Prof. Anisuddin Bhatti Paediatric Orthopaedic surgeon Dr. Ziauddin University hospital Clifton Karachi Pakistan Presented how to take clinic examination short case on Congenital Knee dislocation, at HMC complex Peshawer on 24.11.2023

1. MOCK
CLINICAL EXAMINATION
CKD SORTCASE – LONG CASE
Prof. Anisuddin Bhatti
Dr. Ziuaddin University Hospital
Clifton, Karachi.
dranisbhatti@gmail.com

2. 4 short case
System
 10 Minutes on each case
 1 minutes un-observed delay in
between to switch over candidates
– 5 minutes for clinical examination
– 5 Minutes for Viva
– One examiner ask Q & other to
observe OR other examiner may ask
Q to clarify statement given by
Examinee
 Examiner gives command for what
to examine and give brief history
 Examinee can ask 1-2 relevant
questions about patient condition,
investigation or response to therapy.
 Examiner may respond verbally or
furnishes results if asked for.
 Examinee may narrate findings
• Answers are scored phase-wise on a
key.

3. CASE
EXAMPLE
Short case: CKD

5. Phase1- total 4 Marks:
Attiers 1 marks
• 1. 2 wks old baby Born NVD
• Examinee may collect some more
information on history and perform
focused examination, as asked for.
At the beginning of Viva examiner may
ask for, additional points you would like
to gather on history & examination?

6. What additional Questions U like to
ask?
1. Family history
2. Drug history
3. Oligohydromnios

7. Phase 1b
Clinical
Examination
1 marks
• Focused
clinical
examination
• Detailed MSK
Examination
If Required
• Screening
Exm: Quik
Survey
• General &
systemic Exm:
Other than
MSK

8. Detailed MSK
Examination
2 marks
LOOK, FEEL & MOVE
1. Feet ?
 CAVE
1. Knee ?
 Architecture, Deformity, Dimple
 ROM
1. Hips?
 Abduction
 Galleazi test
 Ortloni Barlows
• Spine?
 Dimple
 Bifida Occulta
• Exclude AGMC: associated
deformities

9. Detailed MSK Examination

10. Detailed MSK Examination

11. Associated Deformities with CKD
A crease-less condition
• developmental dysplasia of the hip
• clubfoot
• metatarsus adductus
• Upper limb contracture

12. Phase-2. total 6 marks
Presentation Technique & Correctness of findings
1 marks
• Limited B/L knee flexion
• B/L knee recurvatum +ve
• MCL lax
• Genu valgus
• Hip ROM normal
• Hip screening test
• Spine
• Upper limbs

13. Phase-2. Examiners Questions
2 marks
After Candidate has furnished his findings on
history and examination, Examiner may ask:
1. What is the likely diagnosis and why?
2. How to define grading of the deformity?
3. What investigations you would like to
order and why?

14. Tarek CDK Grading System
1 Mark
Add Radiological Findings

15. Phase-2:Radiological Findings
1 marks
Candidate must ask investigations:
X-Ray, LAB report
1. What do you find on X-
Ray?
2. How will you proceed
further?
If the candidate reads X-Ray
correctly, draw referral lines and
request additional imaging show him
and examiner may ask why & what?
CT / MRI

16. Phase 2.
Management
plan
2 marks.
Each section
carries 1mark
Now it may be
revealed that
examiner has
declared him fit, he
shall ask treatment
strategies.
Q. Non-operatieve
or
Operative
Justify
1. What specific
Non operative
Rx & How.
1. If failed to
achieve
satisfactory
results how to
proceed?
2. What specific
surgical
procedure you
would
undertake and
why?

17. Chun Chien Cheng &
Jih Yang Ko

18. At 5
month
age

19. Surgical
Procedure
In case of failure to achieve satisfactory result
or delayed presentation
Q. What specific surgical
procedure you would
undertake and why?
Q. What Pathoanatomic
findings U encounter
• Age < 3m: PC mini invasive
Quad tenotomy (Dobb’s)
• Age >3mon: V-Y plasty?
• Pathoanatomy to correct?
• Position of Casting?

20. Patho-anotomy:
CKD
Quadricep tendon
contracture
Anterior subluxation of
hamstring tendon
Absent suprapatellar pouch
Tight collateral ligament

21. WHEN PRESENTED AS LONG CASE
THEN THE EXAMINER CONTINUE
IN DETAILS OF
V-Y PLASTY, COMPLICATIONS,
FOLLOWUP ETC.

22. Surgical
Procedure
Define Surgical Procedure?
• V-Y plasty?
• How to tackle Pathoanatomy?
• Position of Casting?

23. Cephalad
Right knee
Rectus femoris
Vastus lateralis
Vastus medialis

24. Rectus femoris
Vastus lateralis
Vastus medialis
Cephalad end

25. Left knee
Identify
structure

26. Identify
structur

28. Post op casting
position

31. References
• Guidelines Designed by:
DR. Sirajul Haque Shaikh,
Director DME. CPSP, Karachi.
• References:
1. Harless et al 1971
2. Cook et al, 2010.
3. Huang G, Reynolds R, Candler
C.
• Clinical Material:
Prof. Anisuddin Bhatti’s
collection
THANK YOU FOR PATIENCE