Tarsal coalition
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This document discusses tarsal coalition, which is a partial or complete union between bones in the midfoot or hindfoot that can cause rigid pes planus. It notes that tarsal coalition increases strain on the interosseous talocalcaneal ligament and subtalar joint, causing peroneal muscle spasm. The document describes the different types of tarsal coalition and lists the typical ages at which each type becomes symptomatic. It provides details on calcaneonavicular and talocalcaneal coalition, including their clinical features, diagnosis via x-ray, and treatment options.
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Tarsal coalition
Tarsal coalition is a congenital condition caused by abnormal fusion of two or more tarsal bones, most commonly the calcaneus and navicular. It is usually asymptomatic but can cause a flatfoot deformity or recurrent ankle sprains. Imaging such as x-rays, CT, or MRI is used to identify the specific bones fused and determine if the coalition is fibrous, cartilaginous, or bony. Treatment options include conservative management or surgical resection or fusion of the bones.
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Tarsal coalition
Tarsal coalition is a congenital condition caused by abnormal fusion of two or more tarsal bones, most commonly the calcaneus and navicular. It is usually asymptomatic but can cause a flatfoot deformity or recurrent ankle sprains. Imaging such as x-rays, CT, or MRI is used to identify the specific bones fused and determine if the coalition is fibrous, cartilaginous, or bony. Treatment options include conservative management or surgical resection or fusion of the bones.
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Tarsal coalition is a condition where a bridge of bone or cartilage restricts or prevents motion between two or more tarsal bones. It is caused by incomplete division during development and commonly leads to a rigid flat foot. Tarsal coalitions can be classified by tissue type, anatomical location, or an articular classification system dividing them into juvenile and adult types. Common coalitions involve the talocalcaneal and calcaneonavicular joints. Clinical features include foot pain and stiffness while imaging shows a bony bridge between affected joints. Treatment ranges from non-operative options to surgical procedures like resection, fusion, or triple arthrodesis depending on type and symptoms.
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Osteochondroma is a benign bone tumor that projects from the external surface of bones. It consists of a bony projection capped with cartilage. The majority of osteochondromas are solitary lesions that present during childhood in long bones like the femur or humerus. Multiple or hereditary osteochondromas can occur as part of genetic syndromes. Osteochondromas are usually asymptomatic but can cause pain or neurological symptoms from local effects. Malignant transformation is rare in solitary lesions but higher in hereditary forms. Imaging plays a key role in diagnosis and follow up, with plain radiographs, CT and MRI used to characterize lesions. Surgical excision is reserved for symptomatic osteochondromas.
Club foot / CTEV
PATHOLOGICAL ANATOMY of club foot, treatment of CTEV and clubfoot, pirani score of CTEV, surgical procedures of club foot
Common peroneal nerve lesions
Common peroneal nerve lesions often present with foot drop and loss of sensation in the lower leg and foot. The common peroneal nerve is susceptible to injury where it passes between muscles in the leg and around the fibula bone. Injuries can occur from trauma, fractures, compression, ischemia or tight footwear and result in weakness of ankle dorsiflexion. Physical exams may show reduced foot movement and sensation loss while nerve conduction studies can identify injuries. Treatment focuses on bracing, stimulation, positioning and protective devices to prevent foot drop and sprains.
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anatomy and biomechanics of Shoulder joint
The document provides an overview of the anatomy and biomechanics of the shoulder joint. It discusses the following key points:
1. The shoulder joint is formed by the articulation of the humerus, scapula, and clavicle. It includes the glenohumeral, acromioclavicular, sternoclavicular, and scapulothoracic joints.
2. The glenohumeral joint is a ball and socket synovial joint that allows a wide range of motion but is structurally weak. Its stability depends on static stabilizers like muscles, ligaments, labrum and dynamic stabilizers like the rotator cuff.
3.
Shock
Shock is a state of low tissue perfusion that impairs cellular respiration. It results from decreased blood flow caused by factors like blood loss, dehydration, heart issues, or infection. Left untreated, shock progresses through stages as the body's compensatory mechanisms fail. Types include hypovolemic, cardiogenic, obstructive, distributive, and neurogenic shock. Treatment focuses on identifying and treating the underlying cause while improving cardiac output and tissue perfusion through fluid resuscitation, oxygen supplementation, antibiotics for infection, and other interventions depending on the shock type. Monitoring includes vital signs, urine output, blood tests, and imaging to guide resuscitation goals like adequate blood pressure, urine output, and oxygen levels
Scoliosis
This document provides information about scoliosis, including its definition, types, classification, and treatment. Scoliosis is defined as a lateral curvature of the spine combined with vertebral rotation. There are different types classified by cause (idiopathic, congenital), location of curvature, magnitude of curvature (Cobb's angle), and flexibility. Treatment depends on the type and severity of scoliosis, and may include bracing, casting, spinal instrumentation/fusion surgery. The goal is to prevent curve progression and cardiopulmonary compromise.
