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Essentials of Orthopedics
RM Shenoy
1:
Introduction to Fractures and Dislocations
FRACTURES
Definition
Types of Fracture
Deforming Forces
Specific Types of Fracture
Greenstick Fracture (Fig. 1.9)
Compression Fracture (Fig. 1.10)
Pathological Fracture (Fig. 1.11)
Stress Fracture (Fig. 1.12)
Signs and Symptoms of a Fracture
Healing of a Fracture
1st Stage: Stage of Hematoma Formation
2nd Stage: Stage of Cellular Proliferation
3rd Stage: Stage of Primary Woven Bone Formation (Soft Callus)
4th Stage: Stage of Lamellar Bone Formation (Hard Callus)
Stage of Remodeling
Factors Influencing Healing (Predisposing Factors for Delayed Union and Nonunion)
Management of a Fracture
Basic Methods of Treating a Fracture
Steps of Managing an Open Fracture
Definitive Treatment of Open Fractures
Complications
Nonunion
Delayed Union
Malunion (Figs 1.15 and 1.16)
Classification of Delayed and Nonunions (Pseudo-arthrosis)
Hypervascular nonunions (true delayed unions) (Fig. 1.17A)
Avascular nonunions (true nonunions) (Fig. 1.17B)
Treatment of Delayed and Nonunions
Standard Methods
Sources of bone graft
Specialized Methods for the Treatment of Delayed Unions and Nonunions
Treatment of Malunions
Sudeck's Atrophy (Figs 1.21A and B)
Signs and symptoms
Diagnosis
Treatment
Shock and Hemorrhage
Fat Embolism
Crush Syndrome
Pulmonary Embolism
Recent Concept of Fracture Healing
Regenerative Medicine
DISLOCATIONS
Definition of Dislocation and Subluxation
Types of Dislocation (Figs 1.22A to D)
Traumatic Dislocation
Diagnosis
Treatment
Complications of Dislocation
Pathological Dislocation
Paralytic Dislocation
FURTHER READING
2:
Fractures in the Upper Limb
FRACTURES AROUND THE WRIST
Bennett's and Rolando's Fracture
Bennett's Fracture
Definition
Who Described this Fracture?
Mechanism of Injury
Displacements
Treatment
Complications
Rolando's Fracture
Definition
Who Described this Fracture?
Mechanism of Injury
Treatment
Prognosis
Scaphoid Fracture
Blood Supply of Scaphoid
Mechanisms of Injury (Figs 2.4A and B)
Classifications
Investigations
Methods of Treating Fracture Scaphoid
Complications of Fracture Scaphoid
Treatment of the Complications of Fracture Scaphoid
Treatment of Suspected Cases of Fracture Scaphoid
Fall on an Outstretched Hand
Colles’ Fracture
Definition (Based on O riginal D escription by Sir Abraham Colles)
Who Described Colles’ Fracture?
Mechanism of Injury
Common Age Group
Classical Deformity
Displacements Seen in Colles’ Fracture
Treatment
Complications
Treatment of Complications
Smith's Fracture
Definition
Who Described Smith's Fracture?
Mechanism of Injury
Classical Deformity
Treatment
Complications
Treatment of Complications
Barton's Fracture
Definition
Who Described “Barton's Fracture”?
