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Textbook of Orthopaedics
John Ebnezar
SECTION 1: TRAUMATOLOGY
1:
Trauma—A Modern International Epidemic
INTRODUCTION
EPIDEMIOLOGY
Fatal Injuries
Mechanism of Injury Leading to Death
Possible Causes of Death
Mechanism of Trauma
Motor Vehicle Accidents (WHO Statistics)
Global Scenario
Indian Scenario
Firearms
Falls
Overall
Nonfatal Injuries
Mechanism of Injury
Interesting Statistics of Nonfatal Injuries
Sports Injuries
PREHOSPITAL CARE
Prevention of Injury
CONCLUSION
2:
Know Your Skeletal System
BRIEF ANATOMY
Bone Development
About Osteon
About Medulla
About Cortex
About General Structure
ORGANIZATION OF THE BONES
TYPES OF BONES (Figs 2.4A to C)
ABOUT JOINTS
FIBROUS JOINT OR SYNARTHROSIS
CARTILAGINOUS JOINTS OR AMPHORTHOSIS
SYNOVIAL JOINTS OR DIARTHROSIS
Types of Synovial Joints
3:
General Principles of Fractures and Dislocations
INTRODUCTION
DEFINITIONS
TYPES OF FRACTURES
DISPLACEMENT OF FRACTURES
APPROACH TO ORTHOPEDIC INJURY
Mechanism of Injury
Clinical Features
About Tenderness
Interesting Features about the Clinical Signs
INVESTIGATIONS IN ORTHOTRAUMA
Radiography
CT Scan and MRI
MANAGEMENT OF FRACTURES
Management of Simple Fractures
Conservative Methods
Management of Fractures by Closed Reduction
Fracture Management by Open Reduction (Operative Management)
OPEN FRACTURES
CLASSIFICATION (GUSTILLO AND ANDERSON'S) (Figs 3.6A to E)
APPROACH IN COMPOUND FRACTURES
Investigations
Considerations
Treatment Plan
OTHER FORMS OF FRACTURE IMMOBILIZATION
APPROACH TO A POLYTRAUMA CASE
DISLOCATIONS
Pathology
Types of Dislocation: Congenital or Acquired
Clinical Features
Investigations
Treatment
Complications
Chronic
Subluxation
4:
Complications of Fractures
INTRODUCTION
ACUTE RESPIRATORY DISTRESS SYNDROME (Syn: Fat embolism)
Etiology
Pathogenesis
Classification (Sevitt's)
Investigations
Management
VOLKMANN'S ISCHEMIA OR COMPARTMENTAL SYNDROMES
COMPARTMENTAL SYNDROME OF FOREARM
Definition
Incidence and Etiology
Pathology
Clinical Features
Investigations
Management
Methods to Record Intracompartmental Pressure
Volkmann's Ischemic Contracture (VIC)
Treatment Plan in Established VIC
Mild Type
Moderate Type
Severe Type
Chronic Compartmental Syndrome
NONUNION
Definition (FDA panel)
Classification
Hypervascular Nonunion
Types
Reasons
Reasons
Reasons
Avascular Nonunion
Types
Causes for Nonunion
Clinical Features
Investigations
Management
Principles
Role of Bone Grafting in Nonunion
Types
Role of Electrical Stimulation in Nonunion
Role of Ilizarov's Technique in Nonunion
AVASCULAR NECROSIS
Causes
Clinical Features
Investigations
Treatment
TRAUMATIC MYOSITIS OSSIFICANS
Definition
Causes
Pathology
CLASSIFICATION (BASED ON ITS LOCATION)
Clinical Features
Radiograph
Treatment
MALUNION
Causes
Classification
Types
Clinical Features
Radiograph
Treatment
OTHER IMPORTANT COMPLICATIONS OF FRACTURES
DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM
Introduction
Clinical Features
Investigations
Treatment
Complications
INJURY TO BLOOD VESSELS
Causes of Injury
Effects of Injury
Clinical Features
Investigations
Treatment
INJURY TO NERVES
Types
Incidence
Mechanism of Injury
Types of Nerve Injury
CRUSH SYNDROME
JOINT STIFFNESS
REFLEX SYMPATHETIC DYSTROPHY
OSTEOMYELITIS
IMPLANT FAILURE
POST-TRAUMATIC OSTEOARTHRITIS
GROWTH ALTERATIONS
SHORTENING
COMPLICATIONS PECULIAR TO OPEN FRACTURES
SHOCK
Clinical Features
Investigations
Treatment
GAS GANGRENE
Definition
Incidence
Types of Clinical Presentation
Investigations
Prevention
Treatment Measures
TETANUS
Definition
Pathogenesis
Clinical Presentation
Investigations
Treatment
Prevention
CRUSH SYNDROME
5:
Emergency Care of the Injured
FIRST AID
Definition
GOALS OF FIRST AID TREATMENT
INITIAL CARE OF THE INJURED
At the Scene of Accident
MODUS OPERANDI IN FIRST AID
AIRWAY
CARDIA
BLEEDING
EXAMINE THE VITAL STRUCTURES
Head Injuries
Chest Injuries
Abdominal Injuries
Pelvic Fractures
Injuries to the Genitourinary System
Spine Injuries
Fractures
MANAGEMENT AT THE HOSPITAL
6:
Fracture Treatment Methods: Then, Now and Future
HISTORY OF FRACTURE TREATMENT: THEN
THE PLASTER BANDAGES
THOMAS SPLINT
TRACTION
FUNCTIONAL BRACE
OPEN FRACTURES
EARLY FRACTURE SURGERY
EXTERNAL FIXATION
INTRAMEDULLARY FIXATION
AO GROUP
FRACTURE TREATMENT: NOW
GENERAL PRINCIPLES OF THE METHODS OF FRACTURE TREATMENT
SPLINTS
CONVENTIONAL PLASTER SPLINTS
ALL YOU WANTED TO KNOW ABOUT PLASTER OF PARIS SPLINT
History
Chemical Formula
POP Types
Its Various Forms
Stages of Plastering
Complications of POP
Unpleasant Facts About Cast Disease
FUNCTIONAL CAST BRACE
Introduction
IMPORTANT SPLINTS IN ORTHOPEDICS OTHER THAN POP
Thomas Splint
Uses of Thomas Splint
Böhler-Braun (BB) Splint
Indications
Problems of BB Splint
Care of the Splints
TRACTION IN ORTHOPEDICS
Uses of Traction
Methods of Traction
Skin Traction
Types of skin traction
Important Skin Tractions
Skeletal Traction
Know the Pins Used for Skeletal Traction
Know the Rules of Application
Know the Complications of Skeletal Traction
Types
OPERATIVE TREATMENT
IMPLANTS
General Principles
TYPES OF IMPLANTS
VARIETIES OF IMPLANTS
Screws
Machine Screws
ASIF Screws or AO Screws
Parts of a Screw
Methods of Providing Compression by Screws
Lag Effect
Cancellous Screws
PLATES
TYPES OF PLATES
Ordinary Plates
AO PLATES
METHODS OF PROVIDING COMPRESSION
Types
TYPES OF ASIF PLATES
Principles of ASIF Plate
DYNAMIC COMPRESSION PLATES (DCP)
INTRAMEDULLARY NAIL
OTHER IMPORTANT INTERNAL FIXATION METHODS
Circlage
Materials used as Circlage Wires
Transfixion
Indications
Staples
Suture Anchors
Indications
FIXATION TECHNIQUES BY NONCOMPRESSION METHODS
Internal Splints
Biologic Fixation
Composite Fixation
Hybrid Fixation
Bioabsorbable Fixation
EXTERNAL FIXATION
Definition
Highlights of External Fixation
Components of External Fixators
Types of Pins
Other Varieties
Types of Clamps
Types of External Fixators (Based on Frame Design)
Mode of Action
Biotechnical Principles of External Fixation
Complications
7:
Recent Advances in Fracture Treatment
ADVANCES IN THE EXISTING METHODS OF FRACTURE TREATMENT
IMPROVEMENTS IN PLASTER OF PARIS SPLINTS
What is New in Plasters?
Fiber Glass Plasters
Advantage over Conventional Plasters
Indications
FUNCTIONAL CAST BRACE
IMPROVEMENTS IN AO TECHNIQUE
IMPROVEMENTS IN INTRAMEDULLARY NAILS
INTERLOCKING NAILS (Figs 7.2A to C)
Advantages
Principles
Static Locking
Indications
Dynamic Locking
Indications
Achieving Dynamization
What is New in Plate Osteosynthesis?
