Prevent Infection
Preoperative Preparation
Perioperative Care
Pathology
Clinical Features
INVESTIGATIONS
Treatment
Wound Treatment
Flaps
Specific Situations in Postoperative Infections
CONCLUSION
SECTION 33: THE HIP
297:
Surgical Anatomy of Hip Joint
INTRODUCTION
Osteology
Proximal End Femur
The Acetabulum
The Ligaments
Muscles
Fascia
Vascular Supply
Innervation
298:
Surgical Approaches to the Hip Joint
INTRODUCTION
THE POSTERIOR APPROACH: ANATOMICAL CONSIDERATIONS
Position of the Patient
The Incision
Superficial Dissection
Deep Dissection
THE DIRECT LATERAL APPROACH4
Position of Patient
Superficial Dissection (Figs 3A to C)
Deep Dissection
Preparation of the Femur
Closure
Postoperative Management
TROCHANTERIC OSTEOTOMY
Position of the Patient
Deep Dissection
THE ANTEROLATERAL APPROACH
Surgical Anatomy
Position of Patient
Incision (Figs 4A and B)
Superficial Dissection
Deep Dissection
ANTERIOR APPROACH
MEDIAL APPROACH
Incision
Technique
299:
Examination of the Hip Joint
INTRODUCTION
Anatomical Considerations
Certain Important Anatomical Landmarks
Methodology
Traumatic
General and Systemic Examination
Regional Examination
Local Examination
Attitude
Movements (Table 2)
Fixed Deformities
Fixed Flexion Deformity
Criticism of Thomas's Test
Fixed Abduction Deformity
Fixed Adduction Deformity
Fallacies
Fixed Rotational Deformities
Movements at Hip
Methods of Eliciting Different Movements (Table 2)
Measurements
Linear Measurements
Methods
Significance of Apparent Measurement
Measurement in Lying Down Position
Total Length
Supratrochanteric Measurement
Circumferential Measurements (Fig. 18)
Tests for Stability of Hip
Fallacies
Perrectal Examination
Investigations
Radiographic Examination
Special Points to be Noted in AP Projections
Oblique Projection of the Hip
Arthrography
Arthroscopy
Aspiration and Aspiration Biopsy (Anterior or Lateral Route)
Ultrasound
Functional Assessment
300:
Biomechanics of the Hip Joint
KINESIOLOGY OF THE HIP JOINT1
HIP JOINT CONTACT AREAS AND FORCES5
USING A STICK
301:
Avascular Necrosis of Femoral Head and Its Management
INTRODUCTION
Etiopathogenesis
Staging
Diagnosis
Clinicopathological Status of Hip Joint in AVN Femoral Head
Treatment
Prophylactic Measures
Conservative Treatment
Operative Treatment
Femoral Head Preserving Operations
USE OF OTHER VASCULARIZED BONE GRAFTS
Free Cancellous Bone Grafts Combined with Vascularized Fibular Grafts
Vascular Pedicle Iliac Crest Graft (Leung 1981,32 Leung,33 Ganz and Buchlar 198320)
Sickle Cell Disease with AVN
Total Hip Replacement
Proposed Treatment Protocol
302:
Soft Tissue Lesions Around Hip
BURSITIS
Trochanteric Bursa
Treatment
Iliopectineal Bursa
Ischiogluteal Bursa
Subgluteal Bursa
Adventitious Bursa
SNAPPING HIP
Differential Diagnosis
Treatment
303:
Girdlestone Arthroplasty of the Hip
INTRODUCTION
304:
Osteotomies Around the Hip
INTRODUCTION
Radiographic Assessment
History
Osteotomies of Proximal Femur
According to Displacement
Angulational Osteotomies in Sagittal Planes
Angulation Osteotomy in Coronal Plane
Abduction (pelvic supportive) Osteotomy
According to Anatomic Location
Based on Indications
To Obtain Stabilities in Old Unreduced Congenital Dislocations
To Obtain a Compressive Force and Possible Union in Ununited Fractures of Femoral Neck
Relief of Pain in Osteoarthritis
To Correct Unstable Intertrochanteric Fractures
To Correct Deformities of Coxa Vara Especially with Slipped Upper Femoral Epiphysis and Congenital Coxa Vara
In Steonecrosis of Femoral Head
Osteotomies in paralytic disorders of hip
Lorenz Bifurcation Osteotomy
Schanz Osteotomy (Low Subtrochanteric)
Dunn and Hass Osteotomy
McMurray's Displacement Osteotomy
Dickson's High Geometric Osteotomy
Putti's Osteotomy
Pauwel's Y-Osteotomy
In Slipped Femoral Epiphysis
Closing Wedge Osteotomy of Neck by Martin
Cuneiform Subcapital Osteotomy of Femoral Neck by Fish
Dunn's Osteotomy
Compensatory Basilar Osteotomy of Femoral Neck by Kramer, Garig and Noel
Malunited Slipped Capital Femoral Epiphysis
Campbell's Ball and Socket Osteotomy
Tachdjian's High Subtrochanteric Osteotomy
Measured Biplane Intertrochanteric Osteotomy of Southwick
Osteonecrosis of Femoral Head
Wagner Intertrochanteric Osteotomy
Sugioka's Transtrochanteric Rotational Osteotomy (1978)
In Legg-Calve-Perthes Disease
Disadvantages
Osteoarthritis of the Hip
Pauwels I Varus Osteotomy (Adduction Osteotomy)
Pauwels II Valgus Osteotomy (Abduction Osteotomy)
Pelvic Osteotomies
Contraindications
305:
Pelvic Support Osteotomy by Ilizarov Technique in Children
INTRODUCTION
MATERIAL
METHODS
Preoperative Evaluation and Planning
Preoperative Planning (Figs 1A to G)
SURGICAL TECHNIQUE
Position
Proximal Femoral Osteotomy
Distal Osteotomy
Postoperative Care
RESULTS (FIGS 2A TO F)
COMPLICATIONS
CONCLUSION
SECTION 34: INJURIES OF THE KNEE JOINT
306:
Surgical Anatomy and Biomechanics of the Knee
INTRODUCTION
The Osseous Structures
THE EXTRAARTICULAR TENDINOUS STRUCTURES
Extraarticular Ligamentous Structures
INTRAARTICULAR STRUCTURES
INTRODUCTION
307:
Knee Injuries
ANATOMY
Motion of the Normal Knee Joint and Function of the Ligaments50
ACUTE TRAUMATIC LESIONS OF LIGAMENTS
Diagnosis
History and Physical Examination
RADIOLOGIC EVALUATION
MEDIAL COLLATERAL LIGAMENT INJURIES
Treatment20,22,26,32,42, 43
ANTERIOR CRUCIATE LIGAMENT INJURIES
Indication for Surgery
Repair of Acute ACL Tears30
Primary Repair
Augmentation of Acute ACL Tears
CHRONIC ACL DEFICIENT KNEE
Physical Examination (Table 1)57
Concept of the Pivot Shift
Pathomechanics47
Injury Pattern44
Timing of Surgery
Indications Patient Selection21
Contraindications
Surgical Technique68
Notchplasty
Tunnel Location and Isometry
The Femoral Tunnel
The Tibial Tunnel
Graft Selection and Harvest
The Ideal Grafts (Autograft)
The Role of Lateral Extraarticular Reconstructions
Synthetics
Allografts
FAILURE OF ACL RECONSTRUCTION73
POSTERIOR CRUCIATE LIGAMENT (PCL) INJURY
Injury and Pathologic Anatomy
Clinical Evaluation
Anteroposterior Translation
Varus-Valgus and Rotational Stress Testing
Quadriceps Active Test
Tibial External Rotation(Dial) Test
External Rotation Recurvatum Test (Fig. 6)
Reversed Pivot Shift (Fig. 7)
Dynamic Posterior Shift
Radiographic Evaluation
Chronic Posterior Cruciate Ligament Deficient Knee
Treatment
Acute Isolated PCL Injuries59
Surgical Treatment
Chronic PCL Injuries: Surgical Treatment
Lateral Collateral Ligament Insufficiency
Popliteus Insufficiency
INSTABILITY
Straight Instability
Medial Instability
Lateral Instability
Posterior Instability
Anterior Instability
Rotatory Instability
Combined Rotatory Instability
Anterolateral-Anteromedial Rotatory Instability
Anterolateral-Posterolateral Rotatory Instability5
Posterolateral-Anterolateral-Anteromedial Rotatory Instability
REHABILITATION
KNEE DISLOCATIONS
308:
Dislocations of Knee and Patella
CONGENITAL DISLOCATION OF PATELLA
Treatment
ACUTE DISLOCATION OF PATELLA
INTRAARTICULAR DISLOCATION OF PATELLA
Treatment
OLD UNREDUCED DISLOCATION OF PATELLA
RECURRENT, HABITUAL AND PERMANENT DISLOCATIONS OF PATELLA
Definition
Etiopathogenesis
Clinical Features
Roentgenographic Features
Treatment
The Distal Extensor Realignment Techniques
Combined Proximal and Distal Realignment Technique
Quadricepsplasty
THE PROPOSED TREATMENT PROTOCOL FOR RECURRENT, HABITUAL AND PERMANENT DISLOCATIONS OF PATELLA
SECTION 35: DISEASES OF THE KNEE JOINT
309:
Clinical Examination of Knee
INTRODUCTION
PRESENTING COMPLAINTS
Pain
Swelling
Instability
Locking
CLINICAL EXAMINATION
Gait
Inspection
Skin
Genu Varum/Valgum (Figs 2B and C)
Genu Recurvatum (Fig. 2A)
Bakers Cyst
Triple Deformity (Fig. 3)
Palpation
Tenderness
Patellar Tap (Figs 4A and B)
Fluctuation
Transmitted and Expansile Pulsation (Figs 5A and B)
Trans-illumination
Movements
Extension Lag
Flexion Deformity
Fixed Flexion Deformity
Synovium
Measurements
Q Angle
SPECIAL TESTS FOR KNEE JOIN T7
THE VALGUS STRESS TEST (FIG. 6A)
THE VARUS STRESS TEST (FIG. 6B)
Grading with Stress Test
McMurray Test (Fig. 7)
Apley's Grinding Test (Fig. 8)
TEST FOR CRUCIATE LIGAMENTS
Anterior Drawer Test (Fig. 9)
The Lachman Test (Fig. 10)
Posterior Drawer's Test (Figs 11A and B)
Quadriceps Active Test
Squat Test
Lateral Pivot Shift Test of Macintosh8 (Fig. 13A)
Reverse Pivot Shift Test (Fig. 13B)
Tibial External Rotation Test (Fig. 14)
Patellar Tests
Diagnostic Points of Common Knee Pathologies16
Clues to Knee Injury Diagnosis
Infective Conditions
Chondromalacia Patellae
Traumatic Conditions (Fig. 18)
Posterior Cruciate Ligament Injury
Collateral Ligament Injury
Osgood Schlatters (Fig. 19)
SUMMARY
310:
Congenital Deformities of Knee
CONGENITAL DISLOCATION OF THE KNEE (CDK) (FIGS 1 AND 2)
Introduction
Etiopathogenesis
Clinical Fin dings
Diagnosis
Classification
Treatment
CONGENITAL DISLOCATION OF THE PATELLA (FIGS 3 AND 4)
Clinical Features4,5
Treatment6
CONGENITAL TIBIOFEMORAL SUBLUXATION (FIGS 5 AND 6)
Clinical Findings
Radiological Findings
Pathology
Treatment
311:
Disorders of Patellofemoral Joint
ANATOMY2
BIOMECHANICS
MECHANISM OF INJURY
PATHOPHYSIOLOGY OF PATELLOFEMORAL PAIN
Tissue Homeostasis
Role of Loading in Patellofemoral Pain
Envelope Function
CLASSIFICATION OF PATELLOFEMORAL DISORDER
INJURIES WITH NO CARTILAGE DAMAGE
VARIABLE CARTILAGE DAMAGE
SIGNIFICANT CARTILAGE DAMAGE
Radiologic Evaluation of the Patellofemoral Joint
METHODS OF TREATMENT
IMMOBILIZATION
OTHER SUPPORTIVE MEASURES
MUSCULAR REHABILITATION
FLEXIBILITY
AVOID PAIN DURING REHABILITATION
PATELLECTOMY
ARTICULAR CARTILAGE IMPLANTATION
ALTERNATIVES TO PATELLOFEMORAL ARTHROPLASTY
TIBIAL TUBERCLE ANTERIORIZATION OR ANTEROMEDIALIZATION
TOTAL KNEE REPLACEMENT
312:
Osteoarthritis of Knee and High Tibial Osteotomy
INTRODUCTION
Epidemiology
Etiology
Pathology
Clinical Features
Radiograph
MANAGEMENT
CONCLUSION
313:
Osteochondritis Dissecans of the Knee
INTRODUCTION
Etiology
