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CRPS — Budapest Criteria
Define CRPS — Budapest Criteria with common etiologies and pathoanatomy. List key classifications or staging systems used in exams. Clinical features and focused examination; special tests as applicable. Imaging: first‑line and advanced; measurements that change management. Nonoperative indications and protocols. Operative indications; approach and key steps. Implant/technique options with pros/cons. Complications and how to prevent/manage them. Rehabilitation milestones and outcome expectations...
Open topicCubital Tunnel Syndrome - Entrapment Neuropathy
Cubital Tunnel Syndrome (CuTS) is the second most common upper-limb compression neuropathy and results from compression of the ulnar nerve at the elbow, most commonly within the cubital tunnel behind the medial epicondyle. It typically presents with numbness and tingling in the little finger and ulnar half of the ring finger, often worsening with prolonged elbow flexion or pressure on the elbow. Progressive disease leads to intrinsic hand muscle weakness, reduced grip strength, positive Froment...
Open topicDanis–Weber Classification — Ankle (Fibula Level)
A: infra-syndesmotic; B: at syndesmosis; C: supra-syndesmotic (Maisonneuve possible). Instability rises from A→C; C requires ORIF with syndesmotic fixation.
Open topicDelbet–Colonna Classification — Paediatric Femoral Neck Fractures
Type I: Transepiphyseal (with/without dislocation) — highest AVN risk. Type II: Transcervical (through the neck). Type III: Cervicotrochanteric (basicervical). Type IV: Intertrochanteric. AVN risk decreases from I → IV; urgent reduction and stable fixation reduce complications.
Open topicDenis Classification — Sacral Fractures (Zones)
Zone 1: lateral to foramina (alar) — low neuro risk. Zone 2: through foramina — higher L5/S1 root risk. Zone 3: medial to foramina (central canal) — highest cauda equina risk.
Open topicDenis Three-Column — Thoracolumbar Injuries
Compression: anterior column only — usually stable. Burst: anterior + middle columns — unstable, canal compromise risk. Flexion-distraction (Chance): posterior tension failure — unstable. Fracture-dislocation: all three columns — highly unstable, neuro injury common.
Open topicDevelopmental Dysplasia of Hip (DDH) — Pavlik to Osteotomy
Early detection with Barlow/Ortolani; ultrasound (Graf) guides treatment under 6 months. Pavlik harness is first‑line for reducible dislocation under ~6 months; avoid excessive extension/abduction to reduce AVN risk. Failed Pavlik → closed reduction and spica; if unstable/obstructed, open reduction with capsulorrhaphy and femoral shortening/derotation as needed. Residual acetabular dysplasia treated with pelvic osteotomies (Salter, Pemberton, Dega) based on age and pathology. Complications: AVN...
Open topicDevelopmental Dysplasia of Hip (DDH) — Screening & Management
Spectrum: acetabular dysplasia to frank dislocation. Risk factors: breech, female, family history, oligohydramnios. Clinical: Ortolani & Barlow tests in neonates; Galeazzi sign, limited abduction in infants. Imaging: USG (Graf classification) 18 months).
Open topicDiscoid Meniscus
Congenital variant where meniscus is thickened and disk-shaped. Most common in lateral meniscus (incidence 1–3%). Clinical: snapping, pain, locking in children/young adults. Imaging: X-ray may show widened joint space; MRI confirms discoid shape. Treatment: asymptomatic—observe; symptomatic—saucerization + repair.
Open topicDislocation after THA — Risk Factors & Management
Incidence 1–3% after primary THA; higher in revision. Risk factors: posterior approach, malpositioned cup (anteversion 25°, inclination >60°). Patient factors: neuromuscular disease, dementia, noncompliance. Management: closed reduction, bracing; revision for recurrent instability. Prevention: proper cup position, posterior repair, large femoral heads.
Open topicDistal Femur Fractures
AO 33 classification. Locking plate vs retrograde nail. Principles: joint first, then shaft. Complications: nonunion, malalignment, stiffness.
Open topicDistal Radius — Colles/Smith/Barton
Colles: extra-articular, dorsal tilt; Smith: extra-articular, volar tilt; Barton: intra-articular rim fracture. Clinical deformities: dinner-fork (Colles), garden-spade (Smith). Stability factors: dorsal comminution, >20° angulation, >5 mm shortening, intra-articular involvement. Treatment: closed reduction/cast vs volar plate fixation. Complications: malunion, CRPS, post-traumatic arthritis.
Open topicDupuytren’s Contracture
Fibroproliferative disorder of palmar fascia causing fixed flexion deformity of fingers. Risk factors: male, >40 years, northern European descent, diabetes, alcoholism, smoking. Commonly affects ring and little finger; cords/nodules palpable. Hueston’s tabletop test positive (cannot place palm flat on table). Treatment: needle aponeurotomy, limited fasciectomy, collagenase injection; recurrence common.