IMPROVEMENTS IN EXTERNAL FIXATION
ILIZAROV'S TECHNIQUE
Principles of Ilizarov's Method
Law of Tension Force
Use of a Unique Ring Fixator
Corticotomy
About Ring Fixator
Stages
Benefits of Ring Fixator System
Indications
Complex Fractures
Compound Fractures
Nonunion
Limb Lengthening
Deformity Corrections
Other Important Indications
Complications
NEWER EXTERNAL FIXATORS
Umex™—Universal Mini External Fixator
Laser Treatment
ADVANCES IN HIP SURGERY
RECENT ADVANCES IN SPINE SURGERY
RECENT ADVANCES IN BONE GRAFTING METHOD
ADVANTAGES OVER THE CONVENTIONAL ABG
COMPUTERS IN ORTHOPEDICS
8:
Fracture Healing Methods
INTRODUCTION
METHODS OF FRACTURE HEALING
INDIRECT FRACTURE HEALING
Stage of Impact
Stage of Induction
Stage of Inflammation
Stage of Soft Callus
Stage of Hard Callus
Stage of Remodeling
PRIMARY BONE HEALING (DIRECT BONE HEALING, HEALING BY PRIMARY INTENTION)
DISTRACTION HISTOGENESIS
9:
Soft Tissue Injuries
INTRODUCTION
Mechanism of Injury
Direct Trauma
Indirect Trauma
Approach to a Patient with Soft Tissue Injury
The Patient's Story
Your Observation
Goal Setting
Execution of Your Plan
Treatment Goals of Soft Tissue Injury
Immediate Goals
The Distant Goals
Classification of Soft Tissue Injury
MUSCLE INJURY (STRAINS)
Definition
Reasons
Types
Pathophysiology
Severity of Strain
First Degree Strain (Mild ConTusion)
Clinical Features
Management
Second Degree Strain
Pathology
Symptoms
Third Degree Strain
Treatment in Grade II and III Strains
For first 24 hours
During the next 24 to 48 hours
Between 48 and 72 hours
After 72 hours
Grade Four Strain
Pathology
Clinical Features
Treatment
INJURIES TO THE JOINTS
Ligament Injury
Anatomy
Functions
Problems of Healing
Types of Sprain (Fig. 9.8)
Treatment
Treatment
Treatment
After Removal of the POP Cast
Injury to the Synovium
Relevant Anatomy
Functions
Causes
Types
Clinical Features in Synovitis
Treatment
Methods
Chronic Synovitis
Treatment
Injury to the Bursa
Functions
Types
Causes
Common Sites
Clinical Features
Treatment
Tenosynovitis
Types
Treatment
Tenovaginitis
Treatment
SPECIAL TYPES OF MUSCLE INJURIES
Intramuscular Hematoma
Intermuscular Hematoma
Treatment
Methods
IMPORTANT SOFT TISSUE PROBLEMS
Upper Limb
Shoulder
Elbow
Wrist
Lower Limbs
Hip and Pelvis
Knee and Leg
Ankle and Foot
Tendons and Nerves
10:
Fractures in Special Situations
FRACTURES IN CHILDREN
Incidence
Etiology
Types of Fractures
Greenstick Fractures
Buckle Fracture (Torus fracture)
Plastic Bowing
Patterns of Fractures
Clinical Features
Investigations
Treatment
Problems of Treatment
Complications
EPIPHYSEAL INJURIES
Definition
Incidence
Causes
Types
Clinical Features
Investigations
Treatment Options
PATHOLOGICAL FRACTURES
Clinical Features
Investigations
Treatment
FATIGUE OR STRESS FRACTURES
Definition
Clinical Features
Radiograph
Bone Scan
MRI and CT Scan
Treatment
SECTION 2: REGIONAL TRAUMATOLOGY
11:
Injuries Around the Shoulder
INTRODUCTION
FRACTURE CLAVICLE
Functions of Clavicle
Mechanism of Injury
Direct
Direct Trauma
Sites of Fracture
Classification of Fracture Clavicle (Allman's)
Clinical Features
Radiographs
Principles of Treatment
Conservative Methods
Treatment Plan
Methods of Internal Fixation
Indications
More Specific Indications for Open Reduction and Internal Fixation of Fracture Clavicle
Complications of Fracture Clavicle
Problems Posed by Malunion Clavicle
INJURIES OF THE ACROMIOCLAVICULAR JOINT
Mechanism of Injury
Clinical Features
Classification (Sage and Salvatore's)
Radiographs
Management
Complications
INJURIES OF STERNOCLAVICULAR JOINT
Mechanism of Injury
Causes
Classifications (Figs 11.11A and B)
Clinical Features
Radiographs
Management
PROXIMAL HUMERAL FRACTURES
Mechanism
Classification
Role of Muscle Forces
Clinical Features
Investigations
Management
Nonoperative Treatment
Operative Treatment
Complications
DISLOCATION OF SHOULDER
ANTERIOR DISLOCATION OF SHOULDER
Mechanism of Injury
Varieties
Clinical Features
Radiographs
Treatment
After Treatment
RECURRENT ANTERIOR DISLOCATION OF THE SHOULDER (RDS)
Causes
Mechanism of Dislocation
Pathological Anatomy
Triad of Essential Lesion
Clinical Features
Clinical Tests
Investigations
Treatment
Inferior Dislocation (Luxatio Erecta)
FRACTURE OF THE SCAPULA
Incidence
Functions
Mechanism of Injury
Classification (Thompson's)
Clinical Features
Radiographs
Treatment
12:
Injuries of the Arm
FRACTURE SHAFT HUMERUS
Peculiarities of Humeral Shaft Fractures
Anatomic Considerations
Mechanism of Injury
Clinical Features
Radiographs
Treatment Methods
Conservative Methods
Operative Treatment
Methods
Complications
DISTAL HUMERUS FRACTURES
REGIONAL ANATOMY
Incidence
Mechanism of Injury
Clinical Features
Radiographs
Classification (OTA)
Three Types of C-variety
Mehne and Matta A-F Classification
Treatment
Nonoperative Treatment
Methods
Operative Treatment
Advantages
13:
Injuries Around the Elbow
BRIEF ANATOMY
POSTERIOR ELBOW GEOMETRY
Triangle Sign
Carrying Angle
INJURIES AROUND THE ELBOW
Classification of Fractures of Distal Humerus in Children
SUPRACONDYLAR FRACTURE
Mechanism of Injury
Classification
Gartland's Classification (In Children)
Clinical Features
Radiographs
Management
Complications
Complications Causing Functional Impairment
COMPLICATIONS THAT PRODUCE COSMETIC ABNORMALITIES
CUBITUS VARUS (GUNSTOCK ELBOW)
Pathomechanics
Clinical Tests
Radiographs
Treatment
Osteotomy Methods
Mechanism of Injury
Treatment
Complications
DISLOCATION OF ELBOW JOINT
Mechanism of Injury
Classification (Stimson)
Clinical Features
Radiographs
Treatment
Complications
UNREDUCED DISLOCATION OF THE ELBOW
Clinical Features
Treatment Methods
Other Important Complications
RADIAL HEAD FRACTURE
Mechanism of Injury
Mason's Classification
Clinical Features
Investigation
Treatment
Complications
FRACTURE OF THE OLECRANON
Mechanism of Injury
Colton's Classification (Figs 13.36A to C) (Modified Schtazker)
Clinical Features
Radiographs
Treatment
Conservative
Surgery
Complications
CORONOID FRACTURES
Mechanism of Injury
Classification of Regan and Morrey (Fig. 13.39A)
Clinical Features
Radiograph
Treatment
CAPITELLUM FRACTURES
Mechanism of Injury
Classification
Clinical Features
Radiographs
Treatment
PHYSEAL FRACTURES
LATERAL CONDYLE OF HUMERUS (JUPITER FRACTURE)
Classification (2 ways)
Anatomical Location (Figs 13.42A and B)
Stages of Displacement
Clinical Features
Radiographs
Treatment
Stages I and II
Complications
MEDIAL CONDYLE OF HUMERUS
Classification (2 ways)
Anatomical Location
Stages of Displacement (Kilfoyle's)
Clinical Features
Radiograph
Treatment
Complications
SIDE SWIPE INJURIES (SYN: TRAFFIC ELBOW, CAR WINDOW ELBOW)
Mechanism of Injury
Shorbe's Classification
Investigations
Methods of Treatment
14:
Injuries of the Forearm
INTRODUCTION
FRACTURE BOTH BONES OF THE FOREARM
Mechanism of Injury
Clinical Features
Radiographs
Treatment
Choices of IM Nails
Complications of Fracture Both Bones of Forearm
ISOLATED DISTAL ULNAR FRACTURE (ALSO CALLED NIGHTSTICK FRACTURE)
Clinical Features
Radiograph
Treatment
MONTEGGIA'S FRACTURE
Mechanism of Injury
Classification
Clinical Features
Radiographs
Treatment
Complications
DISTAL RADIAL FRACTURE
Treatment Plan in a Nutshell
WHAT IS NEW?
COMMINUTED DISTAL RADIAL FRACTURE
COLLES FRACTURE
DISTAL SHAFT RADIUS FRACTURE
GALEAZZI'S FRACTURE
Mechanism of Injury
Clinical Features
Radiograph
Treatment
Complications
ESSEX-LOPRESTI FRACTURE
Mechanism of Injury
Clinical Features
Radiograph
Treatment
RADIAL STYLOID FRACTURE (CHAUFFEUR'S FRACTURE)
Mechanism
Clinical Features
Radiographs
Treatment
SMITH'S FRACTURE
Mechanism of Injury
Clinical Features
Radiograph
Treatment
Complications
BARTON'S FRACTURE
DORSAL BARTON
Mechanism
Clinical Features
Radiograph
Treatment
Conservative
Surgery
VOLAR BARTON (PALMAR RIM DISLOCATION)
Mechanism
Clinical Features
Radiograph
Treatment
Conservative
Surgery
15:
Injuries to the Wrist
BRIEF ANATOMY
THE WRIST JOINT SPEAKS
Carpal Injuries
General Principles
Incidences
Relative Incidences
Mechanism of Injury
Clinical Features
Investigations
Treatment
Principles
Methods
SCAPHOID FRACTURE
Interesting Features
Etiology
Classification
Cooney, Dobyn's, Linscheid's Classification
Anatomical Classification (Fig. 15.2B)
Clinical Features
Investigations
Principles of Treatment
Conservative Methods
Surgical Management
Surgical Methods
Complications
INJURIES OF THE CARPOMETACARPAL JOINTS OF THE THUMB
BENNETT'S FRACTURE
Mechanism of Injury
Characteristics of this Fracture
Displacing Forces in the Bennett's Fracture
Clinical Features
Radiograph
Treatment
ROLANDO'S FRACTURE
Clinical Features
Radiograph
Treatment Methods
Nonoperative Methods
Closed Reduction and Internal Fixation
Open Reduction and Internal Fixation
External Fixations
RADIOCARPAL INJURIES
ANTERIOR DISLOCATION OF LUNATE
Mechanism of Injury
Clinical Features
Radiograph
Treatment
Problems
Methods
RADIOCARPAL DISLOCATION
VOLAR TRANS-SCAPHOID PERILUNAR DISLOCATION
Mechanism
Clinical Features
Investigations
Treatment
DORSAL TRANS-SCAPHOID PERILUNAR DISLOCATION
Clinical Features
Investigations
Treatment
LUNATE FRACTURES
Clinical Presentation
Investigations
Treatment
Complications
TRIQUETRAL FRACTURES
Mechanism of Injury
Types
Clinical Features
Investigations
Treatment
Body Fractures
Chip or Avulsion Fractures
PISIFORM FRACTURES
Mechanism of Injury
Clinical Features
Investigations
Treatment
HAMATE FRACTURES
Mechanism of Injury
Types
Clinical Features
Investigations
Treatment
CAPITATE FRACTURES
Mechanism of Injury
Types
Clinical Features
Investigation
Treatment
Conservative
TRAPEZOID FRACTURE
Mechanism of Injury
Clinical Features
Investigations
Treatment
TRAPEZIUM FRACTURE
Mechanism of Injury
Classifications
Clinical Features
Investigations
Treatment
16:
Hand Injuries
GENERAL PRINCIPLES
Incidence
Treatment
Indications for Open Reduction in Hand Injuries
Steps of Application of the Universal Hand Splint—The Burkhalter Splint
INJURIES TO THE PHALANX
DISTAL PHALANX FRACTURES
Salient Features
Mechanism of Injury
Classifications
Clinical Features
Radiograph
Treatment
MALLET FINGER (Syn: Baseball finger, Drop finger, Cricket finger)
Tendon Origin
Mechanism of Injury
Clinical Features
Several Types
Radiographs
Treatment
Mallet Finger of Bony Origin
DISTAL INTERPHALANGEAL JOINT INJURIES
Salient Features
FRACTURES OF THE MIDDLE PHALANX
Clinical Features
