05-16-2007, 07:08 AM
ANETRIOR;;;dislocation is common in the shoulder and post dislocation is common in the hip..and in alcoholic and ppl with h/o of seizure they usually have post dislocation of the shoulder.
..treatment of the undislaced fx of the femur need traction...and displaced fx needs closed reduction and int rotation by traction or int rotation.
.fx of th e femoral head pose a great danger so its is fixed by orif meniscal tears have PAIN AND LOCKING OF TH E KNEE ON FULL PASSIVE EXTENTION,
medical meniscal tear is more common than the lateral and mac murray test is diag and arthroscpy is diagnostic.
.acl may b present with med meniscal tear....if all 5 ps r present or atleast 3/5 thenits ischemic limb dont waste time to do angiogram u will looose th elimb give thromolytics and take pt to or to save it bcz if u dont do it in 6 h ...u have to amputate
..ACL...ITS TORN MOSTLY BCZ ITS WEAKER THAN TH E POST CRUCIATE LIG...U HEAR POP,,COMMON IN SKING INJURIES AND NON CONTACT SPORTS...ITS AT RISK WITH HYPEREXTENTION AND ROTATION...REMMBE TH E MOST C C OF HEMARTHROSIS IN A STABLE KNEEE IS RUTURED ACL...LACHMAN TEST IS BEST FOR ACL..WHENEVER THERE IS HEMARTHROSIS DO THE ARTHROSCOPY OTHERWISE MRI...SURGICAL REPAIR IS TH E TREATMENT IN ACL..
.TEAR OF PCL IS RARE AND OCUR WHEN KNEE IS FLEXED AT 90 DEGREELIKE DASH BOARD INJURY TO KNEEWHICH HAPPENED TO B MOST COMMON CAUSE...THE TIBIA IS POSTERIORLY DISPLACED AND TREATMENTIS NON SURGICAL FOR THIS ONE..TIBIAL FX ...MOST COMMON FX I S IN TIBIA AN ITS MOST COMMONLY INVOLVED BONE IN COMPARTMT SYNDROME AN D NEURO VASCULAR COMPROMISE...NON UNION IS COMMON WITH THE LOWER THIRD FX...COMMON PERONEAL N DAMAGE IF HEAD OF TH E FIBULA IS INVOLVED IN TH E INJURY AND FXFIBULAR FX CAN ALSO GIVE COMPARTMNET SYNDROME..FX OF CALCANIOUS IS COMMON WHEN SOM EONE FALL FROM HT ON HIS FEET ITS COMMONLY ASSOCIATED WITH SPINAL FX...ITS UNI OR BILATERAL FX
...SPINE FX IS COMMON WHEN ITS BIOLATERAL CALCANIOUS FX... DISPLACED FX OF CALCANIOUS REQ CT AND TREATMENT IS ORIF...STRESS MARCH FX CAN LEADS TO METATARSAL SHAFT FX. THERE IS A PAIN.HOWEVER THERE IS NO H/O OF INC ACTIVITY..THERE WILL B TENDERNESS IN TH E METATARSAL SHAFT AREA,XRAY R NON CONTRIBUTORYUNTIL 2 WKS BONE SCAN IS GOOODWHICHWILL SHOW INC RADOACTIVE UPTAKE...TREATMENTIS WITHSPLINT.NON WTBEARING AND ANALGESIA.
.RUPTURED GASTRONEMIOUS SOLEUS.......ITS ALSO CALLLED PLANTARIS FX IT IS MOST COMMON FX WHEN RUNNING OR JUMPING LIKE IN BASKET BALL MATCH , TENDER OVER GASTRONEMIOUS AND SOLEUS TENDON ...AND P T WILL HAVE NORMAL PLANTER FLEXTION WITH CALF COMPRESSION..ACTIVE PLANTARIS FLEXTIONIS STRONG BUT QUITE PAINFUL...LOCALIZED SWELLING AND ECHYMOSIS PRESENT...TREATEMNTIS SYMTOMATIC.
