Carries sicca
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Caries sicca is a rare form of tuberculosis affecting the shoulder joint, comprising 1-3% of skeletal tuberculosis cases. It mainly involves the head of the humerus and progresses to involve the glenoid cavity and joint space. Caries sicca presents with insidious onset of pain in the shoulder, especially at night, and patients typically present 3-6 months later due to gradual progression. Radiological findings include periarticular osteoporosis, peripheral bony erosion, and gradual narrowing of the joint space. The mainstay of treatment is early diagnosis and anti-tubercular chemotherapy, with early gentle mobilization advised to retain functional gain.
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Hemiarthroplasty of Hip joint
Hemiarthroplasty involves replacing the femoral head while retaining the natural acetabulum. It is commonly used to treat fractures of the femoral neck in elderly patients. There are two main types - unipolar, which replaces just the head, and bipolar, which adds an inner bearing. Selection depends on factors like bone quality and joint stability. Cemented stems are generally preferred in patients with poor bone stock, while uncemented can be used if bone is adequate. Positioning and fixation are important to optimize function and stability.
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Avascular necrosis (AVN) of the femoral head is a pathologic process that results from interruption of blood supply to the bone. AVN of the hip is poorly understood, but this process is the final common pathway of traumatic or nontraumatic factors that compromise the already precarious circulation of the femoral head. Femoral head ischemia results in the death of marrow and osteocytes and usually results in the collapse of the necrotic segment
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The document discusses spinal tuberculosis, noting that it causes delays in diagnosis, long recovery periods, and high costs. Key points include:
- Paralysis occurs in up to 50% of spinal tuberculosis patients.
- Early diagnosis, expedient treatment, aggressive surgery, and preventing deformity lead to the best outcomes.
- Diagnosis relies on tests like tuberculin skin tests, imaging like MRI to identify bone destruction and abscesses, and microscopy and culture of samples.
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This document discusses proximal humerus fractures, including:
- They are common in older patients and often result from low-energy falls.
- Classification systems include the AO/OTA system and Neer system, which categorizes fractures as one, two, three, or four-part based on displacement of fragments.
- Nondisplaced or minimally displaced one-part fractures are most common and are typically treated non-operatively with rest and sling immobilization.
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This document discusses radial nerve injury, including its anatomy, causes, clinical presentation, diagnostic workup, and management. It describes the radial nerve's course from the brachial plexus into the arm and forearm. Radial nerve injuries can be caused by fractures, compression, or traction injuries. Clinical examination involves assessing motor function of wrist and finger extensors and sensory function on the back of the hand. Management includes nonsurgical treatment, nerve repair or grafting, and tendon transfers in chronic cases. The goal of treatment is to restore wrist and finger extension through nerve regeneration or reconstruction of function.
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- Anatomy of the acetabulum and its components
- Mechanisms and classifications of acetabular fractures
- Evaluation through radiographs and CT scans
- Management considerations including operative vs non-operative treatment and various surgical approaches
- Specifics on fracture types, indications for surgery, timing of surgery, and surgical approaches for different fractures
The document contains detailed information on evaluating and treating acetabular fractures.
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1) Malunion is defined as the healing of bone fractures in an abnormal position and can be caused by failed nonoperative or operative treatment.
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3) Surgical treatment may involve osteotomies to correct deformities, with fixation methods depending on the location and stability required. The goal is anatomical correction to improve function and prevent further issues like arthritis.
Chronic osteomyelitis
Chronic osteomyelitis is difficult to treat and eradicate completely. It is characterized by infected dead bone within scarred soft tissue. Treatment requires long-term antibiotics as well as extensive surgical debridement to remove all infected and dead bone. Multiple surgical procedures may be needed to eliminate residual infection by removing bone sequestra and draining sinus tracts. Even with aggressive treatment, complications like reinfection, joint stiffness, and limb deformity are common.
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Chronic osteomyelitis is a bone infection lasting over 6 weeks. It is characterized by recurrent inflammation, draining sinuses, and dead bone. Common causes are Staphylococcus aureus and other bacteria. Over time, the infection causes bone necrosis and formation of sequestra - dead bone pieces. Surgical treatment aims to thoroughly debride infected tissue, remove sequestra, and reconstruct the bone defect. Antibiotic therapy and soft tissue coverage are also important for treatment. Complications can include pathological fractures, deformity, and malignant transformation if not properly treated.