Radiographs
Management
Volar Base Fractures
DISLOCATIONS OF THE IP JOINT
Salient Features
Clinical Tests
Types
Clinical Features
Radiographs
Treatment
Nonoperative Management
Operative Management
PROXIMAL PHALANX FRACTURES
Salient Features
Classifications
Clinical Features
Radiographs
Treatment Methods
Nonoperative Treatment
Closed Reduction and Percutaneous Fixation
Closed Reduction and Internal Fixation (IF)
Open Reduction and Internal Fixation
Complications of Phalangeal Fractures
METACARPOPHALANGEAL JOINT DISLOCATIONS
Salient Features
Clinical Features
Radiographs
Treatment
Nonoperative Treatment
Operative Treatment
KAPLAN'S LESION
Clinical Features
Radiographs
Diagnostic Clues
Treatment
DISLOCATION OF THE THUMB METACARPOPHALANGEAL JOINT (GAMEKEEPER'S THUMB, SKIER'S THUMB)
INJURIES TO METACARPAL BONES
METACARPAL FRACTURE OF FINGERS
Salient Features
Clinical Features
Radiographs
Treatment Methods
Closed Reduction and Internal Fixation
Open Reduction and Internal Fixation
External Fixations
Complications
METACARPAL FRACTURE OF THE LITTLE FINGER (BOXER'S FRACTURE)
Mechanism of Injury
Clinical Features
Radiographs
Treatment
METACARPAL HEAD FRACTURES
METACARPAL FRACTURE OF THE THUMB
Salient Features
TENDON INJURIES
FLEXOR TENDON INJURIES
Tests to Diagnose Flexor Tendon Injuries
Test for Profundus
Test for Superficialis
Flexor Zones of the Hand
Importance of the Zones
Methods of Treatment
EXTENSOR TENDON INJURIES
Test
Treatment
SOFT TISSUE INJURIES OF THE HAND
CRUSH INJURIES OF THE HAND AND AMPUTATIONS
Principles of Amputation of Fingers
Treatment Protocol in Crush Injuries
Postoperative Considerations
17:
Dislocations and Fracture Dislocations of the Hip Joint
INTRODUCTION
CLINICAL SIGNIFICANCE OF VASCULAR ANATOMY
Mechanism of Injury
Classification
Overall Classification of the Hip Dislocations (Stewart and Milfort, based on the hip stability and femoral head condition, both anterior and posterior)
Comprehensive Classification (Both Anterior and Posterior) (Figs 17.3A to E)
POSTERIOR HIP DISLOCATIONS
THOMPSON AND EPSEIN CLASSIFICATION (Figs 17.4A to E)
PIPKIN TYPES (DISLOCATION OF THE HIP WITH FRACTURES OF THE FEMORAL HEAD) (Fig. 17.5)
Clinical Features
Investigations
Before Reduction
After Reduction
Management
Goal of Treatment
Type I Dislocation
Methods of Closed Reduction
A. Allis Method (Fig. 17.9)
B. Bigelow's Method (Fig. 17.10)
C. Classical Watson-Jones Method (Fig. 17.11)
D. Stimson's Gravity Method (Fig. 17.12)
Postreduction Protocol
Indications for Open Reduction
Technique of Open Reduction
Postoperative Treatment
Type V Posterior Fracture Dislocations
Mechanism of Injury
Classification
Management
Methods of Treatment
Complications
ANTERIOR DISLOCATION OF THE HIP
Mechanism of Injury
Classification
Epstein’ Classification
Clinical Features
Investigations
Treatment
Methods: ABCDE's Method of Reduction
Postreduction Protocol
Complications
Delayed Complications
AVN
CENTRAL DISLOCATION OF HIP
Mechanism of Injury
Classification: Judet's Types
Clinical Features
Investigations
Complications
18:
Fracture Femur
FRACTURE NECK OF FEMUR
PROXIMAL FEMUR FRACTURES
SUBTROCHANTERIC FRACTURE
Mechanism of Injury
Classification
Fielding's Classification
Seinsheimer's Classification
Russel Taylor Classification
Clinical Features
Radiographs
Treatment
Complications
Salient Features About Femur
FRACTURE SHAFT FEMUR
Mechanism of Injury
Classification of Femoral Fractures (Figs 18.10A to E)
Clinical Features
Radiographs
Management
General Principles
Treatment Methods (Flow chart 18.1)
Conservative Methods
Surgery
Technique of Intramedullary Nailing (Küntscher's Nail)
Interlocking Nailing Technique (Gold Standard)
Complications
FRACTURE DISTAL FEMUR
SUPRACONDYLAR FRACTURE OF FEMUR
Mechanism of Injury
Classification
Neer's Classification (Figs 18.24A to D)
Müller's AO Classification
OTA Classification of Supracondylar Fractures of Femur
Clinical Features
Radiographs
Treatment
Complications
IPSILATERAL FRACTURES OF FEMORAL SHAFT AND NECK
INTRODUCTION
EPIDEMIOLOGY
Incidence
Causes
Other Vital Statistics
Mechanism of Injury
Clinical Features
Investigations
Other Special Investigations
Methods of Treatment
Choice of Fixation
Methods of Fixation
Complications
Those Related to Fracture Neck of Femur
CONCLUSION
19:
Injuries of the Knee
BRIEF ANATOMY
KNEE LIGAMENT INJURIES
GENERAL PRINCIPLES
Etiology
Mechanism of Injury (Palmar)
Goals of Treatment
COLLATERAL LIGAMENT INJURY
Mechanism of Injury
Types
Classification (American Medical Association)
Clinical Features
Clinical Tests
Investigations
Treatment
Old Cases
CRUCIATE LIGAMENT INJURIES
ANTERIOR CRUCIATE LIGAMENT (ACL) TEAR
Clinical Features
Clinical Examination
Investigations in ACL Tear
Treatment of ACL Tear
Conservative
Surgical
POSTERIOR CRUCIATE LIGAMENT (PCL) TEAR
Clinical Features
COMBINED KNEE LIGAMENT INJURIES
SEMILUNAR CARTILAGE INJURIES
Anatomy
Functions of the Menisci
MEDIAL MENISCUS INJURY
1Smillie's Classification
Mechanism of Injury
Clinical Features
Investigations
Differential Diagnosis
Treatment
Measures
Surgery
Methods
FRACTURE OF PATELLA
Mechanism of Injury
Classification (Figs 19.21A to D)
Clinical Features
Investigations
Management
Undisplaced Fracture
Displaced Fracture
Surgical Methods
Anterior Tension Band Wiring (ATBW)
Cannulated Screws Fixation
Complications
Disadvantages of Patellectomy
INJURY TO THE EXTENSOR APPARATUS OF KNEE
QUADRICEPS STRAIN
Causes
Sites
Symptoms
Treatment
Treatment Methods
ACUTE DISLOCATION OF PATELLA
Treatment
ACUTE DISLOCATION OF KNEE
Treatment
20:
Fracture of Tibia and Fibula
PROXIMAL TIBIAL FRACTUREs
Incidence
Mechanism of Injury
Causes
Types
Classification
Other Classifications
Clinical Features
Investigations
Management
Aim
Complications
FRACTURES OF TIBIA AND FIBULA
Mechanism of Injury
Classification
Clinical Features
Radiographs
Methods of Treatment
Long Leg Plaster Casts
Indications
Sarmiento's Total Contact below Knee Cast
Advantages
Functional Braces
Pins above and below the Fracture
Indications
Surgical Treatment
Absolute Indications
Advantages
Internal Fixation Methods (Flow chart 20.1)
Complications of Tibial Fractures
DISTAL TIBIAL FRACTURES
PILON FRACTURES (Syn: Tibial plafond fractures)
Incidence
Classifications
Clinical Features
Findings
Investigations
Treatment
OPEN TIBIAL FRACTURES
21:
Injuries of the Ankle
BRIEF ANATOMY
ANKLE INJURIES
Mechanism of Injury
Classification
Lauge Hansen's Classification
Denis Weber Classification
AO Classification of Malleolar Fractures
Clinical Features
Investigations
Radiographic Parameters of the Normal Ankle
Treatment
Goals
Complications of Ankle Fracture
ANKLE SPRAINS
TRIMALLEOLAR FRACTURE (COTTON FRACTURE)
LATERAL LIGAMENT SPRAIN
Clinical Features
Radiograph of the Ankle
Grading of Ankle Sprains
Treatment
MEDIAL LIGAMENT SPRAIN
TENDO-ACHILLES INJURY
Mechanism of Injury
Acute Rupture
Chronic Rupture
Clinical Features
Signs
Clinical Tests
X-ray of the Heel
Treatment
Conservative
Surgery
22:
Injuries of the Foot
FOREFOOT INJURIES
CLASSIFICATION
TREATMENT GOALS IN FOREFOOT FRACTURES
Orthopedic Goals
PHALANGEAL FRACTURES
Salient Features
Mechanism of Injury
Clinical Features
Investigation
Classification (OTA)
Treatment
Nonoperative Treatment
Operative Treatment
INTERPHALANGEAL JOINT DISLOCATIONS (IJD)
Salient Features
Clinical Features
Investigation
Treatment
METATARSOPHALANGEAL JOINT INJURIES
First MTP Joint
Salient Features
Mechanism of Injury
Clinical Features
Investigation
Classification
Treatment
INJURIES TO THE OTHER MTP JOINTS
SESAMOID BONE INJURIES
Functions of Sesamoid Bones
Mechanism of Injury
Clinical Features
Investigations
Treatment
METATARSAL FRACTURES
Mechanism of Injury
Clinical Features
Radiograph
Classification (OTA)
Treatment
FIFTH METATARSAL INJURIES
Mechanism of Injury
Classification
Treatment
JONES FRACTURE
Mechanism of Injury
Clinical Features
Radiology
Treatment
MARCH FRACTURE (INSUFFICIENCY FRACTURE)
MIDFOOT INJURIES
Mechanism of Injury
Treatment Goals
Orthopedic Goal
NAVICULAR BONE FRACTURES
Mechanism of Injury
OTA Classification
Clinical Features
Investigations
Treatment
Complications
CUBOID FRACTURES
Mechanism of Injury
Clinical Features
Investigations
Classification (OTA)
Treatment
CUNEIFORM INJURIES
Clinical Features
Investigations
Classification (OTA)
Treatment
TARSOMETATARSAL INJURIES (LISFRANC INJURIES)
Mechanism of Injury
Clinical Features
Investigations
CLASSIFICATION (OTA) (Figs 22.13A to C)
Treatment
HINDFOOT INJURIES
FRACTURE CALCANEUM
Functions
Structure
Vital Angles
CLASSIFICATION
Essex-Lopresti's Classification
Classification Based on CT Scan Findings (Intra-articular) (Crossby-Fitzgibban's Classification)
EXTRA-ARTICULAR FRACTURES
Mechanism of Injury
Radiography (Fig. 22.19B)
Classification of Extra-articular Fractures
Treatment
Extra-articular Fractures
INTRA-ARTICULAR FRACTURES
Mechanism of Injury
Clinical Features
Clinical Signs
Radiography
Treatment
Conservative
Omoto Technique of Calcaneal Fracture Reduction (Fig. 22.24)
Common Steps of Reduction
Surgery
Complications
FRACTURE TALUS
Blood Supply of Talus
FRACTURE NECK TALUS
Mechanism of Injury
Classification (Hawkin's) (Fig. 22.28)
Clinical Features
Radiography
Treatment
Complications
FRACTURES OF BODY OF TALUS
Types
23:
Pelvic Injuries, Rib and Coccyx Injuries
BRIEF ANATOMY
FRACTURE PELVIS
Stability of the Pelvis
Stable Pelvic Fracture
Unstable Pelvic Fracture
History
Mechanism of Injury
Classification
Fractures not Affecting the Integrity of the Pelvic Ring
Fractures Affecting the Integrity of the Pelvic Ring
Key and Conwell's Classification
Fracture of Individual Bones without a Break in the Pelvic Ring
Single Break in the Pelvic Ring
Double Breaks in the Pelvic Ring
Acetabulum Fractures
Tile's Classification
Clinical Features
Symptoms
Clinical Signs
Clinical Tests
Investigations
Radiography
CT Scan
Management
Treatment Methods
Complications
Hemorrhage
Injuries of Lower Urinary Tract
Other Injuries
Other Complications
INJURY TO THE COCCYX
Mechanism of Injury
Clinical Features
Investigations
Treatment
Conservative Measures
Physiotherapy Management
Injection Therapy
Surgical Excision of the Coccyx
RIB FRACTURES
Clinical features
Radiology
Principles of Treatment
Conservative Measures
24:
Injuries of the Spine
BRIEF ANATOMY
When do we call spine as stable?