RUPTURED ACHILIS TENDON...FEELING OF ANKLE GIVING WAY WHEN JUMPING DURING BASKET BALL PRACTICE...ITS COMMON BET 30-40 YRS OF AGE...PT CA PLANTER FLEX UT NOT WALK TIP TOE...AND SQUEEZING RELAX CALF MUSCLE DOESNT RESULT IN TH E IN SAME DEGREE OF PLANTERFLEXTIONAS ON TH ENORMLA SIDE...PT HAS TENDERNESS OVER THE ACHILIS TENDONAT TH E ANKLE OR LITTLE ABOVE A GAP MAY B FELT...REMMBER TREATMENT IS SPLINT AND NON WT BEARING WITH CRUTCHES AND TENDON REAPIR
FX OF TH E TUBEROSITY OF TH E 5TH METATARSAL IS CALLLED DANCERS FX...SWELLING ECHYMOSIS AND TENDER NESS AT THE SITE OF AVULSION ..TREATMENTIS SHORT LEG CASTFOR 4-6 WKS...ITS IS UTMOST IMP TO KNOW THAT TUBEROSITY OF TH E5TH METATARSAL HEAL QUICKLY BUT SHAFT WILL TAKE LONGER TIME...AND SHAFT IS MOREPRONE TO NONUNION....SO IF FX IS IN TH EMETATARSAL SHAFT THEN PROLONGED CAST AN NON WT BEARING RQ
...TODDLERS FX ..ITS COMMONLY INV DISTAL I/3 OF TH ETIBIA..OCCUR IN TODDLERSITS DUE TO SIMPLE FALL DUE TO RUNNING OR PLAYING SHOULDNT BMISTAKEN FOR THE CHILD ABUSE.
..KID HAS A PAIN HE REFUSE TO WALK,PAIN ON PALPATION SWELLLING ECHYMOSIS POSITIVE XRAY IS NOT HELPFUL IN IST 2 WKSUCNA C IN A OBLIQUE XRAY LATER AFTER A WKBONE SCAN IS BEST BUT ITS RARELY RE...TREATMENTIS LONG LEG CAST ..HELAING OCCUR IN 3-4WKS XRAY AT TH E END OF SEC WK WILL SHOW SUBPEROSTEAL NEW BONE FORMATION.
..THE HIGHEST INJURIES OF MEDCIAL MENISCAL IS AMONG MINERS...THE MEDIAL MENISCUS IS FIRMLY ATTACHED AROUND THE PERIPHRY BUT MOVE LESS THAN THE LAT MENISCUS...SUDDEN LOCKING OF TH EKNEE IS AHALLLMARK OF MENISCAL TEAR IN HEAMRTHROSIS THE KNOCKING IS GRADUAL NOT SUDDEN SO ITS DIF...STRESS FX CAN B TREATED WITH NON WT BEARING,ABULATION AND CRUTCHES...FOR 6 WKSTO 8 WKS..
.IMPACTED FX NEED ORIFFX OF INLET AND OUTLET VIEW OF TH E PELVIS IS MUST WHEN PELVIC INJURY OCCUR...BLEEDING IS TH EMOST COMMON RISK DVT CHANCE IS HALF THAN IT IS WITH KNEE ARTHROPLASTY BCZ OF THE LOCATION..ITS IS LESS WHEN HIP IS REPLACED...PELVIC FX IS DIAG WHEN THERE IS PAIN IN TH ESUPRAPUBIC AREA ORLOW BACK...,
LOWER EXTREMITY SHORTENING,WKNESS AND DIMINISHED SENSATION FOLLOWING TRAUMAA SUGGEST THE PRESENCE OF PELVIC FX..CT IS BEST FOR STABLE PT...XRAY PELVIS IS INTIAL FOR DIAG...IF ACETABULAM IS FXED THEN THEN TWO OBLIQUE VIEW CALLLED JUDET VIEW IS MUST ...ORIF ASAP IS LIFE SAVING AND WILL PREVENT ALL COMPLICATION..IN TH EFURURE MAINTAIN BP GIVE TARNSFUSION BCZ LOTS OF BLLLEDING DURING SURGERY..