Mechanism of Injury
Treatment
Complications
Essex-Lopresti Fracture
Definition
Mechanism of Injury
Clinical Importance
Treatment
Chauffeur's Fracture
Treatment
FRACTURES IN THE FOREARM
Fracture of the Radius and the Ulna
Mechanisms of Injury
Deforming Forces (Figs 2.24A to C)
Treatment
Complications
Monteggia Fracture
Definition
Mechanisms of Injury (Fig. 2.27)
Classification
Hume's Fracture
Treatment
Complications
Galeazzi Fracture
Definition
Mechanism of Injury
Treatment
Complications
FRACTURES AROUND THE ELBOW
Radial Head Fracture
General Information
Classification (Figs 2.34 to 2.36)
Mechanism of Injury
Treatment
Complications
Olecranon Fracture
Mechanisms of Injury
Classification
Treatment
Capitulum and Trochlea Fractures
Medial and Lateral Epicondyle Fractures
Medial and Lateral Condyle Fractures
Mechanisms of Injury
Classifications
Based on Jakob's classification (1975) (Figs 2.40A to C)
Medial Condyle Fracture
Treatment
Complications of Lateral Condyle Fracture
Supracondylar Fracture of the Humerus
Age
Types
Mechanism of Injury
Classification
Treatment
Baumann's Angle (Fig. 2.46)
Complications
Complications of Supracondylar Fracture and their Management
Myositis Ossificans
Intercondylar Fracture
Mechanism of Injury
Types
Diagnosis
Treatment
Complications
FRACTURES IN THE ARM AND AROUND THE SHOULDER
Fracture Shaft of the Humerus
Mechanisms of Injury of the Fracture Shaft Humerus (Figs 2.53A to C)
Treatment
Complications
Treatment of Complications
Fractures of the Proximal Humerus
Mechanisms of Injury
Classification
Treatment
Complications
Treatment of Complications
Fracture of the Clavicle
Mechanisms of Injury
Common Site and Classification (Fig. 2.60)
Treatment
Complications and Treatment (In Brief)
Fractures of the Scapula
Mechanisms of Injury
Sites of the Fracture (Figs 2.63A and B)
Other Injuries Associated with Fracture Scapula and their Incidence
Classification of the Scapular Neck Fractures
Treatment of Scapular Neck Fractures
Classification of the Fractures of the Glenoid
FURTHER READING
Fractures Around the Wrist
Forearm Fractures
Fractures and Injuries about the Elbow
Distal Humerus Fracture
Humerus Shaft Fracture
Proximal Humerus Fracture
Fracture Clavicle and Shoulder Injuries
Scapula Fracture
3:
Ligament Injuries and Fractures in the Lower Limb
FRACTURES OF THE FOOT
Introduction
Hindfoot
Midfoot
Forefoot
Chopart's Injury
Definition
Mechanisms of Injury
Management
Prognosis
Lisfranc's Injury
Definition
Mechanism of Injury
Types
Imaging (Figs 3.2C to E)
Management
Complications
Prognosis
Fracture of the Fifth Metatarsal Bone
Jones’ Fracture
Definition
Diagnosis
Treatment
Pseudo-Jones’ Fracture
Definition
Treatment
Fracture of the Talus
History
Blood Supply (Figs 3.6 and 3.7)
Mechanism of Injury
Classification of the Fractures/Dislocations and Fracture—Dislocations of the Talus
Classification of talar neck fracture
Classification of talar body fractures
Complications
Treatment
Calcaneus Fracture
Functional Importance of the Calcaneus
Surgical Anatomy
Mechanisms of Injury
Classifications of Fracture Calcaneum
Radiology in Fracture Calcaneum
Treatment
INJURIES AROUND THE ANKLE
Ligament Injuries
Management
Bony Injuries of the Ankle (Pott's Fracture)
Definition
Points to Remember
Lauge-Hansen’Genetic Classification
Pathomechanics of Injuries
Management (Figs 3.26A to C)
The Surgical Sequence of Reconstruction Followed in Vertical Compression Injury
TIBIAL DIAPHYSEAL FRACTURES
INJURIES AROUND THE KNEE JOINT
Ligament Injuries
Anatomy and Pathomechanics of Ligament Disruptions
Terrible Triad of O’Donoghue (Unhappy Triad)
Management of Ligament Injuries
Meniscal Injuries
Functions of the Meniscus
Mechanism of Injury
Diagnosis
Diagnostic Clinical Tests
Investigations
Management
Fracture of the Patella
Mechanisms of Injury (Figs 3.43A and B)
Clinical Signs and Symptoms
Investigation
Management
Fractures of the Tibial Condyle (Tibial Plateau)
Mechanism of Injury
Classification
Diagnosis
Treatment
Complications
Fractures of the Femoral Condyles
Mechanisms of Injury
Classification (Fig. 3.50)
Clinical Signs and Symptoms
Diagnosis
Treatment
FRACTURE OF THE SHAFT OF THE FEMUR
4:
Dislocations
DISLOCATION OF THE ACROMIOCLAVICULAR JOINT
Mechanism of Injury (Fig. 4.1)
Classification (Fig. 4.2)
Clinical Features
Diagnosis
Management
DISLOCATION OF THE SHOULDER
Types
Anterior Dislocation of the Shoulder
Types
Diagnosis
Tests
Method of Closed Reduction
Recurrent Anterior Dislocation
Stryker Notch View (Fig. 4.5C).
