10

cutaneous
Mixof congenital muscle
deformities
Y

I
I Coined By Nicholas Andrey
POP Bandages
Antonius Mathigsen
THOMAS Thomas splint
HUGH OWEN Flexion
Thomas Test Hip
Deformity
 Epiphysis ArticularCARTILAGE
naetaphysist

Diaphysis

HUMERUS

II a growth

Haversian's
canal

APPOSITIONAL grow

volkman'scanal
Attachment of Periosteum
to Bone

Hyaline cartilage covering

Epiphysis
Age related degeneration
p g of articular cartilage
 Diaphysis
Metaphysic

TT Ide

Trabecular OSTEON PEP

AO

MALUNION NON UNION

 0 f
Periosteum

µ L ENDOSTEUM

VOLKMAN'S CANAL

Type 2 Collagen
Articularcartilage

Parathyroid hormone
Type I collagen
Alkaline phosphatase Aep Cate 94 in body
ResorptionFromBone
absorptionfrom ant
parang ummm pen
I phosphateinblood
oppofcalcitonin
Osteoblast

glycogen
 Bone Resorption
Monocyte Macrophage system
Shortest life span
carbonic anhydrase

TBone Radiodense
HardbutBrittle MARBLEBONEDISEASE OSTEOPETROSis
Bone

Type I COLLAGEN

Hydroxy Apatite Crystals

Collagen Triple
Helix
Proline lysine
CIF frequentfractures
X Ray A Bone of multiple fractures in different stagesofHealing
BRITTLE BONE DISEASE OSTEOGENESIS
IMPERFECTA
 FI
TENDERNESS

i
ii
CREPITUS
Abnormal mobility
7
iii lots of Transmitted
movements

HAEMATOMA
Accumulation of Blood Aroundfracture
qt
mm
II FIBROBLASTS
Iii NEW BLOODvessels GranularTissue

I Mineralisation

Hard GranularTissue
Mineralised Gr Tissue
Radiologically visible
IMMOBILE
3 weeks
 COMPACT BONE

Fracture not visible in bone

Bony Architecture is restored

se as

I go
 T

Diseased Bone
Abnormal
Normal

OSTEOPOROSIS
me gite off
stoporotic
Ospine2 4 infection ostomy
O Hip Tumors
neckoffemur
Metabolic BoneDisease
wrist Sx
Colle's E Internal Fixation

TIE of underlying pathology

 No external wound overlyingFracture
does not communicate with externalenvironment

Presence
ofexternalwound over
communicates with externalenvironment
infection non union

Gustino ANDERSON

GRADEI
wounds2cm
GRADE I
wound i room
GRADETI

Yuramination
fitted
A IB IC
Associatedwith
Adequate softtissue Flapsurgery vascular injury
coverage is possible

I A internal Fixation

IB IIC External Fixation

Mlc siteof compound fracture TIBIA

complication of external Fixations pin site infection
 APview
Forearms
A to
PI
APview

9 of assaultinjury
eg

intra articular
extendtojoint

É n
no
Extra articular
antenna going

Wigging.im R v

F
LateralTibial
condyle
Intra articular
C BUMPER'S
F T
 F T
Ankle
AP
Bi mandar
POTT's
Malleoluf
Extra articular Lmedial andlateral Impish
malleolus

Latin AI
medial Lateral
maneous
Posterior

Trimalleolar I
cotton's
y

T F
Intraarticular
ofDiseactiBla
Picon
 Ankle latview
N
calcaneus
NeckofTalus

nm

Foot AP
th MidTarsalJoint
Tatonavicular noParis'sJoint
t.fi calcano
cuboid

jj
Joint
Baseof5thmetatarsal

Foust
 CT Scan
c
Cil ca
Arch of Atlas
O
Jeffersons
O

openmouth
view

Pedicle
Lig
Postlong

FYIftp
III ggggg.igeig
A P
CHANCE or

SEAT BELT
sagittal see ofspine
Horizontal from
ant to post vertebrae
 Fall from
Height
BURST i

vertebral in which
vertebrae
height of
Ises ofwidthTees
Axial compression
Injury

Ca Ti
spinous Process
f
CLAY SHOVELLER'S It

X Ray CERVICAL
SPINE
flat view
 a
HANGMAN's ca

Mcc RoadTrafficAcc
Traumatic dislocationof Cz
over Cs C2

siJoint

RostHip
I s
DASHBOARD
Dislocation
INJURY
 whichIused to
Anymaterial
support an injured extremity