.dislocation of knee is usuallly posterior...even if pedal pulses r present u must r/o the popliteal a injury
..treatment of the undislaced fx of the femur need traction...and displaced fx needs closed reduction and int rotation by traction or int rotation.
.fx of th e femoral head pose a great danger so its is fixed by orif meniscal tears have PAIN AND LOCKING OF TH E KNEE ON FULL PASSIVE EXTENTION,
medical meniscal tear is more common than the lateral and mac murray test is diag and arthroscpy is diagnostic.
.acl may b present with med meniscal tear....if all 5 ps r present or atleast 3/5 thenits ischemic limb dont waste time to do angiogram u will looose th elimb give thromolytics and take pt to or to save it bcz if u dont do it in 6 h ...u have to amputate
..ACL...ITS TORN MOSTLY BCZ ITS WEAKER THAN TH E POST CRUCIATE LIG...U HEAR POP,,COMMON IN SKING INJURIES AND NON CONTACT SPORTS...ITS AT RISK WITH HYPEREXTENTION AND ROTATION...REMMBE TH E MOST C C OF HEMARTHROSIS IN A STABLE KNEEE IS RUTURED ACL...LACHMAN TEST IS BEST FOR ACL..WHENEVER THERE IS HEMARTHROSIS DO THE ARTHROSCOPY OTHERWISE MRI...SURGICAL REPAIR IS TH E TREATMENT IN ACL..
.TEAR OF PCL IS RARE AND OCUR WHEN KNEE IS FLEXED AT 90 DEGREELIKE DASH BOARD INJURY TO KNEEWHICH HAPPENED TO B MOST COMMON CAUSE...THE TIBIA IS POSTERIORLY DISPLACED AND TREATMENTIS NON SURGICAL FOR THIS ONE..TIBIAL FX ...MOST COMMON FX I S IN TIBIA AN ITS MOST COMMONLY INVOLVED BONE IN COMPARTMT SYNDROME AN D NEURO VASCULAR COMPROMISE...NON UNION IS COMMON WITH THE LOWER THIRD FX...COMMON PERONEAL N DAMAGE IF HEAD OF TH E FIBULA IS INVOLVED IN TH E INJURY AND FXFIBULAR FX CAN ALSO GIVE COMPARTMNET SYNDROME..FX OF CALCANIOUS IS COMMON WHEN SOM EONE FALL FROM HT ON HIS FEET ITS COMMONLY ASSOCIATED WITH SPINAL FX...ITS UNI OR BILATERAL FX
...SPINE FX IS COMMON WHEN ITS BIOLATERAL CALCANIOUS FX... DISPLACED FX OF CALCANIOUS REQ CT AND TREATMENT IS ORIF...STRESS MARCH FX CAN LEADS TO METATARSAL SHAFT FX. THERE IS A PAIN.HOWEVER THERE IS NO H/O OF INC ACTIVITY..THERE WILL B TENDERNESS IN TH E METATARSAL SHAFT AREA,XRAY R NON CONTRIBUTORYUNTIL 2 WKS BONE SCAN IS GOOODWHICHWILL SHOW INC RADOACTIVE UPTAKE...TREATMENTIS WITHSPLINT.NON WTBEARING AND ANALGESIA.
.RUPTURED GASTRONEMIOUS SOLEUS.......ITS ALSO CALLLED PLANTARIS FX IT IS MOST COMMON FX WHEN RUNNING OR JUMPING LIKE IN BASKET BALL MATCH , TENDER OVER GASTRONEMIOUS AND SOLEUS TENDON ...AND P T WILL HAVE NORMAL PLANTER FLEXTION WITH CALF COMPRESSION..ACTIVE PLANTARIS FLEXTIONIS STRONG BUT QUITE PAINFUL...LOCALIZED SWELLING AND ECHYMOSIS PRESENT...TREATEMNTIS SYMTOMATIC.
