short & fast presentation for medical students to revise orthopedic basic topics . #dr_azanki

1. Ortho PreTest
Abdallah Jomaa El Azanki MBBS, MSc
Orthopedic Surgery & Traumatology Assistant Lecturer
Mansoura Uni. Hospital
Cedar Tree
of Lebanon

2. How to Read an X-Ray!!!

3. Mind the color difference!!!!

4. Sites of each bone:
Fracture or lesion is mentioned according to a specific site

5. Systematic reading of x-rays
 Information to read from an X-ray :
 Quality (soft-old)
 Date of x-ray (recent, old)
 Name and date of birth of the patient (age matters  epiphysis !!)
 Side of extremity/ body
 Views (1 or more !! each what it shows)
 Specific comment( fracture, lesion etc….)
 Never to forget the Joint above Joint Below Principle

6. Two views help to fully describe the fracture (2-planes).
It is easy to miss a fracture with only one view

7.  One of the two fractures could be
missed in an x-ray not showing the
entire bone
 Joint injury could be missed with just
one x- ray
 Both adjacent joints need to be seen.
Just a shaft view is NEVER enough !!!!

8. Types of Fracture
Simple
transvers
e fracture

9. Simple
spiral
fracture

10. Simple
oblique
fracture

11. Wedge
fracture

12. Multi-fragmentary
(comminuted)
fracture

13. Described the Fracture Type!!!!
 fracture displacement is described Too
(related to the distal part always)
 Shortening
 Angulation
 Rotation

14. Sample
 Short oblique fracture of the Lt Femur with:
 Medial dislocation
 Shortening
 Varus displacement

15. ARE YOU
READY!!!!!!

16. Identify the fracture
1.Which bone?
2.Which part of the bone?
3.Which type of fracture?
Test-1

17. Fractures are not always easily
identified!!!!!
Follow the cortex

18. ARE YOU
SATISFIED!!!!!!!!!
Is that enough!!!!!!
Never hesitate to ask for CT scan if needed
(not well defined fracture, near articular
surface)

19. Test -2
Describe the fracture.
1.Which bone?
2.Which part of the bone?
3.Which type of fracture?

21. El Karaoun- West Bekaa, Lebanon
Welcome Back 

22. Femoral Neck Fractures

23. Anatomic Classification of the NOF :
Subcapital Transcervical Basal Neck

24. Type I Incomplete, valgus impacted
Type II Complete fx. Non-displaced
Type III Complete, partially displaced
Type IV Complete, fully displaced
Garden Classification (Displaced or Non)

25. Type I
Type II
Type III
Type IV

26.  High energy in young patients (Tx—Fixation)
 Low energy falls in older patients (Tx– Arthroplasty)
 Most common complications :
 Osteonecrosis (AVN)
 Nonunion
 Failed Osteosynthesis
 LLD
 Sciatic N injury
 Infection

28. Supracondylar Humerus Fracture in
Pediatrics
Once you see, check:
 Edema (compartmental
Syndrome)
 Distal Pulse (radial, ulnar A)
 Distal Nerve Function ( AIO N)

29. Type I Non-displaced (hair line Fx)
Type II Displaced ( Posterio Cortex & Periost. Intact)
Type III
Displaced, often in 2 or 3 planes (but Post Periost.
Intact)
Type IV
Displaced, Complete periost. Disruption + instability in
flexion & extension
Gartland Classificaiton
Flexion type!!!!!!!
extension type

30.  Fall on outstretched hand
 Extension type - most common
 Flexion type -less common (<5%)
Complication of SCH Fx (PREOP):
 AIO nerve neurapraxia (branch of median
n.)
 Radial N
 Ulnar N
 Vascular Injury (Brachial A)

31. Complication of SCH Fx (PostOP):
Ulnar N ( by K-wire)
 Vascular Injury (Brachial A)
Infection
K-wire Migration
Cubitus valgus ( Ulnar Nerve Palsy )
Cubitus varus (medial comminution,
usually cosmetic deformity)

32. Treatment:
by CRIF

33. He did it …but still he can see and smell 

34. Club Foot – Congenital Talipes
EquinoVerus

35.  Idiopathic deformity of the foot of unclear etiology
 Most common musculoskeletal birth defect
 Half of cases are bilateral
Muscle contractures contribute to the
characteristic deformity that includes (CAVE)
 Cavus (tight intrinsics, FHL, FDL)
 Adductus of forefoot (tight tibialis posterior)
 Varus (tight tendoachilles, tibialis posterior, tibialis anterior)
 Equinus (tight tendoachilles)

36. Tx of Club Foot ----- > Mostly by Ponseti method
•Heel cord tenotomy needed in at least 80-90% of children in most
series
•Foot abduction orthosis (FAO)

37. If failed or recurrent!!!!!!!
1- Soft Tissue Release (posteromedial)
2- Osteotomy
3-Fusion

39. Interpretation !!!!!
R
Test - 3

40. Test - 4

41. Hope you enjoyed…..
#dr_azanki