KRAMMER WIRE

emutgnisation

THOMAS SPUNT

shaft of femur
 DENIS BROWN SPLINT

CTE
Congenital Talipes
Equinovarus
CLUB FOOT

SPLINT
pyo
TO COCKY
WRIST DROP
4
Radial N
Mc site Radialgroove
Humerus
MC cause shaftof
muscles ECRL ECRB
 MCP Flexed
KUNKLE BENDER PIPDIP A
SPLINT ended
T
to ulnar N
Injury
d
Paralysisof Intrinsic
muscles

of hand

Volkman's Ischaemic
contracture

Tum Buckle Splint

Aeroplane Splint

Deltoid Paralysis
d

Eet c

Abd
Ext Rotation elbow
 TAYLOR'S BRACE
Immobilize thoracic
Thoraco Lumbar Spine

pea Ankle Foot Drthosis

Fo
DROPYDEFORMITY
Common Peroneal N Injury
Paralysis of Ankle DF

PAVLIK HARNESS
Developmental Dysplasia of
DDR or Hip
CHD

VON ROSEN'S SPUNT

 1 GALLOW's BRYANT'S
TRACTION
Children f Shaftfemur
Iya with

90 90 Traction
children
Shaft femur in
g

DUNLOP's SMITH'S TRACTION

supracondylar
I
Edme
T C
and
Atthe timeof presentations in
hospital

te afterinjury

arm

Maphysis

501ofblood
 Id Hypotension
TAKachycardia
the oliguria Anuria

Ringerlactate frace
Blood Transfusion
resuscitation
OP than contraindicated in initialphase of
Blood URINE OUTPUT 50 75me he
ongoing

Initial Mx ofPolytraung
A B C
se cervicalspine
systemic
inflammatory immobilisation
Response
syndrome
Philadelphiacollar
duetocytokinesurge

HYPOXEMIA IPOs in blood

ABGAnalysis

T Tachypnea
I
Xray
Diffuse pulmonary infiltrates

do
in lung Pulmona
Body clears this
edema own its own 5 7days

mechanical ventilation

seat of Mr

yu
occurs only in

pwt .se

TOXIC VASCULITIS
 Brain confused Disoriented Drowsy
Lungs
Skin Conjunctiva Red PetechiaRashes

Patchy Pulmonary Infiltrates

snow storm Appearance

globose

Low molecular wt Heparin subcutaneous

mechanical ventilation
Prevent
III lung complications
pneumonitis

ARTHROPATHY
Pain

I
Swelling
Skindiscolouration

91

If passive dorsiflexion 9 systems in patient

HOMAN's stg

If directly squeezing affected part MOSES sign

color size of
thrombus
Duplex USA colour venous doppler

Prophylaxis But pumps Dry stockings

Low mol we Heparin LMWH
Factor Ia Inhibitors

MCC RoadTraffic Accident RTA

Earthquakes Mining Accidents

mum
 ATN Acute Renal ARA
failure
acidosis
Electrolyte Imbalance Hyperkalemia metabolic

Renal symptoms

Ily Fluids
correction of electrolyte imbalance
Diuretics Hannodialysis

compression
of
Blood vessels
Pulse still maybe
Nerves palpable

Jess Parestheta

FDP FPL
offorearm
Humerus
EFI BigBelly
nycsupracondylar
forearm bones Radius Ulna
 Closed Tibia
Ant compartmentofleg EHL
EP
StretchTest re

