Tuberculosis of the hip is a rare form of skeletal tuberculosis that can lead to significant deformity if not treated properly. It typically begins as a tuberculous synovitis that can progress to arthritis and destruction of the hip joint if left untreated. Treatment involves a combination of anti-tubercular medications for at least one year as well as rest and traction to prevent deformities. For more advanced cases, surgical procedures like synovectomy, osteotomies or arthrodesis may be needed. With adequate treatment, outcomes can be good, especially if caught early, but significant deformity can negatively impact function.
This document discusses septic arthritis of the hip in children. It defines septic arthritis and notes that the hip is the most commonly infected joint in children. Early diagnosis and treatment is important to prevent joint damage. Signs include limping, groin pain, and limited hip movement. Treatment involves identifying the organism, administering sensitive antibiotics, and potentially surgery. Long term sequelae can include joint deformities, leg length discrepancies, and arthritis. Various classification systems and treatment approaches are presented. Prevention of septic arthritis through early diagnosis and management is emphasized.
This document discusses tuberculosis of the hip joint. It begins by describing the causative organism, Mycobacterium tuberculosis, which is an acid-fast bacillus. It then covers the pathophysiology of tuberculosis infection in the hip, including the formation of tubercles and caseation necrosis. The document outlines the clinical presentation of TB of the hip and its radiographic appearance. It discusses the different stages of TB arthritis in the hip and associated radiographic findings. The document concludes by covering treatment approaches for TB of the hip including chemotherapy, traction, arthroplasty, arthrodesis and osteotomy.
This document discusses cubitus varus, which is a deformity where the forearm is deviated inward at the elbow joint, reducing the normal valgus angle. It describes the causes, types, clinical examination findings, measurements on x-rays, and treatment options. The most common treatment involves corrective osteotomy, with various techniques described such as lateral closing wedge osteotomy, medial open wedge osteotomy, oblique osteotomy, and dome osteotomy. Complications of osteotomy include stiffness, nerve injury, persistent or recurrent deformity, non-union, and skin issues.
The hip joint is a ball and socket synovial joint that connects the femur to the acetabulum. It is the largest and most stable joint in the body. The hip joint allows for flexion, extension, abduction, adduction, and rotation. Several strong ligaments reinforce the hip joint capsule to provide stability, including the iliofemoral, ischiofemoral, and pubofemoral ligaments. The main muscles that act on the hip joint are the gluteal muscles, iliopsoas, quadriceps femoris, hamstrings, and adductors.
Nonunion definition, causes, classification and managementBipulBorthakur
This document discusses nonunion fractures, including definitions, classifications, causes, and management approaches. It begins by defining nonunion and discussing factors that can lead to nonunion, such as poor vascularity, instability, and infection. It then summarizes several classification systems for nonunions. The document outlines local and systemic risk factors for nonunion and describes diagnostic tools. It provides an overview of surgical management principles and specific treatment approaches, including external/internal fixation, bone grafting, and bone stimulation techniques.
This document discusses infected non-union, which occurs when the healing process stops due to mechanical or biological failure. It classifies infected non-unions based on the extent of infection and describes various classification systems. These include the Weiland, Cierny-Mader, Umiarov, G.S. Kulkarni, Gordon, and May classifications. The document also discusses the pathogenesis of infected non-union, how infection causes non-union, diagnosis, and the goals and methods of treatment, which include eradicating infection, achieving bone union, and addressing soft tissue issues. Treatment involves antibiotics, debridement, bone grafting, electrical or ultrasound stimulation, and sometimes vascularised bone gra
Poller or blocking screws are used to stabilize fractures treated with small diameter intramedullary nails. They guide the nail like "poller" traffic devices guide vehicles. Blocking screws increase stability of distal and proximal metaphyseal fractures after nailing and can help manage malunited fractures. They work by narrowing the canal to guide the nail anteriorly and prevent sagittal plane deformity. Blocking screws are typically placed medially and laterally as close to the fracture as possible for optimal stabilization. Their placement on the concave side of deformities helps improve reduction by deflecting the nail.
CORA (center of rotation of angulation)Morshed Abir
This document discusses the concept of the center of rotation of angulation (CORA) in orthopedic surgery. The CORA is the point about which a deformed bone may be rotated to achieve correction of an angular deformity without introducing a translational deformity. Proper identification of the CORA allows selection of the optimal correction axis and type of osteotomy, such as opening, closing, or dome osteotomy, to realign the bone. Correction along the bisector line passing through the CORA ensures pure angular correction without residual translation. Identification of multiple CORAs indicates more complex multi-apical or translational deformities requiring different surgical techniques.
This document discusses septic arthritis of the hip in children. It defines septic arthritis and notes that the hip is the most commonly infected joint in children. Early diagnosis and treatment is important to prevent joint damage. Signs include limping, groin pain, and limited hip movement. Treatment involves identifying the organism, administering sensitive antibiotics, and potentially surgery. Long term sequelae can include joint deformities, leg length discrepancies, and arthritis. Various classification systems and treatment approaches are presented. Prevention of septic arthritis through early diagnosis and management is emphasized.
This document discusses tuberculosis of the hip joint. It begins by describing the causative organism, Mycobacterium tuberculosis, which is an acid-fast bacillus. It then covers the pathophysiology of tuberculosis infection in the hip, including the formation of tubercles and caseation necrosis. The document outlines the clinical presentation of TB of the hip and its radiographic appearance. It discusses the different stages of TB arthritis in the hip and associated radiographic findings. The document concludes by covering treatment approaches for TB of the hip including chemotherapy, traction, arthroplasty, arthrodesis and osteotomy.
This document discusses cubitus varus, which is a deformity where the forearm is deviated inward at the elbow joint, reducing the normal valgus angle. It describes the causes, types, clinical examination findings, measurements on x-rays, and treatment options. The most common treatment involves corrective osteotomy, with various techniques described such as lateral closing wedge osteotomy, medial open wedge osteotomy, oblique osteotomy, and dome osteotomy. Complications of osteotomy include stiffness, nerve injury, persistent or recurrent deformity, non-union, and skin issues.
The hip joint is a ball and socket synovial joint that connects the femur to the acetabulum. It is the largest and most stable joint in the body. The hip joint allows for flexion, extension, abduction, adduction, and rotation. Several strong ligaments reinforce the hip joint capsule to provide stability, including the iliofemoral, ischiofemoral, and pubofemoral ligaments. The main muscles that act on the hip joint are the gluteal muscles, iliopsoas, quadriceps femoris, hamstrings, and adductors.
Nonunion definition, causes, classification and managementBipulBorthakur
This document discusses nonunion fractures, including definitions, classifications, causes, and management approaches. It begins by defining nonunion and discussing factors that can lead to nonunion, such as poor vascularity, instability, and infection. It then summarizes several classification systems for nonunions. The document outlines local and systemic risk factors for nonunion and describes diagnostic tools. It provides an overview of surgical management principles and specific treatment approaches, including external/internal fixation, bone grafting, and bone stimulation techniques.