Scaphoid fractures
1) The scaphoid bone lies at the radial side of the wrist and bridges the proximal and distal carpal rows. It has a vulnerable blood supply and is prone to fractures from falls onto the outstretched hand.
2) Scaphoid fractures are difficult to diagnose on standard X-rays and often require additional views or MRI to detect. Clinical tests like the Watson shift test can reproduce pain.
3) Treatment depends on the fracture location and stability. Most distal fractures heal with casting but unstable or proximal fractures may require surgery like screw fixation to achieve union. Nonunion can lead to post-traumatic arthritis requiring salvage procedures like scaphoidectomy.
Perthes
This document discusses Legg-Calvé-Perthes disease (LCPD), a condition where the blood supply to the femoral head is disrupted, causing bone cell death. As the necrotic bone breaks down and is reabsorbed, the femoral head can become misshapen. The summary is:
LCPD involves avascular necrosis of the femoral head, leading to bone resorption and potential deformity. Treatment aims to contain the femoral head within the acetabulum during healing to restore its shape, and may include bracing, osteotomies or arthrodiastasis. Surgical options depend on the stage, extent of involvement and deformity present.
Pelvic injuries
This document provides information on pelvic injuries, including anatomy, mechanisms of injury, classification systems, evaluation, and management. The pelvic ring is composed of the sacrum and two innominate bones. High energy injuries can cause pelvic ring disruptions while low energy injuries usually fracture individual bones. Injuries are classified based on the Young-Burgess or Tile systems. Evaluation involves inspection, palpation, and radiographic imaging. Management depends on the stability of the injury, with non-operative treatment for stable fractures and external or internal fixation for unstable injuries. Complications include thromboembolism and high mortality rates depending on the injury pattern.
Nutritional rickets
Nutritional rickets is caused by vitamin D deficiency, calcium deficiency, or both. It results in softening of bones and skeletal deformities as mineralization fails at growth plates. Main causes are lack of vitamin D from sunlight exposure or diet, impaired absorption from malnutrition or digestive disorders, and rare hepatic or renal issues. Symptoms include skull bossing, delayed fontanelle closure, limb deformities, and bone pain. X-rays show widened growth plates and bone changes. Treatment is high dose oral vitamin D supplements with calcium as needed. Surgery may correct severe deformities not resolved by medical treatment.
Mx of distal radius fractures
1) Closed reduction is recommended for all distal radius fractures to limit swelling and provide pain relief, even if later surgical treatment is anticipated.
2) Indications for closed treatment include non or minimally displaced fractures, displaced fractures with a stable pattern that is expected to heal with acceptable alignment, and low demand elderly patients.
3) Acceptable reduction criteria include ulnar variance within 2mm, no more than 2mm of shortening, neutral palmar tilt, and radial inclination of at least 10 degrees.
Median nerve
This document provides information on the median nerve including its course, branches, and clinical significance. It begins with the median nerve's origin from the brachial plexus and course through the arm. It then describes branches and distribution in the forearm, hand, and injuries such as carpal tunnel syndrome. Clinical tests for median nerve function and management options are also summarized.
Intracapsular fracture neck of femur
This document discusses intracapsular fractures of the femoral neck. It notes that these fractures most commonly occur in elderly women from low-energy falls. Risk factors include older age, female sex, osteoporosis, and previous fractures. Relevant anatomy including vascular supply and bone structure are described. Mechanisms of injury are low-energy trauma like falls or high-energy impacts. Fractures are classified based on displacement and angulation. Clinical signs include inability to bear weight and leg rotation. Treatment depends on age and fracture type, and may include fixation with screws or plates, osteotomies, hemiarthroplasty or total hip replacement. Complications can include nonunion, osteonecrosis, and
Foot drop
This document discusses foot drop, which is caused by weakness of the dorsiflexors and evertors of the foot due to common peroneal nerve palsy. It describes the anatomy of the common peroneal nerve and its branches. Causes of foot drop include trauma, infection, metabolic conditions, and toxins. Clinical features are loss of dorsiflexion and high stepping gait. Management includes ankle foot orthoses, tendon transfers like Ober's technique or Kaufer's technique, and tendoachilles lengthening. The goal is to prevent deformity and improve gait.