Clinical Features
Symptoms and Signs
Investigations
Arthroscopy
Treatment
Non-operative Treatment
Operative Treatment
Excision of Osteochondritis Dissecans
Complications
Summary of the Treatment of Osteochondritis Dissecans
314:
Miscellaneous Affections of the Knee
INTRODUCTION
POST INJECTION QUADRICEPS CONTRACTURES
PATHOMECHANICS
Clinical Features
Clinical Signs
On inspection of the knee:
Regional Examination
Clinical Tests
In the Prone Position
RADIOGRAPHIC FINDINGS
Treatment
Conservative Methods
Surgical Methods
Procedure
Postoperative Protocol
Distal Release: Thompson's Quadriceps Plasty12
Disadvantages
POSTOPERATIVE REHABILITATION
Other Procedures
Prognostic Factors
Results
Grading
REFERENCES
INTRODUCTION
Popliteal Cyst (Baker's cyst)
Diagnosis
Differential Diagnosis
Investigations
Surgical Treatment
Prepatellar Bursitis
Treatment
Intrapatellar Bursitis
Pes Anserine Bursitis
Tibial Collateral Ligament Bursitis
Fibular Collateral Ligament Bursitis
BIBLIOGRAPHY
INTRODUCTION
ETIOPATHOGENESIS
Clinical Features
RADIOLOGICAL EVALUATION
Management
Quadricepsplasty
Distal Quadricesplasty
Proximal Quadricesplasty
Arthrolysis1,3,6
ARTHRODIATASIS18
SECTION 36: INJURIES OF THE ANKLE AND FOOT
315:
Functional Anatomy of Foot and Ankle: Surgical Approaches
316:
Biomechanics of the Foot
317:
General Considerations of the Ankle Joint
LOCAL EXAMINATION
Inspection
Attitude
Anteriorly, Note the Following
Laterally, Note the Following
Posteriorly, Note the Following
Medially, Note the Following
Palpation
Mode of Demonstration of Cross Fluctuation in between Anterior and Posteior Swellings (Fig. 3C)
MOVEMENTS
Dorsiflexion (15°-30°)
Plantar Flexion (30°-45°)
Assessment for Lateral Collapse of Ankle
Critical Arc
Abnormal Movements
Stress Test (To Assess Integrity of the Controlling Group of Ligament)
Anteroposterior Stress Test—(Brostrom-1965)—Anterior Drawer Sign
Special Test
Test for Rupture of Tendo-Achilles (Figs 7A to C)
Thompson's Test (1962)
Needle Test
Test for Pre-Achilles and Post-Achilles Pathologies (Mainly Bursitis) (Figs 8A and B)
Test for Tendovaginitis of Tibialis Posterior Tendon (Fig. 9)
Test for Peroneal Spasm (Fig. 10)
MEASUREMENTS
Linear
Circumferential Measurement (Fig. 11)
Oblique Circumferential Measurement (Fig. 12)
Auscultation
Power
INVESTIGATION FOR ANKLE PATHOLOGY
Routine Investigations
Radiology
Stress Radiology
Arthroscopy
INTRODUCTION
TECHNIQUE OF RADIOGRAPHIC EXAMINATION
Routine Views of the Foot
Dorsoplantar View
Lateral View
Oblique View
Routine Views of the Ankle
Anteroposterior View
Lateral View
Oblique View
Special Views
Toes
Standing Full Weight-bearing Views
Anteroposterior View
Lateral View
Dorsoplantar View
Anterior Tangential View
Posterior Tangential View
Stress Views: Orthopedic Aspects
Lateral Rotation Stress View
Inversion Stress View
Eversion Stress View
Anterior Transpositional Stress View
Flexion Stress View
Parameters Measurable on the Anteroposterior View
Linear Measurements and Relationships
Parameters Measurable on the Lateral View
Linear Measurements and Relationships
Other Radiological Techniques/Modalities Magnification Radiography
Xeroradiography
ARTHROGRAPHY OF THE ANKLE JOINT
Technique
Tenography
Bursography
Ultrasound of the Foot and Ankle (Table 1)
Computed Tomography (CT)
SECTIONAL PLANES
CT
Technique
Positioning
Imaging
Radiation Exposure
Metallic Interference
Ordering a CT Examination of the Foot and Ankle
Magnetic Resonance Imaging (MRI)
Principles
Disadvantages
318:
Fractures of the Ankle
INTRODUCTION
Pathomechanics of Ankle Fractures
Classification
AO Classification (Fig. 1)
Danis-Weber Classification (Fig. 8)
CLINICAL FEATURE
Physical Examination
Radiological Assessment
Lateral Complex (Fibula and Tibiofibular Syndesmosis)
The Talus
Tibial Avulsion
Decision Making
Management
Initial Management
Clinical and Biomechanical Studies
General Principles of ORIF (Figs 20 to 25)
Syndesmosis Instability
Postoperative Care
Complications
Closed Reduction
Method of Closed Reduction4,31
Treatment of Ankle Fractures in Elderly2
Fracture Dislocation
The Maisonneuve Fracture29
Cycle Spoke Injury of Ankle
Postoperative Care
Special Problems in Ankle Fractures
DISLOCATION OF ANKLE5
Dislocation of Distal Tibiofibular Joint
319:
Ligamentous Injuries Around Ankle
ANATOMY
TYPES OF ANKLE INJURIES
Sprain of Ankle Joint
Clinical Feature
Method of Anterior Drawer Test
Investigations
Classification of Sprain
Differential Diagnosis
Management33
Conservative Treatment by Plaster Cast
Surgical Repair of Acute Rupture of Lateral Ligaments
Chronic Ligamentous Lateral Instability
Diagnosis
Conservative Treatment
Operative Treatment
Modified Brostrom Procedure
Modified Chrisman-Snook Procedure (Fig. 3)
Lateral Ligament Reconstruction with free tendon:
320:
Fractures of the Calcaneus
INTRODUCTION
Historical Aspect
Historical Aspect Biomechanics
Restoration of Heel Height, Improves Tibiotalar Position
Surgical Anatomy of the Calcaneus7 (Fig. 1)
Surface Anatomy
Radiological Evaluation
Plain Films
Broden's View15
Classification
Mechanism and Geometry of Fracture Calcaneus
Variations in Fracture Lines
Displacement of Individual Fragments
Sustentaculum Fragment
Controversies in Management
TREATMENT OF EXTRAARTICULAR FRACTURE
Lined in Roockwood
Closed reduction and manipulation
Indications for Non-operative Treatment
Indication for non-operative Treatment
METHODS OF CLOSED REDUCTION
Complications of Conservative Treatment
Pain
Soft Tissue Problems
Arthritis of Calcaneocuboid Joint
Pinning
Percutaneous Fixation
POSITIONING
SURGICAL TECHNIQUE8
Open Reduction and Internal Fixation (ORIF)
Assessment
Surgical Approaches (Table 2)
Technique11,12
Postoperative Care
Primary Arthrodesis
Initial Phase
COMBINATION OF OPEN REDUCTION AND PRIMARY ARTHRODESIS10
Prognostic Factors
Incongruity of the Joint
MALUNITED CALCANEAL FRACTURES17
Peroneal Tendon Pathology
Diffuse Burning Pain
Types of Surgery
In Situ Subtalar Fusion or Subtalar Arthrodesis
Subtalar Distraction Bone Block Arthrodesis
Triple Arthrodesis
Calcaneal Osteotomy
Kashiwagi Modified Technique of Resection of Lateral Prominence of Calcaneus.17
Romesh Procedure
Subtalar Arthrosis
Smashed Heel Syndrome
321:
Talar and Peritalar Injuries
INTRODUCTION
Classification of the Fractures of the Talus
Clinical Features
FRACTURE NECK TALUS
Management7,12
Methods of Fixation
Indications or Talectomy
Complications
Infection
Avascular Necrosis (AVN)10,13
Rx of AVN
Delayed Union
Malunion
Posttraumatic Arthritis
FRACTURE OF THE BODY OF TALUS
FRACTURE OF THE HEAD OF TALUS
FRACTURES OF LATERAL PROCESS, MEDIAL AND POSTERIOR ASPECTS OF TALUS
DISLOCATIONS OF AND AROUND TALUS
PERITALAR DISLOCATIONS
SUBTALAR DISLOCATIONS
Osteochondritis Dissecans (Osteochondral Fractures)
Treatment
322:
Injuries of the Midfoot
INTRODUCTION
FRACTURE OF TARSALS (OTHER THAN TALUS AND CALCANEUM)
Injuries to Isolated Tarsal Bones (Other than Calcaneus and Talus)
Navicular Fracture
Cuboid Injuries3
Lisfranc's Joint/Injuries
Management
Complications of Midfoot Injuries
323:
Injuries of the Forefoot
INTRODUCTION
FRACTURES OF METATARSAL BASES
Fracture of the Base of Fifth Metatarsal
Treatment
Fracture of the Base of First Metatarsal
Injuries of the Tarso-metatarsal Joints
Clinical Presentation (of Metatarsal Fracture)
Management
March Fracture (Stress Fracture of the Metatarsals)
Clinical Features
Treatment
Metatarsophalangeal Dislocation
Injuries of Phalanges
Dislocations of the Interphalangeal Joint
Fractures of the Sesamoid Bones
324:
Tendon Injuries Around Ankle and Foot
INTRODUCTION
Overview
Specifics
Origin and Insertion
Action of Tibialis Posterior
Classification of Tibialis Posterior Dysfunction and Clinical Presentation
Diagnosis of TPT Dysfunction
Radiographic Evidence
Differential Diagnosis
Treatment
Conservative Methods
Surgical Options
Technique of Medial Calcaneal Slide Osteotomy and Transfer FDL to PTT in Severe Posterior Tibial Tendon Dysfunction
Complications and Prognosis
SUMMARY
Conclusion
Rupture of Peroneal Tendons
Traumatic Subluxation and Dislocation of Peroneal Tendons
Treatment
REFERENCES
SECTION 37: DISORDERS OF ANKLE AND FOOT
325:
Management of Clubfoot
INTRODUCTION
Etiology
Genetic Factors
Histologic Anomalies
Vascular Anomalies
Anomalous Muscles
Intrauterine Factors
Pathoanatomy
Physical Examination
Observe
Radiological Assessment
Common Radiographic Measurements
Classification and Evaluation
REFERENCES
INTRODUCTION1
Complications Associated with Nonsurgical Treatment
Spurious Correction
Bean-Shaped Deformity
Fractures
Pressure Sores
Flat Top Talus
Failure of Correction
Complications Associated with Surgical Treatment
Neurovascular Complication
Bony Damage
Physeal Damage
Skin Slough and Wound Dehiscence
Avascular Necrosis of the Talus
Aseptic Necrosis of the Navicular
Failure to Achieve or Loss of Correction2,3,5
Overcorrection
Undercorrection
Persistent Medial Spin4
Skew Foot (Serpentine Foot)
Sinus Tarsi Syndrome
Reduced Calf Girth and Foot Size
Recurr ence of the Deformity6
SKEW FOOT
326:
Metatarsus Adductus
327:
Pes Planus
INTRODUCTION
Types of Pes Planus
Congenital
Acquired
Flexible Pes Planus: Flat Foot
Pathologic Anatomy
Clinical Features (Figs 2A to C)
Radiography
Treatment
Conservative Treatment
Miller Procedure
Midfoot Osteotomy
Calcaneal Osteotomy17
Accessory Navicular Bone (Prehallux, Os Tibial Externum)
Tarsal Coalition
Calcaneonavicular Coalition
Treatment
Surgical Treatment
Talocalcaneal Coalition
Radiography
Treatment
328:
Congenital Vertical Talus
INTRODUCTION
Etiology
Pathoanatomy
Clinical Features
Radiology
Treatment
Closed Manipulation
Surgical Treatment
Technique of Single Stage Open Reduction (Figs 5 A and B)
Two Stage Procedure
Treatment of Congenital Vertical Talus by Manipulation by Ponseti Technique
Technique of manipulation by Ponseti Method (Matthew B. Dobbs)
329:
Pes Cavus