This document discusses infected non-union, which occurs when the healing process stops due to mechanical or biological failure. It classifies infected non-unions based on the extent of infection and describes various classification systems. These include the Weiland, Cierny-Mader, Umiarov, G.S. Kulkarni, Gordon, and May classifications. The document also discusses the pathogenesis of infected non-union, how infection causes non-union, diagnosis, and the goals and methods of treatment, which include eradicating infection, achieving bone union, and addressing soft tissue issues. Treatment involves antibiotics, debridement, bone grafting, electrical or ultrasound stimulation, and sometimes vascularised bone gra
Poller or blocking screws are used to stabilize fractures treated with small diameter intramedullary nails. They guide the nail like "poller" traffic devices guide vehicles. Blocking screws increase stability of distal and proximal metaphyseal fractures after nailing and can help manage malunited fractures. They work by narrowing the canal to guide the nail anteriorly and prevent sagittal plane deformity. Blocking screws are typically placed medially and laterally as close to the fracture as possible for optimal stabilization. Their placement on the concave side of deformities helps improve reduction by deflecting the nail.
CORA (center of rotation of angulation)Morshed Abir
This document discusses the concept of the center of rotation of angulation (CORA) in orthopedic surgery. The CORA is the point about which a deformed bone may be rotated to achieve correction of an angular deformity without introducing a translational deformity. Proper identification of the CORA allows selection of the optimal correction axis and type of osteotomy, such as opening, closing, or dome osteotomy, to realign the bone. Correction along the bisector line passing through the CORA ensures pure angular correction without residual translation. Identification of multiple CORAs indicates more complex multi-apical or translational deformities requiring different surgical techniques.
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
This study evaluates the outcomes of 18 patients who underwent surgical dislocation of the hip using Ganz's technique to treat Pipkin fractures of the femoral head. Pipkin fractures are rare fractures that occur when the femoral head fractures as a result of a posterior hip dislocation. Traditional approaches provide limited exposure, while Ganz's technique allows 360 degree visualization through an anterior dislocation of the femoral head. The study found statistically significant improvements in functional scores at 1 year follow up, with no cases of avascular necrosis, demonstrating that Ganz's technique is an effective and safe method for treating these complex fractures.
Osteotomies around the hip are surgical procedures used to correct biomechanical alignment and load transmission across the hip joint. They involve removing a portion of bone. The goals are to improve femoral head coverage, containment, motion, relieve pain, and correct leg length discrepancies. Different types of osteotomies target the proximal femur or pelvis. Proximal femoral osteotomies are classified based on anatomical location and degree of displacement. Pelvic osteotomies aim to redirect the acetabulum and include Salter, Sutherland, Steel/Tonnis, and Ganz/Bernese procedures. Key considerations for each procedure include indications, approach, osteotomy cuts made, advantages/disadv
This document provides an overview of the anatomy of the ankle joint and ankle arthrodesis (fusion). It describes the bones and ligaments that make up the ankle joint, including the tibia, fibula, and talus. It discusses the indications, contraindications, surgical technique, and postoperative care of ankle arthrodesis, which is performed to treat ankle arthritis and pain. The optimal position for fusion is slight dorsiflexion with mild hindfoot valgus and external rotation. Preoperative planning involves assessing bone quality, alignment, and arthritis in other joints like the subtalar.
This document discusses nonunion of femoral neck fractures, which have a higher incidence in young patients compared to elderly patients. It defines nonunion and outlines the vascular anatomy and causes of nonunion. Classification systems for femoral neck fractures are described. Symptoms, investigations, and radiographic signs of nonunion are provided. Treatment options are discussed, including head-salvaging versus head-sacrificing procedures based on factors like patient age and viability of the femoral head. The Sandhu classification system for staging nonunion is presented along with recommended treatment approaches for each stage.
Slipped capital femoral epiphysis (scfe)farranajwa
This document provides an overview of slipped capital femoral epiphysis (SCFE). SCFE is a displacement of the femoral epiphysis through the proximal growth plate, usually occurring gradually in obese adolescent boys. Risk factors include obesity, endocrine disorders, and sexual immaturity. Clinically, patients present with hip or knee pain and limping. Examination reveals limited hip movement and leg length discrepancy. X-rays and MRI show displacement of the growth plate. Treatment depends on stability and degree of slip, ranging from pinning to corrective osteotomy. Complications include avascular necrosis and osteoarthritis.
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
This document discusses outcomes of treating distal tibia fractures using minimally invasive plate osteosynthesis (MIPO) technique. It provides an overview of the MIPO surgical procedure and reviews several studies comparing MIPO to traditional open reduction and internal fixation. The studies found MIPO resulted in high union rates, shorter healing times, and fewer complications like infection compared to open reduction. MIPO preserves the fracture site's blood supply and limits soft tissue damage, allowing for better callus formation and healing.
Legg - Calve - Perthes disease is a self-limiting disorder of the hip caused by reduced blood flow and necrosis of the femoral head. It most commonly affects boys ages 4-8 and is characterized by pain and limping. While the exact cause is unknown, factors such as blood clotting disorders, abnormal arterial or venous blood flow, growth delays, trauma, genetics, and environmental influences may play a role in reducing blood supply to the femoral head. Treatment aims to allow the femoral head to remodel itself through non-weight bearing or minimal weight bearing methods.
Poller screws, also known as blocking screws, are non-interlocking screws placed outside an intramedullary nail to improve fracture reduction and fixation. They provide a more rigid construct by serving as a surrogate cortex where nail-cortex contact is insufficient. Their placement helps centralize the guidewire in the medullary canal and maintains reduction through a blocking effect. While there is no consensus on their exact placement, they are generally inserted on the concave side of expected deformities to prevent malalignment during nailing.
This document discusses the sequelae and management of septic arthritis. Septic arthritis results in inflammation and destruction of the joint space. This can lead to several orthopedic sequelae including joint destruction, bony or fibrous ankylosis, fractures, limb length discrepancy, and persistent infection. The management depends on factors like the patient's age, delay in treatment, and extent of joint involvement. Treatment may include conservative measures, surgical stabilization, deformity correction, lengthening procedures, or arthrodesis to achieve a stable, mobile joint without pain. Classification systems help guide treatment, with the goal of optimizing long term function and quality of life.
This document discusses various osteotomies around the hip joint. It begins with defining osteotomy and providing a brief history of important developments. It then explains the biomechanics of the hip joint and why osteotomies are effective. Several types and classifications of osteotomies are outlined. Specific procedures like McMurray's displacement osteotomy, Pauwel's varus osteotomy, and Schanz angulation osteotomy are described in detail. Contraindications and postoperative care are also mentioned.
A Lisfranc injury involves fracture or ligament disruption of the tarsometatarsal joint complex of the midfoot. It results from high-energy twisting or axial loading injuries and often requires surgical fixation to achieve proper anatomical reduction. Non-operative treatment may be considered for non-displaced or minimally displaced injuries. Proper diagnosis involves weight-bearing radiographs to assess joint congruity, and sometimes CT or MRI. Surgical management focuses on anatomical reduction and stable fixation of the joints to allow early weight bearing and prevent post-traumatic arthritis.