Incidence of Spine Injuries
INJURIES OF THE CERVICAL SPINE
Causes
Mechanism of Injury (Figs 24.7A to D)
WHIPLASH INJURY (SYN: Acceleration injury, cervical sprain syndrome, soft tissue neck injury)
Definition
Incidence
Clinical Features
Symptoms
Signs
Investigations
Treatment
Allen's Classification of Cervical Spine Fractures (Figs 24.8A to D)
Clinical Features
Concussion
Nerve Root Involvement
Vital Steps
Other Examinations
Investigations
Treatment Methods
At the Accident Site
At the Hospital
Indications
Surgical Treatment
Methods
INDIVIDUAL CERVICAL FRACTURE OF INTEREST
Burst Fracture of C1
Treatment
Rotary Subluxation of C1 or C2
Odontoid Process Fracture
Anderson and D'olonzo's Classification
Hangman's Fracture
THORACIC AND LUMBOSACRAL SPINE INJURIES
Mechanism of Injury
Mc Afee's Classification—3-Column Classification (Figs 24.23A to D)
Wedge Compression
Stable Burst Fractures
Unstable Burst Fractures
Chance Fracture (Seatbelt injury)
Flexion Distraction Injury
Translational Injuries
Modified Magerl Classification (AO/ASIF)
Clinical Features
Investigations
Management
Fixation Choices
SPINAL CORD INJURY
Incidence
Pathology
Clinical Classification of Neurological Damage
Clinical Assessment
Investigations
Treatment
Paralyzed Bladder
UMN Type (automatic bladder)
LMN Type (autonomous bladder)
Bedsore Management
Preventing Bedsores (Figs 24.29 and 24.30)
Managing Bedsores
Bowel Program
Advantages
CAUDA EQUINA SYNDROME
Causes
Clinical Features
Symptoms
Investigations
Treatment
Prognosis in Spinal Cord Injuries
25:
Peripheral Nerve Injuries
BRIEF ANATOMY
MICROSCOPIC ANATOMY
GENERAL PRINCIPLES OF NERVE INJURY
NERVE DEGENERATION
NERVE REGENERATION
CLASSIFICATION OF NERVE INJURIES
Seddon's Classification (1943)
Sunderland's Classification
Etiology
General Causes
Local Causes
Types
Clinical Diagnosis
Diagnostic Tests
Electromyography
Utility of Strength Duration Curve (SDC)
Nerve Conduction Studies
Tinel's Sign
Sweat Test (Starch Test)
Skin Resistance Test
Electrical Stimulation
Management
General Principles
Conservative Management
Operative Management
Types of Nerve Repair
Techniques
ULNAR NERVE INJURY
Causes of Ulnar Nerve Injury
General Causes
Local Causes
CLAW HAND
Types and Causes
Pathomechanics
Clinical Features
Clinical Tests
For Ulnar Nerve Injury
Treatment of Ulnar Nerve Injury
For Claw Hand Deformity
Methods of Stabilization of MP Joints
Choice of Surgery
Modified 2S Bunnel's Operation
Riordan's Operation
Brand's Operation
Fowler's Operation
Tardy Ulnar Nerve Palsy
Entrapment Neuropathy
RADIAL NERVE INJURY
Causes for Radial Nerve Injury
General
Local
Between Spiral Groove and Lateral Epicondyle
Clinical Features
Investigations
Treatment
Treatment of Late Cases (> 1 year)
INJURY TO SCIATIC NERVE
FOOT-DROP
Causes of Foot-drop
General
Local
Clinical Features
Treatment of Early Foot-drop
Choice of Surgery
MERALGIA PARESTHETICA
Types
Clinical Features
Diagnostic Test
Treatment
Conservative
Operative
BRACHIAL PLEXUS INJURIES
Causes
TYPES OF LESIONS
Supraclavicular Lesion
Pre-ganglionic Lesion
Postganglionic Lesions
Clinical Assessment of Brachial Plexus Injury
Investigations
Treatment
During the initial stages
During the Later Stages
Surgical Measures
ERB'S PALSY
Effects of the Injury
Management
Splinting
Measures to Prevent Contractures
Electrical
Surgery
KLUMPKE'S PARALYSIS
AXILLARY NERVE INJURY
Relevant Anatomy
Clinical Features
Treatment
INJURY TO THE LONG THORACIC NERVE (WINGING OF THE SCAPULA)
Highlights
Causes
Relevant Clinical Findings
Treatment
SECTION 3: NONTRAUMATIC ORTHOPEDIC DISORDERS
26:
Approach to Orthopedic Disorders
HISTORY
Certain Points of Importance in the History
EXAMINATION
STEP I
Examination of Gait
STEP II
General Physical Examination
STEP III
Clinical Examination
Symptoms
Signs
INVESTIGATIONS
27:
Deformities and their Management
DEFINITION
CLASSIFICATION
DEFORMITIES SINCE BIRTH (CONGENITAL)
ACQUIRED DEFORMITIES
BONE CAUSES
Growth Disturbances
Bone Disorders
Fractures
JOINT CAUSES
Dislocation or Subluxation
Muscle Imbalance
Tethering of Muscles and Tendons
Arthritis
Postural
Idiopathic
SOFT TISSUE CAUSES
Treatment Options
Conservative Measures
Surgical Measures
28:
Treatment of Orthopedic Disorders
OPERATIVE TREATMENT METHODS
Osteotomy (Figs 28.10A and B)
Arthrodesis
Methods
Intra-articular Arthrodesis
Extra-articular Arthrodesis
Combined Arthrodesis
Arthroplasty
Types
Bone Grafting Operations
Types
Role of a Bone Graft
Tendon Surgeries
Indications
29:
Regional Conditions of the Neck
TORTICOLLIS (WRYNECK)
Causes
Clinical Features
Management
Conservative
Surgical
THORACIC OUTLET SYNDROME
Sites of Compression
Rare Cause
Contributing Factors
Dynamic Factors
Static Factors
Clinical Features
Vascular Problems
Neurogenic Problems
Tests
Intermittent Claudication Test
Allen's Test
Costoclavicular Maneuvers
Provocative Tests
Complications
Investigations
Treatment
Methods
CERVICAL RIB
Developmental Factors
Types
Pathological Anatomy
Clinical Features
Radiograph
Treatment
CERVICAL DISK SYNDROMES
30:
Regional Conditions of the Upper Limb
REGIONAL CONDITIONS OF THE SHOULDER
FROZEN SHOULDER (Syn: Periarthritis, Adhesive Capsulitis)
History
Causes
Pathology
Clinical Features
Clinical Stages
Radiology
Treatment
ROTATOR CUFF LESIONS
Role of Rotator Cuffs
Impingement Syndrome
SUPRASPINATUS TENDINITIS
ROTATOR CUFF TEARS
About Rotator Cuff Tears
Classification of Rotator Cuff Tears
Clinical Tests
Clinical Features
Investigations to Diagnose Rotator Cuff Lesions
Management
Conservative Treatment
Surgical Treatment
Methods
Differential Diagnosis of Impingement Syndrome
DELTOID CONTRACTURE
Causes
Clinical Presentations
Treatment
Prevention
Curative
Rehabilitation
REGIONAL CONDITIONS OF THE ELBOW
TENNIS ELBOW
History
Definition
Lateral Tennis Elbow
Causes
Pathophysiology and Related Symptoms
Etiology
Clinical Features
Clinical Tests
Radiograph for Tennis Elbow
Treatment
Conservative Management
Mill's Maneuver
Surgical Management
Indications
Surgical Methods
GOLFER'S ELBOW (Syn: Epitrochleitis, Medial tennis elbow)
Definition
Treatment
OLECRANON BURSITIS (STUDENT'S ELBOW) (Sign: Miner's elbow or Draughtsman elbow)
Clinical Features
Investigations
Treatment
REGIONAL CONDITIONS OF THE WRIST AND HAND
de QUERVAIN'S DISEASE
Etiology
Clinical Features
Treatment
Conservative Methods
Surgery
TRIGGER FINGERS AND THUMB
Treatment of Trigger Finger
GANGLIA (GANGLION CYST)
Definition
Clinical Features
Investigations
Treatment
DUPUYTREN'S CONTRACTURE
Causes
Pathogenesis
Clinical Features
Treatment
Surgical Methods
CARPAL TUNNEL SYNDROME
Anatomy
Contents
Causes
General
Local
Clinical Stages or Features (Figs 30.31A and B)
Clinical Tests
Other Tests
Treatment
COMPOUND PALMAR GANGLION
Clinical Features
Investigations
Treatment
BIBLIOGRAPHY
31:
Regional Conditions of the Spine
SCOLIOSIS
Varieties
Clinical Features
Radiology
Compensation
Treatment
SPONDYLOLISTHESIS (SPONDYLOS—SPINE; OLISTHEIN—TO SLIP)
Definition
Classification (Wiltse, Macnab and Newman)
Types
Clinical Features
Investigations
Treatment
Conservative Treatment
Surgical Management
KYPHOSIS
Definition
Causes
Defective Growth or Poor Postural Habits
Types
Knuckle
Angular
Round
Methods of Examination
Investigations
Treatment
LUMBAR CANAL STENOSIS
32:
Regional Conditions of the Lower Limb
REGIONAL CONDITIONS OF THE HIP
COXA VARA
Definition
Classification
Congenital
Acquired
Disadvantages of Coxa Vara
Clinical Features
Radiography
Treatment
LEGG-CALVÉ-PERTHES DISEASE (Syn: Osteochondritis deformans juvenilis and coxa plana)
Definition
Predisposing Factors
Etiology
Changes in
Clinical Features
Symptoms
Signs
Clinical Tests
Radiographic Characteristics
Classification
Salter-Thompson's Classification
Assessment
Management
Treatment Methods
Late Surgical Management for Deformity
SLIPPED CAPITAL FEMORAL EPIPHYSIS (Syn: Epiphyseal coxa vara; Adolescent coxa vara)
Etiology
Predisposing Factors
Clinical Features and Investigations
Stages
Radiographic Changes
Classification of Slipping
Complications
REGIONAL DISORDERS OF THE KNEE
GENU VALGUM (KNOCK-KNEE)
Definition
Incidence
Types
Clinical Features
Assessment of Genu Valgum Deformity
Clinical Assessment
Radiographs
Treatment of Genu Valgum
Severe cases
GENU VARUM (BOW LEGS)
Definition
Types and Causes
Unilateral
Bilateral
Clinical Measurements of the Deformity
Child
Adults
Clinical Features
Radiograph
Treatment
GENU RECURVATUM
Definition
Causes
Quadriceps Contracture
Features
Clinical Tests to Measure Genu Recurvatum
Features
Radiograph
Treatment
Methods
BURSAE AROUND THE KNEE
POPLITEAL CYST (BAKER'S CYST)
How is it Produced?