INTRODUCTION
Pathogenesis and Biomechanics
Types of Deformities
Etiology (Table 1)
Clinical Examination
Radiology
Treatment
Soft Tissue Procedure
Steindler Plantar Fascia Release Procedure
Bony Procedures
Procedure
330:
Pain Around Heel
DISORDERS OF TIBIALIS POSTERIOR TENDON8–10
Disorders of Peroneal Tendons
Clinical Features
Treatment
Injuries to Flexor Tendons
Fibula Pinch Syndrome
Xanthoma of the Achilles Tendon
Planter Fasciitis
Clinical Features
Etiology
Physical Examination
Investigations
Radiographs
Treatment
Conservative Treatment
Local Steroids
Operative Treatment
Sever's Disease
Relevant Anatomy
Clinical Features
Treatment
Plantar Fibromatosis
Retrocalcaneal Bursitis (Haglund's disease)
Tendo–Achilles Bursa
Retrocalcaneal Bursitis
Investigations
Treatment
SUBTALAR ARTHRITIS
Clinical Features
Investigations
Treatment
331:
Metatarsalgia
INTRODUCTION
Forefoot Biomechanics
Static
Dynamic
Investigations for Forefoot Pain
Blood Investigations
Radiological Investigations
Pressure Studies
Classification of Metatarsalgia
Primary Metatarsalgia
Static Causes of Metatarsia
Freiberg's Disease
Treatment Options
Kohler's Disease
Relevant Anatomy
Clinical Features
Treatment
Traction Epiphysitis of Fifth Metatarsal Base (Iselin's Disease)
Secondary Metatarsalgia
Treatment
Forefoot Pain Unrelated to Disorders in Weight Distribution
Neurological Problems in the Spine
Tarsal Tunnel Syndrome13,14
Cause of Constriction
Clinical Features
Diagnosis
Treatment
Conservative Treatment
Anterior Tarsal Tunnel Syndrome
Treatment of Metatarsalgia
Conservative Treatment
Silicone Insertions
Morton's Metatarsalgia (Moton's Digital Neuralgia)
Historical Aspects
Pathological Findings
Clinical Features
Examination
Treatment
Surgical Treatment9
Plantar Warts
332:
Disorders of Toes
ACQUIRED HALLUX VARUS
Static Variety
Dynamic Variety
BIBLIOGRAPHY
INTRODUCTION
Anatomy
Etiology
Conservative Management
Operative Treatment
Winograd's Method
Zadik's Procedure
Partial Nail Plate, Nail Matrix and Nailfold Removal
Phenol and Alcohol Partial Nail Matrixectomy
Terminal Syme Procedure
Electrosurgery and Cryosurgery
Braces (Devices)
BIBLIOGRAPHY
BIBLIOGRAPHY
BIBLIOGRAPHY
333:
Diabetic foot
INTRODUCTION
EPIDEMIOLOGY
CLASSIFICATION
PATHOGENESIS
Neuropathy
Neuropathy and Risk of Falling
Angiopathy
Charcot Foot
Charcot Joint in Diabetes
Anatomic Classification
Foot Infection
Non-ulcer Pathologies
Nail deformities (Figs 24 to 26)
DIAGNOSIS
Imaging
Neuropathic Foot
Osteomyelitis
Neuroischaemic Foot
Ankle/Brachial Pressure Index (ABI)
Duplex Color Doppler
Angiography
MANAGEMENT
Neuropathic Ulcers
Three Factors Must be Considered
Charcot Foot
First Metatarsophalangeal Ulcerations
Immobilization
Orthoses
Ostectomy
Realignment and Arthrodesis
Infected Foot
Amputation
Minor Amputations
Major Amputations
REVASCULARIZATION IN PVD
Percutaneous Transluminal Angioplasty (PTA)
Indications for Vascular Surgery in Lower Limb
Principles of Vascular Surgery
PREVENTION
Dressing Material
Newer Dressings
Newer Therapies
Dermagraft
Maggot's Therapy
334:
Tumors of the Foot
INTRODUCTION
Clinical Evaluation of Foot Neoplasms
Soft Tissue Tumors
Benign Lesions
Malignant Soft Tissue Tumors
Synovial Cell Sarcoma
Fibrosarcoma / Neurofibrosarcoma
Malignant Melanoma
Skeletal Tumors (Bony, Cartilaginous, Marrow, Miscellaneous)
Benign Bony Neoplasms
Giant Cell Tumor—GCT (Figs 1 to 3)
Benign Cartilaginous Tumors
Enchondroma
Osteochondroma
Chondroblastoma
Chondromyxoid Fibroma
Benign Osseous Neoplasms
Osteoid Osteoma (Figs 4 and 5)
Osteoblastoma
Miscellaneous Bony Lesions
Malignant Bony Tumors
Osteosarcoma
Chondrosarcoma
Marrow Tumors
Ewing's Sarcoma (Figs 6 to 8)
Lymphoma/Myeloma
SECTION 38: PEDIATRIC ORTHOPEDICS: TRAUMA
335:
Peculiarities of the Immature Skeleton (The Child is not a Miniature Adult)
INTRODUCTION
Plastic Deformation
Remodeling Following Injury
Healing Responses
Osseous Healing
Trabecular Healing
Physeal Healing
Epiphyseal Cartilage Repair
336:
Physeal Injuries
INTRODUCTION
Physeal Anatomy
Zone I
Zone II
Zone III
Zone IV
Vascular Supply of the Physis
Physiology of Physeal Growth
Classification of Physeal Injuries
Open and Closed Injuries
Salter and Harris Classification (Fig. 6)
Peterson's Classification
DIAGNOSIS
Management of Acute Physeal Injuries
Radiographic Assessment
General Principal of Treatment in Acute Physeal Injuries
Factors Affecting the Prognosis for Future Growth Disturbance
Type of Injury
Complications of Physeal Injuries
Growth Acceleration
Malunion
Nonunion
Osteomyelitis
Neurological Complications
Vascular Complications
Avascular necrosis of Epiphysis
Growth Arrest
General Principles of Treatment
Apophyseal Injuries
Common Apophyseal Injuries
Treatment
Causes of Physeal Injuries
337:
Fractures of the Shaft of the Radius and Ulna in Children
INTRODUCTION
Mechanism of Injury and Pathological Anatomy
The Rule of Thirds
Classification
Diagnosis
Radiographic Findings
Treatment
Greenstick Fractures of the Middle Third of the Radius and Ulna
Complete Fracture of Middle Third of The Radius and Ulna
Fracture of the Proximal Third of the Shaft of the Radius and Ulna
PLASTIC DEFORMATION (OR TRAUMATIC BOWING) OF BOTH BONES OF THE FOREARM
Site of Involvement
Signs and Symptoms
Radiographic Findings
Treatment
MONTEGGIA FRACTURE DISLOCATION
Classification
Pediatric Monteggia Lesion Classification by Letts4
Monteggia Lesion16
True monteggia lesions (bado)
Monteggia Equivalents (Fig. 10)14
Radiocapetalar Relation
Mechanism of Injury
Diagnosis
Fundamental Principles of Treatment
Operative Treatment
Complications
GALEAZZI FRACTURE DISLOCATION
Mechanism of Injury
Walsh's Classification
Diagnosis
Treatment
Complications
338:
Fractures Around the Elbow in Children
INTRODUCTION
Applied Anatomy
Carrying Angle
Ossification Around the Elbow
Baumann's Angle
Lateral View of the Elbow
Fat Pad Sign
Jone's View
Blood Supply
Landmarks
Classification of Injuries Around the Elbow in Children
SUPRACONDYLAR FRACTURE OF HUMERUS15,16
Classification
Extension Type of Supracondylar Fracture
Incidence
Mechanism of Injury
Role of Periosteum
Classification
Clinical Features
Signs
Radiographic Finding
Treatment
Totally Displaced Fractures (type III) (Fig.7)
Complications
Immediate Complications
Pulseless Pink Hand
Late Complications
Flexion Type of Supracondylar Fractures
FRACTURES OF THE LATERAL CONDYLE OF THE HUMERUS
Classification
Mechanism of Injury
Pathology
Soft Tissue Injury
Signs and Symptoms
Treatment
Immobilization without Reduction
Closed Reduction and Immobilization
Closed Reduction and Pinning
Open Reduction and Internal Fixation17
Complications
Lateral Condylar Overgrowth and Spur Formation22
Nonunion
Cubitus Valgus
Cubitus Varus
Neurological Complications
Physeal Arrest (Fishtail deformity)
Avascular
Myositis Ossificans
MEDIAL CONDYLAR FRACTURES
Surgical Anatomy and Pathology
Mechanism of Injury
Treatment
Complications
FRACTURES INVOLVING THE ENTIRE DISTAL HUMERAL PHYSIS
Mechanism of Injury
Classification
Clinical Features and Diagnosis
Treatment7
FRACTURES OF THE MEDIAL EPICONDYLAR APOPHYSIS
Mechanism of Injury
Condylar Epiphysis
Clinical Features and Diagnosis
Treatment
Clinical Features and Diagnosis
Treatment
FRACTURES OF THE MEDIAL EPICONDYLAR APOPHYSIS
Clinical Features
Treatment29
Complications
FRACTURES OF THE LATERAL EPICONDYLAR APOPHYSIS30
Mechanism of Injury
Treatment
DISLOCATION OF THE ELBOW
Classification12
Mechanism of Injury
Clinical Features and Diagnosis
Radiographs
Treatment
Closed Reduction
Complications
Neurological Complications
Arterial Injury
Myositis Ossificans
Recurrent Dislocation
FRACTURES OF THE NECK AND HEAD OF RADIUS
Classification
Mechanism of Injury
Treatment
Simple Immobilization
Closed Reduction and Immobilization
Open Reduction
Intramedullary Pin Reduction
Complications
FRACTURES OF THE PROXIMAL PHYSIS OF THE OLECRANON
Introduction
Classification
Mechanism of Injury
Signs and Symptoms
Treatment
Complications
339:
Fractures of the Distal Forearm, Fractures and Dislocations of the Hand in Children
INCIDENCE
Mechanism of Injury
Classification
Clinical Features of Distal Forearm Injuries
Diagnosis
Soft Tissue Signs in Occult Fractures
Treatment (Fig. 3)
Operative Indications
Distal Metaphyseal Fractures of the Radius
Treatment
Nonoperative Treatment
Operative Treatment
Indications4
Galeazzi Fracture Dislocation
Complications of Fractures of Distal Forearm7,9
340:
Fractures of the Humeral Shaft in Children
INTRODUCTION
TYPES OF FRACTURES AND MECHANISM OF INJURY
High Energy Direct Force
Transverse Fractures
Oblique Fractures
Spiral Fractures
Comminuted Fractures
Open Fractures
Signs and Symptoms
Anatomy
Radiography
Prognosis
Complications
Nerve Injuries
Rotational Deformity
Growth Disturbances
Treatment
Reduction of the Fractures
Neonates
Neonates to 3 Years
3 to 12 Years
12 Years to Maturity
Open Fractures
Distal Humerus Fracture
341:
Fractures and Dislocations of the Shoulder in Children
INTRODUCTION
Fractures of the Proximal Humerus
Deforming Forces
Incidence
Mechanism of Injury
Classification
Symptoms and Signs
Treatment
Complications
Glenohumeral Subluxation and Dislocation
Surgical Anatomy
Incidence
Classification
Etiology
Mechanism of Injury
Symptoms and Signs
Radiography
Treatment
Fractures of the Scapula
Surgical Anatomy
Fractures of the Body of the Scapula
Fractures of the Glenoid
Fractures of the Acromion
Fractures of the Coracoid
Fractures of the Clavicle
Incidence
Mechanism of Injury
Symptoms and Signs
Radiology
Treatment
Indications for surgical treatment
Complications
Injuries of the Medial end of the Clavicle and Sternoclavicular Joint
Mechanism of Injury
Classification
Signs and Symptoms
Radiographic Findings
Treatment
Injuries of the Lateral End of the Clavicle and Acromioclavicular Joint
Mechanism of Injury
Classification
Signs and Symptoms
Radiographic Findings
