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EXOSTOSIS

Posted on: March 16th, 2016 by admin No Comments

TERM:

Its is an starting stage of over growth of a pre-existing bone. It usually form during an the active growth stage. For an example (an extra bone formed in ankle. )

In a case of bone growth is capped with cartilage and its known as osteochondroma.

They are often result of trauma and in many case exostosis is asymptomatic.

1. It usually found while during an medical checkup.

2. It is the most common benign bone tumor.

 

Clinically presentation:

  • v Swellings.
  • v Non-tender.
  • v Its look like a firm.
  • v Immovable mass occur near end of the long bone.
  • v It may cause irritation.

 

Prevention Method:

  • Try to wear an comfortable shoes and the chapels.
  • Avoid tight shoes and the high heel chapels.
  • Try wear an shoe that with the help of insert alleviate pressure to heel.

 

Diagnosis Method and investigation of choice is:

X-ray shows : appearance of Exostosis is either in flat or lesion or peduculated.

 

Treatment:

  • ü Usually for this condition no treatment.
  • ü If the bone become problematic so required an surgery.
  • ü in which case malignancy is suspected (surgical resection is also indicated).
  • ü prognosis for a solitary exostosis is excellent
  • (< 5% recurrence following marginal excision).

DVT

Posted on: March 16th, 2016 by admin No Comments

DEFINITION

It is a blood clot that from within a normally functioning vein. (Eg) leg and mostly occur in leg and also occur in other part of body such as arm.

DVT become classified as embolism. When it clot; DVT and PULMONARY EMBOLISM are dangerous because of their potential to become wedged. When the blood reaches the lungs and can cause an vary problems. Potentially cause death.

CAUSES

1. IN TRAUMA

  • the veins inner lining becomes damaged due to an injuries caused by a variety of factor including surgery.
  • surgery injuries.
  • Inflammation.
  • Immune response.

 

2. LACK OF BLOOD MOVEMENT :

  • Slow blood flow due to lack of motion can occur an after surgery.
  • If you are in ill and in bed for long period of time .
  • While long standing (eg) Road traffic police.

 

3. GENETICS (or ) HYPERCOAGULABLE STATE :

  • Your blood is thicker (or) more likely to clot than normal.
  • Inherited condition. Hormone theraphy, certain cancer drug and birth control pills, increased clotting risk.

 

RISK FACTOR OF DVT:

  • Elderly people
  • Over weight and obesity.
  • Smoking.
  • Damaged to vein resulting from recent trauma (or) surgery.
  • History of previous injury (or) immobilization.
  • Being in Hyper coagulable state (increased clotting ).
  • Recent history of surgical procedure.
  • Pregnancy and first 6 weeks after giving birth.

 

SYMPTOMS:

  • Fever
  • Edema / swelling of the leg or along a vein in the leg.
  • Pain and tenderness in the leg. Which may you feel while walking or standing position.
  • Warmth is swollen area of the leg.
  • Erythema (redness of the skin) or cyanosis (blue skin).
  • Rapid breathing.
  • Fast heart rate (tachycardia).
  • History of previous or immobilization.
  • Recent history of surgical procedure.

 

TREATMENT:

  • Drugs like (warfarin, heparin and Coumadin.)
  • Thrombin inhibitors. (patents who are not able to take heparin )
  • Thrombolytic (only in life threatening situations)
  • Vena cava filter
  • compression stockings.

Bunion

Posted on: March 15th, 2016 by admin No Comments

Terms

It is an deformity on the medial site of 1st MTP joint and the  joint connecting with the big toe of the foot its known as the hallux.

It is an enlargement of bone or may be tissue around the joint at the bottom of the big toe. It is usually seen in metatarsophalangeal joint.

Physical Examination

  • Pain over the medial eminence, due to footwear.
  • Deformity.
  • on medial  site of 1st MTP.
  • Range of motion may be restricted, especially in dorsi-flexion.

 

Risks factor

  • Numbness in the big toe
  • The wound does not heal well
  • Continously pain.
  • Stiffness on the toe
  • Arthritis on the toe

 

There are 3 different stages:

Stage 1

  • Its usually seen adolescents to 25 y/o.
  • bunion presents as a slight bump.

 

Stage 2

  • from 25 y/o  to 55 y/o
  • 1st metatarsal head adducts, hallux abducts ,callosity on medial  site of 1st MTP joint
  • Foot continues to pronate.

 

Stage 3

  • overlapping of hallux either above or below  2nd  digit
  • rarely find footwear
  • extreme  pain, need surgical to correct.

 

Non-operative management

  • Footwear changes.
  • Drugs like NSAID.
  • Foot strengthening exercise.
  • Bunion strapping.

 

Surgical Method:

  • Hallux valgus based on the degree of deformity.
  • Dorsal Cheilectomy.
  • Modified McBride Procedure.
  • Distal Chevron Osteotomy.
  • Proximal Metatarsal Osteotomy.

Fat Embolism

Posted on: January 5th, 2016 by admin No Comments

Fat Embolism is a complication of closed fracrures.  It may lead to Respiratory distress, cerebral dysfunction and rash. It is often very difficult to diagnose.