Clinical Features
Investigations
Treatment
RECURRENT DISLOCATION OF PATELLA
Clinical Features
Radiographs
Treatment
A Nonsurgical or Conservative Measure
Surgical Methods
Treatment of Habitual Dislocation
CHONDROMALACIA PATELLA
Factors
Clinical Features
Investigations
Differential Diagnosis
Treatment
LOOSE BODIES IN THE KNEE (JOINT MICE)
Clinical Features
Investigations
Remedy
LESSER-KNOWN BUT IMPORTANT REGIONAL CONDITIONS OF THE KNEE
JUMPER'S KNEE
Clinical Features
Treatment
OSGOOD-SCHLATTER DISEASE
Clinical Features
Treatment
SINDING-LARSEN-JOHANSSON SYNDROME
ILIO-TIBIAL BAND (ITB) SYNDROME
PLICA SYNDROME
OSTEOCHONDRITIS DISSECANS
Causes
Clinical Features
Investigations
Treatment
HOFFA'S SYNDROME (Syn: Fat pad syndrome)
Clinical Features
Treatment
INFANTILE QUADRICEPS CONTRACTURE
Introduction
Causes
Congenital
Acquired
Post-Injection Quadriceps Contractures
Historical Facts of Interest
Important Past Clinical History
Sites of Contractures
Pathomechanics
Clinical Features
Clinical Signs
From the sides
Clinical Tests
In the Supine Position
In the Prone Position
Radiographs
Treatment
Conservative Methods
Surgery
Surgical Methods
Procedure
Postoperative Protocol
Distal Release: Thompson's Quadriceps Plasty
Disadvantages
Postoperative Rehabilitation
Other Procedures
Prognostic Factors
Results
Grading
REGIONAL DISORDERS OF THE FOOT
ARCHES OF THE FOOT
Longitudinal Arch
Transverse Arches of the Foot
PES CAVUS
Theories of Pathogenesis
Pathologic Anatomy
Classification
Clinical Features
Radiographs
AP view
Lateral View
Treatment
Early Stages
Late Stages
PES PLANUS
Definition
Types
Clinical Features
Radiograph
Treatment Plan
Surgical Correction
Principles
Techniques
FOOT PAIN
METATARSALGIA
Definition
Types
Clinical Features
Treatment
MORTON'S NEUROMA
Clinical Features
Tests
Treatment
Nonoperative Treatment
Surgical Treatment
PAINFUL HEEL
TRAUMATIC DISTURBANCES
Trauma around the Region of Tendo-Achilles
Hageland's Disease or Winter Heel
Bursa Enlargements
Treatment
Partial Tears of Tendo-Achilles
Treatment
DEVELOPMENTAL AND PATHOLOGICAL DISTURBANCES OF THE HEEL
PLANTAR FASCITIS (SUBCALCANEAL PAIN)
Clinical Features
Clinical Tests
Radiographs
Treatment
Rehabilitation Methods
CALCANEAL SPURS
Causes
Clinical Features
Radiographs
Treatment
Methods
FAT PAD INSUFFICIENCY (ATROPHY OF FAT PAD)
Salient Features
Clinical Features
Radiograph
Treatment
CALCANEAL STRESS FRACTURE
Traumatic Subtalar
EPIPHYSITIS OF THE CALCANEUM (5SEVER'S Disease)
Treatment
FIBROMATOSIS OF THE PLANTAR FASCIA
LESSER-KNOWN BUT IMPORTANT FOOT CONDITIONS
PLANTAR FIBROMATOSIS (LEDERHAM SYNDROME)
Definition
Presentation
Treatment
PUMP-BUMP
Salient Features
DANCER TENDINITIS
IMPORTANT BUT LESSER KNOWN CONDITIONS OF THE FOREFOOT
HALLUX VALGUS
Secondary Problems
Causes
Clinical Features
Radiographs
Treatment
Mild Cases
Severe Cases
Physiotherapy Measures after Surgery
HALLUX RIGIDUS
Causes
Clinical Features
Radiographs
Treatment
Mild Cases
Severe Cases
Physiotherapy Measures following Surgery
HAMMER TOES
Definition
Clinical Features
Radiographs
Treatment
CLAW TOES
Definition
Causes
Clinical Features
Radiographs
Treatment
SESAMOIDITIS
Definition
Associated Problem
Clinical Features
Investigations
Treatment
Effective Conservative Treatment for all Forefoot Conditions
BIBLIOGRAPHY
Arthroplasty
Hip
Total Knee Arthroplasty
Total Ankle Arthrosplasty
Total Shoulder Arthroplasty and Elbow
Painful Heel Syndrome
Arthrodesis
Regional Disorders
Frozen Shoulder
Tennis Elbow
Olecranon Bursitis
Cervical Disk
Scoliosis
Kyphosis
Hallux Valgus
Knee
Arthroscopic treatment of popliteal cyst
Pes planus
Morton's Neuroma
Sesamoid Bones of the Forefoot
Chronic Heel Pain
Infantile Quadriceps Contracture
33:
Disorders of the Hand
CONGENITAL ANOMALIES OF THE HAND
INFECTIONS OF THE HAND
PARONYCHIA
Clinical Features
Treatment
APICAL SUBUNGUAL INFECTION
DISTAL PULP SPACE INFECTION (SYN: Felon)
Clinical Features
Treatment
MIDDLE AND PROXIMAL VOLAR SPACE INFECTION
INFECTION OF THE WEB SPACES
Clinical Features
Treatment
DEEP PALMAR ABSCESS
Surgical Anatomy
Clinical Features
Diagnostic Test
Treatment
TENOSYNOVITIS
Surgical Anatomy
Etiology
Clinical Features
Treatment
ARTHRITIC HAND
PARALYTIC HAND
SECTION 4: COMMON BACK PROBLEMS
34:
Low Backache and Repetitive Stress Injury (RSI)
EPIDEMIOLOGY OF BACKACHE
POSTURE
PATHOLOGICAL PHYSIOLOGY
Functional Anatomy
Structures Involved in Backache (Figs 34.3A to C)
LUMBAR DISK DISEASE AND DISK PROLAPSE
Disk Anatomy
DISK PHYSIOLOGY
NATURAL HISTORY OF LUMBAR DISK DISEASE
CLASSIFICATION OF PROLAPSED INTERVERTEBRAL DISK (FIG. 34.5)
ETIOLOGY OF DISK HERNIATION
DEFINITIVE CAUSES
CLINICAL FEATURES
EXAMINATION OF THE BACK (TABLE 34.2)
INVESTIGATIONS OF LOW BACKACHE
DIFFERENTIAL DIAGNOSIS
Extrinsic Causes (unrelated to spine)
Intrinsic Causes (related to spine)
Important Causes
Unimportant Causes
TREATMENT OF LOW BACKACHE DUE TO LUMBAR DISK DISEASE
Epidural Steroids
Surgery
Surgical Methods
CHEMONUCLEOLYSIS
Ways to Prevent Recurrence
APPROACH TO A PATIENT WITH LOW BACKACHE
CAUSES OF BACKACHE
Common Causes of Backache
Uncommon Causes of Backache
Presenting Complaints
Pain
Biochemical Causes
Neurogenic Claudication
Neurological Symptoms
Facet Syndromes
Other Complaints
Physical Signs
Neurological Examination
Other Examinations
Investigations
Treatment
Other Important Causes of Backache
BACKACHE IN SPECIAL SITUATIONS
BACKACHE IN CHILDREN (SCHOOL BAG SYNDROME)
Features
Prevention
Policy Matter
REPETITIVE STRESS INJURY (RSI)
Definition
Incidence
Presentation
Stages
Investigations
Treatment
Preventive Measures
Curative Measures
Health Education
Role of the Insititutions
SECTION 5: GENERAL ORTHOPEDICS
35:
Congenital Disorders
INTRODUCTION
Causes
Genetic Factors
Embryonic Trauma
CONGENITAL DISORDERS OF UPPER LIMB
CONGENITAL TORTICOLLIS (WRYNECK)
Etiology
Clinical Features
Radiograph
Treatment
Principles
Surgical Methods
1SPRENGEL'S DEFORMITY
Etiology
Pathology
Clinical Features
Cavendish's Grading
Radiograph
Treatment
CLEIDOCRANIAL DYSOSTOSIS
Types
Etiology
Clinical Features
Radiograph
Treatment
CONGENITAL RADIOULNAR SYNOSTOSIS
Classification
Clinical Features
Radiograph
Treatment
MADELUNG'S DEFORMITY
Causes
Clinical Features
Other Features
Radiographic Abnormalities
Treatment
Conservative Treatment
Surgery
CONGENITAL ABSENCE OF RADIUS (RADIAL CLUB-HAND)
Heikel's Classification
Clinical Features
Radiograph
Treatment
CONGENITAL DISLOCATION OF RADIUS
Clinical Features
Radiology
Treatment
CONGENITAL DISORDERS OF LOWER LIMBS
DEVELOPMENTAL DYSPLASIA OF HIP (DDH) [EARLIER KNOWN AS CONGENITAL DISLOCATION of Hip (CDH)]
Definition
Theories of Etiology
Pathology
Bone
Muscles
Stages of DDH
Clinical Features
In Infants
Children and Adolescents
In Adults
Treatment
In infants
Between 6 and 18 Months
Between 18 and 36 Months
3–8 years
8–18 years
Innominate Osteotomy in DDH
Salter's Osteotomy
Pemberton's Osteotomy
Steel's Osteotomy
Shelf Operation
Chiari's Osteotomy
CONGENITAL DISLOCATION OF KNEE
Pathology
Clinical Features
Radiograph
Treatment
Mild to Moderate
Severe
CONGENITAL PSEUDARTHROSIS OF TIBIA
Incidence
Classification
Clinical Features
Radiograph
Treatment
Principles
Established Pseudarthrosis
CONGENITAL TALIPES EQUINOVARUS (CTEV)
Idiopathic CTEV
Pathology
Clinical Features
Dorsiflexion Test
Plumb Line Test
Classification
Investigation
Management
Conservative Management
PONSETI TECHNIQUE
Benefits of the Ponseti Method
Surgical Management
Indications (5 R's)
Surgical Methods (Table 35.11)
STRUCTURES RELEASED IN TURCO'S PROCEDURE (POSTEROMEDIAL RELEASE)
Surgeries for Uncorrected Clubfoot
Treatment by External Fixators
RETENTION OF CTEV CORRECTION
CONGENITAL ABSENCE OF FIBULA
Treatment
CONGENITAL ABSENCE OF TIBIA
CONGENITAL VERTICAL TALUS (SYN: Rocker bottom flatfoot, congenital rigid flatfoot)
Clinical Presentation
Radiographs
Treatment
Conservative Measures
Surgery
BIBLIOGRAPHY