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This document discusses Monteggia fractures, which involve a fracture of the ulna bone in the forearm combined with a dislocation of the radial head. It begins with a historical description of the injury and provides details on epidemiology and classifications. Bado's classification system from 1958 divides Monteggia fractures into four main types based on the direction of radial head dislocation and location of the ulna fracture. The document discusses mechanisms of injury, clinical evaluation, radiographic assessment, non-operative and operative management approaches, potential complications, and emphasizes the importance of anatomic reduction and stabilization of both the ulna fracture and radial head dislocation.
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This document discusses avascular necrosis (AVN) of the bone, also known as osteonecrosis. It begins by explaining that AVN results from interrupted blood supply to the bone, which can lead to bone and cell death. The most common sites of AVN are the femoral head, scaphoid, and talus. Non-surgical treatments include limited weight bearing, while surgical options include core decompression, bone grafting, and osteotomies to preserve the joint. More advanced cases may require joint replacement like hip resurfacing or total hip arthroplasty. Risk factors include corticosteroid use, alcoholism, trauma, and various medical conditions.
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The document discusses extracapsular intertrochanteric hip fractures. It describes the anatomy and classification systems for these fractures. Conservative management involves traction but is associated with high complication rates. Internal fixation with devices like the dynamic hip screw or proximal femoral nail is now the standard of care to allow early mobilization. Surgical techniques like closed or open reduction may be used along with supplemental procedures like medial displacement osteotomy in unstable patterns.
Cubitus varus deformity
Cubitus varus, or gunstock deformity, is caused by malunion of supracondylar fractures and results in the forearm being deviated inward at the elbow with loss of the carrying angle. It is a triplanar deformity involving varus, hyperextension, and internal rotation. Treatment options include observation for young children, hemiepiphysiodesis to alter growth, and corrective osteotomy. The lateral closing wedge osteotomy is commonly used to safely correct the varus deformity through removal of a lateral wedge. Other techniques include medial opening wedge, oblique, dome, and step-cut osteotomies. Postoperative management focuses on immobilizing the arm in extension
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This document discusses avascular necrosis of the femoral head, also known as osteonecrosis. It begins by providing a brief history and definitions. It then discusses the blood supply of the femoral head and covers traumatic vs. non-traumatic causes. Risk factors for atraumatic osteonecrosis like corticosteroids, alcohol abuse, smoking, and others are outlined. The pathophysiology section explores theories of arterial occlusion, fat emboli, and increased bone marrow pressure as causes. Signs and symptoms, diagnostic imaging methods, staging classifications, and non-operative and operative treatment options are summarized.
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This document provides an overview of Legg Calve Perthes disease, including its definition, demographics, risk factors, pathogenesis, clinical features, investigations, classifications, management, and surgical procedures. Some key points:
- It is avascular necrosis of the femoral head in children, most common in ages 4-8 years. Positive family history and low birth weight are risk factors.
- Clinical features include hip/thigh pain aggravated by movement. Imaging shows stages from avascular necrosis to fragmentation to regeneration/healing.
- Conservative management includes bracing for young/mild cases. Surgical containment is used for more severe/older cases to encourage spherical remodeling.
- Procedures
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This document provides an overview of giant cell tumor, a type of benign bone tumor. It discusses the definition, epidemiology, clinical presentation, investigations, grading, differential diagnosis, and treatment options. Giant cell tumor commonly involves the ends of long bones and is locally aggressive, destroying bone tissue. While benign, it can occasionally metastasize. Treatment typically involves curettage with the use of adjuvants like phenol or bone cement to reduce the high risk of recurrence. Reconstruction of residual defects is often done with bone grafts or cement.
Tuberculosis of hip
Tuberculosis of the hip is caused by Mycobacterium tuberculosis infection. It typically affects people aged 20-30 years old. The infection spreads hematogenously from a primary focus and causes destruction of bone and joints over several years. Clinical features include limping, decreased range of motion, and deformities in advanced cases. Imaging shows osteopenia, joint space narrowing, and bone erosion. Treatment involves chemotherapy for at least 6-9 months along with local measures like joint aspiration and traction. Surgery may be needed for debridement, arthrodesis, or arthroplasty in advanced cases.