RUPTURED ACHILIS TENDON...FEELING OF ANKLE GIVING WAY WHEN JUMPING DURING BASKET BALL PRACTICE...ITS COMMON BET 30-40 YRS OF AGE...PT CA PLANTER FLEX UT NOT WALK TIP TOE...AND SQUEEZING RELAX CALF MUSCLE DOESNT RESULT IN TH E IN SAME DEGREE OF PLANTERFLEXTIONAS ON TH ENORMLA SIDE...PT HAS TENDERNESS OVER THE ACHILIS TENDONAT TH E ANKLE OR LITTLE ABOVE A GAP MAY B FELT...REMMBER TREATMENT IS SPLINT AND NON WT BEARING WITH CRUTCHES AND TENDON REAPIR
FX OF TH E TUBEROSITY OF TH E 5TH METATARSAL IS CALLLED DANCERS FX...SWELLING ECHYMOSIS AND TENDER NESS AT THE SITE OF AVULSION ..TREATMENTIS SHORT LEG CASTFOR 4-6 WKS...ITS IS UTMOST IMP TO KNOW THAT TUBEROSITY OF TH E5TH METATARSAL HEAL QUICKLY BUT SHAFT WILL TAKE LONGER TIME...AND SHAFT IS MOREPRONE TO NONUNION....SO IF FX IS IN TH EMETATARSAL SHAFT THEN PROLONGED CAST AN NON WT BEARING RQ
...TODDLERS FX ..ITS COMMONLY INV DISTAL I/3 OF TH ETIBIA..OCCUR IN TODDLERSITS DUE TO SIMPLE FALL DUE TO RUNNING OR PLAYING SHOULDNT BMISTAKEN FOR THE CHILD ABUSE.
..KID HAS A PAIN HE REFUSE TO WALK,PAIN ON PALPATION SWELLLING ECHYMOSIS POSITIVE XRAY IS NOT HELPFUL IN IST 2 WKSUCNA C IN A OBLIQUE XRAY LATER AFTER A WKBONE SCAN IS BEST BUT ITS RARELY RE...TREATMENTIS LONG LEG CAST ..HELAING OCCUR IN 3-4WKS XRAY AT TH E END OF SEC WK WILL SHOW SUBPEROSTEAL NEW BONE FORMATION.
..THE HIGHEST INJURIES OF MEDCIAL MENISCAL IS AMONG MINERS...THE MEDIAL MENISCUS IS FIRMLY ATTACHED AROUND THE PERIPHRY BUT MOVE LESS THAN THE LAT MENISCUS...SUDDEN LOCKING OF TH EKNEE IS AHALLLMARK OF MENISCAL TEAR IN HEAMRTHROSIS THE KNOCKING IS GRADUAL NOT SUDDEN SO ITS DIF...STRESS FX CAN B TREATED WITH NON WT BEARING,ABULATION AND CRUTCHES...FOR 6 WKSTO 8 WKS..
.IMPACTED FX NEED ORIFFX OF INLET AND OUTLET VIEW OF TH E PELVIS IS MUST WHEN PELVIC INJURY OCCUR...BLEEDING IS TH EMOST COMMON RISK DVT CHANCE IS HALF THAN IT IS WITH KNEE ARTHROPLASTY BCZ OF THE LOCATION..ITS IS LESS WHEN HIP IS REPLACED...PELVIC FX IS DIAG WHEN THERE IS PAIN IN TH ESUPRAPUBIC AREA ORLOW BACK...,
LOWER EXTREMITY SHORTENING,WKNESS AND DIMINISHED SENSATION FOLLOWING TRAUMAA SUGGEST THE PRESENCE OF PELVIC FX..CT IS BEST FOR STABLE PT...XRAY PELVIS IS INTIAL FOR DIAG...IF ACETABULAM IS FXED THEN THEN TWO OBLIQUE VIEW CALLLED JUDET VIEW IS MUST ...ORIF ASAP IS LIFE SAVING AND WILL PREVENT ALL COMPLICATION..IN TH EFURURE MAINTAIN BP GIVE TARNSFUSION BCZ LOTS OF BLLLEDING DURING SURGERY..
.dislocation of knee is usuallly posterior...even if pedal pulses r present u must r/o the popliteal a injury