Congenital Disorders
Clubfoot
Congenital Pseudarthrosis
Congenital Dislocation of Hip
Other Congenital Disorders
Congenital Wryneck
Congenital Elevation of Scapula
Congenital Radioulnar Synostosis
36:
Developmental Disorders
INTRODUCTION
Bone Ossification Methods
Diagnostic Guidelines
History
Clinical Examination
CLASSIFICATION OF DEVELOPMENTAL DISORDERS (TABLE 36.1)
Role of Radiographs
ACHONDROPLASIA
Definition
Clinical Features
Radiograph
Treatment
OSTEOGENESIS IMPERFECTA
Definition
Etiology
Pathogenesis and Pathology
Classification (Falvo's)
Clinical Features
Investigations
Treatment
Principles
Surgical Methods
MUCOPOLYSACCHARIDE DISORDERS
MORQUIO-BRAILSFORD DISEASE
HURLER'S (GARGOYLISM)
HUNTER'S DISEASE
HEREDITARY MULTIPLE EXOSTOSIS (DIAPHYSEAL ACLASIA)
Clinical Features
Radiology
Treatment
DYSCHONDROPLASIA (OLLIER'S DISEASE)
Clinical Features
MAFFUCCI'S DISEASE
Radiographs
OSTEOPETROSIS
MARBLE BONE DISEASE, ALBERS-SCHöNBERG DISEASE
Complications
Pathology
Etiology
Clinical Features
Radiographs
Treatment
Prognosis
Other Variants
EPIPHYSEAL DYSPLASIAS
Epiphyseal Dysplasia Multiplexa
Radiographs
Epiphyseal Dysplasia Punctata
Conradi's Disease
EPIPHYSEAL DYSPLASIA HEMIMELIA
METAPHYSEAL DYSPLASIAS
Metaphyseal Dysplasia (Pyle's disease)
Craniometaphyseal Dysplasia
Metaphyseal Chondrodysplasia
DIAPHYSEAL DYSPLASIA
Progressive Diaphyseal Dysplasia (Canuati or Engelmann's disease)
Craniodiaphyseal Dysplasia
FIBROUS DYSPLASIA
Etiology
Pathology
Gross
Microscopy
Clinical Features
ALBRIGHT'S SYNDROME
Laboratory Investigation
Radiology
Treatment
NAIL-PATELLA SYNDROME (ONYCHO-OSTEODYSPLASIA)
1MARFAN'S Syndrome
HOMOCYSTINURIA
ACROCEPHALOSYNDACTYLY (APERT'S SYNDROME)
CARPENTER'S SYNDROME
CLEIDOCRANIAL DYSPLASIA
CONGENITAL NEUROFIBROMATOSIS (VON RECKLINGHAUSEN'S DISEASE)
Clinical Features
Radiographs
Treatment
PAGET'S DISEASE
Clinical Features
Investigations
Radiograph
Treatment
37:
Metabolic Disorders
INTRODUCTION
Bone Formation and Remodeling
Role of Calcium
Calcium Metabolism
RICKETS
Definition
Causes
TYPES OF RICKETS
Fetal Rickets
Infantile Rickets (Nutritional rickets)
Late Rickets or Rachitis Tarda
Clinical Features
Symptoms
Signs
Other Features
Pathology
Bones of the Skeletal System
Investigations
Treatment
Treatment of Established Deformity
Differential Diagnosis
RENAL OSTEODYSTROPHY
Causes
Clinical Features
Parson's Radiological Features
Investigations
Treatment
VITAMIN D-RESISTANT RICKETS
Clinical Features
Tackle Deformity
Radiograph
Treatment
Prognosis
CELIAC RICKETS
GLUTEN-SENSITIVE ENTEROPATHY
Etiology
Clinical Features
Investigations
Treatment
OSTEOMALACIA
Etiology
Pathogenesis
Pathology
Clinical Features
Radiographs
Laboratory Investigation
Treatment
HYPERPARATHYROIDISM
PRIMARY HYPERPARATHYROIDISM (Osteitis Fibrosa Cystica, Von Recklinghausen's Disease)
Pathogenesis
Pathology
Causes
Clinical Features
Radiographs
Laboratory Investigation
Treatment
Differential Diagnosis
SECONDARY HYPERPARATHYROIDISM
SCURVY
Definition
Etiology
Pathology
Clinical Features
Investigations
Radiographs
Differential Diagnosis
Treatment
METABOLIC DISORDERS LEADING TO OSTEOSCLEROSIS
FLUOROSIS
Clinical Features
Investigations
Treatment
38:
Osteomyelitis
INTRODUCTION
Definition
Classification
ACUTE OSTEOMYELITIS
Etiology
Agent Factors
Host Factors
Age
Sex
Economic Status
Environmental Factors
General Factors
Local Factors
Pathophysiology
Clinical Features
Fever
Swelling
Limitation of Movement
Clinical Signs
General Features
Local Features
Investigations
Management
General Management
Local Management
Surgical Methods
Differential Diagnosis
Acute Septic Arthritis
Scurvy
Acute Anterior Poliomyelitis
Cellulitis
Other Differential Diagnosis
Complications (seen in 5% of the cases)
Course
SUBACUTE OSTEOMYELITIS
CHRONIC OSTEOMYELITIS
Clinical Features
Symptoms
Signs
Investigations
Classification
Management
Surgery Methods
Other Methods of Treatment
Complications
Most Common Complications
Common Complications
Rare Complications
Residual Osteomyelitis
OSTEOMYELITIS OF SPECIAL IMPORTANCE
1BRODIE'S ABSCESS
Clinical Presentation
Etiology
Radiograph
Treatment
SCLEROTIC OSTEOMYELITIS OF GARRE
Clinical Features
Investigations
Treatment
TUBERCULAR OSTEOMYELITIS
39:
Skeletal Tuberculosis
INTRODUCTION
Etiology
Pathology
Changes in the Marrow
Lamellae
Periosteum
Clinical Features
Monoarticular
Constitutional Symptoms
Investigations
General Investigations
Principles of Treatment
Chemotherapy
Current Trends of Chemotherapy in Musculoskeletal TB
General Principles of Chemotherapy in Tuberculosis
Prognosis
TUBERCULOSIS SPINE
Sites of Involvement within the Vertebra
Sequences of Pathological Events
Clinical Features
Physical Findings
Investigations
Laboratory Tests
Radiographs
Earliest Change
Late Changes
Paravertebral Shadow
CT Scans
MRI
Biopsy
Ultrasound
Treatment
Surgical Procedures
Objectives of Surgery
Middle Path Regime
TB SPINE WITH PARAPLEGIA
Pathology
Classification
Seddon's Classification
Clinical Features
Principles of Treatment
Treatment of Pott's Paraplegia
Conservative Treatment
Surgical Treatment
Surgical Techniques
Costotransversectomy
Anterolateral Decompression (ALD)
Anterior Decompression
Laminectomy
Treatment
TUBERCULOSIS OF THE HIP JOINT
Pathogenesis
Clinical Features
Limb Length Discrepancy
Stages of Tuberculosis Hip
Investigations
Laboratory Tests
Radiograph of the Hip
Other Investigations
Treatment
Surgical Treatment in Tuberculosis Hip
TUBERCULOSIS OF THE KNEE
Clinical Features
Investigations
Treatment
Non-operative Treatment
Surgical Treatment
Role of Supracondylar Osteotomy
TUBERCULOSIS OF THE SHOULDER
Pathology
Clinical Features
Late Stages
Radiographs
Treatment
TUBERCULOSIS OF THE ANKLE
Clinical Features
Radiographs
Treatment
Aim
Surgery
TUBERCULAR OSTEOMYELITIS
TUBERCULAR OSTEOMYELITIS WITHOUT JOINT INVOLVEMENT
Clinical Features
Radiographs
SPINA VENTOSA TYPE
Tuberculosis of Tubular Bones
Short Tubular Bones
Clinical Features
Radiographs
Treatment
40:
Disorders of Joints (Arthritis)
INTRODUCTION
INFECTIVE ARTHRITIS
PYOGENIC INFECTION OF JOINT OR SEPTIC ARTHRITIS
Definition
Causative Organisms
Predisposing Factors
Sites of Involvement of the Joint
Pathology
Clinical Features
Investigations
Joint Aspirate and Synovial Fluid Analysis
Laboratory Investigations
Radiographs
Early Stages
Late Stages
Treatment
Complications
GONOCOCCAL ARTHRITIS
Pathology
Clinical Features
Treatment
SYPHILIS OF JOINTS
Investigations
Treatment
NEUROPATHIC JOINTS (CHARCOT'S1)
Pathology
Clinical Features
Radiograph
Treatment
HEMOPHILIC ARTHRITIS (BLEEDER'S JOINTS)
Definition
Pathology
Clinical Features
Investigations
Plain X-ray
MRI
Laboratory Tests
Treatment
Acute stage
Chronic Hemarthropathy
41:
Rheumatic Diseases
INTRODUCTION
CLASSIFICATION
RHEUMATOID ARTHRITIS
Definition
Etiology
Current Hypothesis
Antigenic Agents
Pathogenic Spectrum
Pathology
Microscopy
Clinical Features in Rheumatoid Arthritis
Classical Presentation
Other Presentations
Extra-articular Features
ORTHOPEDIC DEFORMITIES IN RHEUMATOID ARTHRITIS
Orthopedic Deformities of the Hand (Rheumatoid Hand)
Rheumatoid Foot
Other Joints
Investigation
Laboratory
Serological Tests
Radiological Features of Rheumatoid Arthritis (Fig. 41.7)
Other Common Abnormalities
Synovial Fluid Analysis
MRI
Differential Diagnosis
Management
Aims of Treatment
General Measures
Splints
Drug Therapy
First Line of Drugs: NSAIDs
Second Line of Drugs
Antimalarial Drugs
Third Line of Drugs
Local Steroids
Surgical Procedures in Rheumatology
Preoperative Considerations
Surgical Methods
Synovectomy
Osteotomy
Arthrodesis
Arthroplasties
Self-management Techniques for Rheumatoid and Other Forms of Arthritis
Ten Self-help Techniques
SERONEGATIVE SPONDYLOARTHROPATHIES
Introduction
Etiology
Signs and Symptoms
Articular Features
Extra-articular Features
Diagnosis
Radiological Diagnosis
CAT Scan
HLA-B27
ANKYLOSING SPONDYLITIS (SYN: Marie-Strumpell Disease)