These documents contain past examination questions from orthopedics qualifications at Dr. NTR University of Health Sciences in Vijayawada, India. The questions cover topics in basic medical sciences relevant to orthopedics, and require short essay answers. Sample topics include bone healing, calcium metabolism, gait analysis, synovial fluid analysis, bone scans, fractures, joint disorders, metabolic bone diseases, and orthopedic implants. The exams provide questions over multiple years to test students' understanding of fundamental orthopedic science concepts.
The document discusses classifications and treatment approaches for subtrochanteric fractures of the femur. It describes Fielding and Seinsheimer classifications which categorize fractures based on their location and number of fragments. Temporary options include a Thomas splint for unstable patients. Surgical treatments involve plates, intramedullary nails, or external fixators. Precise surgical approaches depend on the fracture location and stability. Potential complications are also noted.
Please find the power point on Fracture of Talus with well diagrammatic explanation from very reliable sources. If you need such a power point on different topics related with MBBS then please write it on comment section. Thank you
Blount disease is a developmental condition characterized by disordered bone growth of the medial proximal tibia, resulting in genu varum deformity of the knee. It is most common in overweight children ages 2-5 years old. Management options depend on the stage and severity of deformity, and may include bracing, osteotomies, hemiepiphyseodesis, or guided growth with external fixation. The goal of treatment is to correct alignment and prevent long term complications like osteoarthritis.
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
Distal radius fractures account for up to 20% of emergency department fractures. They typically result from a fall on an outstretched hand. Diagnosis involves history of injury mechanism and physical exam finding of wrist deformity and pain with movement. Classification systems help understand fracture patterns and challenges. Treatment depends on factors like stability, alignment, comminution and patient age/demands. Options include closed reduction with casting, percutaneous pinning, external fixation, plating, and open reduction with internal fixation. Complications can include arthritis, loss of motion, nerve issues, contractures and nonunion.
This document discusses tuberculosis of the knee joint. It begins by providing background on skeletal tuberculosis and noting that the knee joint is the third most common site. It then describes the typical 3 stage progression of knee joint tuberculosis over 3-5 years from synovial involvement to joint destruction to repair. Key diagnostic signs and symptoms at each stage are outlined. Treatment approaches are also summarized, including use of antitubercular drugs, drainage of abscesses, traction, synovectomy, and arthrodesis.
1) Tuberculosis can infect bones and joints, with the spine being a common site. Other sites include the skull, phalanges, and greater trochanter.
2) Risk factors include malnutrition, poor sanitation, crowded living conditions, and immunodeficiency. Radiographs are used to diagnose and assess bone destruction and joint space narrowing.
3) Advanced imaging like CT and MRI help evaluate bone marrow edema, paravertebral abscesses, and spinal cord compression. Ultrasound can detect tuberculous abscesses. Joint involvement may initially cause effusions before erosions occur.
This document discusses bone and joint infections, focusing on osteomyelitis, septic arthritis, and tuberculosis of the bone and joints. It covers the typical causative organisms, presentations, investigations, treatments and potential sequelae of each condition. For osteomyelitis, it describes the progression of infection and radiological appearance. Septic arthritis is an emergency requiring drainage of pus and high dose antibiotics. Bone and joint tuberculosis commonly affects the spine, hips and knees, presenting with pain, stiffness and deformity on x-ray. Treatment involves prolonged antibiotic therapy with possible surgery for severe cases or paralysis.
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
This study evaluates the outcomes of 18 patients who underwent surgical dislocation of the hip using Ganz's technique to treat Pipkin fractures of the femoral head. Pipkin fractures are rare fractures that occur when the femoral head fractures as a result of a posterior hip dislocation. Traditional approaches provide limited exposure, while Ganz's technique allows 360 degree visualization through an anterior dislocation of the femoral head. The study found statistically significant improvements in functional scores at 1 year follow up, with no cases of avascular necrosis, demonstrating that Ganz's technique is an effective and safe method for treating these complex fractures.
Osteotomies around the hip are surgical procedures used to correct biomechanical alignment and load transmission across the hip joint. They involve removing a portion of bone. The goals are to improve femoral head coverage, containment, motion, relieve pain, and correct leg length discrepancies. Different types of osteotomies target the proximal femur or pelvis. Proximal femoral osteotomies are classified based on anatomical location and degree of displacement. Pelvic osteotomies aim to redirect the acetabulum and include Salter, Sutherland, Steel/Tonnis, and Ganz/Bernese procedures. Key considerations for each procedure include indications, approach, osteotomy cuts made, advantages/disadv
This document provides an overview of the anatomy of the ankle joint and ankle arthrodesis (fusion). It describes the bones and ligaments that make up the ankle joint, including the tibia, fibula, and talus. It discusses the indications, contraindications, surgical technique, and postoperative care of ankle arthrodesis, which is performed to treat ankle arthritis and pain. The optimal position for fusion is slight dorsiflexion with mild hindfoot valgus and external rotation. Preoperative planning involves assessing bone quality, alignment, and arthritis in other joints like the subtalar.
This document discusses nonunion of femoral neck fractures, which have a higher incidence in young patients compared to elderly patients. It defines nonunion and outlines the vascular anatomy and causes of nonunion. Classification systems for femoral neck fractures are described. Symptoms, investigations, and radiographic signs of nonunion are provided. Treatment options are discussed, including head-salvaging versus head-sacrificing procedures based on factors like patient age and viability of the femoral head. The Sandhu classification system for staging nonunion is presented along with recommended treatment approaches for each stage.
Slipped capital femoral epiphysis (scfe)farranajwa
This document provides an overview of slipped capital femoral epiphysis (SCFE). SCFE is a displacement of the femoral epiphysis through the proximal growth plate, usually occurring gradually in obese adolescent boys. Risk factors include obesity, endocrine disorders, and sexual immaturity. Clinically, patients present with hip or knee pain and limping. Examination reveals limited hip movement and leg length discrepancy. X-rays and MRI show displacement of the growth plate. Treatment depends on stability and degree of slip, ranging from pinning to corrective osteotomy. Complications include avascular necrosis and osteoarthritis.
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
This document discusses outcomes of treating distal tibia fractures using minimally invasive plate osteosynthesis (MIPO) technique. It provides an overview of the MIPO surgical procedure and reviews several studies comparing MIPO to traditional open reduction and internal fixation. The studies found MIPO resulted in high union rates, shorter healing times, and fewer complications like infection compared to open reduction. MIPO preserves the fracture site's blood supply and limits soft tissue damage, allowing for better callus formation and healing.
Legg - Calve - Perthes disease is a self-limiting disorder of the hip caused by reduced blood flow and necrosis of the femoral head. It most commonly affects boys ages 4-8 and is characterized by pain and limping. While the exact cause is unknown, factors such as blood clotting disorders, abnormal arterial or venous blood flow, growth delays, trauma, genetics, and environmental influences may play a role in reducing blood supply to the femoral head. Treatment aims to allow the femoral head to remodel itself through non-weight bearing or minimal weight bearing methods.