Treatment
342:
Fractures and Dislocations of the Spine in Children
CERVICAL SPINE
Clinical Features
Symptoms
Evaluation
X-ray Evaluation
X-ray Evaluation of Specific Areas
Special Imaging Techniques
Initial Management of Cervical Spine Injuries
SCIWORA
Neonatal Trauma
Pseudosubluxation and Other Normal Anatomic Variations
Occipital Condylar Fracture
Occipitoatlantal Dislocation
Atlas Fractures
Atlantoaxial Lesions
Traumatic Ligamentous Disruption
Atlantoaxial Displacement Due to Inflammation
Atlantoaxial Rotary Displacement
Treatment
Odontoid Fractures
Fracture of the Pedicle of the Axis
Subaxial Injuries
THORACIC AND THORACOLUMBAR SPINE
Compression Fractures (Fig. 4)
Axial (Burst) Fractures
Flexion Distraction Injuries
Fracture Dislocation
LUMBAR SPINE
Spinal Cord Injury in Children
343:
Fractures of the Pelvis in Children
INTRODUCTION
Mechanism of Injury
Applied Anatomy
Ossification Centers
Clinical Examination
General Examination
Physical Signs
Radiological Examination
Classification
Fractures Without a Break in the Continuity of the Pelvic Ring
Avulsion Fractures
Clinical Features
Diagnosis23
Treatment
Complications
Fractures of the Pubis or Ischium
Fractures of the Wing of the Ilium (Duverney Fracture)
Fractures of Sacrum and Coccyx
Single Break in the Pelvic Ring
Double Break in the Pelvic Ring
Straddle Fractures
Malgaigne Fracture
Mechanism of Fractures
Treatment
Fractures of the Acetabulum
Diagnosis
Treatment
Complication of Acetabular Fractures
344:
Pediatric Femoral Neck Fracture
INTRODUCTION
Relevant Anatomy
Peculiarities of the Fractures of the Hip in Children
Classification
Mechanism of Injury
Diagnosis
Differential Diagnosis30,31
Treatment
Current Recommended Treatment Protocols
The Concept of Primary Proximal Defunctioning (Undisplaced Intertrocanteric) Osteotomy
Type I
Type II
Type III
Type IV
Complications of Femoral Neck Fractures in Children
345:
Femoral Shaft Fractures in Children
346:
Fractures and Dislocations of the Knee
SEPARATION OF THE DISTAL FEMORAL EPIPHYSIS
Mechanism of Injury
Classification
Classification Based on Mechanism of Injury and Direction of Displacement
Radiographic Findings
Management
Closed Reduction
Postreduction Care
Complications
SEPARATION OF THE PROXIMAL TIBIAL EPIPHYSIS
Radiographic Evaluation
Management
Complications
AVULSION OF THE TIBIAL TUBEROSITY
Mechanism of Injury
Classification
OSTEOCHONDRAL FRACTURES
FRACTURE OF THE INTERCONDYLAR EMINENCE OF THE TIBIA
Radiologic Finding
Management
FRACTURES OF THE PATELLA
DISLOCATIONS ABOUT THE KNEE
LIGAMENT INJURIES
Classification
Management
OSGOOD-SCHLATTER LESION
Mechanism of Injury
Signs and Symptoms
Radiology
Treatment
Prognosis
347:
Fractures of the Tibia and Fibula in Children
FRACTURES OF THE DISTAL TIBIAL AND FIBULAR PHYSIS
Classification
Supination-External Rotation
Pronation-Eversion-External Rotation
Supination-Plantar Flexion
Supination-Inversion
Axial Compression
Juvenile Tillaux3
Triplane Fracture
Other Injuries
SALTER-HARRIS CLASSIFICATION-APPLIED TO DISTAL PHYSEAL FRACTURES (FIG. 8)
Clinical Features and Diagnosis
Treatment
Supination-External Rotation Injuries
Pronation-Eversion-External Rotation Fracture
Supination-Plantar Flexion
Supination-Inversion Injuries
Axial Compression
Juvenile Tillaux Fracture
Triplane Fractures4
Other Fractures
Complications
Angular Deformity due to Asymmetrical Arrest
Angular Deformities Secondary to Malunion
Treatment of Angular Deformities
Leg Length Discrepancy
Rotational Deformity
Nonunion and Delayed Union
Aseptic Necrosis of the Distal Tibial Physis
FRACTURES OF TIBIA AND FIBULA IN CHILDREN
Classification1
Mechanism of Injury of Tibia Fractures
Pathology of Tibial Fractures
Treatment (Figs 9 and 10)
Remodeling of the Bone
Operative Indication for Tibial Fractures
Complications
Angulation
Upper Tibial Physeal Closure2
Leg Length Discrepancy
Malrotation
Delayed Union and Nonunion
Compartmental Syndrome
Avascular Necrosis of Distal Tibial Epiphysis
Deformity Secondary to Malunion
348:
Fractures and Dislocations of the Foot in Children
INTRODUCTION
FRACTURES OF THE TALUS
Anatomy
Classification
Diagnosis
Treatment
Complications
Avascular Necrosis of Talar Body
Other Complications
Fracture of the Dome and Body of the Talus
Transchondral Fractures of Talus (Osteochondral fractures)
Osteochondral Fractures of the Talus
Classification Described by Anderson and Colleagues
FRACTURES OF THE CALCANEUS
Classification
Signs and Symptoms
Radiographic Examination
Treatment
FRACTURES OF THE TARSAL BONES
FRACTURES OF THE METATARSALS
FRACTURE OF THE BASE OF THE FIFTH METATARSAL
FRACTURES OF THE PHALANGES
OPEN FRACTURES OF THE FOOT
349:
Birth Trauma
INTRODUCTION
Subgaleal Hematoma
Caput Succedaneum
Abrasions and Lacerations
Subcutaneous Fat Necrosis
Differential Diagnosis
Investigation
Treatment
Humerus
Treatment
Elbow
Diagnosis
Treatment
Proximal Femur Fracture
Fracture of the Shaft
Fracture of the Distal Epiphysis
Treatment
Fracture of Femoral Shaft
Fracture Distal Epiphysis
SPINAL INJURIES IN THE NEONATE
Cervical
The Flying Fetus Syndrome
SUPPORTIVE THERAPY IS IMPORTANT
Differential Diagnosis of Fractures
Nerve Injuries
Brachial Plexus Injury in the Newborn
350:
The Battered Baby Syndrome (Child Abuse)
INTRODUCTION
RISK FACTORS FOR CHILD ABUSE
Manchausen Syndrome by Proxy
HISTORY TAKING
Clinical Features
Radiologic Features
The Skeletal Survey
Laboratory Studies
Diagnosis
Differential Diagnosis
Management
Prevention of Child Abuse
SECTION 39: PEDIATRIC ORTHOPEDICS: GENERAL
351:
General Considerations in Pediatric Orthopedics
INTRODUCTION
Normal Development
The Newborn
Early Childhood
Body Proportions
Upper to Lower Segment Ratio
General Examination
Examination of Lower Limb
Examination of the Affected Part
Examination of Joint Mobility
Limb Length Measurement
Spine
Shoulder and Upper Limbs
REFERENCES
INTRODUCTION
Technique
Images
Clinical Indications
Infection (Fig. 1)
Bone Necrosis (Fig. 2)
Trauma (Fig. 3)
Chronic Pain (Fig. 4)
Tumors (Fig. 5)
352:
Gait Analysis
INTRODUCTION
Biomechanics
The Normal Gait Cycle (Stride)
Stance Phase
Swing Phase
At Ankle
At Knee
At Hip
Gait Cycle in Walking and Running
Development of Mature Gait
Gait Analysis
Observational Gait Analysis
Instrumented Gait Analysis
REFERENCES
353:
Anesthetic Considerations in Pediatric Orthopedics
INTRODUCTION
Temperature Regulation
Preoperative Considerations
Inhalational Anesthetics
Intravenous Anesthetics
Sedatives and Hypnotics
Narcotics
Muscle Relaxants
Nondepolarizing Muscle Relaxants
Preoperative Starvation
General Anesthesia
Intraoperative Management
Postoperative Pain Relief
Specific Entities
Treatment of Postoperative Nausea and Vomiting
354:
Genetics in Pediatric Orthopedics
INTRODUCTION
Normal Karyotype
Basis of Genetic Disorders
Modes of Inheritance
Autosomal Dominant (AD) Inheritance
Autosomal Recessive (AR) Inheritance
X-Linked (XL) Inheritance
CHROMOSOMAL ABERRATIONS
Autosomal Trisomy
Down's Syndrome
Sex Chromosome Anomalies
Turner's syndrome (45, X)
Klinefelter's Syndrome (47, XXY)
Lobster Hand
AUTOSOMAL RECESSIVE INHERITANCE
Pycnodysostosis
X-LINKED RECESSIVE INHERITANCE
Duchenne Type Progressive Pseudohypertrophic Muscular Dystrophy
X-linked Dominant Inheritance
Multifactorial Inheritance
Myositis Ossificans Progressive
Marfan's Syndrome
NONTRADITIONAL MODES OF INHERITANCE
Dysmorphology
Prenatal Diagnosis
METHODS OF PRENATAL DIAGNOSIS OR SCREENING
Genetic Counseling in Pediatric Orthopedic Disorders
Autosomal Dominant Conditions
Autosomal Recessive Conditions
X-linked Disorders
Multifactorial Inheritance
Congenital Dislocation of Hip (CDH)
Congenital Talipes
Perthes Disease
Scoliosis
Neural Tube Defects
Ankylosing Spondylitis
355:
Congenital Anomalies
INTRODUCTION
Teratology
Classification
Congenital Torticollis
Pathology
Differential Diagnosis
Treatment
Nonoperative
Operative Treatment
CONGENITAL ANOMALIES OF THE UPPER LIMBS
Congenital High Scapula (Sprengel's Shoulder)
Longitudinal Suppression (Ectromelia)
Congenital Dislocation of Radius
Treatment
Madelung's Deformity
Etiology
Clinical Features
Differential Diagnosis
Congenital Humeroradial Synostosis
Transverse Suppression
Multiple Congenital Anomalies of Upper Limb
Congenital Constricture Bands of Limbs (Streeter's syndrome)
Etiology
Clinical Features
Treatment
Congenital Genu Recurvatum and Anterior Dislocation of Knee
Pes Planus
Congenital Metarsus Adductus
Congenital Hallux Varus
Congenital Joint Laxity
REFERENCES
356:
Osteogenesis Imperfecta
357:
Dysplasias of Bone
INTRODUCTION
Nomenclature and Classification
Pathology
Clinical Features
Radiographic Findings and Differential Diagnosis
Treatment
MULTIPLE EPIPHYSEAL DYSPLASIA2
Chondrodysplasia Calcificans Punctata (Conradi's Disease)1
Achondroplasia
LETHAL FORMS OF SHORT LIMBED DWARFISM
CHONDROECTODERMAL DYSPLASIA
(Ellis-van Creveld Syndrome)
Clinical Features
METAPHYSEAL CHONDRODYSPLASIA
Jonsen Type
Schmid Type
Spar-Hartmann Type
CARTILAGE HAIR HYPOPLASIA (MCKURICK TYPE)
PROGRESSIVE DIAPHYSEAL DYSPLASIA (CAMURATI ENGELMANN DISEASE)
Clinical Features
MISCELLANEOUS DYSPLASIAS: METAPHYSEAL DYSPLASIA (PYLE'S DISEASE)
REFERENCES
INTRODUCTION
Pathology
Radiology
Treatment
358:
Hematooncological Problems in Children
INTRODUCTION
HEMOPHILIA
Inheritance
Clinical Features
Treatment and Response to Transfusion
Hemophilia B (Factor IX Deficiency, Christmas Disease)
Inheritance
Clinical Features
Laboratory Features
Treatment and Response to Transfusion
Mild and Moderately Severe Hemophilia A and B
von Willebrand's Disease
Inheritance
Clinical Features
Treatment and Response to Transfusion
RIFAMPICIN SYNOVIORTHOSIS IN HEMOPHILIC SYNOVITIS
Factor XI Deficiency
Inheritance
Clinical Features
Laboratory Features
Treatment
HEMARTHROSES
Pathophysiology of Hemarthroses
Physical Examination
Treatment of Acute Hemarthrosis
Why aspirate?