Putti-Platt's Procedure
Bankart's Procedure
Helfet Bristow's/Latarjet-Bristow's Procedure
Posterior Dislocation of the Shoulder
Types
Diagnosis
Recurrent Posterior Dislocation
DISLOCATION OF THE ELBOW
Types
Mechanism of Injury
Diagnosis
Management
DISLOCATION OF THE HIP JOINT
Types
Mechanism of Injury
Anterior Dislocation
Posterior Dislocation
Central Dislocation
Classification of Posterior Dislocation
Thompson-Epstein Classification
Stewart and Milford Classification
Diagnosis
Management
Anterior Dislocation
Reverse Bigelow's Method
Posterior Dislocation
Complications
DISLOCATION OF THE KNEE
Diagnosis
Treatment
FURTHER READING
Shoulder Dislocation
Hip Dislocation
Knee Dislocation
5:
Fractures of the Pelvis
FORMATION OF PELVIS
Mechanisms of Injury (Figs 5.2A to C)
External Rotation Force
Compression Force
Vertical Shear
Combined
Classifications
Based on Tile's Classification (1995) as Follows
Sacral Fracture Classification
Clinical Signs of Importance
Investigations
Principles of Management
Complications of Fracture Pelvis
Early
Late
MALGAIGNE FRACTURE (FIG. 5.8)
FURTHER READING
Pelvic Ring Injury
Acetabular Fracture
6:
Spinal Injuries
SPINAL INJURY
FURTHER READING
7:
Peripheral Nerve and Brachial Plexus Injuries
INTRODUCTION
STRUCTURE OF A PERIPHERAL NERVE
RESPONSE OF A NEURON TO INJURY
CLASSIFICATION OF NERVE INJURY
Based on Seddon's Classification (1943)
Neuropraxia
Axonotmesis
Neurotmesis
Based on Sunderland Classification (1951): (In brief)
DIAGNOSIS
Autonomic and Sensory Changes
Motor Changes
Special Tests (D iscussed in D etail in L ater P art of this C hapter)
Sensory Zones of a Peripheral Nerve
Diagnostic Tests
Electromyography (EMG)
Strength Duration Curve
Rheobase
Chronaxie
Starch Iodine Test (Tests Autonomic Function)
MANAGEMENT
Neuropraxia and Axonotmesis
Neurotmesis
Types of Nerve Repair (Neurorrhaphy)
Factors Influencing Nerve Repair
Methods of Closing the Gaps While Repair
Critical Limit of Delay
Reconstructive Procedures in Cases of Absent Recovery
Tendon Transfers (Dynamic Procedure)
Static Procedures
Correction of Claw Hand
Opponens Plasty (Fig. 7.13)
Tendon Transfer for Wrist Drop (High Radial Nerve Injury)
Tendon Transfer for Finger and Thumb Drop (Low Radial Nerve Injury)
Tendon Transfer for Foot Drop
Prerequisites for a Tendon Transfer
Injuries of the Other Peripheral Nerves
Management
Pathomechanics of Various Deformities and Signs
Claw Hand (Intrinsic Minus Deformity) (Fig. 7.16)
Ulnar Paradox
Ape Thumb Deformity
Wrist Drop (Fig. 7.20A)
Finger Drop and Thumb Drop
Flail Foot
Claw Toes
Foot Drop
Oschner's Clasp Test
Pen Test
Card Test
Book Test and Froment's Sign
Igawa's Sign
Tinel's Sign
FORMATION OF BRACHIAL PLEXUS
INJURIES OF BRACHIAL PLEXUS
Upper Plexus Injury—Erb's Paralysis (Fig. 7.28)
Lower Plexus Injury—Klumpke's Paralysis
Whole Plexus Injury
Injuries of the Trunks
Injuries of the Divisions
Injuries of the Cords
Management
Nonoperative
Operative
Surgical Procedures
8:
Bone and Joint Infections
INTRODUCTION
Osteomyelitis
Route of Entry of Microorganism
Specific Osteomyelitis