Blounts disease
Blount's disease, also known as tibia vara, is a progressive orthopedic condition that causes bowing of the legs in children. It results from a growth disturbance in the proximal medial tibial growth plate. The deformity includes varus alignment of the knees, internal tibial torsion, and leg length discrepancy. Radiographs show a characteristic wedging and irregularity of the proximal medial tibial epiphysis. Treatment depends on age and severity, ranging from bracing to corrective osteotomies. Congenital metatarsus adductus is another common pediatric foot deformity involving inward twisting of the forefoot. It is often mild and resolves with stretching, but more severe cases may require
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This document provides information on tuberculosis of the skeletal system, with a focus on vertebral tuberculosis. It begins with an introduction and history of the topic. It then discusses the epidemiology, pathogenesis, clinical presentation, investigations including imaging findings, laboratory tests, classifications, treatment approaches including drug regimens and surgical indications and techniques. Key points covered include the high prevalence of skeletal TB in India, typical radiological features, classification of neurological deficits, Tuli's middle path treatment regime, and various surgical approaches for abscess drainage and spinal decompression/stabilization.
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- Other conditions discussed include adhesive capsulitis (frozen shoulder), biceps tendon disorders, calcific tendinitis of the shoulder, and tuberculosis of the glenohumeral joint. A variety of imaging tools and both nonsurgical and surgical treatment approaches
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Wrist drop
The radial nerve innervates the extensor muscles of the forearm and hand. Damage to the radial nerve causes wrist drop where the patient is unable to extend the wrist and fingers, impairing grasping. Symptoms include pain, numbness, weakness of hand grip and drooping of the wrist and fingers. Diagnosis involves assessing range of motion, imaging tests and electrodiagnostic tests. Treatment depends on the underlying cause but may include medications, injections, bracing and physical therapy.
Tourniquets
Tourniquets are devices used to control blood flow to an extremity during surgery. Various types of tourniquets have been developed throughout history including the Esmarch bandage and modern pneumatic tourniquets. Proper tourniquet placement and pressure are important to minimize complications like nerve injury, muscle injury, and bleeding. Tourniquet time should be limited to 1.5-2 hours to avoid local and systemic effects. Complications can be further reduced by following precautions during tourniquet application and use.
Torticollis
Torticollis is a twisting of the neck that can have several causes. In newborns, it is often due to injuries during birth or fetal positioning, while in older children it may result from neck injuries, infections, or other conditions. The document discusses the main types and causes of torticollis, including congenital muscular torticollis in newborns, self-limiting torticollis, trauma, infections, tumors, and certain drugs. Ultrasound is often used to diagnose congenital cases in newborns, while CT and MRI are used to diagnose other causes like trauma, infections, or tumors in older children. Treatment depends on the underlying cause but may include stretching, physical therapy
Thoracic outlet syndrome
Thoracic outlet syndrome occurs when the blood vessels or nerves in the thoracic outlet - the space between the lower neck and upper chest - become compressed. This can cause pain and numbness in the shoulders and neck as well as reduced pulse. It is commonly caused by anatomical variations like cervical ribs or muscle abnormalities that reduce the space available to the neurovascular structures passing through. Diagnosis involves clinical tests like Adson's maneuver and imaging like MRI. Treatment ranges from physiotherapy and analgesics for mild cases to surgical removal of the first rib and scalene muscles for more severe or progressive cases.
Tennis elbow
Tennis elbow, also known as lateral epicondylitis, is a tendinopathy of the common extensor tendon near the lateral epicondyle of the elbow. It results from repetitive microtears in the tendon due to overuse from activities involving forceful wrist extension. Clinically, it presents as lateral elbow pain that worsens with activities like handshaking or turning a doorknob. Physical examination reveals tenderness over the lateral epicondyle. While most cases resolve with conservative treatment like rest, NSAIDs, bracing, and physical therapy within 6-12 months, surgical debridement may be considered for persistent or recurrent cases.
Tendo achilles
The Achilles tendon connects the calf muscles to the heel bone and is active during walking, running, and jumping. It is vulnerable to rupture, which commonly occurs in the watershed area 2-6cm above the heel in males ages 25-50 during sports. Diagnosis involves physical exam findings like inability to raise the toes and a gap or defect being felt. Treatment options include immobilization in a cast or surgical repair, with the goal of restoring proper tension and length. Post-operative care focuses on protecting the repair during healing over 6 months using casts, braces, and physical therapy.
