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#WRWU Image Based Discussion - Orthopaedics
Marrow
1:07:52
Overview
This video provides a comprehensive, image-based review of essential orthopaedic concepts for examinations. It covers a wide range of topics, from common fractures and splinting devices to classifications of open fractures and surgical interventions. The presenter uses numerous X-rays and clinical images to illustrate conditions such as greenstick fractures, stress fractures (March and Jones), dislocations (anterior and posterior shoulder), and various elbow and wrist fractures (supracondylar, Holstein-Lewis, Colles', Smith's, and chauffeur's). It also delves into nerve palsies (radial, median, ulnar), deformities (cubitus varus/valgus, pes planus, pes cavus), and specific conditions like congenital pseudoarthrosis of the tibia and osteogenesis imperfecta. The session emphasizes differentiating between similar-looking conditions and understanding key radiological signs and clinical presentations for accurate diagnosis and management.
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Chapters
- •Introduction to orthopaedics as a visual subject and the importance of image interpretation.
- •Identification and use of the Thoms splint for lower limb fractures, particularly femur fractures.
- •Identification and use of the Bohler-Braun splint for lower limb fractures, including femur and tibia, and prevention of equinus deformity.
- •Distinguishing between greenstick fractures (unicortical, convex side, in children) and torus fractures (buckling, in children).
- •Understanding normal femur anatomy and identifying shaft fractures.
- •Intramedullary nailing for femur shaft fractures leads to secondary healing (with callus formation).
- •Compression plating with screws for forearm fractures leads to primary healing (without callus).
- •Differentiating primary (intramembranous) and secondary (endochondral) bone healing based on fixation methods.
- •Congenital pseudoarthrosis of the tibia: characterized by anterolateral angulation and association with neurofibromatosis.
- •Gustilo-Anderson classification for open fractures based on wound size and contamination.
- •Understanding the nuances of Type 3A, 3B (periosteal stripping), and 3C (vascular compromise) classifications.
- •Introduction to external fixators: conventional, rail fixator (LRS), Ilizarov ring fixator, and spanning external fixators.
- •Normal foot anatomy and identification of abnormalities.
- •March fracture: stress fracture in the neck of the metatarsals, typically the second or third.
- •Jones fracture: fracture at the base of the fifth metatarsal with poor healing potential.
- •Understanding the vascular watershed zone in the base of the fifth metatarsal.
- •Normal shoulder anatomy and identification of clavicle fractures.
- •Anterior shoulder dislocation: characterized by a flattened shoulder contour and the humeral head displaced anteriorly.
- •Posterior shoulder dislocation: identified by the 'light bulb sign' where the humeral head appears spherical.
- •Holstein-Lewis fracture: fracture of the humeral shaft, often associated with radial nerve injury.
- •Supracondylar humerus fracture: fracture above the condyles, common in children.
- •Differentiating supracondylar humerus fractures from Holstein-Lewis fractures.
- •Gartland's classification for supracondylar humerus fractures (Type 1, 2, 3).
- •Complications of supracondylar humerus fractures: cubitus varus (malunion) and myositis ossificans.
- •Distinguishing cubitus varus (medial deviation, from supracondylar fracture) from cubitus valgus (lateral deviation, from lateral condyle fracture).
- •Montaggia fracture: ulnar shaft fracture with radial head dislocation.
- •Galeazzi fracture: radial shaft fracture with distal radioulnar joint disruption.
- •Normal wrist anatomy, identifying radius, ulna, scaphoid, and lunate.
- •Colles' fracture: extra-articular distal radius fracture with dorsal displacement ('dinner fork' deformity).
- •Smith's fracture: extra-articular distal radius fracture with volar displacement ('garden spade' deformity).
- •Chauffeur's fracture: fracture of the radial styloid.
- •Scaphoid fracture: often at the waist, associated with pain in the anatomical snuffbox.
- •Scapholunate dissociation: increased gap between scaphoid and lunate ('terrycloth' sign).
- •Boxer's fracture: fracture of the fifth metacarpal neck.
- •Mallet finger: hyperflexion injury causing avulsion of the extensor tendon at the DIP joint.
- •Attitudes of hip dislocation: posterior (flexion, adduction, internal rotation) and anterior (flexion, abduction, external rotation).
- •Shenton's line as a reference for hip dislocation.
- •Intracapsular (neck femur) vs. extracapsular (intertrochanteric) femur fractures.
- •Management of intertrochanteric fractures: proximal femoral nail or dynamic hip screw.
- •Hemiarthroplasty and total hip replacement for femur neck fractures.