Definition
Causes
Pathology
Clinical Features
Extra-articular Manifestations
Differential Diagnosis
Investigations
Treatment
FIBROMYALGIA
Introduction
Incidence
Causative Factors
Clinical Features
Diagnostic Criteria
Treatment
Alternative Therapies
CRYSTALLINE ARTHROPATHIES
MONOSODIUM URATE ARTHROPATHY (GOUT)
Sites
Role of Hyperuricemia
Incidence
Age
Clinical Features
Investigations
Radiology
Treatment
PSEUDOGOUT (CPPD)
42:
Neuromuscular Disorders
CEREBRAL PALSY (SYN: Static Encephalopathy)
Definition
Lesions
Classification
Lesions in the Brain
Causes
Clinical Features
Orthopedic Deformities
Upper Limb
Lower Limb
Spine
Knee
Foot
Treatment
Methods
Choice of Surgery
POLIOMYELITIS
Definition
Viruses
Pathogenesis
Clinical Features
Orthopedic Deformities
Differential Diagnosis
Treatment
Treatment Methods
Role of Appliances
ARTHROGRYPOSIS MULTIPLEX CONGENITA [Syn: Multiple Congenital Contractures (MCC)]
Causes
Classification (Sharrard, Brown and Robson)
Clinical Features
Investigations
Treatment
Principles of Orthopedic Treatment
LEPROSY IN ORTHOPEDICS
National Leprosy Eradication Program
Classification
Investigations
Treatment
ORTHOPEDIC AFFECTIONS IN LEPROSY
Ankle and Foot
Classification of Foot Deformities in Leprosy
FOOT-DROP
Treatment
Surgical Methods
PLANTAR ULCERS
Treatment
Aim of Treatment
Treatment Methods
AFFECTIONS OF THE HAND IN LEPROSY
Surgery for Hand
MUSCULAR DYSTROPHIES
Classification
1DUCHENNE MUSCULAR DYSTROPHY
Clinical Features
Investigations
FACIOSCAPULOHUMERAL MUSCULAR DYSTROPHY
LIMB GIRDLE MUSCULAR DYSTROPHY
Treatment for Muscular Dystrophies
NEURAL TUBE DEFECTS (DYSTROPHISM)
SPINA BIFIDA
Definition
SPINA BIFIDA OCCULTA
Treatment
SPINA BIFIDA APERTA OF MANIFESTA
Investigations
Early Diagnostic Tools to Detect Neural Tube Defects (Dysraphism)
Other Investigations
Treatment
Preventive Measures
Curative Measures
BIBLIOGRAPHY
Cerebral Palsy
Poliomyelitis
Spina Bifida
43:
Bone Neoplasias
INTRODUCTION
GENERAL PRINCIPLES OF TUMORS
History
Clinical Examination
Investigations
Routine Laboratory Investigation
Special Investigations
Types
Enneking's Staging
Surgical Techniques
Curettage
Resection or Excision
Choice of the Surgical Procedures
Adjunctive Therapy
Radiotherapy
Chemotherapy
Newer Modalities of Treatment
CLASSIFICATION OF BONE TUMORS
BONE TUMORS OF CARTILAGINOUS ORIGIN
OSTEOCHONDROMA (EXOSTOSIS)
Theory of Histogenesis
Clinical Features
Symptoms
Signs
Radiographs
Treatment
CHONDROMA (Enchondroma, Chondromyxoma)
Radiographs
Treatment
Prognosis
CHONDROBLASTOMA
Radiographs
Treatment
CHONDROSARCOMA
Classification
Antecedent lesions
Clinical Features
Radiographs
Diagnosis
Treatment
Prognostic Factors
CHONDROMYXOID FIBROMA
Clinical Features
Radiographs
Treatment
OSSEOUS ORIGIN BONE TUMORS
OSTEOMA
1OSTEOID OSTEOMA
Clinical Features
Radiographs
Treatment
OSTEOGENIC SARCOMA
Exciting Factors
Pathology
Histology
Classification
Secondary Osteosarcoma
Clinical Features
Investigations
Plain X-ray
CT Scan and MRI
Frozen Biopsy
Bone Scan
Treatment
Surgery
Treatment of Pulmonary Metastasis
Prognosis
RESORPTIVE BONE TUMORS
ANEURYSMAL BONE CYST
Pathology
Clinical Features
Radiographs
Treatment
UNICAMERAL BONE CYST
Pathology
Types of Cyst
Clinical Features
Radiographs
Treatment
Types of Surgery
Complications
GIANT CELL TUMOR (GCT) (Syn: Osteoclastoma)
BENIGN GIANT CELL TUMOR
Pathology
Gross
Microscopy
Clinical Features
Radiographs
MALIGNANT GIANT CELL TUMOR
Treatment of GCT
Surgical Methods
Other Methods
TUMORS OF NONOSSEOUS ORIGIN
2EWING'S Sarcoma
Pathology
Histology
Clinical Features
Course
Investigations
Radiographic Features
Biopsy
Other Tests
Recommended Treatment
Effective Chemotherapy
Radiation
Surgery
MULTIPLE MYELOMA (PLASMACYTOMA)
Pathology
Clinical Features
Findings
Investigations
Laboratory Findings
Radiographs
Treatment
Chemotherapy
Surgery
Prognosis
Complications
METASTATIC TUMORS OF BONE
Definition
Occurs in Three Clinical Settings
Clinical Features
Laboratory Diagnosis
Other Investigations
Radiographs
Bone Scan
Biopsy
Treatment
INCLUSION TUMORS
SYNOVIOMA (SYNOVIAL SARCOMA)
Definition
Pathology
Microscopy
Clinical Features
Radiographs
Treatment
RECENT TRENDS IN LIMB SALVAGE SURGERY
SECTION 6: GERIATRIC ORTHOPEDICS
44:
Distal Forearm Fractures
COLLES' FRACTURE
Definition
Mechanism of Injury
Clinical Features
Styloid Process Test
Radiology
Classification
Treatment Methods
Conservative Methods
TECHNIQUE OF CLOSED REDUCTION AND APPLICATION OF A COLLES' CAST UNDER LOCAL ANESTHESIA (Figs 44.11A to I)*
TECHNIQUE OF CLOSED REDUCTION AND PERCUTANEOUS FIXATION WITH K-WIRES under GA (Figs 44.12A to P)*
Complications
Treatment
45:
Fracture Neck of Femur
BRIEF ANATOMY
THE HIP JOINT SPEAKS
FRACTURE NECK OF FEMUR
Clinical Significance of Vascular Anatomy
Etiology
Mechanism of Injury
Classification
Broad Classification
Structural Classification
Causatively
Based on Fracture Character
Delbet's Classification (Fig. 45.7)-in Children
Clinical Features
Investigations
Radiography
Other Investigations
Treatment
Aims of Treatment
Treatment Plans as per Garden's Classification
Reduction Techniques
Radiograph
Techniques of Internal Fixation for the Fracture Neck of Femur
Procedure
Choices of Implants for Internal Fixation
Cardinal Points in Internal Fixation
Complications of Internal Fixation
Meyer's Muscle Pedicle Graft
Other Treatment Options
COMPLICATIONS OF FEMORAL NECK FRACTURE
THROMBOEMBOLISM
NONUNION
Causes
Clinical Features
Radiograph
Treatment
OSTEOTOMY
AVASCULAR NECROSIS
Incidence
Investigations
Treatment
TROCHANTERIC FRACTURE
Mechanism
Clinical Features
Radiograph
Treatment
Indications
Methods
Methods of Reduction
Open reduction
Choice of an Implant
Complications
46:
Osteoporosis
47:
Osteoarthritis
OSTEOARTHRITIS OF THE KNEE
Definition
PRIMARY OSTEOARTHRITIS OF THE KNEE (ALSO CALLED IDIOPATHIC)
Features
Clinical Features
Criteria and Classification of OA Knee (American College of Rheumatology—ACR)
Clinical
Clinical and Radiological
Investigations
Kellegren and Lawrence Radiological Grading
Other Investigations
Treatment
ACR Guidelines: Traditional Format
Conservative Methods
Nonpharmacological Treatment
Components of Therapeutic Exercise
Physiotherapy
Weight Loss
Pharmacologic Drugs
Mechanical Aids
Alternative Therapies
Surgery
SECONDARY OSTEOARTHRITIS OF THE KNEE
OSTEOARTHRITIS OF THE HIP (Familiarly Called As Malum Coxa Senilis)
PRIMARY OSTEOARTHRITIS OF THE HIP
SECONDARY OSTEOARTHRITIS OF THE HIP
Pathology
Clinical Features
Radiographs
Primary Osteoarthritis
Treatment
Conservative Measures
Surgical
Choice of Osteotomy
Modifications of Activity of Daily Living in the Management of Osteoarthritis of Hip and Knee Joints
Role of Exercises in the Management of Osteoarthritis of the Hip and Knee
Types of Exercises in Osteoarthritis of Hip
OSTEOARTHRITIS OF OTHER REGIONS
48:
Cervical Disk Syndromes
49:
Lumbar Disk Disease and Canal Stenosis
CANAL STENOSIS
Introduction
Definition
Classification
Causes
Clinical Features
Investigations
Treatment
Conservative Methods
Surgical Methods
SECTION 7: COMMON SURGICAL TECHNIQUES
50:
Common Surgeries of the Humerus
DCP PLATING FOR FRACTURE SHAFT OF HUMERUS
Indications
Approach
Surgical Steps (Figs 50.1 to 50.17)
Aftercare
INTERLOCKING HUMERUS*
SUPRACONDYLAR FRACTURE HUMERUS—PERCUTANEOUS FIXATION**
Technique
Indications
Surgical Steps (Figs 50.34 to 50.62)
Method of Closed Reduction of the Supracondylar Fracture
Method of Percutaneous Fixation
Aftercare
INTERCONDYLAR FRACTURE HUMERUS—RECONSTRUCTIONS
Indications
Approach
Surgical Steps (Figs 50.63 to 50.86)
Aftercare
51:
Common Forearm Surgeries
EXCISION OF THE RADIAL HEAD
Indications
Approach
Steps
Aftercare
FOREARM DCP PLATING
Indications
Approaches
Surgical Steps (Figs 51.1 to 51.11)
Aftercare
MEDULLARY FIXATION FOR FRACTURE OF RADIUS AND ULNA
Indications
Some Principles According to Stage
Surgical Steps
For Ulna