Gait cycle
The document summarizes the gait cycle and its phases. It describes that the gait cycle begins when one foot strikes the ground and ends when the same foot strikes again. The cycle consists of a stance phase, where the foot is on the ground, and a swing phase, where the foot is off the ground. It then provides details on the sub-phases of the stance and swing phases, muscle contractions during gait, gait parameters, and pathological gaits caused by musculoskeletal and neuromuscular problems.
Elbow dislocation
1) Elbow dislocations are most commonly posterior dislocations, which occur due to a combination of hyperextension, valgus stress, arm abduction, and forearm supination.
2) Treatment depends on whether the dislocation is simple or complex, with associated fractures or ligament injuries requiring operative management like open reduction and repair of soft tissues.
3) The terrible triad of elbow injuries involves a dislocation with fractures of the radial head and coronoid process, requiring restoration of stability through fixation of the fractures and repair of collateral ligaments.
Dupuytrens disease
Dupuytren's disease is a condition where the normal palmar and digital fascia is replaced by abnormal fibrous tissue containing immature fibroblasts. It commonly affects the ring finger. Risk factors include family history, smoking, and diabetes. In advanced stages, it can cause hand contractures. Treatment options range from observation to corticosteroid injections to surgery like fasciectomy or dermofasciectomy to release contractures. Post-surgical complications can include recurrence, nerve damage, or wound healing issues.
Developmental dysplasia of hip
This document provides information on developmental dysplasia of the hip (DDH). It discusses the definition, causes, incidence, clinical findings, pathology, diagnosis through imaging like ultrasound and X-rays, and treatment approaches for different age groups from newborns to older children. Key tests like Barlow, Ortolani and imaging classifications including Graf are outlined. The main treatment mentioned is use of Pavlik harness for young infants, while older infants may require traction and closed reduction or open reduction if closed fails.
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Tarsal coalition
- 1. TARSAL COALITION Dr. Harsha Nandini Talasila M.S. ORTHO
- 2. • Complete or partial union between 2 or more bones in the midfoot or hindfoot. • Cause of Peroneal Spastic Flat Foot and rigid Pes planus.
- 3. • Normal: interosseous talocalcaneal ligament is under least strain when the foot is in valgus. • Tarsal coalition increases the strain on interosseous talocalcaneal ligament and subtalar joint • Peroneal muscles go into spasm.
- 4. ETIOLOGY • Failure of primitive mesenchyme to segment by cleavage
- 5. CAUSES • GENETIC: Autosomal Dominant Inheritence • INCIDENCE: 1 to 2 % • BILATERALNESS: 70% in calcaneonavicular coalition 20-50% talocalcaneal coalition
- 6. TYPES • SYNCHONDROSIS • SYNOSTOSIS • SYNDESMOSIS Symptomatic when coalition begins to ossify
- 7. • TALONAVICULAR COALITION : 2-4years • CALCANEONAVICULAR COALITION : 8-12years • TALOCALCANEAL COALITION: 12-16 years
- 8. CALCANEONAVICULAR COALITION • CLINICAL FEATURES: Dorsolateral pain Painful limp Decreased subtalar motion Hindfoot valgus
- 9. XRAY • SLOMAN VIEW: 45 degree internal oblique view
- 10. TREATMENT • CAST FOR 3-6WEEKS • IF no improvement: surgical resection of bar and filling of defect with extensor digitorum brevis or fat. • In adults with degenerative joint: TRIPLE ARTHRODESIS
- 11. TALOCALCANEAL COALITION/HARRIS BAR • CLINICAL FEATURES: Foot fatigue Marked loss of subtalar motion Tenderness at sinus tarsi/talonavicular joint
- 12. XRAY • Beaking of head of talus @ dorsal articular margin • Broadening /rounding of lateral process of talus • Narrowing of posterior talocalcaneal joint space • Asymmetry anterior facet of subtalar joint • Due to convexity of dome of talus: APPARENT BALL AND SOCKET ANKLE JOINT
- 13. TREATMENT • Short leg cast • Steroid injection at sinus tarsi • If no response: Resection of bar and interposition of fat/bone wax • If extensive coalition/degenerative arthritis: TRIPLE ARTHRODESIS
- 14. THANK YOU