FASCIOTOMY

shoe Heel Raise

EXTERNA
surgery
uzarov
Fixator

Distraction
ÉE
 TOPATHIC
Femoral head PII

Head of femur

4
04
Talus
Body of
aviator's
Movements

a
 MRI Scan

Early AVM Protected wt bearing

CORE Decompression
IsAdvancedAVN
Surgery
ARTHROPLASTY

Ap lat

J
9in
torestorevascularity

Incomplete in
children

GREENSI

E
M

cortical BUCKLING

Torus
FT TT Physicalseparation

injury ofphysis
Ey
4 1
Meaneysis

Asay
MetaphysedBeak

Thurston Hollandsign
E
Distal lower end ofRadius
Eg
 physis Epiphysis

metaphysis
Physis Epiphysis t
Humerus
lateral condyle
11 Eg

pure
Eg Tibia amusingly
 misnormat
Normal

d Neck Femur
ii Pubic Ramus
PYQ iii Metatarsals
I 2nd 3rdmetatarsal

i Army Recruits
ii long distance II to caws

Marathon Runners
iii Dancers
PIE MRI scan

POP CAST
PI
fasten u

I in densityof bone

trabecular

Postsenile Osteoporosis Age Related

Post immobilization
Post Menopausal osteoporosis
d s estrogen
Protein Deficiency Chronic liver kidney Disease
Endocrine Cushing syndrome cortisol
fHyperthyroidism
Drug Induced eg Steroids Anticonvulsants

Back Pain
Nfcsite Spine712 4 HIP weekoffemur
wrist faeries

4
 Ground
Glass
Appearance

I É Biconcave

On S calcium codfishvertebrae
S Phosphorus
S AlkalinePhosphatase

comparison of Bonedensity of Patient with

30yrs same sax I same race

If Tscore is y 2.5
osteoporosis

DRUG OF CHOICE

MI I OSTEOCLASTIC
Resorption 3yrs
I no more than 18months SUBTROCHANTE
OF FEMUR
Atypical
 SERM

IDENOSOMAB

i Ca Vit D supplements
ii Parathyroid Hormone related Peptide PTH P
TERIPARATIDEI

Rickett
Osteomalacia

nutritional Rickets

Earliffppywares
Frontal Bossing
caput Quadratus

o PIGEON CHEST PectusCarinatum

o Rachitic Rosary Costochondral
0 HARRISON'S GROOVE swelling
Depressionformed due to pull of
Diaphragm
pea
F Rickets
Osteoarthritis
KHILEE
1
I
Distanone windswept Bone
Distal
Rickets goesin goesout
Deformity Blugenu
Bilgenu
Rheumatoid varus valgus
Arthritis

Rickets
Rheumatoid Arthritis

wrist
E delayed app ofepiphysis CAD
P widening of Physis
M cupping splaying ofmetaphysics E
p
Item

Is or
IL
LILI
TTT 20Hyperparathyroidism
TTT
 3 61 IV of Vit D
Best investigation to assesshealing
X Ray Cuteline of
Frankel
Jt
Young F
Vit D

Bone Pain
Tiredness Fatigue
Pathological fractures
Eg Neck femur Scapula
of
Pubic Ramus
L
LOSERSZONE
It
O
 Parathyroid Adenoma
T osteoclastic activity
A Bonet
resorption

BRYWYImor

subperiosteal salt Pepperapp I

maxillaof
mandible
ofPhalanges
Resorption of skull

TTT
LIL
TTT repairmech
MATT
 7.0
Adults
child birth
Medial 213d Lateral43rd
TO ii medial 315th Lat45th

Figure 8 Bandage

Open reduction of internal Fixat

i of Lateral 43rd of clavicle
Cii Open
involvement
Iii Associated with neurovascular
Mal union
MICcomplication

Head ant
Ant Mtc
Posterior Head post
Inferior

Note Naming ace to position of distalbone

Wirt joint
 falls on outstretched hand with limb
i Abduction 4
Ii External Rotation

Inabilityofpatient to
touch opposite shoulder

funder sedation GAJ

Traction
External Rotation
ABDUCTION
Medial Internal Rotation

missed

EPILEPSY
ELECTROCUTION
 Internal Rotation

lightbulb
sign

LUXATIO ERECTA
Hyperabduction
ji
 Recurrent ant shoulder dislocation

Tear
of ant Glenoid labrum

Bony defect present at

posterior humerus head

Arthroscopic
MIC Bankart's Repair
Surgical
latarjet Bristow

cisant gÉÉYTbonedefect
ii Bony Bankart
 MEER'S CLASSIFICATION

34kg7 Axillary N
I sensation in upperlateral arm

Radial N
tff upperyz lowery
Humerus Radial N injury

of Shaftof Humerus
Hanging cast
A
used for Rx for diaphyseal
 not United both
clinically
Radiologically In 9 months