Nonspecific Osteomyelitis
NONSPECIFIC INFECTION
Acute Hematogenous Osteomyelitis
Etiopathogenesis
Pathology
Types of Sequestrum (Fig. 8.1B)
Clinical Features
Investigations
Other Investigations
Treatment
Complications
Chronic Osteomyelitis
Subacute Osteomyelitis
Brodie's Abscess
Treatment
Sclerosing Osteomyelitis of Garre
Acute Suppurative Arthritis
Mode of Spread
Organisms
Pathology
Diagnosis
Treatment
Tom Smith's Arthritis of Infancy
SPECIFIC INFECTIONS
Tuberculosis of B ones and J oints
Tuberculosis of the Spine
Types of Kyphus/Gibbus
Cold Abscess
Pott's Paraplegia
Tuberculosis of the Hip
Tuberculosis of the Knee
Tuberculosis of the Ankle and Foot
Tuberculosis of the Shoulder and Elbow
Tuberculosis of the Wrist
Spina Ventosa (Tuberculous Dactylitis)
Mycotic Infections of the Bone
Maduromycosis
Syphilitic Infection of the Bone
Parasitic Infestation of the Bone
Hydatid Cysts in the Bone
9:
Bone Tumors
EVALUATION OF A BONE TUMOR
Clinical Evaluation
Onset
Plane, Nature and Consistency of the Swelling
Rate of Growth
Extension into Surrounding Soft Tissue
Regional Lymph Node
Radiological Evaluation
Role of Angiography
Enneking Staging
Bone Biopsy
Indications for Biopsy
Contraindication
Basic Information
Specific Information
Techniques of Biopsy
Laboratory Investigations
MANAGEMENT
COMMON BENIGN BONE TUMORS
Osteoid Osteoma (Figs 9.2A and B)
Clinical Symptoms
Investigations
Treatment
Benign Osteoblastoma
Clinical Features
Investigations
Treatment
Osteochondroma
Pathogenesis
Clinical Features
Investigations
Treatment
Chondroblastoma
Clinical Features
Investigations
Treatment
Chondromyxoid Fibroma
Clinical Features
Investigations
Treatment
Enchondroma
Clinical Features
Pathogenesis
Investigations
Treatment
Aneurysmal Bone Cyst (ABC)
Etiology
Clinical Features
Investigations
Treatment
Unicameral Bone Cyst (UBC)
Etiology
Clinical Features
Investigation
Treatment
COMMON MALIGNANT BONE TUMORS
Giant Cell Tumor (GCT) (Figs 9.8A to G)
Clinical Features
Investigations
Based on Jaffe's Grading (1940)
Treatment
Osteosarcoma
Clinical Features
Investigations
Treatment
Angiography
Surgical Procedures
Chondrosarcoma
Clinical Features
Investigations
Treatment
Ewing's Tumor
Clinical Features
Investigations
Treatment
Myeloma
Types
Clinical Features
Investigations
Treatment
METASTATIC BONE DISEASE
10:
Slipped Capital Femoral Epiphysis, Perthes' Disease and Other Osteochondritis
SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)
Predisposing Factors (Flow Chart 10.1)
Pathology of the Slip (Fig. 10.3)
Clinical Features
Investigations
Anteroposterior View
Lateral View
Frog Leg View
Radiological Classification of the Slip
Treatment
Objectives
Surgical Procedures
LEGG-CALVE-PERTHES' DISEASE
Predisposing Factors
Pathology
Radiological Features
Based on Elizabethtown Staging (Figs 10.8A to D)
Based on Catterall Grouping (Figs 10.9A to D)
Classifications Useful to Assess Prognosis
Clinical Features
Head at Risk Signs
Clinical “Head at Risk” Signs
Radiological “Head at Risk” Signs (Fig. 10.11)
Investigations
Treatment