Surgical site infections
Surgical site infections occur when bacteria enter through an incision made during surgery. They are classified as superficial, deep, or organ/space infections. Common causative agents include Staphylococcus aureus and Streptococcus pneumoniae. Factors that increase risk include patient health issues like malnutrition or diabetes as well as surgical factors like poor technique, inadequate prophylactic antibiotics, or an unclean operating environment. Diagnosis involves clinical signs plus lab and imaging tests. Treatment consists of antibiotics, wound debridement, and drainage. Prevention strategies focus on proper patient preparation, strict sterile techniques in the operating room, and careful post-operative wound care.
Spinal cord tractography
Diffusion tensor imaging (DTI) and fiber tractography are MRI techniques that can be used together to non-invasively visualize spinal cord tracts. DTI measures the anisotropic diffusion of water in tissue to infer the orientation of white matter tracts. Fiber tractography then generates 3D reconstructions of the tracts. This technique provides information about spinal cord injuries or other pathologies. However, it faces challenges from motion artifacts and has limitations when tracts converge or cross or are non-homogeneous. Despite this, DTI tractography can be used to prognosticate outcomes from spinal cord deformities, injuries, tumors, or myelopathies. Two case studies are described, one with a C6 burst fracture
Snapping hip syndrome
There are three main types of snapping hip: external, internal, and intra-articular. External snapping hip is caused by increased tension in the iliotibial band over the greater trochanter with repeated flexion and extension. Internal snapping hip involves snapping of the iliopsoas tendon over the femoral head. Intra-articular snapping hip is caused by labral tears or loose bodies in the hip joint. Conservative treatments include rest, stretching, strengthening, and therapies like cold compression, while operative options involve procedures like Z-plasty of the iliotibial band or arthroscopic surgery to address intra-articular issues.
Scurvy
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- Symptoms include bleeding gums, loose teeth, bruising of the skin, and bone fractures. In infants, scurvy can cause pseudoparalysis and swelling over bones from subperiosteal hemorrhaging.
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Screws in orthopedics
This document provides an overview of screws in orthopedic surgery. It discusses the history of screw development from ancient times through modern innovations in materials. The anatomy of a screw is described in detail, including the head, shaft, thread, tip, and special features like pitch, diameter, and cannulation. Different types of screws are compared based on their properties and intended uses in cortical versus cancellous bone. Special screw designs like Herbert screws, lag screws, and dynamic hip screws are also briefly mentioned.
Sacral chordoma
Sacral chordoma is a rare, slowly growing malignant tumor that arises from remnants of the notochord, usually occurring in the sacrum. It accounts for 1-4% of all malignancies and is the most common primary malignancy of the sacrum. Patients typically experience lower back pain worsening with sitting in their 5th-7th decade. Imaging shows a destructive lytic lesion in the sacrum. Complete surgical resection is the primary treatment, but recurrence is common due to the locally aggressive nature, leading to poor long-term survival rates.
Robotics in orthopedics
This document discusses the use of robots in orthopaedic surgery. It describes how robotic systems can improve accuracy of bone cuts and component placement compared to manual surgery. Both autonomous and haptic robotic systems are presented. Applications discussed include unicondylar knee replacement using the Mako robotic arm and spinal pedicle screw placement using the Renaissance system. While robotic surgery may provide benefits like increased accuracy, it also has drawbacks such as high costs and long-term outcomes have not proven superiority over manual techniques.
Reverse shoulder arthroplasty
Reverse shoulder arthroplasty involves replacing the humeral head and glenoid fossa with prosthetics to alter the center of rotation and increase deltoid tension and function. It is indicated for rotator cuff tear arthropathy, proximal humeral fractures in the elderly, failed shoulder replacements, and other conditions. The procedure involves an deltopectoral approach to expose the joint, removal of the humeral head and shaping of the glenoid, then implantation of the glenosphere and humeral cup components. Outcomes are best for osteoarthritis and worse for trauma or revision cases. Complications can include infection, nerve injury, implant loosening or breakage.
Prolapsed intervertebral disc
The intervertebral disc consists of three main components: the cartilage end plates, the nucleus pulposus, and the annulus fibrosus. Degeneration of the intervertebral disc is a natural aging process but can be exacerbated by factors like poor nutrition, trauma from sports or injuries, and biomechanical factors related to posture and repetitive microtrauma. The degenerative process typically begins with softening of the nucleus pulposus and weakening of the annulus fibrosus, which can lead to protrusion or extrusion of the nucleus through tears in the annulus. Eventually fibrosis and calcification may occur as the body attempts to repair the degenerated disc.