Muscle Hemorrhages
Treatment
Iliopsoas Hemorrhage
Clinical Features of Iliopsoas Hemorrhage
Differential Diagnosis of Iliopsoas Hemorrhage
Aids to the Diagnosis of Iliopsoas Hemorrhage
Treatment of Iliopsoas Hemorrhage
Orthopedic Aspects
Chronic Hemophilic Arthropathy
Prevention of Chronic Hemophilic Arthropathy
Treatment of Contractures in Chronic Hemophilic Arthropathy
Joint Surgery in the Treatment of Chronic Hemophilic Arthropathy
Fractures and Dislocations
Physiotherapy
Active Exercises
Exercises after an Acute Hemarthrosis
Exercises after a Muscle Hemorrhage
Hydrotherapy
Exercise Programs and Chronic Hemophilic Arthropathy
Splints
Types of Splints
HEMOGLOBINOPATHIES
Molecular Basis of the Hemoglobinopathies
Management
Diagnosis
THALASSEMIAS
Clinical Pathology
Beta Thalassemia Major
Fanconi's Anemia
Recent Research Shows These Discoveries
Acute Lymphoblastic Leukemia (ALL)
Signs and Symptoms
Evaluation
Prognostic Groups
Treatment
HISTIOCYTOSIS SYNDROMES
Class I—Langerhans Cell Histiocytosis
Class II—Histiocytosis of Mononuclear Phagocytosis (other than Langerhans’ Cells)
Class III—Malignant Histiocytic Disorders
Diagnostic Evaluation
Laboratory and Radiographic Studies
Treatment
359:
Caffey's Disease (Infantile Cortical Hyperostosis)
INTRODUCTION
Natural History
Etiology
Pathology
Clinical Features
Radiography
Diagnosis
Treatment
360:
Myopathies
INTRODUCTION
Clinical Features
Differential Diagnosis
Classification
Muscular Dystrophies
Myotonic Disorders
Periodic Paralyses
Congenital Myopathies
Storage Disorders
Mitochondrial Disorders
Acquired Myopathies
Infective Myopathies
Inflammatory Myopathies
Endocrine and Metabolic Myopathies
Drug-induced and Toxic Myopathies
CONCLUDING REMARKS
361:
Arthrogryposis Multiplex Congenita
INTRODUCTION
ARTHROGRYPOSIS MULTIPLEX CONGENITA
Types of Arthrogryposis
Incidence
Etiology
Pathology
Clinical Features
Diagnosis
Treatment
Other Forms of Arthrogryposis
Distal Arthrogryposis
Freeman-Sheldon Syndrome
Pterygia Syndromes
Other Orthopedically Important Syndromes
Fetal Alcohol Syndrome
Nail-Patella Syndrome
Turner Syndrome
Noonan Syndrome
Down Syndrome
362:
Cerebral Palsy
GENERAL CONCEPTS
Definition
Epidemiology
Etiology
Time of brain injury
Manifestations of Cerebral Palsy
Risk Factors
Prenatal
Postnatal (0-2 years)
Risk Factors
Pathological Findings in the CNS
Clinical Findings
Mechanism of the Movement Problems
Causes of the Motor Problem
Maturation of the Central Nervous System
Evolution of CP During Infancy and Early Childhood
BIBLIOGRAPHY
SIGNS SUGGESTIVE OF CP IN AN INFANT
Major Deficits in Patients With CP
Anatomical Classification
Clinical Classification
Tonus Lesion Site
Classification (Fig. 3)
Spastic CP
Hemiplegia
Diplegia
Dyskinetic CP
Ataxic CP
Mixed CP
Exceptions
BIBLIOGRAPHY
ASSOCIATED PROBLEMS IN CP
Associated Problems
Intellectual Impairment
Epileptic Seizures
Vision Problems
Hearing
Communication Problems and Dysarthria
Oromotor Dysfunction
Gastrointestinal Problems and Nutrition
Oromotor Dysfunction
Urinary Problems
Causes of Urinary Problems
BIBLIOGRAPHY
HISTORY
Key Points in History
Goals of Physical Examination in a Child With Movement Disorder
A Detailed History Provides Knowledge About
Clinical Examination
Examination Outline
Neurological Examination
Vision and Hearing
Muscle Strength and Selective Motor Control
Reflexes
Muscle Tone and Involuntary Movements
Normal Developmental Stages of the Child
Signs of Poor Prognosis
Differences Between Spasticity and Dystonia
Musculoskeletal Examination
Musculoskeletal Examination
Range of Motion
Back Assessment
Pelvic Obliquity
Limb-length Discrepancy
Hip Assessment
Knee Assessment
Foot and Ankle Assessment
Flexion Contracture
Upper Extremity Examination
Using Local Anesthetic Blocks to Test Contractures
Using Dynamic Electromyography to Test Contractures
Examination of the Upper Extremity
Classification of Sitting Ability
Functional Examination
Sitting
Balance
Classification of Ambulation
Functional Scales Used in CP
Scale
Ages
Measures
Gross Motor Function Measure (GMFM)
Gross Motor Function Classification System (GMFCS)
Gross Motor Function Classification System (GMFCS)
Progressive Disorders Resembling CP
Nonprogressive Disorders Resembling CP
Early Differential Diagnosis in Developmental Disability
Differential Diagnosis
Imaging Studies
Radiology
Cranial Ultrasonography (USG)
Cerebral Computerized Tomography (CT)
Cranial Magnetic Resonance Imaging (MRI)
Electroencephalography (EEG)
Muscle Function During Gait
Energy Consumption
Clinical Examination of Gait
Gait Analysis
Examination of Gait
Observation
Components of Computerized Gait Analysis (Fig. 9)
Computerized Gait Analysis
Advantages
Disadvantages
Characteristics of Gait in Children (Figs 10 to 12)
Types of Gait in Diplegic and Ambulatory Total Body Involved Children
Jump Gait
Crouch Gait
Stiff Knee Gait
Scissoring Gait and Internal Hip Rotation
Trunk Lurching
Traps to Avoid: Apparent Equinus
Types of Gait in Hemiplegic Children
BIBLIOGRAPHY
HINTS ON HOW TO ANALYZE GAIT
Factors Affecting Prognosis
Reflexes
Prognosis and Goals of Management
The Natural History
Predicting Functional Prognosis
Factors Adversely Affecting Independent Living in the Adult
Activities of Daily Living
Mobility
Ambulation
BIBLIOGRAPHY
MANAGEMENT PRINCIPLES
Summary
Rehabilitation and Physiotherapy
Components of Child Rehabilitation
Planning Rehabilitation
Treatment Team
Medical Problems of the Child
The Child's Character
The Family
Physiotherapy
Physiotherapy Tries to Improve
Principles of Therapy Methods
Basic Problems in the Neuromotor Development of Children with CP
For Functional Ambulation a Child Needs
General Principles of Physiotherapy
Therapy Methods
Conventional Exercises
Vojta Method of Therapy
Bobath Neurodevelopmental Therapy
Benefits and Limitations
Occupational Therapy and Play
Advantages of Swimming
Early Intervention
BIBLIOGRAPHY
BRACING
Lower Extremity Bracing
Ankle Foot Orthoses (AFO)
Braces in CP
Functions of the AFO
Types of AFO
Various Types of the AFO
GRAFO or FRO (Ground Reaction or Floor Reaction AFO) (Fig. 15)
Hinged AFO (Figs 18 and 19)
Knee Orthoses
Knee Immobilizers
Plastic KAFOs
Foot Orthoses (FO)
Supramalleoler Orthosis (SMO)
University of California Biomechanics Laboratory Orthosis (UCBL)
Heel Cup
Hip Abduction Orthoses
Spinal Orthoses
Upper Extremity Bracing
BIBLIOGRAPHY
STANDERS
Mobility Aids, Wheeled Mobility and Assistive Devices
Transfer Aids
Prone Frames
Supine Frames
Gait Trainer
Gait Aids Walkers
Canes, Crutches and Gait Poles
Wheelchairs
Factors in Wheelchair Prescription
Seating Systems
Linear Systems
Contoured Systems
Custom-molded Systems
Cushions and Positioning Components
Assistive Aids
Feeding Aids
Aids for Communication
Recreational Equipment
BIBLIOGRAPHY
ORTHOPEDIC SURGERY
Preparing for Surgery
Improvements Expected by Surgical Procedures
Tendon Surgery
Timing of Surgery
Patient Selection
Factors to Consider in Patient Selection
Neurological Impairment
Factors to Consider in Surgical Selection
Orthopedic Interventions
Corrective Casting
Surgical Methods
Preoperative Assessment
Postoperative Care
Analgesia
Mobilization
Early Mobilization is Crucial for the Success of Postoperative Physiotherapy
The ‘Birthday Syndrome’
Complications of Surgery
BIBLIOGRAPHY
ANESTHESIA AND CHRONIC PAIN MANAGEMENT
Preoperative Assessment
Special Considerations in Preoperative Assessment
Dental and Mouth Hygiene
Epilepsy
Latex Allergy
Spasticity
Postoperative Management
BIBLIOGRAPHY
PATHOPHYSIOLOGY OF SPASTICITY
Physiology of Movement
The Upper Motor Neuron Syndrome
Positive-Findings
Negative-findings
Results in muscle
Modified Ashworth Scale
The Upper Motor Neuron Syndrome
Definition of Spasticity
Pathogenesis
Measuring Spasticity
The Ashworth Scale
Measurements in Spasticity
Clinical Measures
Mechanical Instruments
Electrophysiological Measures
Functional Measures
The Tardieu Scale
Effects of Spasticity
Adverse Effects
Beneficial Effects
BIBLIOGRAPHY
TARDIEU SCALE
Quality of Muscle Reaction is Measured
Effects of Spasticity
Positive Effects
Negative effects
Goals of Spasticity Treatment
Treatment Methods
Essentials of Spasticity Treatment
Indications for Treatment
Treatment Methods
Physiotherapy
Inhibitive (Tone Reducing) Casting and Bracing
BIBLIOGRAPHY
ORAL MEDICATIONS
Indications
Oral Antispastic Drugs
Baclofen
Diazepam
Clonazepam
Dantrolene Sodium
Tizanidine
BIBLIOGRAPHY
NEUROMUSCULAR BLOCKING AGENTS
Local Anesthetics (Phenol, Botulinum Toxin)
Mechanism of Effect
Dosing and Administration
Electrical Stimulation Technique
Indications
Advantages
Side Effects and Precautions
CHEMICAL NEUROLYSIS: ALCOHOL AND PHENOL
Alcohol
Phenol
Mechanism of Effect
Dosing and Administration
Side Effects and Precautions
Botulinum Toxin
Disadvantages and Precautions
Hints on Using Phenol
The Mechanism of Effect
Specific Pharmacology
Indications
Dosing and Administration
Patient Selection
Muscle Selection
Injection Technique
Dilutions
Post-injection Treatment
Resistance
Advantages and Disadvantages
Contraindications
Conclusion
REFERENCES
INTRATHECAL BACLOFEN (ITB)
Indications for ITB
Factors to Consider
Performing the Test Dose
Implanting the Pump
Symptoms of Acute Baclofen Withdrawal
Follow-up
Dosing and Clinical Evaluation
Complications
BIBLIOGRAPHY
SELECTIVE DO RSAL RH IZOTOMY AND OTHER NEUROSURGICAL TREATMENT MODALITIES
Indications
Technique
Follow-up
Contraindications
Side Effects and Precautions
Other Neurosurgical Treatment Modalities
BIBLIOGRAPHY
HEMIPLEGIA
Common Musculoskeletal Problems (Fig. 25)
Physiotherapy and Occupational Therapy
Botulinum Toxin A
Bracing Upper Extremity Bracing
Lower Extremity Bracing (Fig. 26)
Orthopedic Surgery
The Foot
Pes Equinus (Fig. 27)
Pes Varus (Fig. 28)
EMG
The Knee
Flexed Knee
Genu Recurvatum (Fig. 29)
Stiff Knee
The Hip
Limb Length Discrepancy
Management of Hemiplegic Gait (Fig. 30A)
Upper Extremity
Physical and Occupational Therapy (Fig. 30B)
Bracing
Local Anesthetic and Botulinum Toxin Blocks
Surgery
BIBLIOGRAPHY
DIPLEGIA
Physiotherapy and Occupational Therapy
Botulinum Toxin
Bracing (Fig. 36)
Other Measures
Orthopedic Surgery
Multilevel Surgery (Figs 37A and B)
Musculoskeletal Problems and Their Treatment
Scissoring (Figs 38A and B)
Jump Gait (Fig. 39)
Crouch Gait (Fig. 40)
Stiff Knee (Figs 41A and B)
Genu Recurvatum (Fig. 42)
Torsional Deformities (Figs 43A and B)
Hip
Pes Valgus
Hallux Valgus (Figs 44E to F)
Postoperative Care (Fig. 45)
Upper Extremity
BIBLIOGRAPHY
QUADRIPLEGIA
Goals of Treatment
Physiotherapy and Occupational Therapy
Bracing
Orthopedic Treatment
Scoliosis
Hyperlordosis
Hyperkyphosis (Fig. 48 and 49)
The Hip (Fig. 50 and 51)
The Knee, Ankle and the Foot
Upper Extremity
BIBLIOGRAPHY
DYSKINESIA (FIG. 55)
Classification (Fig. 56)
Associated Features
Musculoskeletal Issues
Treatment
BIBLIOGRAPHY
THE NEGLECTED CHILD (FIG. 57)
The Diplegic Child (Fig. 59)
The Hemiplegic Child
The Adult
Special Problems of the Adult Patient
Pain
Fractures
Scoliosis
Sexuality Issues
Feeding and Nutrition
General Goals of Management
The Ambulatory Patient
The Nonambulatory Patient
BIBLIOGRAPHY
MANAGEMENT WITH LIMITED RESOURCES
What Happens When Resources are Limited?
Hemiplegia
Diplegia
Quadriplegia
What to do When Resources are Limited?