Factors to be Considered in Planning the Treatment
Nonsurgical Containment Methods
Surgical Methods of Containment
Prognostic Factors
IDIOPATHIC AVASCULAR NECROSIS/OSTEOCHONDRITIS
Kienbock's Disease
Etiology
Investigations
Treatment
Kohler's Disease
Etiology
Investigations
Treatment
FURTHER READING
Slipped Capital Femoral Epiphysis
Perthes’ Disease
11:
Intervertebral Disc Prolapse
INTRODUCTION
Pathomechanics of Intervertebral Disc Prolapse
DIAGNOSIS
Investigations
Treatment
Nonoperative Management
Operative Management
12:
Nutritional, Endocrine, Degenerative and Autoimmune Disorders
RICKETS AND OSTEOMALACIA
Rickets
Etiology and Classification
Pathology
Clinical Features
Rickets
Osteomalacia
Assessment of Bilateral Genu Varum and Genu Valgum
Investigations
Nutritional Rickets
Vitamin D Resistant Rickets (Type II)
X-rays Changes in Rickets
X-rays Changes in Osteomalacia
Treatment
Familial and Hereditary Rickets
Correction of Deformities in Rickets (Figs 12.6A and B)
OSTEOPOROSIS
Types
Risk Factors
Pathology
Clinical Features
Investigations
Treatment
Drug Therapy
Treatment of Fractures
OSTEOARTHRITIS
Types
Etiology and Pathogenesis
Pathology
Primary
Secondary
Clinical Features
Diagnosis
Radiological Findings (Figs 12.9A to D)
Management
Nonoperative Management
Surgical (Operative) Management
RHEUMATOID ARTHRITIS
Definition
Etiology
Joints, Organs and Tissues Involved
Pathology
Clinical Features
Investigations
Blood Investigations
What is ANA (Antinuclear Antibodies)?
What is Rheumatoid Factor?
What is CCP Antibody?
X-rays (Figs 12.10B and C)
Treatment
Medical
Surgical
HYPERPARATHYROIDISM
Classification
Pathology
Effect on Kidneys
Effect on the Bone
Clinical Features
Radiological Features
In the Hand
In the Spine
In the Long Bones
In the Skull
Laboratory Investigations
Treatment
FURTHER READING
Rickets Osteomalacia and Hyperparathyroidism
Rheumatoid Arthritis
13:
Congenital and Developmental Anomalies
CONGENITAL TALIPES EQUINOVARUS
Etiology and Pathogenesis
Deformities in Clubfoot
Ligaments Involved
Medially
Posteriorly
Inferiorly
Tendons and Muscles Involved
Diagnosis
Radiological assessment of clubfoot (Figs 13.2A and B)
Talocalcaneal Index
Treatment
Nonoperative
Ponseti's Method of Manipulation (Ignacio Ponseti, 1940)
Operative Methods
CONGENITAL VERTICAL TALUS
Synonyms
Definition
Etiology
Pathological Anatomy
Bone
Ligaments
Muscles and Tendons
Diagnosis
Radiological Features (Figs 13.11A and B)
Differential Diagnosis
Congenital Oblique Talus
Treatment
One Stage Release
DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)
Predisposing Factors
Clinical Features
Up to 2–3 Months (the neonate)
Barlow's Test (Fig. 13.15A)
Ortolani's Test (Fig. 13.15B)
After 3–6 Months (the infant)
After the Child Begins to Walk
Investigations
Treatment
Nonoperative
Open Reduction
Reconstructive Procedures
SKELETAL DYSPLASIA AND OTHER CONDITIONS
Skeletal Dysplasias
Dynamic Classification of Bone Dysplasias
IMPORTANT SKELETAL DYSPLASIAS (FIG. 13.26)
Spondyloepiphyseal Dysplasia
Types
Clinical features
Radiological features
Orthopedic care