Nailing of Radius
Aftercare
DARRACH'S OPERATION
Indication
Approach
Surgical Steps
Aftercare
52:
Common Hip Surgeries
HEMIREPLACEMENT ARTHROPLASTY
Indications
Approaches
Advantages
Disadvantages
Surgical Steps (Figs 52.1 to 52.36)
Aftercare
Complications
Common Ones
Rare
SURGICAL TECHNIQUE OF AMP PROSTHESIS*
DYNAMIC HIP SCREW (DHS) TECHNIQUE
Indications
Approach
Surgical Steps (Figs 52.37 to 52.52)
Aftercare
INTERNAL FIXATION OF FRACTURE NECK OF FEMUR
Indication
Choice of Implants
Surgical Steps
Aftercare
53:
Common Surgery of the Femur
INTRAMEDULLARY NAILING
Indications
Approach
Surgical Steps
Aftercare
INTERLOCKING NAILING
Indications
Approach
Surgical Steps
Aftercare
DCP PLATING
Indications
Approach
Surgical Steps
Aftercare
54:
Common Surgery of the Patella
PATELLECTOMY
Indications
Approach
Surgical Steps
Aftercare
TENSION BAND WIRING (MODIFIED)
Indications
Approach
Surgical Steps
Aftercare
55:
Common Surgery of the Tibia
DCP PLATING FOR TIBIA
Indications
Approaches
Surgical Steps (Figs 55.1 to 55.20)
Aftercare
INTERLOCKING NAILING OF TIBIA
Indications
Surgical Steps (Figs 55.21 to 55.36)
Aftercare
MALLEOLAR FIXATIONS
Indications
Approach
Steps to Fix Lateral Malleolus
Steps for Medial Malleolus Fixation (Figs 55.37 to 55.57)
Aftercare
56:
Turco's One Stage Posteromedial Release for CTEV
57:
Common Surgery of the Spine
LAMINECTOMY
Surgical Steps (Described for L5 Disk Prolapse) (Figs 57.1 to 57.16)
Aftercare
POSTERIOR INSTRUMENTATION FOR VERTEBRAL COMPRESSION FRACTURES
Surgical Steps (Figs 57.17 to 57.38)
Aftercare
POSTERIOR DECOMPRESSION AND SURGICAL STABILIZATION
Surgical Steps (Figs 57.39 to 57.60)
Aftercare
58:
Common Finger and Toe Surgery (Percutaneous Fixations)
FINGER FRACTURE
TECHNIQUE OF K-WIRE STABILIZATION OF COMPOUND PROXIMAL PHALANX FRACTURE
TECHNIQUE OF FIXATION OF IPSILATERAL PHALANGEAL FRACTURES
SURGICAL TECHNIQUE OF K-WIRE FIXATION OF A METACARPAL FRACTURE FROM FIGURES 58.28 TO 58.44
TOE INJURIES
SURGICAL TECHNIQUE OF PERCUTANEOUS FIXATION OF TOE FRACTURES FROM FIGURES 58.45 TO 58.59
59:
External Fixation
SURGICAL TECHNIQUE OF APPLICATION OF EXTERNAL FIXATORS FROM FIGURES 59.1 TO 59.22
SECTION 8: MISCELLANEOUS
60:
Amputations
INTRODUCTION
Definition
Incidences
Indications
TYPES
Closed Amputation
Open Amputation
Amputation Levels
Upper Limbs (Fig. 60.1)
Lower Limbs (Fig. 60.2)
Ankle Amputation
Foot Amputation
PRINCIPLES
CLOSED AMPUTATIONS
OPEN AMPUTATIONS (GUILLOTINE OPERATION)
Indications
Types
AFTER TREATMENT
IMPORTANT AMPUTATIONS OF LOWER EXTREMITY
Below Knee Amputation
Knee Disarticulation
Amputation through the Thigh
1Syme's Amputation
COMPLICATIONS
61:
Prosthetics and Orthotics
PROSTHETICS
Classification
Types
PROSTHESIS FOR THE LOWER LIMBS
PROSTHESIS FOR BELOW KNEE AMPUTATIONS
PROSTHESIS FOR SYME'S AMPUTATION
SACH FOOT
Ankle Units and Artificial Feet
JAIPUR FOOT (INDIA'S PRIDE)
ORTHOTICS
Classsification
Varieties
Types
Supportive Spinal Orthosis
Corrective Spinal Orthosis
Orthosis for Cervical Spine
LOWER LIMB ORTHOSIS
Hip-knee-ankle-foot Orthosis (HKAFO) and Lumbosacral Hip-knee-ankle-foot Orthosis (LSHKAFO)
Ankle-foot Orthosis (AFO)
Footwear and its Modifications
Foot Supports
UPPER LIMB ORTHOSIS
62:
Sports Injuries
INTRODUCTION
CLASSIFICATION OF SPORTS INJURIES
Williams' Classification
Among the Consequential Injuries
Primary Extrinsic
Primary Intrinsic
Secondary
No Consequential Injuries
COMMON SPORTS INJURIES
Upper Limbs
Lower Limbs
Head, Neck, Trunk and Spine
Investigations
TREATMENT OF SPORTS INJURY
Preventive Measures
Treatment
General Principles
Training
Exercises to Increase the Cardiopulmonary Capacity
Exercises to Increase the Muscle Strength
Exercises for Free Weight Training
Measures to Improve the Agility
Measures to Improve the Speed-Polymetrics
Measures of Relaxation
63:
Arthroscopy*
INTRODUCTION
What is Arthroscopy?
INDICTIONS FOR ARTHROSCOPY
64:
Standard Arthroscopy Portals*
PATIENT POSITIONING
LATERAL PORT (VISUALIZATION PORT)
SUPEROLATERAL PORT (DRAINAGE PORT)
MEDIAL PORT (OPERATING PORT)
SUPEROLATERAL PORT (PATELLAR TRACKING PORT)
MY INFEROLATERAL PORT “LATERAL RELEASE PORT”
OTHER PORTS
Midpatellar Port
65:
9-Point Diagnostic Knee Arthroscopy*
FIRST POINT: SUPRAPATELLAR POUCH
SECOND POINT: PATELLA
THIRD POINT: TROCHLEA
FOURTH POINT: MEDIAL GUTTER
FIFTH POINT: MEDIAL COMPARTMENT
SIXTH POINT: INTERCONDYLAR NOTCH AND ANTERIOR CRUCIATE LIGAMENT
SEVENTH POINT: LATERAL COMPARTMENT
EIGHTH POINT: LATERAL GUTTER
NINTH POINT: PATELLAR TRACKING
66:
Arthroplasty*
INTRODUCTION
ARTHROPLASTY
Types of Prosthesis
Choice of Prosthesis
HIP AND KNEE ARTHROPLASTY
Indications
Contraindications
Complications
SURGICAL STEPS OF TOTAL HIP REPLACEMENT (FIGS 66.1 TO 66.28)
SURGICAL STEPS OF TOTAL KNEE REPLACMENT (FIGS 66.29 TO 66.53)
Types
Components
67:
Evidence Based Orthopedics
INTRODUCTION
Real Life Incidences
What is EBM?
History
Why is EBM Necessary?
When to Practice EBM?
Real Life Incidents
How to Practice EBM?
Who should Practice EBM?
Quality of Research: Is it good or bad?
What is the Hierarchy of Evidence?
What is the Type of Study?
EBM Triad
User's Guide
How to Critically Appraise a Level 1 (RCT) Research Article and what is the role of the user's guide?
How to assess the adequacy of the sample size based on the results?
COST EFFECTIVENESS ANALYSIS
STUDIES OTHER THAN RCT
Cohort Study
Types
Case Series
Diagnostic Study
DECISION ANALYSIS STUDY
Components of Decision Analysis
Sensitivity Analysis
QUALITY OF REPORTING
DEVELOPING AN EVIDENCE BASED BALANCE SHEET
COMMUNICATION TO A PATIENT
Tools for Communication
Appliances for Communication
Problems in EBM
APPENDICES:
Appendix I: Instruments and Implants in Orthopedics
GENERAL SURGICAL INSTRUMENTS
REGULAR ORTHOPEDIC INSTRUMENTS
BONE HOLDING, PLATE HOLDING AND ROD HOLDING INSTRUMENTS
Instruments
INSTRUMENTS USED TO CUT, NIBBLE, CURETTE AND MAKE HOLES IN the bones
MISCELLANEOUS ORTHOPEDIC INSTRUMENTS
Instruments
Periosteal Elevators
Bone Levers
Fracture Reduction Forceps
INSTRUMENTS USED FOR INSERTION OF PLATE AND SCREWS
INSTRUMENTS USED FOR CUTTING PLASTER CASTS
INSTRUMENTS USED FOR WIRE INSERTION
IMPLANTS IN ORTHOPEDICS
Different types of plates used in orthopedics
Instruments
Different Sets of Screws
DYNAMIC HIP AND ANKLE IMPLANTS
SOME OF THE SPECIAL PLATES USED IN ORTHOPEDICS
DIFFERENT CONVENTIONAL INTRAMEDULLARY NAILS
INSTRUMENTS USED FOR K-NAIL INSERTION FOR FEMUR
KÜNTSCHER'S CLOVERLEAF* INTRAMEDULLARY NAIL
Methods of Insertion
PROSTHESIS OF THE HIP
Technique of Prosthesis Insertion (Moore's)
Complications
DIFFERENT HIP IMPLANTS
INSTRUMENTS USED FOR HIP HEMIREPLACEMENT SURGERY
INSTRUMENTS USED FOR SMITH-PETERSON NAILING
Appendix II: Guidelines for Practical Examinations
GUIDELINES TO FARE BETTER IN CLINICAL EXAMINATION IN ORTHOPEDICS
AVOID THE FOLLOWING PITFALLS IN THE EXAMINATION HALL
INSTRUMENTS REQUIRED FOR CLINICAL EXAMINATION
COMMON EXAMINATION CASES
Glossary
IMPORTANT CLASSIFICATIONS IN ORTHOPEDICS
Spine
Upper Limbs
Pelvis Fractures
Lower Limbs
Hip Joint
Knee and Proximal Tibia
Ankle
Foot
Peripheral Nerve Injuries
Epiphyseal Injuries
Miscellaneous
IMPORTANT RADIOLOGICAL APPEARANCES
Hip Joint
Knee Joint
Ankle Joint
Shoulder
Elbow Joint
Hand
Spine
Infection
Metabolic Disorders
Developmental Disorders
Congenital Disorders
Bone Tumors
IMPORTANT FRACTURES WITH EPONYMS
Spine
Upper Limbs
Pelvis
Lower Limbs
IMPORTANT CLINICAL TESTS IN ORTHOPEDICS
Neck
Shoulder Joint
Elbow Joint
Forearm
Wrist Joint
Hand
Spine
Sacroiliac Joint
Hip Joint
Pelvis
Knee Joint
IMPORTANT ORTHOPEDIC SURGERIES BY NAMES
Upper Limbs
Shoulder Joint
Elbow Joint
Wrist Joint
Lower Limbs
Hip Joint
Knee Joint
Foot
TERMINOLOGIES ASSOCIATED WITH FRACTURES
IMPORTANT ORTHOPEDIC TERMINOLOGIES
Joint
Movements
Spine
Foot and Ankle
Tendons and Nerves
IMPORTANT OSTEOTOMIES IN ORTHOPEDICS
Upper Limbs
Hip Joint
Knee
Spine
Foot
INDEX
TOC
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