Poller screws, also known as blocking screws, are non-interlocking screws placed outside an intramedullary nail to improve fracture reduction and fixation. They provide a more rigid construct by serving as a surrogate cortex where nail-cortex contact is insufficient. Their placement helps centralize the guidewire in the medullary canal and maintains reduction through a blocking effect. While there is no consensus on their exact placement, they are generally inserted on the concave side of expected deformities to prevent malalignment during nailing.
This document discusses the sequelae and management of septic arthritis. Septic arthritis results in inflammation and destruction of the joint space. This can lead to several orthopedic sequelae including joint destruction, bony or fibrous ankylosis, fractures, limb length discrepancy, and persistent infection. The management depends on factors like the patient's age, delay in treatment, and extent of joint involvement. Treatment may include conservative measures, surgical stabilization, deformity correction, lengthening procedures, or arthrodesis to achieve a stable, mobile joint without pain. Classification systems help guide treatment, with the goal of optimizing long term function and quality of life.
This document discusses various osteotomies around the hip joint. It begins with defining osteotomy and providing a brief history of important developments. It then explains the biomechanics of the hip joint and why osteotomies are effective. Several types and classifications of osteotomies are outlined. Specific procedures like McMurray's displacement osteotomy, Pauwel's varus osteotomy, and Schanz angulation osteotomy are described in detail. Contraindications and postoperative care are also mentioned.
A Lisfranc injury involves fracture or ligament disruption of the tarsometatarsal joint complex of the midfoot. It results from high-energy twisting or axial loading injuries and often requires surgical fixation to achieve proper anatomical reduction. Non-operative treatment may be considered for non-displaced or minimally displaced injuries. Proper diagnosis involves weight-bearing radiographs to assess joint congruity, and sometimes CT or MRI. Surgical management focuses on anatomical reduction and stable fixation of the joints to allow early weight bearing and prevent post-traumatic arthritis.
These documents contain past examination questions from orthopedics qualifications at Dr. NTR University of Health Sciences in Vijayawada, India. The questions cover topics in basic medical sciences relevant to orthopedics, and require short essay answers. Sample topics include bone healing, calcium metabolism, gait analysis, synovial fluid analysis, bone scans, fractures, joint disorders, metabolic bone diseases, and orthopedic implants. The exams provide questions over multiple years to test students' understanding of fundamental orthopedic science concepts.
The document discusses classifications and treatment approaches for subtrochanteric fractures of the femur. It describes Fielding and Seinsheimer classifications which categorize fractures based on their location and number of fragments. Temporary options include a Thomas splint for unstable patients. Surgical treatments involve plates, intramedullary nails, or external fixators. Precise surgical approaches depend on the fracture location and stability. Potential complications are also noted.
Please find the power point on Fracture of Talus with well diagrammatic explanation from very reliable sources. If you need such a power point on different topics related with MBBS then please write it on comment section. Thank you
Blount disease is a developmental condition characterized by disordered bone growth of the medial proximal tibia, resulting in genu varum deformity of the knee. It is most common in overweight children ages 2-5 years old. Management options depend on the stage and severity of deformity, and may include bracing, osteotomies, hemiepiphyseodesis, or guided growth with external fixation. The goal of treatment is to correct alignment and prevent long term complications like osteoarthritis.
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
Distal radius fractures account for up to 20% of emergency department fractures. They typically result from a fall on an outstretched hand. Diagnosis involves history of injury mechanism and physical exam finding of wrist deformity and pain with movement. Classification systems help understand fracture patterns and challenges. Treatment depends on factors like stability, alignment, comminution and patient age/demands. Options include closed reduction with casting, percutaneous pinning, external fixation, plating, and open reduction with internal fixation. Complications can include arthritis, loss of motion, nerve issues, contractures and nonunion.
This document discusses tuberculosis of the knee joint. It begins by providing background on skeletal tuberculosis and noting that the knee joint is the third most common site. It then describes the typical 3 stage progression of knee joint tuberculosis over 3-5 years from synovial involvement to joint destruction to repair. Key diagnostic signs and symptoms at each stage are outlined. Treatment approaches are also summarized, including use of antitubercular drugs, drainage of abscesses, traction, synovectomy, and arthrodesis.
1) Tuberculosis can infect bones and joints, with the spine being a common site. Other sites include the skull, phalanges, and greater trochanter.
2) Risk factors include malnutrition, poor sanitation, crowded living conditions, and immunodeficiency. Radiographs are used to diagnose and assess bone destruction and joint space narrowing.
3) Advanced imaging like CT and MRI help evaluate bone marrow edema, paravertebral abscesses, and spinal cord compression. Ultrasound can detect tuberculous abscesses. Joint involvement may initially cause effusions before erosions occur.
This document discusses bone and joint infections, focusing on osteomyelitis, septic arthritis, and tuberculosis of the bone and joints. It covers the typical causative organisms, presentations, investigations, treatments and potential sequelae of each condition. For osteomyelitis, it describes the progression of infection and radiological appearance. Septic arthritis is an emergency requiring drainage of pus and high dose antibiotics. Bone and joint tuberculosis commonly affects the spine, hips and knees, presenting with pain, stiffness and deformity on x-ray. Treatment involves prolonged antibiotic therapy with possible surgery for severe cases or paralysis.
This document provides information on Potts spine, including its pathophysiology and management principles. It discusses how tuberculosis spreads to the spinal column, causing destruction of vertebral bodies and discs, collapse, and deformity. Risk factors, symptoms, investigations, classifications of lesions and paraplegia, medical management using antitubercular therapy, and indications for surgical treatment are summarized. The goals of surgery are decompression, deformity correction, and spinal stabilization.
This document discusses Pott's spine, or spinal tuberculosis. It begins by describing how Percival Pott first described tuberculosis of the spinal column in 1779. Spinal tuberculosis spreads hematogenously through the paravertebral veins and most commonly involves the vertebrae and discs. It describes the pathogenesis of how the bacteria spread and cause destruction of vertebral bodies and kyphotic deformity. Clinical features include back pain, stiffness, and potentially paraplegia if left untreated. Imaging like CT and MRI are useful for detection and characterization of lesions.
Tuberculosis of the spine, also known as Pott's disease, is caused by Mycobacterium tuberculosis infection that spreads to the vertebrae. It most commonly involves the lower thoracic spine. Symptoms may include back pain, stiffness, deformity, and neurological deficits in 20% of cases. Diagnosis is made through clinical features, imaging such as x-rays showing vertebral destruction, and tests like tuberculin skin test or biopsy. Treatment involves anti-tuberculosis medications and surgery to correct deformities or treat neurological complications. Management aims to diagnose early, begin medical treatment promptly, and use surgery aggressively to prevent deformity and achieve good outcomes.
Join us for an enlightening seminar delving into the intricate world of Ankylosing Spondylitis (AS). This event aims to provide a deep understanding of AS, a chronic inflammatory arthritis primarily affecting the spine and pelvis.
Seminar Highlights:
Introduction to Ankylosing Spondylitis:
Definition, prevalence, and demographic insights.