Multiple Epiphyseal Dysplasia
Achondroplasia
Types
Clinical features (Fig. 13.27)
Radiological features
Orthopedic care
Hypochondroplasia
Osteopetrosis
Types
Inheritance
Clinical features
Radiological features
Orthopedic care
Paget's Disease
Etiology
Pathology
Clinical signs and symptoms
In vestigations
Treatment
Fibrous Dysplasia
Types of fibrous dysplasia
Clinical signs and symptoms
Investigations
Treatment
Osteogenesis Imperfecta
Pathology
Classification
Clinical Features
Investigations
Treatment
Prognosis
FURTHER READING
DDH
CTEV
14:
Miscellaneous Conditions
MALLET FINGER
Etiology
Clinical Features
Treatment
BOUTONNIERE DEFORMITY
Etiology
Trauma
Rheumatoid Arthritis
Clinical Features
Treatment
TRIGGER FINGER/THUMB
Etiology
Clinical Features
Treatment
de QUERVAIN'S DISEASE
Clinical Features
Finkelstein's Test
Treatment
DUPUYTREN'S CONTRACTURE
Etiology
Clinical Features
Treatment
CARPAL TUNNEL SYNDROME
Etiology
Clinical Features
Treatment
TENNIS ELBOW
Pathology
Clinical Features
Test
Treatment
GOLFER'S ELBOW
Test
Treatment
SUPRASPINATUS TENDINITIS
Treatment
Calcific Tendinitis
Clinical Features
Treatment
SUBACROMIAL BURSITIS
Etiology
Clinical Features
Treatment
Nonoperative
Operative
PAINFUL ARC SYNDOME
Etiology
Clinical Features
Treatment
Nonoperative
Operative
PERIARTHRITIS SHOULDER
Clinical Features
Treatment
Current Concept
CALCANEAL SPUR
Etiology
Clinical Features
Treatment
GANGLION
Treatment
Nonoperative
Operative
BAKER'S CYST
Treatment
Important Differential Diagnosis
NEUROPATHIC JOINT
Etiology
Pathology
Clinical Features
Diagnosis
Treatment
CONGENITAL TORTICOLLIS OR WRY NECK
Natural Course of the Fibromatosis
Clinical Features
Diagnosis
Treatment
Role of Surgery
Type of Surgeries
Prognosis
IDIOPATHIC AVASCULAR NECROSIS OF THE HEAD OF THE FEMUR
Other Names
Clinical Features
Staging: Ficat and Arlet (1980)
(Based on this classification 4 stages are identified)
Radiological Features of AVN
Treatment
SPONDYLOLISTHESIS
Types: Based on Wiltse Classification (Figs 14.16A and B)
Etiopathogenesis
Clinical Features
Diagnosis
Treatment
Nonoperative
Operative
BURSA AND BURSITIS
MYOSITIS OSSIFICANS
Predisposing Factor
Pathophysiology
Common Sites
Treatment
15:
Fractures in Children
INTRODUCTION
TYPES OF INJURIES
Physeal Injuries
Structure of a Physis (Fig. 15.1)
Classification of Physeal Injuries based on Salter and Harris (Fig. 15.2)
Thurston Holland Sign (Shiny Corner Sign)
Diagnosis of Physeal Injuries
Management
Complications
Plastic Deformation
Buckle Fractures (Figs 15.5A and B)
Greenstick Fractures
COMMON FRACTURES IN THE LOWER LIMB: DIAGNOSIS AND MANAGEMENT
Fracture of Shaft of Femur in Children
Mechanism of Injury
Diagnosis
Treatment
Fracture of Neck of Femur in Children
Mechanism of Injury
Classification
Diagnosis
Treatment
16:
Poliomyelitis
GENERAL INFORMATION
EPIDEMIOLOGY
PATHOGENESIS
Stages of Poliomyelitis
Differential Diagnosis
Laboratory Diagnosis of Poliomyelitis
Treatment of Poliomyelitis
IMMUNIZATION AND ITS CURRENT STATUS
SKELETAL DEFORMITIES IN POLIOMYELITIS
Pathogenesis of Deformities
Preoperative Considerations