open reduction Internal Fixation

I MK site of BG harvesting

tilt
from iliac crest
 Distal Humerus Metaphysis
of
above condyles
5 Ayn

me Q vascular injury
Brachial artery
g p
FlexionType
extension
A Es
Type
me

A
Post medial o
f I
g

Brachial artery
Anterior interosseous at median N

Above elbow pop

 Kirschnes

Associated
injury to Br artery AI

VOLKMAN'S ISCHEMIA Ischemic injury

to EDP FLP

cubity
mannion air
MEET
MEET F on
cameramen

Massaging injured area

Brachialis
Humerus
supracondylar
Sequelae of compartment syndrome
Dead muscles FDP are replaced
Tissue contracture
by fibrous

Turn Buckle Splint

Lat epicondyle t capitulum

Type I

surgery
I Neck of femur
DISLOCATION
Montreggia
I Galeazzi Dislocation

Non union MY tardy slow

CUBITus ulnar N palsy
valgus
DEFORMITY
injury involving lateral
Physis of Distal
Humerus
 Pronation

Normal

Reduce backRadielHead by
direct pressure t
supinating forearm

c 0R
Proximal 43
R U ulna
I 6
Radial head
y 8 dislocation
0 10 Montana Dislocation
E 12

injury of distal
Radioulnar Joint

g
Galeazzi Dislocation
 In distalRadius metaphysis

p A
9 50yrs
osteoporotic

Posterior Lateral

i Below elbowcart

Palmar flexion
i it
Medial deviation I Handshaking cast
Note Thumb is spared Thumb is spared
In scaphoid Thumb included
I
to finger stiffness
 O Dinnerborndeformity
P

CRPS a RSI

occursafter softtissue boxy

nfc cause colles

occursafterinjuryto peripheral nerve

o my cause median N
a fatty
osteoporos

deformity
Éi
 www.y.nm.ng.in
YoungAdults
APL EPB
waist of scaphoid

Oblique views Acute

Chronic occult

BIE Scaphoid cast

I
wrist in dorsiflexion Glass
RadialDeviation 4J Holding
Position
Thumb involved till IP joint

HERBGERT'S SSEREN
 non union
Avascular necrosis
Prox fragment

Intra articular I
1 metacarpalBase
TRAPEZIUM
BENNET'S of
Dislocation

DISLOCATION 1stCme joint

Bastof
metacarpal

ROLANDO't
 Neckof 5th

t
BETTE
a

injury of extensor tendon of

Distal Phalanx
UF Active extension at
not swanneck
Dipjoint Absent
deformity
Tx Mallet finger splint
Dip joint in hyperextension
 Dashboard injury
OF Flexion
Adduction internal Rotation

closed reduction wider

sedation GA

me I injury to
Saetofootdrop
Ame of femoral head
20
Flexion Abduction
external rotation

Acetabulum
Medial Dislocation
of femoral head

ÉE
it
intertrochouteric
IT

extracapsular
 1
2 F LM M F
3 how High
Pain sweeting skin
SEVERE
µ Bruisingsiscolouration
cess
less higher
Externalrotation

6 nonunion marmion

Your
Goal Presentation of femoral
head
TIE CRIOR If with screws

AX
Goal Early mobilization
Hip replacement
Tt
arthroplasty

I
Hemiarthroplasty
only femoral component
is changed
i Limited physical activity
ii No history of any pre existing
hip arthritis
Total hip arthroplasty A
Both acetabulum Femoral
components are changed

of weak femur
Non union not
Avascular
necrosis of
femoralhead
 1250

N S angle Kiso
If
coxa vans
1350
coxa valgus

closedRed It with
I mendmathPEN Proximalfemoral
t
hall
PED

Mal union
Coxa varus
 Dioping

WINQUIST TANSEN'S CLASSIFICATION

Thomas Splint

Laps
Gallows Bryant's traction

2 5
yes
thip Spica

skeletal maturity
Gyu
Tens Titanium
Elastic
Nails
M Skeletally Mature
Ey Patients
I
Intermedullary
Maiming