Clinical Features and Diagnosis:
Recognizing early symptoms and the diagnostic journey.
The role of imaging and laboratory tests.
Understanding the Pathophysiology:
In-depth exploration of the immune system's role.
Genetic factors and their impact on AS.
Treatment Modalities:
Current pharmacological interventions.
Physical therapy and lifestyle management.
Quality of Life and Mental Health:
Addressing the holistic impact of AS on daily life.
Strategies for maintaining mental and emotional well-being.
Research Advances and Future Directions:
Overview of cutting-edge research in AS.
Promising avenues for future treatments and interventions.
Spinal tuberculosis and spinal infectionsVijay Anand
Tuberculosis of the spinal column, also known as Pott's disease, is caused by infection with Mycobacterium tuberculosis bacteria. It most commonly affects the lower thoracic and thoracolumbar regions of the spine. Clinical features include back pain, spinal deformity, and possible paralysis. Diagnosis involves x-rays, CT scans, MRI, and microbiological testing. Treatment consists of a lengthy multi-drug antibiotic regimen lasting 18 months or longer to prevent disability and complications like abscesses. Proper treatment is important to avoid development of multi-drug resistant tuberculosis strains.
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.
1) Tuberculosis of the spine is the most common form of skeletal tuberculosis, frequently affecting the dorsal spine.
2) It is caused by hematogenous spread of Mycobacterium tuberculosis from a primary focus. This can lead to destruction of vertebral bodies and discs, collapse, deformity, and neurological deficits in advanced cases.
3) Treatment has evolved tremendously from ancient herbal preparations and hot iron drainage to modern multi-drug anti-tubercular regimens with aggressive surgical management to prevent deformity and paralysis when needed.
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.
- Patterns of bone involvement include paradiscal, central, anterior, and appendiceal lesions.
- Complications include paralysis, cold abscesses, deformities, and secondary infections.
Dorso-lumbar tuberculosis is a common form of spinal tuberculosis. It most commonly occurs at the dorso-lumbar junction due to factors like greater movement, weight bearing, and proximity to organs. Clinical presentation includes back pain and constitutional symptoms over weeks. Investigations show abnormalities on plain radiograph, CT, MRI and tuberculosis tests. Treatment involves anti-tubercular chemotherapy for 18 months and surgery if needed to drain abscesses or correct deformities. Long term follow up assesses for resolution of symptoms and radiological healing of lesions.
This document provides an overview of the radiographic features seen in various rheumatic diseases. It describes the early and late manifestations seen in rheumatoid arthritis on x-rays, including periarticular osteopenia, erosions, and bone deformities. Features of psoriatic arthritis include asymmetric joint involvement and enthesophyte formation. Ankylosing spondylitis is characterized by sacroiliac joint fusion and syndesmophyte formation leading to a "bamboo spine." Gout typically causes well-defined erosions, often with overhanging edges. Calcium pyrophosphate disease results in chondrocalcinosis. Diffuse idiopathic skeletal hyperostosis is identified by flowing
Congenital anomalies and degenerative conditions of vertebraBipulBorthakur
This document summarizes CT findings related to congenital anomalies, infections, and degenerative conditions of the spine. It describes common congenital anomalies such as spina bifida occulta, coronal cleft vertebra, and block vertebra. It also discusses spinal infections including bacterial spondylodiskitis caused by pathogens like Staphylococcus aureus and tuberculous spondylitis. Finally, it reviews degenerative changes in the spine seen with aging and conditions like ankylosing spondylitis. CT is useful for evaluating bony abnormalities, spinal infections, and the extent of fusion in diseases like ankylosing spondylitis.
Dorso-lumbar tuberculosis is a common form of spinal tuberculosis that usually involves the lower thoracic and upper lumbar regions. It spreads hematogenously from a primary infection, most commonly in the lungs or genitourinary system. Clinically it presents with chronic back pain and stiffness. Investigations like radiography, CT, MRI and biopsy help in diagnosis. Treatment involves anti-tubercular medications for 18 months along with bracing. Surgery to debride and fuse the affected segments may be needed if there is neurological involvement, deformity or abscess formation. Long term follow up is important to monitor healing and prevent complications like paraplegia.
Caffey disease, also known as infantile cortical hyperostosis, is a self-limited condition characterized by asymmetric thickening of bone cortices in infants less than 5 months old. It presents as fever, soft tissue swelling, and irritability and typically resolves without sequelae within 6-9 months. Osteopetrosis is a rare genetic disorder where bone resorption is impaired, leading to abnormally dense and brittle bones. It can range from mild to lethal depending on the mutated gene. Legg-Calve-Perthes disease involves osteonecrosis of the femoral head epiphysis in children, commonly presenting with hip pain and limping. It is diagnosed based on imaging findings of femoral
Here are the answers to your questions:
1. Most common site of osteomyelitis - Metaphysis of long bones, especially distal femur and proximal tibia.
2. Most common organism causing osteomyelitis - Staphylococcus aureus.
3. Earliest radiographic and MRI findings of acute osteomyelitis - Soft tissue swelling and loss of fascial planes seen within 24-48 hours on radiographs. Bone marrow edema seen as low signal on T1 and high signal on T2/STIR sequences in MRI.
4. What is sequestrum - Avascular/necrotic bone fragment formed due to osteonecrosis in chronic osteomyelitis
This document provides an overview of the management of open fractures. It defines an open fracture as a soft tissue injury complicated by a broken bone with communication to the external environment. The history of open fracture treatment is discussed, from ancient practices like debridement to modern advances with antibiotics and fixation methods. Classification systems for open fractures are presented, including the Gustilo-Anderson classification which correlates the degree of soft tissue injury with infection risk. Key steps in managing open fractures are described, including thorough debridement and irrigation, antibiotic administration, fracture stabilization options like external or internal fixation depending on the injury, and wound management. Overall infection rates and healing times are correlated with the classification of the soft tissue injury.
1. Fat embolism syndrome is a serious manifestation of fat embolism that can cause multi-system dysfunction, most commonly affecting the lungs and brain.
2. It occurs most often after long bone fractures, especially femur fractures, when fat droplets enter the bloodstream and lodge in the pulmonary capillaries or brain vasculature.
3. Clinical features include a triad of respiratory distress, neurological changes like confusion, and petechial rash. Diagnosis is based on clinical criteria and imaging may show changes in the lungs and brain. Treatment is supportive with oxygen, ventilation if needed, IV fluids and steroids. Prognosis is generally good if respiratory failure can be prevented.
This document discusses the investigation profile for acute hematogenous osteomyelitis. It notes that C-reactive protein levels and bacterial cultures from aspirated bone or tissue are important for diagnosis. Imaging plays a key role as well, with X-rays able to detect bone changes within a few days while MRI is most sensitive for detecting early bone marrow changes. The presentation reviews the typical findings and timeline of changes seen on various imaging modalities in the evaluation of acute osteomyelitis.
- A sequestrum is a separated, necrotic fragment of bone surrounded by infected tissue and pus. It acts as a nidus for bacteria to thrive.