The Necessities
INTRODUCTION AND HISTORY
Classification
Anatomicophysiological Classification
Pathophysiological Classification
Spasticity: Treatment Protocol
Selection of Cases5–7
Procedures
363:
Spinal Dysraphism
INTRODUCTION
Embryology
Terminology
Classification (Table 1)
Spina Bifida Cystica
MYELOMENINGOCELE
Associated Abnormalities
Tethered Cord Syndrome
Arnold-Chiari Deformity
Hydrocephaly
EVALUATION
Diagnosis
Treatment After Birth
MANAGEMENT
ORTHOPEDIC TREATMENT5
Foot
Clubfoot
Congenital Vertical Talus
Other Deformities of the Foot
Knee
Hip
Dislocation of Hip
Spinal Deformities
Additional Problems
BIBLIOGRAPHY
364:
Miscellaneous Neurologic Disorders
INTRODUCTION
Clinical Features
Treatment
REFERENCE
BIBLIOGRAPHY
INTRODUCTION
Classification
Charcot-Marie-Tooth Disease
Pathology
Clinical Features
Diagnosis
Cavus Deformity in Poliomyelitis
Neurologic Causes of Cavus Foot
Post-traumatic Cavovarus Foot Deformities
Treatment
Scoliosis
Involvement of Upper Limb
REFERENCES
CONGENITAL ABSENCE OF PAIN
Differen tial Diagnosis
Treatment
INTRODUCTION
Clinical Features
REFERENCE
365:
Scoliosis and Kyphosis Deformities of Spine
INTRODUCTION
Structural Scoliosis
Classification
Apical Vertebra
Major Curve
Minor Curve
Primary Curve
Structural Curve
Pathological Changes in Structural Scoliosis
Evaluation of the Patient
Physical Examination
Radiological Examination
Idiopathic Scoliosis
Infantile Idiopathic Scoliosis
Juvenile Idiopathic Scoliosis
Adolescent Idiopathic Scoliosis
Treatment
Surgical Treatment of Idiopathic Scoliosis
Selection of the Fusion Area
Surgical Techniques
Complications of Surgery
Neurological Complications
Anterior Surgery in Idiopathic Scoliosis
Rigid Idiopathic Scoliosis
Thoracolumbar and Lumbar Curves
Congenital Scoliosis
Natural History of Congenital Scoliosis
Clinical Presentation
Evaluation of the Patient
Follow-up
Treatment
Thoracic Insufficiency Syndrome
Kyphosis
Congenital Kyphosis
Clinical Features and Evaluation
Treatment
Adolescent Kyphosis (Scheuermann Disease)
Clinical Features
Natural History
Radiological Features
Surgical Treatment
366:
Developmental Dysplasia of the Hip
INTRODUCTION
Causes of Hip Dislocation
Nomenclature
Embryology
Epidemiology
Etiology and Risk Factors
Etiology of DDH
PATHOANATOMY OF DDH AND OBSTACLES TO REDUCTION
Obstacles to Concentric Reduction
Intra-articular
Extra-articular
DIAGNOSIS AND CLINICAL ASSESSMENT OF DDH
INVESTIGATIONS
TREATMENT OF DDH
SEQUELAE AND COMPLICATIONS
367:
Congenital Short Femur Syndrome (Proximal Focal Femoral Deficiency)
INTRODUCTION
Classification
Aitken Classification (Figs 1A to D)
Congenital Short Femur2 Severity Grade
Associated Anomalies
Clinical Feature
Evaluation3
Treatment
Congenital Short Femur with Hip and Knee Normal
PALEY'S CLASSIFICATION (FIGS 3A TO C)
Paley's CFD Classification
Type 1 CFD: Intact Femur
Choice of Osteotomy Level for Lengthening of the Congenital Short Femur
Treatment CFD Type 2
Treatment of Type 3a: Diaphyseal Deficiency, Knee Range of Motion > 45° (Figs 6 and 7)
REFERENCES
368:
Perthes Disease
WALDENSTROM'S STAGING OF LCPD
First Stage of Ischemia and Avascular Necrosis
Second Stage of Revascularization and Resorption
Pathological Subchondral Fracture (Crescent Sign)
Third Stage of Reossification (Healing) Stage
Fourth Stage of Healing and Remodeling and Sequelae of Perthes Disease
Clinical Features
Changes in the Physis
Changes in the Acetabulum
Synovitis Type
Tuberculous Type (Figs 3A and B)
Ankylosing Type (Fig. 4)
Signs
Radiological Features
Radioisotope Scintigraphy
Arthrography
Magnetic Resonance Imaging (MRI)
Ultrasonography
Computed Tomography
Classification
Caterall Classification (Fig. 5)
Salter's Classification
Harring's Lateral Pillar Classification
Natural History
PROGNOSTIC FACTORS IN LCPD13
Classification of Outcome
The Moss Classification
The Stulberg Classification
Differential Diagnosis (Table 6)
Tuberculosis
Epiphyseal Dysplasia (Multiple or Spondylo)
TREATMENT
Supervised Neglect
Weight Relief
Broomstick Plaster (Patrie Cast)
Symptomatic Therapy
Orthrotic Treatment
Surgical Containment
Surgical Treatment Consist of
Femoral Osteotomy (Fig. 7)
Apophyseodesis
Technique
Salter's Innominate Osteotomy
Technique
Complication
Combined Procedure
Postopertive Management
Reconstructive Surgery
Postoperative Management
CONCLUSION
Arthrodiastasis in Perthes’ Disease
1984-2004 Multicenter Prospective LCP Disease Study was Carried out by B Stephens Richards, MD16
369:
Slipped Capital Femoral Epiphysis
INTRODUCTION
Epidemiology
Etiology and Pathogenesis
Diagnosis
Radiographs
Treatment of Stable SCFE
Treatment of Unstable SCFE
Complications
Controversies
Role of Secondary Procedures
Prophylactic Pinning of Contralateral Normal Hip
370:
Developmental Coxa Vara
INTRODUCTION
Pathology
Etiology
Classification
Clinical Findings
Before the Child Learns Working
After the Child Learns Walking
A Neglected Case in Adult Life
Physical Signs
Radiographic Features
Diagnosis
Natural History
Treatment
Types of Osteotomies (Figs 6A to D)
371:
Septic Arthritis in Infants and Children
INTRODUCTION
PATHOPHYSIOLOGY
CARTILAGE DESTRUCTION
PATHOPHYSIOLOGY
History
Examination
LABORATORY INVESTIGATIONS
Hematology
Joint Aspiration
IMAGING
X-ray and CT Scan
Nuclear Imaging
MRI
Ultrasound
DIFFERENTIAL DIAGNOSIS
TREATMENT
Surgery
RESULTS AND PROGNOSIS
THE NEONATAL SEPTIC ARTHRITIS
THE SEQUELAE OF NEONATAL SEPTIC ARTHRITIS OF HIP
TREATMENT
372:
Transient Synovitis of the Hip
373:
Idiopathic Chondrolysis of the Hip
INTRODUCTION
Etiology
Pathology
Clinical Features
Laboratory Features
Investigations
Natural History
Treatment
374:
Angular Deformities in Lower Limb in Children
375:
Toe Walking
INTRODUCTION
Clinical Features
Idiopathic Toe Walking
Clinical Examination
Diagnosis
Treatment
Operative Treatment
Other Causes of Toe Walking
Clinical Features
Treatment
Cerebral Palsy
Duchenne's (Pseudohypertrophic) Muscular Dystrophy
Congenital Subluxation or Dislocation of Hip
SECTION 40: MICROSURGERY
376:
Microvascular Surgery
INTRODUCTION
Role of Microvascular Surgery in Orthopedics
Replantation
Free Tissue Transfer
Applications of Free Flaps (Figs 4 and7)
Vascularized Bone Transfers (Fig. 5)
Toe to Hand Transfer (Fig. 6)
Functioning Muscle Transfers
Recent Advances in Microsurgery (Figs 8 and9)
SECTION 41: ARTHROPLASTY
377:
Total Hip Arthroplasty
INTRODUCTION
HISTORICAL REVIEW
Interposition of Membranes and Other Materials
Partial Joint Replacement
Total Joint Replacement
Femoral Component
Acetabular Component
BIOMECHANICS
Rotational Torque on the Femoral Component
Coefficient of Friction
Wear
SELECTION OF IMPLANTS
HEAD DIAMETER
INDICATIONS
Group 1
Group 2
Group 3
Group 4
Group 5
Group 6
Group 7
Group 8
Group 9
Group 10
Group 11
CONTRAINDICATION
PREOPERATIVE RADIOGRAPHS AND TEMPLATING
SURGICAL TECHNIQUE
Surgical Approaches
Acetabular and Femoral Preparation
Component Implantation
THR IN SPECIFIC CONDITIONS
THR in Ankylosing Spondylitis
Fracture Acetabulum Converted to THR
Conversion of Hemiarthroplasty to THR
Protrusio
Excised Hip—THR
THR in TB
THR in Sickle Cell
COMPLICATIONS
Infections
Management of Infection
Stage I
Stage II
Stage III—Late Hematogenous Infection
NERVE INJURY
DISLOCATION AND SUBLUXATION
LIMB LENGTH INEQUALITY
VASCULAR INJURY
PERIPROSTHETIC FRACTURE
Classification
Site of Fracture
ECTOPIC OSSIFICATION
Heterotrophic Ossification
Treatment and Prevention
STEM FRACTURE
ACETABULAR LOOSENING
FEMORAL LOOSENING
BIBLIOGRAPHY
INTRODUCTION
TRIBOLOGY AND COMPARATIVE ANALYSIS OF BEARING SURFACES
HIP REPLACEMENT SURGERY
Implant Fixation
Biological Fixation
Porous Coated Surface (Fig. 1)
Grit Blasted Surface
Factors Determining Successful Fixation
Extent of Porous Coating
HIP STABILITY
Component Design
Alignment
Soft Tissue Tension
Soft Tissue Function
COMPLICATIONS
Recent Advances in THA
SURFACE REPLACEMENT ARTHROPLASTY OF HIP
Evolution of Surface Replacement Arthroplasty
Results of Early Resurfacing Surgeries
Revival of Metal-on-metal Resurfacing
Current Hip Resurfacing Options
Relevant Biomechanics of the Hip
Patient Selection Indication and Contraindication
High Risk Patient Factors
Surface Replacement: Implant Design and Rationale
Metallurgy
Fixation of Metal-on-metal Resurfacing Implants
Preoperative Planning for Surgery
Femoral Templating7(Fig. 4A)
Acetabular Templating7(Fig. 4B)
ASRTM (Surface Replacement) Instrumentation7
Femoral Instruments
Acetabular Instruments
Surgical Steps for Surface Replacement Arthroplasty (SRA)
Posterolateral Approach
Femoral Sizing/Gauging (Fig. 5A)
Acetabular Preparation (Fig. 5B)
Femoral Pin Insertion
Femoral Reaming
Cementing Technique
Postoperative Management
Immediate Postoperative Care
Surface Replacement Arthroplasty: Complications and Problems Associated
Femoral Neck Fractures
Avascular Necrosis of the Femoral Head
Metal Ion Levels
Aseptic Loosening of the Components (Femoral)
CONCLUSION
REFERENCES
EVALUATION OF A PAINFUL HIP
Pathologic Processes in Failed Hips and its Evaluation
ASEPTIC LOOSENING IN CEMENTED THA
Radiographic Evaluation
ACETABULUM
EVIDENCE OF LOOSENING
CATEGORIZING THE BONE LOSS-CLASSIFICATION (FIG. 2)
FEMUR
CEMENT—IMPLANT INTERPHASE
BONE—CEMENT INTERPHASE
DEFINITE SIGNS OF LOOSENING
HIGH INDEX OF SUSPICION
CLASSIFICATION OF FEMORAL BONE LOSS
EVALUATION OF LOOSENING IN UNCEMENTED HIPS
Acetabulum
FEMUR
PLANNING THE SURGERY
General Remarks
TREATMENT
Surgical Exposure
Trochanteric Osteotomy
Extended Trochanteric Osteotomy
Acetabular Reconstruction
SURGICAL OPTIONS IN ACETABULAR RECONSTRUCTION
CONTAINED SITUATIONS
Uncemented Pressfit Devices
Uncontained Defects
Reconstruction Rings and Cages
Features
Impaction Grafting10
Results
FEMORAL REVISION
Cemented Femoral Revisions
Important Requirements
Impaction Grafting15
Uncemented Femoral Revisions
Algorithm for Choice of the Prosthesis
Other Options
CONCLUSION
REFERENCES
INTRODUCTION
BIOMECHANICS
FRICTIONAL FACTORS
WEAR FACTORS
CENTRICITY CONSIDERATIONS (FIGS 1A TO C)
DISLOCATION
IMPLANT
INDICATIONS
Fracture Neck Femur
OSTEOARTHRITIS OF THE HIP
AVASCUAL NECROSIS HEAD FEMUR
RHEUMATOID ARTHRITIS
DYSPLASIA
REVISION TOTAL HIP REPLACEMENT
SURGICAL TECHNIQUE
Preoperative Planning
TEMPLATING
THROMBOPROPHYLAXIS
Technique
COMPLICATIONS
INTRAOPERATIVE COMPLICATIONS
POSTOPERATIVE COMPLICATIONS
Dislocation
Dissociation
Ectopic Para Articular Bone
EROSION
Aseptic Loosening
Calcar Resorption
Misconceptions about Bipolar Arthroplasty
Differential Motion
Acetabular Erosion
Bipolar Use in Diseased Hips
378:
Total Knee Arthroplasty
HISTORY AND EVOLUTION OF TOTAL KNEE ARTHROPLASTY (TKA)
Prosthesis Selection
Constraint
Requirement of Suitable Prosthesis
Indications and Patient Selection
TKR in Young Patients
Preoperative Evaluation
Radiography
Treatment Options
Arthrodesis
Contraindications
Preoperative Care and Investigations (Figs 2A to D)
Preoperative Radiographic Analysis
Operative Technique
Surgical Exposure
Use of Knee System Instruments
Management of Bone Defects
Management of Deformity
Postoperative Management
Complications
Revision Arthroplasty
Simultaneous Bilateral Total Knee Replacement
Hybrid Total Knee Arthroplasty
Life of Total Knee Arthroplasty
REFERENCES
INTRODUCTION
BIOMECHANICAL CONSIDERATIONS
The Stabilizing Role of the Ligaments
Motion of the Joint
Knee Joint Loading
GENERAL CRITERIA FOR KNEE JOINT REPLACEMENTS
FUNCTIONAL FACTORS AFFECTING SURFACE SHAPE AND DEGREE OF MOTION CONSTRAINT
Function Design Factors
Designs that Substitute for Ligaments
Cruciate Ligament Retention Considerations
Mechanical Factors Affecting Surface Shape and Degree of Motion
Effect of Degree of Constraint on Load Transmission
Effect of Surface Contact on HDP Wear
Load Transfer Considerations
Thickness of the HDP Component
Surgical Tensioning and the Tibial Component
Effect of a Metal Backing Plate
The Effect of a Tibial Component Stem
The Stiffness of the HDP
Prosthesis Design Features
Femoral Component Shape
Tibial Surface Shape
Method of Anchorage of Components
Patellar Resurfacing
Meniscal Bearings
Hemiarthroplasty
Revision Knees
Summary
BIBLIOGRAPHY
TKR IN THE YOUNG
INDICATIONS
BENEFITS, RISKS AND ALTERNATIVES
EXAMINATION AND PATIENT ASSESSMENT
General Medical History
General Physical Examination
CLINICAL PRESENTATIONS
CONTRAINDICATIONS TO TOTAL KNEE ARTHROPLASTY
REFERENCES
HISTORY
1. Pain
2. Function
Absolute Contraindications
Relative Contraindications
Extensor Mechanism Deficiency
B. Physical Examination of Knee Joint
C. Diagnostic Assessment
Standard Radiographic Views
Standing 52 Inches Cassette [three joint view]
Knee is Fit For Surgery But is the Patient Bearing That Knee Fit For The Surgery?