Hypovolemic shock
Fat embolism

MIG involved in
4 OSTEOARTHRITIS genu varus

dead
MC Rheumatoid arthritis

Mlc involved in
0T
eat Chondsomalacia
he in young people
Prevents ant tibial
translation
Preventspost tibial translation

parents meant opening qg.at 811

4414
Lat

Extra Extra
Capsular TW
Extra
capsular synovial
Intracapsular lutrasynovial
4164

valgus force

valgus
femoral attachment
force
E valgus
stress Test
 Varus force

Attachment on fibularhead

Varus Stress Test

Twisting injuryto knee

soft tissue medial meniscus

me ALL
injury KUCID
in
iii Ma difficulty in walking downstairs

MfcDone test 10 15 knee

flexion acute AEL Tears

Chronic ACL Tears

knee 90flexion
Gracilis
Semi tendinous

UPHILL A Walking upstairs

Post Drawer Test

Arthroscopic PCL Reconstr

 Kumi 1
Keenan
Myre

Avascular
T Vascular
Twisting Injury
Rigid fixedstructure
F P mm
i Mc site Posthome of M M
LM
ii Mc Type oftear Bucket
handle Tear
A
Pain
Recurrent Swellings
hocking of knee joint

McMurrays Test

O
 Mariscal
Repair

Meniscectomy

big
fibular
post Tag
Lateral
ligament
of
Ankle
on ATFL

Calcanofibular
 Mvfibre neuron

ry
4 2
cell body
reEÉIi
Blood
supply

Ends
IhK
covers axon

Perineurium
coversfasciculus

Epineuriumnerve
 Degeneration Distal to
injury IX
Degeneration proximal to injury

10 22 Days

2mm day
T
tutus MM

yÉÉÉ
1
Advancing Progressive beg
Tine's sign present

MOTOR MARCH
Sequential Recoveryin muscle contractions
which progresses from proximal to distal
 I NEUROMA
i collection ofnerve cell body

NEUROPRAXIA

Axonomesis
NEUROTMESIS
me mildest

Temporary conduction Block

anatomically Nv intact
Disruption ofmyelin sheath
Both wallerian pr deg 7 Absent
TINEL'SSIGN Absent

It Spontaneous Recovery in
6 wks

Injury to Axon t myelin

But outer ENDONEURIUM
is intact
Both wallesian t PR Deg Present

o Tinel's sign
Advancing
Motor March
tines sign
1 Present

TIE Intervention is only

required when recovery
stops
 Eo Io
o complete anatomical Transactionof N
0 Degeneration Present
Present
Tinels sign
Advancing tinel'ssign Absent
Motor March

It surgery

mentfratia Itftment mÉÉmesis

FEI
Primary Nove Repair
Secondary N Repair
It
I Mc N Nerve
neggural
wristdjtendon transfer
 long LateralHead of Triceps

Medial head t Anconers

ofTriceps
BR ECRU ECRA
PIN

EDC FEPL
extensionoffingers extension ofthumb
atMCP joint

Injury of N in axis
At muscles supplied try Nerve axilla are paralysed

Shaftof humerus
wrist drop
com up
Jones
Tendon
transfer
 Finger 4 Thumb Drop
ED Ere

PT FCR FDS PL

FPL PQ Lateral112of Fpp

CAIN

ABPB FPB OP
 OSCHNER'S CLASPTEST

Paralysis of FDS FDP

Index finger
of

Paralysis of Oponens Pollicis

Thumbis extended Adducted

It lies in same plane as other
fingers

Abductor pollicis brevis

Ip Index finger

AT LFPL thumb
Tip of Little finger
FCU
Medial 1 2 of FDP

Adductor novices
All Interossei
3rd 4th Lambrical
All hypothenermuscles

Partial claw hand

intrinsic

Intrinsic minus
clawing is less prominent
in high ulnar
N Palsy Paralysis ofmedial 42of FDP
Flexion at DIP
KNUCKEE Bender Joints is absent

Splint

Palmar Interosser

Dorsal Interossei
ofmiddlefinger

Abducted position of
littlefinger
I
weakness of 4th
Palmar Interosser
 Adductor Pollicis

X r

non
hold
to

Nerve 90 Serratus Anterior

WINGING OF SCAPULA

Iatrogenic

FoosDROP

AFO Anklefoot orthosis

 upper

Axillary N
MuscatocutN lossofcilio spinal
reflex
Suprascapular N

Lower Horner
Syndro

INTRINSIC MINUSHAND
CLAW HAND