- Sequestra come in different shapes, sizes, colors and consistencies depending on the underlying condition. Common types include pencil-like in infants and cylindrical in tuberculosis.
- Identifying sequestra involves injecting dyes like methylene blue which will stain live bone gray but leave dead bone blue. Removal of sequestra via sequestrectomy eliminates the infection and aids healing.
- Conditions that can mimic sequestra on imaging include radiation necrosis, bone tumors and mineralization of other lesions.
1) Dr. U. Jagadish presented on the X-ray findings of tuberculosis (TB) of the spine.
2) The most common sites of spinal involvement in TB are the dorsolumbar spine. Common X-ray findings include narrowing of the disc space and loss of disc margins indicating paradiscal involvement.
3) Other findings include paravertebral shadows produced by tuberculous granulation tissue and abscesses, as well as central lesions causing vertebral body collapse and deformity with minimal disc space narrowing.
This document summarizes a presentation on malignancy in chronic osteomyelitis given by Dr. Kiran. It discusses chronic osteomyelitis as a long-lasting bone infection caused by biofilm-protected microorganisms. Malignant changes can develop due to factors like chronic inflammation, poor vascularization, and treatment failure. The most common malignancy is aggressive squamous cell carcinoma of the skin near the infected bone. Clinical features include ulceration, bleeding, and bone destruction visible on imaging. Diagnosis involves biopsy and imaging tests. Management may include amputation and adjuvant therapies depending on the malignancy.
1. Tuberculosis of the spine, also known as Pott's disease, is the most common form of skeletal tuberculosis. It accounts for 50% of all bone and joint tuberculosis cases.
2. Characteristic features on radiology include destruction of the intervertebral disc space and adjacent vertebral bodies, resulting in collapse and kyphotic deformity.
3. Treatment involves a prolonged course of multi-drug anti-tuberculosis therapy to prevent neurological complications and disabling deformities. With modern treatment, patients can often heal with minimal residual deformity.
This document provides information about Dupuytren's contracture, including its history, definition, epidemiology, associated conditions, pathogenesis, treatment options, and complications. Specifically, it describes how Dupuytren's contracture results from abnormal proliferation of fibroblasts in the palmar fascia, which can cause fingers to bend into the palm. Treatment involves nonsurgical options like collagenase injections or surgery to release contracted tissues through techniques like fasciectomy. Postoperative rehabilitation with splinting and range of motion exercises aims to prevent recurrence of contractures.
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.
This document provides information on vacuum-assisted closure (VAC) dressing for wound management. It begins by describing standard wound care and the development of VAC therapy. It then explains the mechanism of action of VAC, which uses subatmospheric pressure to remove fluid, decrease edema, and increase blood flow to promote healing. Components of the VAC system and application process are outlined. The document discusses the range of pressures used, indications, advantages, and complications of VAC therapy. It also addresses interventions to maximize healing and future developments.
This document discusses physeal injuries in children. It begins by describing the anatomy and zones of the physis. The most common causes of physeal injuries are fractures, but other mechanisms include infection, tumors, and vascular issues. It then details the Salter-Harris classification of physeal fractures in 5 types based on the location of the fracture plane. Treatment depends on the type, with types I and II generally treated non-operatively and types III and IV requiring anatomic reduction and potential internal fixation. Complications can include growth disturbances leading to angular deformity or limb length discrepancy.
A 19-year-old male presented with knee pain after falling during a basketball game. Radiographs revealed a bipartite patella, which is a congenital condition where the patella fails to fuse, seen in 2-3% of the population. It is typically asymptomatic but can cause anterior knee pain aggravated by activity. Non-operative management is indicated initially but surgical excision may be needed if non-operative treatment fails after 6 months or for displaced fragments. The main risk of surgery is patellofemoral maltracking.
1. The epiphysis are the cartilaginous ends of growing bones that consist of spongy bone with a thin outer wall of compact bone.
2. There are different types of epiphysis including pressure, traction, and aberrant epiphysis that develop in response to stresses on the bone.
3. Epiphysis develop through enchondral ossification from secondary ossification centers and injuries involving the epiphyseal growth plate are classified using the Salter-Harris classification system.
This document discusses the treatment of scaphoid non-union bone fractures. Scaphoid non-union can be caused by delayed diagnosis, displacement of the fracture, smoking, and other factors. Treatment options include traditional bone grafting, vascularized bone grafting, fragment excision, and wrist fusion or replacement. The Matti-Russe and Fernandez techniques use bone grafts to fill the fracture site and stabilize the bone fragments, while vascularized grafts from the radius or iliac crest aim to improve healing rates. Postoperative immobilization lasting several months is usually needed to allow the bone to fuse.
Heterotopic ossification refers to bone formation in soft tissues. It commonly occurs after trauma, burns, or head injuries. Surgical excision is recommended if the extra bone limits elbow motion or function. The document describes techniques for excising heterotopic ossification around the elbow through various approaches. Postoperative care involves physical therapy and sometimes manipulation under anesthesia to improve range of motion outcomes. Recurrence is more common in patients with central nervous system injuries.
Supracondylar humerus fracture percutaneous pinning video demoAnil Kumar Prakash
Supracondylar humerus fractures are common pediatric elbow fractures that are usually caused by a fall onto an outstretched hand. They are classified using the Gartland or modified Gartland classification. Type I fractures are nondisplaced, while Type III have complete displacement. Type III and unstable fractures are typically treated with closed reduction and percutaneous pinning (CRPP) or open reduction if needed. CRPP involves realigning the bones under imaging guidance and inserting two divergent lateral pins. Complications can include pin migration, infection, and nerve injury.
The document provides guidelines for writing prescriptions. It outlines that prescriptions should have 3 parts: general patient information, the list of prescribed medications, and a conclusion. The content section explains what information should be included for each prescribed medication such as name, strength, route, dose, frequency, and duration. The conclusion should have the consultant's signature, department, unit, and date. Key points are to use legible handwriting and proper formatting while common mistakes to avoid are missing the diagnosis or seals/dates.
1) The physis, also known as the growth plate, is located between the epiphysis and metaphysis of growing bones. It is responsible for the longitudinal growth of bones.
2) The physis contains several zones, including a germinal zone, proliferative zone, hypertrophic zone, and zone of provisional calcification. Blood is supplied to the physis from epiphyseal, perichondrial, and metaphyseal arteries.
3) Physeal injuries are classified using the Salter-Harris system. Type 1 and 2 fractures can usually be treated non-operatively, while more severe types often require open reduction and internal fixation.
This document provides an overview of tendons, including:
- Tendons are dense fibrous tissues that connect muscle to bone and transmit muscle forces to produce joint movements.
- Tendons are composed of collagen fibrils bundled into fascicles surrounded by endotendon tissue and epitenon sheath.
- Muscle and tendon attach through interdigitation of collagen fibrils. Peritendonous structures like bursae and sheaths facilitate tendon gliding.
- Tendons insert directly into bone through four stiffening zones or indirectly by joining the periosteum. Blood vessels and nerves course through tendons.