General Medical History
Physical Examinations
Systemic Examination
A. Cardiac Evaluation
B. Pulmonary Evaluation
C. Renal Evaluation
D. Urological Evaluation
E. Gastrointestinal Evaluation
Other Routine Investigations Include
Communication with Patient and Relatives
Discussion of the Critical Pathways
PREOP COUNSELLING
Mechanical Axis
PLANNING FEMORAL AND TIBIAL CUTS
PREOPERATIVE RADIOGRAPHIC EVALUATION
Purpose
TECHNIQUE
Whether to do a Simultaneous Bilateral or Unilateral
INTRODUCTION
Biomechanics of the Knee
Historical Review
Early Prosthetic Models
Constrained Prostheses
Graduated System Concept
Unconstrained Prosthesis
LCS (low contact stress meniscal bearing prosthesis) [DePuy Warsaw]
Original Design Features (Unconstrained TKR prosthesis)
Semi Constrained Prostheses
Cruciate Excision, Retention and Substitution
Arguments for PCL Excision
Arguments Against Cruciate Ligament Excision
PCL Retention Vs Substitution
Uncemented TKR Prostheses
Posterior Cruciate Retaining TKA Prostheses
High Flex CR Prosthesis
Mobile Bearing CR Prostheses
PCL Sacrificing TKR Prostheses
Total Condylar Prosthesis
PCL Substituting Designs
Mobile Bearing Design
LOW CONTACT STRESS DESIGN
Hinges and Rotating Hinges
Biaxial Constrained TKR Prostheses
Constrained Prosthesis
Patellar Component in TKR
BIBLIOGRAPHY
INFECTION
Clinical Features
Investigations
X-ray Features
Prophylaxis Against Infection
Treatment Options
Patello-Femoral Complications
Patellar Maltracking/Patello-Femoral Instability
Causes
Treatment
Patellar Fracture
Treatment
Patellar Failure
Patellar Loosening
Patellar Clunk Syndrome
Extensor Mechanism Rupture
Vascular Injury
Prevention
Treatment
Neurological Injury
Causes
Treatment
PERI PROSTHETIC FRACTURES
A. Supra Condylar Femur Fractures
Classification
Treatment
B. Tibial Fractures
Classification
Treatment
WOUND COMPLICATIONS
THROMBOEMBOLISM (TE)
Clinical Features
Radio Active Iodine Labeled Fibrinogen
D Dimer Assay
Diagnosis of PE
Clinical Features
Perfusion Scan
Ventilation Perfusion Scan
Chest X-ray
Arterial Blood Gases
Pulmonary Angiography
DVT PROPHYLAXIS
TREATMENT OF DVT AND PE
BIBLIOGRAPHY
INTRODUCTION
Factors in the Pre-Operation Evaluation Of Patients
Factors in Basic Surgical Techniques
Primary Soft Tissue Release
Basic Bony Cuts and Flexion – Extension Gap balancing
Upper Tibial Cut
Distal Femoral Cut
ANTERIOR POSTERIOR FEMORAL CUTS
Flexion-Extension Gap Balancing
Flexion Extension Gap Balancing
Extension Gap
Trial Reduction and Final Soft Tissue Balancing
Patellar Replacement and Patellar Balancing
Specific Condition and Situations
Correction of Varus Deformity
Correction of Valgus Deformity
BIBLIOGRAPHY
INTRODUCTION
HISTORY
FACTORS INFLUENCING LONG-TERM RESULTS
LONG-TERM RESULTS OF INDIVIDUAL DESIGNS
1. Cruciate Retaining (PCL – Sparing) Total Knee Arthroplasty
2. PCL Sacrificing Total Knee Arthroplasty
3. Posterior Stabilised (PCL Substituting) Total Knee Arthroplasty
4. Meniscal Bearing (Low Contact Stress) Total Knee Arthroplasty (Fig. 7)
5. Uncemented TKA
SUMMARY
BIBLIOGRAPHY
INTRODUCTION
Advantages
Disadvantages
Indications
Contraindications
Pre Operative Evaluation
Implant Design
Technique18,21
Complications
Long Term Results
REFERENCES
INTRODUCTION
Biology of Osteolysis
Classification of Bone Defects
Preoperative Planning and Choice of Prosthesis
Incision and Exposure
Removal of Components
Intramedullary Stem
Management of Bone Defects
Constrained Prosthesis
SUMMARY
ABSTRACT
INTRODUCTION
Pre-operative Assessment
Principles
EXTENSILE APPROACHES
Quadriceps Snip
Patellar Turn-down
Tibial Tubercle Osteotomy
Femoral Peel
Medial Epicondylar Osteotomy
Quadriceps Myocutaneous Flap
SUMMARY
ACKNOWLEDGEMENTS
REFERENCES
INTRODUCTION
Principles
SURGICAL APPROACHA
Anterolateral (Watson - Jones) Approach
Direct Lateral (Modified Hardinge) Approach
Posterior Approach (I,angenbeck/Moore)
Trochanteric Slide
Vastus Slide
Extended Trochanteric Osteotomy
REFERENCES
BIBLIOGRAPHY
379:
Shoulder Arthroplasty
INTRODUCTION
EVOLUTION OF PROSTHETIC DESIGN
OBJECTIVES
INDICATIONS
Primary Osteoarthritis (Fig. 4)
Secondary Osteoarthritis
Avascular Necrosis (Fig. 5)
Septic Arthritis (Fig. 6)
Rheumatoid Arthritis (Fig. 7)
Fracture Dislocations (Fig. 8)
Early Presentations
Late Presentation
CUFF ARTHROPATHY (FIG. 15)
OTHERS
Recurrent Dislocation
Ankylosing Spondylitis
Hemophiliac Arthropathy
CONTRAINDICATIONS
PREOPE RATIVE PLANNING AND EVALUATION
SURGICAL PROCEDURE
Anesthesia
Patient Positioning
SURGICAL APPROACH (FIGS 19 TO 26)
RESTORATION OF JOINT MECHANICS
The Humeral Head
Diameter
Retroversion Angle
Neck Shaft Angle
Distance Above Tuberosity
Medial Offset (Fig. 28)
Neck Length
Joint Line
Posterior Offset
THE GLENOID
Problems with the Glenoid
Diameter
Surface Shape
Thickness
Retroversion and Facing Angle
BONE PREPARATION
CLOSURE
REHABILITATION
COMPLICATIONS
Peroperative Complications
Fractures
Nerve Injury
Component Malpositioning
POSTOPERATIVE COMPLICATIONS
Loosening
Dissociation
Instability
Cuff Tears
Stiffness
Infection
Nerve Injury
Deltoid Dysfunction
REVERSE SHOULDER PROSTHESIS (FIGS 35 TO 38)
SURFACE REPLACEMENT
SUMMARY
380:
Total Elbow Arthroplasty
NONPROSTHETIC ARTHROPLASTY
Excisional Arthroplasty
Functional Anatomic Arthroplasty (Hass, 1944)11
Interposition Arthroplasty
DISTRACTION INTERPOSITION ARTHROPLASTY
Prosthetic Elbow Arthroplasty
Hemiarthroplasty
Total Elbow Arthroplasty
The Constrained Linked Prosthesis
(Dee, McKee, Shiers. Stanmore, Baksi, 19781)
The Unconstrained Resurfacing Prosthesis
(Ewald, Souter, Kudo, Wadsworth, Lowe-Miller, etc.)
Semiconstrained/Sloppy Hinge Prosthesis
(Pritchard – Walker, GSB III, prosthesis, Triaxial, coonrad – Morrey, Baksi Sloppy Hinge 19842, etc.)
BAKSI'S SLOPPY HINGE PROSTHESIS
SURGICAL TECHNIQUE OR BAKSI'S SLOPPY HINGE ELBOW ARTHROPLASTY
Postoperative Care
RESULTS OF PROSTHETIC ARTHROPLASTY OF ELBOW
Results of Elbow Arthroplasty in Rheumatoid Arthritis
Complications of Baksi's Sloppy Hinge Elbow Replacement
CONCLUSION
381:
Ankle Arthroplasty
SECTION 42: ARTHRODESIS
382:
Shoulder Arthrodesis
INDICATIONS
Paralysis
Infection
Reconstruction Following Tumor Resection7
Failed Total Shoulder Arthroplasty
Shoulder Instability
Rotator Cuff Tear
Malunion
Osteoarthrosis
Rheumatoid Arthritis
Contraindications
Timing of Procedure
OPTIMUM POSITION
PREREQUISITE
TECHNIQUES
Extra-articular Procedures
Intra-articular Procedure
Combined Intra- and Extra-articular Procedure
Compression Method
AO Technique (Fig. 4)
Complications
Functional Outcome After Shoulder Arthrodesis12,23
Fusion
Pain Relief
Acromioclavicular Joint Pain
CONCLUSION
383:
Hip Arthrodesis
JUSTIFICATION
Historical Review
INDICATIONS
In Young Adults
For Failed Arthroplasty
In Skeletally Immature Person
CONTRAINDICATIONS
RELATIVE CONTRAINDICATIONS
TECHNIQUE
General Considerations
Specific Techniques
Combined Intra-extraarticular Arthrodesis
Postoperative Schedule
Arthrodesis in Children
Arthrodesis in Special Situations
Gait in a Fused Hip
Function After Arthrodesis
Total Hip Replacement after Hip Fusion
CONCLUSION
384:
Knee Arthrodesis
INDICATIONS
CONTRAINDICATIONS
SURGICAL TECHNIQUES
Compression Arthrodesis3
Arthrodesis with Intramedullary Nail
Plating12
Arthroscopic Assisted Fusion
RESULTS
Arthrodesis of Knee in Children
Functional Impact of Arthrodesis
CONCLUSION
385:
Ankle Arthrodesis
INDICATIONS
CONTRAINDICATIONS
Optimum Position
Gait Alteration
PREOPERATIVE PLANNING
Bone Quality
Skin
Timing of Arthrodesis
Subtalar Arthritis
Preoperative Counseling
Surgical Techniques
Surgical Approaches
Methods of Arthrodesis
Extra-articular Fusion with or Without Intra-articular Fusion3
Fixation Options
COMPLICATIONS
Nonunion
Malunion
Infection
Persistent Pain
Degenerative Changes
Tendon Laceration
CONCLUSION
SECTION 43: AMPUTATIONS
386:
Amputations
INCIDENCE
GENERAL PRINCIPLES
Indications
Lack of Circulation
Injury (Fig. 1)
Infection
Tumors
Congenital Anomalies
Types of Amputation
Open Amputation
Closed Amputation
Revision Amputation
Reamputation
Early Amputation
Intermediate Amputation
Late Amputation
Level of Amputation (Table 2, Fig. 2)
GENERAL GOALS OF BURGESS TECHNIQUES
Amputation Versus Disarticulation
Advantages
Disadvantages
Basics of Surgical Technique
Anesthesia General or Spinal
A TENSION FREE CLOSURE IS IMPORTANT
In Transfemoral Amputation
POSTOPERATIVE CARE
Aftertreatment
Complications
DERMATOLOGICAL PROBLEMS
The Stump
AMPUTATIONS IN LOWER EXTREMITY
Amputation of Foot
Syme's Amputation
Below-Knee (BK) Amputation
Disarticulation of Knee
Above-Knee Amputation
Amputations of Hip Pelvis
Disarticulation of Hip
Hindquarter Amputation
Hemicorpectomy
Rehabilitation
Amputations of the Upper Extremities
Indications
Trauma
Tumors
Infection
Burns
Principles of Amputations of Upper Limb
Wrist Amputation
Below Elbow Amputations
Elbow Disarticulation
Above Elbow Amputations
Disarticulation of Shoulder
Forequarter Amputation
Amputations Through the Hand
INTRODUCTION
Surgical Technique
Rehabilitation
BIBLIOGRAPHY
INTRODUCTION
INTRODUCTION
The Concept
The Jig
Indigenous Version
Material
Putation Technique
IPPF Technique
Postoperative Management
Concept, Rationale and Advantages of IPPF
BIBLIOGRAPHY
INTRODUCTION
Amputation Through a Toe
Disarticulation of the Metatarsophalangeal Joint
Disarticulation of the Fifth Toe
Disarticulation of the Great Toe
Amputation of a Single Metatarsal
Amputation of All The Toes
Transmetatarsal Amputation
Amputation Through The Middle of the Foot
Lis Franc's Amputation
Chopart's Amputations
SECTION 44: REHABILITATION-PROSTHETIC AND ORTHOTIC
387:
Prosthetics and Orthotics: Introduction
MATERIALS USED IN PROSTHETICS AND ORTHOTICS
Metals
Steel
Aluminum
Alloys of Titanium
Plastics
Thermoplastics
Thermosetting Plastics
Foams
Wood
Leather
Fabric
Rubber
IMPORTANT CHARACTERISTICS OF PROSTHETIC AND ORTHOTIC MATERIALS
Strength
Stiffness
Durability (Fatigue Resistance)
Density
Corrosion Resistance
Ease of Fabrication
Cost and Availability
STEPS IN PROVIDING PROSTHESES/ORTHOSES
Fabrication Option
Central Fabrication vs Local Fabrication
Disadvantages of Central Fabrication
SPECIFICATIONS FOR THE IDEAL PROSTHESIS/ORTHOSIS
Function
Comfort
Cosmesis
Fabrication
Economics
REACTIONS AND ADJUSTMENT ASSOCIATED WITH AMPUTATION AND USE OF PROSTHESIS
Physical Factors
Psychological/Psychosocial Factors
Grief Reactions
Vocational/Economic Factors
388:
Upper Extremity Prostheses
BODY POWERED COMPONENTS
Terminal Devices
Passive Terminal Devices1
Voluntary Opening Hook Terminal Devices
Manufacturers
Elbow Units
Shoulder Units
Endoskeletal Upper Limb Prosthesis