- •Trendelenburg test: assessing hip abductor weakness (gluteus medius/minimus) or coxa vara.
- •Thomas test (flexion contracture test) for hip flexion deformities.
- •Normal knee and ankle anatomy, including tibial tuberosity and malleoli.
- •Gallows traction for femur fractures in children under 2 years.
- •Transverse patellar fracture: treated with tension band wiring.
- •Bipartite patella: congenital anomaly, often bilateral.
- •Malleolar fractures: Pilon (trimalleolar) and Weber (bimalleolar) classifications.
- •Calcaneal fractures and Hawkins classification for talar neck fractures.
- •Popliteal sign: rupture of the long head of the biceps tendon.
- •Olecranon bursitis ('student's elbow').
- •Shepherd's crook deformity: seen in fibrous dysplasia.
- •Fallen leaf sign: seen in simple bone cysts.
- •Osteochondroma (exostosis): abnormal growth from the growth plate.
- •Enchondroma: benign cartilaginous tumor, common in small bones.
- •Giant cell tumor (osteoclastoma): epiphyseal lesion in skeletally mature individuals, often near the articular surface.
- •Aggressive bone lesions: Codman's triangle, sunburst/sunray appearance, onion peel (lamellated) periosteal reaction.
- •Claw hand (ulnar nerve palsy) vs. ape hand (median nerve palsy).
- •Tests for ulnar nerve function: Card test, Froment's sign, Wartenberg's sign, Jigawa test.
- •Tests for median nerve function: Pen test, OK sign (Kenevin sign), pointing index (benediction sign).
- •Wrist drop (radial nerve palsy): often associated with humeral shaft fractures.
- •Policeman's tip/Waiter's tip deformity (Erb's palsy): adduction, internal rotation, elbow extension, forearm pronation.
- •Foot drop: common peroneal nerve palsy due to proximal fibula fracture, leading to high-stepping gait.
- •Carpal tunnel syndrome tests: Phalen's test, reverse Phalen's test, Durkan's test (thumb compression).
- •Roos test for thoracic outlet syndrome.
- •Rickets: cupping, fraying, widening of growth plates; white line of Frankel in healing rickets.
- •Genu varum ('bow legs') and genu valgum ('knock knees'): causes include rickets and idiopathic.
- •Scurvy: white line of Frankel, Vamberger's ring sign.
- •Codfish/fish mouth vertebrae: biconcave endplates, common in osteoporosis.
- •Wedge compression fracture: shortened anterior vertebral body, seen in flexion injuries.
- •Rugger jersey spine: sclerosis of endplates, seen in renal osteodystrophy.
- •Picture frame vertebrae: sclerosis of anterior and posterior vertebral body margins, seen in Paget's disease.
- •Ivory vertebra: dense, sclerotic vertebra.
- •Cotton wool skull and tam o'shanter skull: seen in Paget's disease.
- •Osteogenesis imperfecta: blue sclera, bone deformities.
- •Chronic osteomyelitis: discharging sinus, sequestrum, involucrum, cloaca, loss of corticomedullary differentiation.
- •Brodie's abscess: subacute osteomyelitis with a central lucency and sclerotic rim.
- •Clay shoveler's fracture: avulsion of spinous process.
- •Chance fracture (seat belt fracture): horizontal fracture through vertebral body and posterior elements.
Key Takeaways
- 1Accurate interpretation of X-rays is crucial in orthopaedics, requiring knowledge of normal anatomy and common fracture patterns.
- 2Understanding different types of bone healing (primary vs. secondary) is essential for selecting appropriate fixation methods.
- 3Classifications like Gustilo-Anderson for open fractures and Gartland's for supracondylar humerus fractures provide standardized approaches to diagnosis and management.
- 4Recognizing specific radiological signs (e.g., 'light bulb sign', 'dinner fork deformity', 'shepherd's crook') aids in diagnosing conditions.
- 5Knowledge of nerve palsies and their associated clinical tests (e.g., Phalen's, Tinel's, Froment's) is vital for neurological assessment.
- 6Deformities like cubitus varus/valgus, pes planus, and genu varum/valgum have distinct causes and clinical implications.
- 7Differentiating between intracapsular and extracapsular hip fractures is important for treatment planning and prognosis.
- 8Metabolic bone diseases like rickets, scurvy, and Paget's disease have characteristic radiographic findings.
- 9Aggressive bone lesions often present with periosteal reactions like Codman's triangle and sunburst appearance, requiring further investigation.
- 10Common orthopaedic conditions like carpal tunnel syndrome and trigger finger have specific clinical tests and anatomical involvements.