Dr. Tarun gave an 8 minute lesson on compartment syndrome. He discussed what compartment syndrome is, its etiology and pathophysiology. There are two main types - acute and chronic. Acute compartment syndrome is a medical emergency caused by severe injury that can lead to permanent muscle damage if not treated urgently. Chronic compartment syndrome is known as exertional compartment syndrome and is not an emergency, often caused by athletic exertion. Management involves reducing intra-compartmental pressure through fasciotomy, hydration, and positioning the affected limb above the heart level. Complications include permanent nerve and muscle damage if not treated promptly.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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1. TUBERCULOSIS OF HIP
MODERATOR – DR. NAGAKUMAR JS
PROFESSOR AND HOU
DEPT OF ORTHOPAEDICS
RLJALAPPA HOSPITAL KOLAR
PRESENTER – DR. NANDINI SANJAY
JUNIOR RESIDENT
2. HISTORY
• It has been hypothesized that the genus Mycobacterium
originated more than 150 million years ago
• The illness in the middle ages was known in England and
France as "king's evil", and it was widely believed that persons
affected could heal after a royal touch
• Percival Pott first described TB of spinal column in 1779
3. • “White plague” - during the 18th century
• French physician Laennec, discovered the basic microscopic
lesion – tubercle
• Robert Koch was able to isolate the tubercle bacillus in 1882
5. INTRODUCTION
• TB of the musculoskeletal system – 1-3% of total TB cases
• Vertebral TB – mc form of skeletal TB
• TB hip constitutes 15-20% of skeletal TB
6. PATHOGENESIS
Hematogenous dissemination - 1° infected visceral focus
Osteoarticular tubercular lesion
• Vascular channels
• 2-3 years after primary focus
• Disease starts in the bone or the synovial membrane
• One infects the other – uncontrolled disease
7. Tubercular bacilli
via bloodstream
Subsynovial vessels
Joint space
Peripheral Articular cartilage
Ring like granulation tissue (pannus)
Subchondral region
Erosion of margins and surface of articular cartilage
Flakes and loose sheets of necrosed articular cartilage + fibrinous material in synovial
fluid
RICE BODIES
8. Articular surfaces in contact
Ingrowth of tuberculous granulation tissue
Necrosis of subchondral bone on either side of the joint line
Kissing lesion / Kissing sequestrae
9. • Typically starts in the metaphysis in pediatric age group
• May infect the neighboring joint through sub-periosteal space
and capsule or through the destruction of the epiphyseal plate –
shortening or angulation
• In adults – bone ends
11. Tuberculous process reaches the subchondral region
Articular cartilage looses its nutrition, attachment to the bone
Lies free in the joint cavity
12. • Host – good/competent immunity – usually TB synovitis occurs
– course of disease is slow
• Synovial membrane – swollen and congested with synovial
effusion
• Granulation tissue from synovium extends to bone at synovial
reflections – erodes the bone
13. LOCATION
• The initial focus of TB lesion may start in –
• Acetabular roof
• Epiphysis Babcock’s
• Metaphyseal region
• Greater trochanter
• Rarely presents as synovitis of hip joint
• May involve the subtrochanteric bursa without involving the hip
joint
14. • Upper end of femur – intracapsular – rapid involvement of joint
if any osseous lesion within the capsular attachments
• If initial focus starts in acetabular roof – joint involvement is late
and severity of symptoms is mild – patient reports late
• COLD ABSCESS may form – Within the joint and may perforate
through the inferior weaker part of the capsule or rarely through
acetabular floor
15. COLD ABSCESS
• Formed by collection of products of liquefaction and reactive
exudation
• Abscess – serum, leucocytes, caseous material, bone debris
and tubercle bacilli
• May penetrates ligament, bone and periosteum
16. • Migrates along facial planes and along neurovascular bundles
• May burst to form a sinus or ulcer
• Cold abscess may present anywhere around the hip joint –
• Femoral
• Medial, Lateral/Posterior aspects of thigh
• Ischiorectal fossa
• Pelvis
17.
18. CLINICAL FEATURES
• Starts during the first 3 decades
• Active disease –
• Pain, limping, deformity and fullness around the hip
• Pain – referred to the medial aspect of the knee, Night cries
• Limping – Earliest and mc symptom, Antalgic gait
21. INVESTIGATIONS
1. XRAYS – of hip joint and chest
• Changes may be visible 2-4 months after onset of disease
2. CT – extent of bone involvement and localization of the lesion
• Small lytic lesions in bone and marginal erosions
• Dystrophic calcification
3. MRI
• Edema of involved bone
• Extent of soft tissue involvement
4. Blood –
• Lymphocytosis
• Low Hb
• Raised ESR and CRP
25. STAGE OF TUBERCULAR SYNOVITIS
• Juxta – articular osseous lesion
• Joint is in Flexion, Abduction and External rotation (FABER)
• Apparent lengthening
• Extremes of movement – limited and painful
• Xrays – soft tissue swelling
26. • USG – swelling of soft tissue around the hip joint
• MRI – synovial effusion and bone edema
• Synovial effusion can be aspirated and sent for cytology, AFB
smear and PCR examination
• Biopsy can be taken from diseased tissue to establish the
diagnosis
27.
28. DIFFERENTIAL DIAGNOSIS AT THIS
STAGE
• Traumatic synovitis
• Rheumatic/rheumatoid disease
• Nonspecific transient synovitis
• Low-grade pyogenic infection
• Perthes’ disease
• Juxta-articular disease causing irritation of the joint
• Slipped capital femoral epiphysis.
29. STAGE OF EARLY ARTHRITIS
• Destruction or damage to the articular cartilage
• Joint is in Flexion, Adduction and Internal rotation (FADIR)
• Apparent shortening
• Appreciable muscle wasting
• Restriction of hip movements due to pain in all directions
30. • Xrays –
• Localized osteoporosis
• Slight reduction of joint space
• Localized erosions of articular margins
• MRI –
• Synovial effusion
• Minimal areas of bone destruction
• Osseous edema
31.
32. STAGE OF ADVANCED ARTHRITIS
• Gross destruction of articular cartilage and femoral head and acetabulum
• Capsule further destroyed, thickened and contracted
• Flexion, Adduction and Internal rotation (FADIR) is exaggerated
• True shortening
• Severe muscle wasting
• Severe restriction of hip movements
33. • Xrays –
• Destroyed and atrophic femoral head
• Obliteration of joint space
• Severe erosion of articular margins
34.