Open topicDVT Prophylaxis in Orthopaedics
Risk high in hip/knee arthroplasty, hip fracture surgery, pelvic/acetabular trauma, prolonged immobility. Options: LMWH, DOACs (apixaban/rivaroxaban), aspirin (selected low‑risk arthroplasty), mechanical methods (IPC/stockings). Duration: 10–14 days minimum; up to 35 days after hip fracture/arthroplasty. Balance bleeding risk (neuraxial anesthesia timing) with VTE prevention.
Open topicElbow Dislocations — Terrible Triad
Terrible triad = posterior elbow dislocation + radial head fracture + coronoid fracture. Highly unstable pattern, requires surgical fixation of all components. Goal: concentric reduction + early mobilization in stable arc. Complications: stiffness, recurrent instability, arthritis, heterotopic ossification.
Open topicElbow Stiffness — Release
Functional elbow arc ≈ 30–130° flexion and 50°/50° pronation–supination (Morrey). Common causes: trauma, HO, prolonged immobilization, intra‑articular fracture, infection. Initial treatment: therapy, static/dynamic splinting, CPM; MUA in early soft‑tissue contracture. Operative options: arthroscopic or open capsular release ± HO excision ± ulnar nerve transposition. Complications: recurrence, instability, nerve injury (ulnar), HO recurrence.
Open topicEnchondroma vs Osteochondroma
Enchondroma: intramedullary cartilage tumor, common in hand phalanges. Osteochondroma: cartilage-capped exophytic lesion from metaphysis. Syndromes: Ollier, Maffucci (enchondroma); Multiple Hereditary Exostoses (osteochondroma). Malignant transformation rare in solitary lesions, higher in syndromic cases. Treatment: observation, excision if symptomatic or suspicious.
Open topicEpiphyseal Growth Plate — Zones & Regulation
Zones: reserve (resting), proliferative, hypertrophic (maturation, degeneration, provisional calcification). Regulation: Ihh/PTHrP feedback loop, GH/IGF‑1 axis, local factors (TGF‑β, BMPs, FGFs, Wnt). Hypertrophic zone is weakest → site of Salter‑Harris fractures. Vascular invasion and endochondral ossification occur at metaphyseal side. Clinical: growth arrest, bar formation, angular deformity after physeal injury; SCFE affects hypertrophic zone. Imaging: physeal widening (rickets), metaphyseal...
Open topicEvans/Jensen — Intertrochanteric Femur
Stable: intact posteromedial buttress; Unstable: posteromedial comminution, reverse obliquity, subtrochanteric extension. Stable → DHS; Unstable → cephalomedullary nail/fixed-angle device.
Open topicEwing’s Sarcoma — Protocols
Second most common malignant bone tumor in children/adolescents after osteosarcoma. Characterized by t(11;22) → EWS-FLI1 translocation. Common sites: diaphysis of long bones, pelvis, ribs. Onion-skin periosteal reaction on X-ray is classical. Treatment: multi-agent chemotherapy (VDC/IE), surgical resection ± radiotherapy. Overall survival ~70% in localized disease,
Open topicExpandable Prosthesis in Paediatric Oncology
Indicated for skeletally immature patients undergoing limb-salvage near a growth plate (e.g., distal femur/proximal tibia). Designs: minimally invasive magnetically driven expanders vs older surgical-lengthening types. Aims to maintain limb length equality during growth while preserving function and oncologic safety. Complications: infection, mechanical failure, soft-tissue problems, stiffness; multiple lengthenings required. Requires multidisciplinary follow-up through growth until maturity.
Open topicExtensor Mechanism Failure after TKA
Includes quadriceps tendon rupture, patellar fracture, patellar tendon rupture, patellar component failure. Risk factors: previous surgery, patellar resurfacing, malalignment, steroid use. Presentation: extensor lag, inability to extend knee, palpable gap. Management: direct repair (acute), augmentation with graft/allograft (chronic). High failure rates with chronic repairs — need reinforcement.
Open topicExternal Fixators — Concepts
Types: uniplanar, biplanar, circular. Biomechanics: stiffness ↑ with larger pins, more pins, wider spread, closer frame. Indications: open fractures, polytrauma, infected nonunion, limb lengthening. Advantages: minimal soft tissue stripping, adjustability. Disadvantages: pin site infection, stiffness, bulky frame.
Open topicFat Embolism Syndrome
Classically 24–72 h after long‑bone/pelvic fractures or IM reaming; triad: hypoxemia, neurological signs, petechiae. Diagnosis is clinical; supported by Gurd’s criteria (1 major + 4 minor) or Schonfeld score (>5). ABG hypoxemia, CXR fluffy infiltrates; brain MRI 'starfield' pattern on DWI. Prevention: early stabilization of long bone fractures; careful reaming/venting. Management: supportive (oxygen/PEEP, fluids), avoid overload; steroids controversial.
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