Pre operative care
The document outlines the steps involved in pre-operative care, which includes conducting a pre-anaesthetic checkup of the patient's medical history and current health status. A series of blood investigations, imaging tests like ECG, ultrasound, and radiological tests are performed. The patient's medication needs and consent for the procedure are also addressed. The pre-operative preparation involves both physical and psychological preparation of the patient by explaining the procedure and potential complications to calm them before surgery.
Plantar fascitis
Plantar fasciitis is a painful condition caused by inflammation of the plantar fascia, a thick ligament connecting the heel to the toes. The pain is usually felt on the bottom of the foot near the heel and is worst upon waking or after long periods of sitting. Repeated microtears in the fascia from overuse can cause degeneration and inflammation. Risk factors include obesity, excessive running or prolonged standing, especially with inadequate foot support. Treatment focuses on reducing inflammation and strain through stretching, orthotics, night splints, and physical therapy exercises.
Pigmented villonodular synovitis
Pigmented villonodular synovitis is an idiopathic overgrowth and pigmentation of the synovial membrane that most commonly affects the knee joint. It presents with pain, swelling, stiffness, and recurrent atraumatic hemorrhaging in the joint. Diagnosis is made through arthroscopic biopsy showing characteristic chocolate-colored lesions. Treatment involves surgical synovectomy or radiation therapy, with recurrence being a potential complication.
Pes cavus
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
Peri arthritis shoulder
This document discusses periarthritis shoulder, also known as frozen shoulder. It is characterized by significant restriction of both active and passive shoulder movements, especially external rotation, due to inflammatory changes and fibrosis in the shoulder joint capsule. It typically affects females aged 40-60 and risk factors include diabetes and thyroid dysfunction. Treatment involves physiotherapy, analgesics, and steroid injections, with manipulation under anesthesia or arthroscopic capsular release considered for cases of more severe symptoms or those that fail to improve after 4-6 months of conservative treatment.
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Carries sicca
- 1. Caries sicca
- 2. • Caries sicca is a rare form of tuberculosis affecting shoulder joint • Incidence is 1-3 % of skeletal tuberculosis • Males > females
- 3. • Head of humerus mainly involved • Progressively involving glenoid cavity and joint space • Predominantly seen in adults • Tuberculosis of shoulder joint divided into two forms mainly • Dry form ( caries sicca) • Wet / fulminant form ( caries exudata)
- 4. • Caries sicca involves mainly adults • Caries fulminant involves mainly children • Mainly presented by degenerative changes in shoulder joint involving head of humerus , joint space , glenoid cavity and associated with pain which is aggravated by movements • Reduction in joint space is a Delayed finding • Advanced cases lead to inferior subluxation of humerus head and fibrous ankylosis
- 5. Clinical features • Presents with pain in insidious onset ,often at night • Patients usually present 3-6 months later due to gradual progression of disease • On examination • Shoulder muscles atrophy • Prominent bony landmarks • Reduced movements in all directions and painful • Sometimes misdiagnosed as adhesive capsulitis • Generalized tenderness present which is uncommon finding in adhesive capsulitis
- 6. Radiological findings • PHEMISTER’S TRIAD • Periarticular osteoporosis • Peripheral located bony erosion • Gradual narrowing of joint space
- 7. • For confirmatory diagnosis • Synovial fluid aspiration and biopsy is recommended to prove histopathologically •
- 8. • Differential diagnosis • Rheumatoid arthritis • Adhesive capsulitis • Osteoarthritis • Gout • Osteochondromatosis
- 9. • In rheumatoid arthrtis , bony erosion and osteoporosis is accompanied by early joint space reduction while in caries sicca joint space reduction is delayed finding and rheumatoid arthrtis may be associated with other clinical features • In gout osteoporosis is mild or absent • Adhesive capsulitis , there is no joint space reduction and xray shows normal shoulder joint • In osteochondromatosis xray shows calcified and ossified loose bodies
- 10. Treatment • Mainstay of treatment for caries sicca early diagnosis and Anti tubercular chemotherapy • Previously shoulder immobilisation with chemotherapy had been recommended • But currently early akt drugs and early gentle mobilisation advised to retain functional gain.
- 11. • Patients with delayed presentation and with shoulder arthrosis, surgical management is recommended • Shoulder arthroplasty is advised for the functional outcome
- 12. Thank you