35. STAGE OF ADVANCED ARTHRITIS
WITH SUBLUXATION/DISLOCATION
• Severe destruction of acetabulum, femoral head, capsule and
ligaments
• Upper end of femur is displaced upwards and dorsally
• Wandering/Migrating acetabulum
• Shenton’s arc broken
36. • Frank pathological posterior dislocation of femoral head
• Flexion, Adduction and Internal rotation (FADIR)
• Gross restriction of movement at hip joint
• Protrusion acetabuli
• Coxa breva
• Mortar and Pestle appearance of hip joint
37. • If limb has been plastered for >12 months –
• Growth plate in the knee undergoes premature fusion – marked
shortening and limitation of movements (FRAME KNEE)
• Coxa Magna deformity may occur – due to hyperemia and
overgrowth of femoral head and neck
• Coxa Vara may also occur – destructive lesion in femoral head
and neck(arrested growth of capital physis) with normal growth
of greater trochanter
40. CLINICORADIOLOGICAL CLASSIFICATION OF TB
HIP
STAGES CLINICAL
FINDINGS
RADIOLOGICAL
FEATURES
I. Synovitis FABER, apparent
lengthening
Soft tissue swelling, haziness of
articular margins and rarefaction
II. Early arthritis FADIR, apparent
shortening
Rarefaction, osteopenia, marginal
bony erosions in femoral head,
acetabulum or both. No reduction in
joint space
III. Advanced arthritis FADIR, true shortening All of the above and destruction of the
articular surface, reduction in joint
space
IV. Advanced arthritis
with
FADIR, gross shortening Gross destruction and reduction of
joint space, wandering acetabulum
41. SHANMUGASUNDARAM
CLASSIFICATION
• Radiological classification of TB hip in children(C) and adults(A)
–
1. Normal appearance (C)
2. Travelling acetabulum (C,A)
3. Dislocated hip (C)
4. Perthes’ type (C)
5. Protrusio acetabuli (C,A)
6. Atrophic type (A)
7. Mortar and Pestle type (C,A)
51. CAMPBELL AND HOFFMAN’S
PROGNOSTIC PREDICTORS
RESULT
S
DESCRIPTION POPULATION
(%)
GOOD
NORMAL 92
PERTHES’ TYPE 80
DISLOCATING TYPE 50
TRAVELLING ACETABULUM + MORTAR-
PESTLE TYPE
29
POOR JOINT SPACE <3mm -
52. CHILDHOOD
C/H Hyperemia
Enlargement of femoral head epiphysis and metaphysis(COXA
MAGNA)
Thromboembolic phenomenon of selective terminal vasculature
Changes resembling Perthes’ ds, rapidly developing tense
intracapsular effusion
Gross decrease in blood supply to the femoral head and its physis
COXA BREVA/COXA VALGA
54. ANTI-TUBERCULAR TREATMENT
• All cases of bone and joint TB should be treated with extended
courses of ATT with – 2HRZE/10HRE
• 2-month intensive phase consisting of four drugs
1. Isoniazid (H)
2. Rifampicin (R)
3. Pyrazinamide (Z)
4. Ethambutol (E)
• Followed by a continuation phase lasting 10–16 months,
depending on the site of disease and the patient’s clinical
course with HRE
INDEX-TB GUIDELINES - Guidelines on extra-pulmonary tuberculosis for India
55. 1. NON-OPERATIVE TREATMENT
a) ATT
b) Traction
• Relieves muscle spasm
• Corrects deformity and subluxation
• Maintains joint space
• Decreases the chance of developing migrating acetabulum
• Close observation
c) Rest
d) Any cold abscess – aspiration + instillation of Streptomycin
+/- INH
56. • Favorable response – CST
• If mild ankylosis present, active assisted movements of hip
should be performed as tolerable
• With traction, patient encouraged to sit and touch forehead to
knee and put the thigh in abduction and external rotation
57. • After 4-6 months,
• Non-weight bearing ambulation permitted with walker/crutches
for first 12 weeks
• Partial weight bearing ambulation for next 12 weeks
• After 12 months from onset of treatment, crutches discarded
• Non-operative treatment – synovial disease, early arthritis and
some cases of advanced arthritis
58. • If response to non-op treatment – Unfavorable, then –
• Synovectomy/Debridement as needed
• Disease under control – ambulation after 3-6 months after
surgery
59. • Advanced arthritis – Gross fibrous ankylosis –
• Non-op treatment to overcome the deformities and assess
movement of hip joint
• Limb immobilized using hip spica for 4-6 months
• Neutral, 5-10° of ER and flexion of 10° in children, 30° for adults
• After 6 months, partial weight bearing in a single spica for 6
months after which support with walker/crutches for 2 years
60. TREATMENT IN CHILDREN
• Traction
• Correction of deformity – rarely plaster application under GA +/-
adductor tenotomy
• Failure to correct deformity – Open arthrotomy, synovectomy
and debridement of the joint
• Arthrodesis/Excisional arthroplasty – delayed till completion of
growth of proximal femur
61. • Gross deformity in child -
• Extra-articular corrective osteotomy is done
• Subtotal excision of contracted fibrous capsule – if some
anatomy of hip joint is retained, + traction, repetitive exercises
62. SURGICAL MANAGEMENT
1. OSTEOTOMY –
• Upper femoral corrective osteotomy – ideal site is as near to the
deformed joint as possible
2. ARTHRODESIS –
• Before ATT – ischiofemoral/iliofemoral arthrodesis
• After ATT – Intracapsular fusion b/w femoral head and acetabulum
• Indication – adult with painful fibrous ankylosis with active/healed
disease
63. 3. EXCISIONAL ARTHROPLASTY
• After completion of growth potential of hip joints
• Provides mobile, painless hip joint with control of infection and
correction of deformity
• Shortening (3.5-5cm) and Instability – can be minimized by post op
traction for 3 months
• Recommended in adults with active/healed disease
66. STAGE I & II
• Disease not responding or doubtful diagnosis – ARTHROTOMY
AND SYNOVECTOMY
• II – Synovectomy + removal of loose bodies, debris, loose
articular cartilage and careful curettage of osseous foci should
also be done
• Post op – Triple drug therapy, traction, intermittent active and
assisted exercises for 4-6 weeks, ambulation with walker
support 3-6 months after surgery
67. STAGE III & IV
• Ankylosis of hip joint
• Hip immobilized in slight abduction(10-15°)
68. GUIDELINES FOR INDICATION AND OPERATIONS FOR
TB HIP
Therapeutically refractory or doubtful
diagnosis
Arthrotomy, synovectomy, debridement
Dislocation/subluxation during active stage of
disease
Arthrotomy and repositioning of joint
Juxtaarticular non resolving lesion threatening
the joint
Debridement of the lesion
Unacceptable gross ankylosis of hip in active
stage of disease
Excision arthroplasty
Partial ankylosis with healed disease with
useful range of motion
Juxtaarticular osteotomy to bring the range
of motion to the functional arc
Bony ankylosis of hip in non functioning
position
Juxtaarticular osteotomy to bring the fused
joint to the best functioning position
Painful ankylosis of hip Excisional or replacement arthroplasty
69. HEALED STATUS OF DISEASE
• Upper femoral corrective osteotomy - severe flexion-adduction
deformity
• Upper femoral displacement-cum-corrective osteotomy - fibrous
ankylosis with gross deformity
• Intra-articular or extra-articular arthrodesis – painful ankylosis
• Girdlestone arthroplasty or total joint replacement
70.
71. • In healed TB with subluxation/dislocation of long duration –
• Replacement surgery not advisable
• Stability can be provided by TECTOPLASTY
• It aims to provide an extra-articular weight-bearing surface in
cases of dysplastic acetabulum, hip subluxation or dislocation
with a false acetabulum