Design of Surgical Procedures
DEFORMITIES AROUND THE HIP
Role of Iliotibial Band in Contractures
Paralytic Dislocation of the Hip
Surgical Procedures for Release of Contractures
Surgical Procedures for Paralytic Dislocation of the Hip
DEFORMITIES OF FOOT AND ANKLE
Tendon Transfers and Corrective Procedures for Muscle Insufficiency
Bony Procedures for Deformity Correction
Triple Arthrodesis
Other Bony Procedures
Claw Toes
Correction of Claw Toes
17:
Cerebral Palsy
ETIOLOGY
Prenatal Causes
Natal Causes
Postnatal Causes
TERMINOLOGIES USED IN THE ASSESSMENT OF LIMB INVOLVEMENT
Monoplegia
Hemiplegia
Paraplegia
Triplegia
Quadriplegia
Whole Body Involvement
CLINICAL EVALUATION OF A CHILD WITH CEREBRAL PALSY
Signs of Prognosis
Signs of Poor Prognosis
TREATMENT
Role of Surgery
Procedures
18:
Gait
DEFINITION
PHASES (FIG. 18.1)
GAIT CYCLE
Common Terminologies Used in the Analysis of Gait
ABNORMAL GAITS
Due to Muscle Weakness, e.g. Poliomyelitis
Gluteus Maximus Lurch
Quadriceps Lurch
High Stepping Gait of Foot Drop
Calcaneus Gait
Due to Changes in the Bones and Joints
Stiff Hip Gait
Stiff Knee Gait
Short Leg Gait
Due to Abnormalities in the Nervous System
Scissors Gait
Festinant Gait
Stamping Gait
Drunkard's Gait
Hemiplegic Gait
Antalgic Gait
TRENDELENBURG GAIT (Figure 18.2)
Pathomechanics of Trendelenburg Gait
19:
Amputations
DEFINITION
INDICATIONS
TYPES OF AMPUTATIONS (Fig. 19.1)
General Amputations
Specific Amputations
Gille's Amputation
Lisfranc's and Chopart's Amputation (Ref: Foot injuries pages 61 and 63)
Syme's Amputation
Pirogoff's Amputation
Kruckenberg's Amputation
AN IDEAL STUMP OF AMPUTATION
Recommended Ideal Length of the Stump
20:
Arthroscopy and Total Joint Arthroplasty
ARTHROSCOPY
Evolution of Arthroscopes
Components of an Arthroscope
Technique
Advantages of Arthroscopic Procedures
Limitations of the Arthroscopic Procedures
Complications
Common Arthroscopic Procedures
TOTAL JOINT REPLACEMENT (ARTHROPLASTY)
Evolution
Complications
Postoperative Rehabilitation after Joint Replacement Surgery
21:
Implants and Instruments
INTRODUCTION
Materials Used for Orthopedic Implants
Desirable Properties of an Implant
Types of Implants
Types of Prosthesis
Two Types
Implant Selection
Implant Insertion
Asepsis in the Operating Room
SURFACE IMPLANTS
Screws
The Screw Design (Figs 21.3 to 21.7)
Plates (Figs 21.8 to 21.11)
Dynamic Compression Plate (DCP)
1/3 Tubular and Semitubular Plates
Limited Contact, Dynamic Compression Plate: LC, DCP (Figs 21.9A and B)
Locking Compression Plate (LCP) (Figs 21.10A to C)
SS wires
INTRAMEDULLARY IMPLANTS
Rigid Nails
Hollow Nails
Elastic Nails
Kuntscher Nail or K-nail
Rush Nail
BIODEGRADABLE IMPLANTS
Dynamic Hip Screw and a Barrel Plate (Fig. 21.17A)
Jewett Nail (Fig. 21.17B)
Cannulated Cancellous Hip Screw
GENERAL INSTRUMENTS USED IN ORTHOPEDICS (FIGS 21.20 TO 21.29)
Mallet
Chisel
Osteotome
Bone Gouge
DESIGNS OF LIMB LENGTHENING APPARATUS
Ilizarov Fixator (Fig. 21.30)
Orthofix Type (Fig. 21.31)
Wagner Type (Fig. 21.32)
INDEX
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