Harnessing and Controls for Body Powered Devices2
Modifications of Transradial Harness
Mechanism of Transradial Harness System
Mechanism of Transhumeral Control System
Standard Transhumeral Harness
COMPONENTS OF EXTERNALLY POWERED SYSTEMS
Prehension Mechanism
Prehension Force
Otto Bock System
Controls
Enhancements to Body Powered Elbows
CONTROL OF LIMB PROSTHESES
Goals
Sources of Body Inputs to Prosthesis Controllers
Biomechanical
Bioelectric/acoustic
Transducers
Neuroelectric Control
Role of Surgery in the Creation of Control Sites
PARTIAL HAND AMPUTATIONS
Esthetic Restoration
WRIST DISARTICULATION AND TRANSRADIAL AMPUTATIONS
Definitive Electronic Prosthesis
Self-Suspended Socket Designs
ELBOW DISARTICULATION AND TRANSHUMERAL AMPUTATIONS
Shoulder Disarticulation and Forequarter Amputation
389:
Rehabilitation of Adult Upper Limb Amputee
POSTOPERATIVE THERAPY PROGRAM
Preprosthetic Therapy Program
Determining The Prosthetic Prescription
Fabrication and Training Time
Adult Upper Limb Prosthetic Training
Body Control Motions
Prosthetic Controls Training
390:
Lower Limb Prosthesis
PARTIAL FOOT AMPUTATIONS
Prosthesis for Ray Amputation
Transmetatarsal Amputation
Tarsometatarsal and Transtarsal Amputations
Above Ankle Designs
Below Ankle Designs
SYME'S ANKLE DISARTICULATION
TRANSTIBIAL AMPUTATION
Patellar Tendon Bearing Socket
Socket Interfaces
PTB Hard Socket
Disadvantages
Soft Liners
Advantages
Disadvantages
Distal Pads
Advantages
Disadvantages
Flexible Socket with Rigid External Frames
Advantages
Disadvantages
Suspension Variant
Cuff Suspension (Fig. 2)
Advantages
Disadvantages
Patellar Tendon Bearing Supracondylar Suprapatellar (PTBSCSP) Suspension (Fig. 3)
Advantages
Disadvantages
Patellar Supracondylar Suspension (Fig. 4)
Advantages over PTBSCSP socket
Disadvantages as compared to PTBSCSP socket
Variants of PTBSCSP and PTBSC Socket
Sleeve Suspension (Fig. 5)
Advantages
Disadvantages
Silicone Suction Socket (Fig. 6)
Advantages
Disadvantages
Joint With Thigh Corset (Fig. 7)
Advantages
Disadvantages
Waist Belt Suspension (Fig. 8)
Advantages
Disadvantages
Prosthetic Shank/Shin Piece
Exoskeleton
Endoskeleton (Modular)
Disadvantage
Ankle Foot Assesmbly
SACH (Solid Ankle Cushioned Heel) Foot
Advantages
Disadvantages
Other SACH foot types
SAFE (Stationary Attachment Flexible Endoskeleton) Foot
STEN (Stored Energy)
Carbon Copy II
Quantum Foot
Seattle
Flex Foot
Springlit e
Jaipur Foot
Advantages
Modi Rubber Foot
Ankle Foot/Prosthesis with Articulated Bone Skeleton
Single Axis Foot
Disadvantage
Multiple Axis Foot
Prescription of Transtibial Prosthesis
Analysis of Transtibial Amputee Gait
Midstance
Midstance and Toe-off
Computer Aided Design (CAD), Computer Aided Manufacturing (CAM)
KNEE DISARTICULATION
Biomechanics
Socket Variations
Cast Techniques
Knee Mechanisms
Disadvantages
TRANSFEMORAL AMPUTATION-PROSTHETIC MANAGEMENT
Biomechanics
Biomechanics of Knee Stability (Stance Phase of Gait)
Biomechanics of Pelvis and Trunk Stability
Biomechanics of Knee and Shank Control— Swing Phase of Gait
Transfemoral Socket
Quadrilateral Socket (Fig. 13)
Ischial Containment Socket
Flexible Transfemoral Sockets
Advantages
Indications
Socket option
Prosthetic Feet
Prosthetic Knee Components
Single Axis Knee
Polycentric Axis Knee
Advantages
Disadvantages
Weight Activated Stance Control Knee
Manual Locking Knee
Friction Control
Extension Assist
Pneumatic Control
Hydraulic Control
Suspension Variants
Suction Suspension
Disadvantages
Soft Belts
Hip Joint with Pelvic Band or Belt
Analysis of Transfemoral Amputee Gait
Lateral Trunk Bending
Wide Walking Bases (abducted gait)
Circumduction
Vaulting
Swing Phase Whips
Foot Rotation at Heel Strike
Foot Slap
Terminal Impact
Uneven Step Length
Exaggerated Lordosis
HIP DISARTICULATION AND TRANSPELVIC AMPUTATION
Hip Joint Mechanisms
Knee Mechanisms
Foot Mechanisms
PHYSICAL THERAPY AND MANAGEMENT OF ADULT LOWER LIMB AMPUTEE
Presurgical Management
Postsurgical Management
Evaluation
Patient Education and Limb Management
Preprosthetic Exercise
Pregait Training
Gait Trainin g Skill
Advanced Gait Training Activities
THE CHILD AMPUTEE
Upper Limb Deficiency : Prosthetic and Orthotic Management
When to fit and with what?
Whether mechanical or powered components?
Recommendations by Level
Special Needs of Child Amputee
Prosthetic and Orthotic Management of Lower Limb Child Amputee
Birth to Six Months
7 Months to 14 Months
15 to 36 Months
37 to 72 Months
7 to 12 Years
13 to 18 Years
Consideration by Level of Amputation
Partial Foot
391:
Upper Limb Orthoses
HAND OR WRIST ORTHOSES
Assistive or Substitutive Orthoses
Positional Orthoses
Functions
Functions
Function
Function
Function
Functions
Function
Function
Utensil Holders
Volar Wrist Hand Stabilizer
Functions
Dorsal Wrist Hand Stabilizer
Function
Digital Stabilizers
Functions
Functions
Corrective Orthoses
Metacar pophalangeal ‘Flexor Orthosis’ Knuckle Bender
Function
Extensor Orthosis / Reverse Knuckle Bender
Function
Adjustable Wrist Hand Orthosis (Swanson Postarthoplasty Orthosis)
Functions
Interphalangeal
Functions
Function
ELBOW AND SHOULDER ORTHOSES
Protective Orthoses
Elbow Control Orthoses
Functions
Shoulder Abduction Stabilizer (Aeroplane splint) Orthosis
Functions
Slings
Functions
Functions
Function
Function
Corrective Orthosis
Functions
Dorsal Elbow Extensor Orthosis
Functions
Assistive and Substitutive Orthoses
Suspension Systems
Balanced Forearm Orthosis
Environmental Control Systems
Evaluation of Orthosis
Prescription of Orthosis
Burns
Problems of Ortho ses
392:
Lower Limb Orthoses
ANKLE FOOT ORTHOSES
Metal and Metal-Plastic Design
Shoe or Foot Attachment
Ankle Joints and Controls
Ankle Stops
Ankle Joint Assists
Uprights and Calf Bands
Plastic Designs
Posterior Leaf Spring
Modifications
In Summary
Use of Biomechanical Principles in
Checking Orthoses
KNEE-ANKLE-FOOT ORTHOSIS
Free Motion Knee Joints
Offset Knee Joint
Knee Locks
Accessory Pads and Straps
HIP-KNEE-ANKLE-FOOT ORTHOSIS
Hip Joints and Locks
Pelvic Bands
Knee Orthoses
Patellar Tendon Bearing Orthosis
Indications Use on Short-term Basis
Indications Long-term Use
Reciprocating Gait Orthosis
Pneumatic Orthosis
Orthoses Using Electrical Stimulation
FOOTWEAR
Agewise Need for the Shoe
Footwear Modifications
Elevations
Forefoot Deformities
Painful Heel Spurs and Plantar Fascitis
Flat Feet
Insensitive Feet
The Arthritic Foot
Athletic Shoes
Achilles Tendinitis
Metatarsalgia
Cavus Foot
393:
Physical Therapy and Therapeutic Exercises
THERAPEUTIC HEAT
Microwaves
Propagation and Absorption of Microwaves in the Tissues
Ultrasound
Equipment
Therapeutic Temperature Distribution
Technique of Application
Physiological Effects of Ultrasound
Contraindications
Superficial Heating Agents
Radiant Heat
Technique
Superficial Heating by Conduction
Superficial Heating by Convection
Technique of Application
LASER THERAPY
Role in Wound Healing
Role as Antiinflammatory Effect
THERAPE UTIC COLD
Role in Muscle Spasm, Spasticity and Muscle Reeducation
Use of Cold in Mechanical Trauma
Use of Cold in Burns
Use of Cold as Analgesic
Use of Cold in Arthritis
Techniques of Cold Application
Skeletal Muscle
Contractures
Joint Stiffness and Pain
Epicondylitis, Bursitis, Tenosynovitis
Trauma
Inflammation Associated with Infection
Vascular Diseases
Precautions
Adverse Effects
Contraindications
Therapeutic Uses
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)
Analgesia Mechanism
Equipment
IONTOPHORESIS
Complications and Contraindications
Indications
Functional Electrical Stimulation
Equipment
Limitations
Indications
Physiological Effects
Mechanical Effects
Technique
Stroking Massage (Effleurage)
Compression (Petrissage)
Percussion (Tapotement)
Indications
Psychoneurotic Patients
Therapeutic Exercise
Definition
EXERCISES TO INCREASE MOBILITY IN SOFT TISSUES
Physiology of Fibrous Connective Tissue
Loose Connective Tissue
Dense Connective Tissue
Normal Maintenance of Mobility
Hip
Knee
Ankle
Mobility Exercises to Maintain the Range of Motion
Stretching to Increase Range of Motion
Principles of Stretching
Continuous Passive Motion
THERAPEUTIC EXERCISES TO DEVELOP THE NEUROMUSCULAR COORDINATION
Training of Control of Individual Muscles
Requirements for Training of Control
Technique for Training Individual Muscles
Training of Multimuscular Coordination
Factors Increasing Coordination
Retraining Coordination for Proprioceptive or Cerebellar Function (Frenkel's Exercises)
Exercises While S u pine
Exercises While Sitting
Exercises While Standing
Exercises to Teach Relaxation
THERAPEUTIC EXERCISES TO MAINTAIN STRENGTH AND ENDURANCE
394:
Orthopedic Rehabilitation
INTERDISCIPLINARY OR TEAM APPROACH
Role of Physical Therapist
Role of Occupational therapist
Role of Prosthetist — Orthotist
Role of Rehabilitation Nurse
Role of Speech Therapist
Role of Psychologist
Role of Biomedical Engineer
Role of Social Worker
Role of Vocational Counselor
Principles of Orthopedic Rehabilitation of Specific
Disorders Rehabilitation of Hand
Management of Edema incudes
Rehabilitation of Peripheral Nerve Injury
Rehabilitation Interventions
Reconstructive Surgery
Rehabilitation of Brachial Plexus Injuries
Rehabilitation of Myopathies
Rehabilitation interventions include
Rehabilitation for Spina Bifida
MOBILITY AIDS
Rehabilitation of Decubitus Ulcer
Definition
Site
Etiology
Primary Factors
Contributing Factors
Prevention
General Preventive Measures
Recognition of Impending Skin Breakdown
Specific Preventive Measures
Management
395:
Rehabilitation of Spinal Cord Injury
INTRODUCTION
Figure and Facts
Mechanism of Injury
Neurological Presentations and Pathophysiology
MANAGEMENT
Transportation of a Spinal Cord Injury Victim
Acute Management in the Hospital
Investigations
Surgical In tervention/Stabilization in the Acute Stage
Conservative Management
Cardiopulmonary Complications
Pressure Sores
Soft Tissue Contractures
Neurogenic Bladder
Gastrointestinal Complications
Vascular Complications
Paraarticular Ossification (PAO)
Spasticity
Problems that May Result due to Spasticity
Management of Spasticity
Intrathecal Baclofen (ITB)
Sign/Symptoms of Baclofen Overdose
Autonomic Hyperreflexia or Dysreflexia
Chronic Pain
Pathological Fractures and Osteoporosis
Functional Aspects of Rehabilitation in Spinal Cord Injury (SCI) Patients
Acute Intervention
Rehabilitation Phase
Psychosocial, Sexual and Vocational Considerations in Spinal Cord Injury Rehabilitation Program
Follow-up Care
396:
Disability Process and Disability Evaluation
INDEX
TOC
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