Causes

1. Fractures – closed fractures produce more emboli than open fractures. Long bones pelvis and ribs cause more emboli. Sternum and clavicle furnish less. Multiple fractures produce more emboli.
2. Orthopedic procedures – most commonly intramedullary nailing of the long bones hip or knee replacements.
3. Massive soft tissue injury.
4. Severe burns.
5. Bone marrow biopsy

Non – traumatic settings occasionally lead to fat embolism. These include Conditions associated with:

  1. Liposuction
  2. Fatty liver.
  3. Prolonged corticosteroid therapy
  4. Acute pancreatitis
  5. Osteomyelitis
  6. Conditions causing bone infarcts,especially sickle cell disease.

 

Symptoms

Patients often presents with the following symptoms:

  1. Breathlessness
  2. Chest pain
  3. Fever
  4. Petechial rash
  5. Cerebral dysfunction ( disorientation, confusion, seizures)
  6. Oliguria, haematuria, anuria
  7. Respiratory failure

 

Diagnosis

Major Criteria

  1. Respiratory insufficiency.
  2. Cerebral involvement
  3. Petechial rash

 

Minor Criteria

  1. Tachycardia
  2. Pyrexia ( usually > 39 degrees. C)
  3. Confusion
  4. Sustained pO2,< 8 kPa.
  5. Sustained respiratory rate> 35/minute in spite of sedation.
  6. Retinal changes – cotton wool exudates and small haemorrhages, occasionally fat globules seen in retinal vessels.
  7. Jaundice
  8. Renal signs
  9. Thrombocytopenia
  10. Anaemia
  11. High ESR
  12. Fat macroglobulinemia
  13. Diffuse alveolar infiltrates ‘snow storm apperance’on CXR.

One study concluded that atleast two symptoms for the major criteria Or one symptom for the major criteria must be present to diagnose the Syndrome.

Investigations

–    Chest X-ray
–    Blood gas analysis
–    Blood investigations
–    Urine analysis
–    MRI scan study of Brain
–    Transoesophageal Echocardiogram

Management

–    Sufficient oxygenation
–    Restriction of fluid intake
–    Diuretics
–    Albumin Infusion
–    Mechanical ventilation
–    Heparin anti coagulation

Prevention

–    Early immobilisation of fractures
–    Heparin anti coagulation

Chondromalacia

Posted on: December 8th, 2015 by admin No Comments

Chondromalacia is a condition where the cartilage of the under surface of the knee cap undergoes wear and tear. Chondromalacia in other terms is called as Runners Knee as it is very common in athletes who involve specially in running. However it may equally affect other individuals too.

Chondromalacia can also occur in individuals with osteoarthritis of knee, young individuals who are obese, or in individuals with trauma to knee cap.

Causes of  Chondromalacia

  • Trauma
  • Obesity
  • Athletics
  • Repeated usage
  • Age related wear and tear
  • Lack of exercises

 

Who is at Risk for Chondromalacia?

  • Female sex
  • Elderly people
  • People with flat foot
  • Athletes
  • Individual with osteoarthritis

 

Symptoms of Chondromalacia

  • Pain over knee
  • Joint line tenderness
  • Crepitus
  • Swelling over knee
  • Severe pain while getting up after prolonged sitting

 

Diagnosis

  • Signs and symptoms
  • Clinical examination
  • X-ray
  • MRI scan study
  • Arthroscopic Examination

 

Treatment

  • Analgesics and Anti- inflammatory
  • Physiotherapy
  • Exercises
  • Lubricants
  • Hot fermentation
  • Surgery

OCCUPATIONAL HAZARDS

Posted on: November 6th, 2015 by admin No Comments

DEFINITION

It’s a kind of work related musculoskeletal disorder, which may include.

(1) Muscles
(2) Tendons
(3) Nerves
(4) Carpel tunnel syndrome
(5) Thoracic outlet syndrome
(6) Tension neck syndrome

CAUSED BY

Often affected due to overstrain

(1) Repetitive strain
(2) Repetitive motion injuries
(3) Over use syndrome
(4) Soft tissue disorder
(5) musculoskeletal disorder

RISK FACTORS

1. General movements like
(i) Bending
(ii) Straightening
(iii) Gripping
(iv) Holding
(v) Twisting
(vi) clenching
(vii) Reaching

Movements are not harmful in the ordinary activities of daily living.\

BUT WHAT REALLY CAUSE OF THE INJURIES ARE

(A) Speed of movements.
(A) Fixed body positions.
(B) Some posture can cause discomfort.
(C) Unwanted posture maintained for prolonged period of time.
(D)    Lack of time for recovery between them.

PREVENTION’S

(1) Proper ergonomic corrections.
(2) Often changing the body posture from one position to another.
(3) Free & strengthening exercise to maintain the muscle strength of the body.
(3) Exercises help to prevent further injuries.

KEY POINTS

SITTING

Rest your back firmly against the back of the chair.

Put a pre made support, a small cushion, behind your lower back.

If your using computer:

(i) The keyboard should be right in front of you and the monitor should be at eye level.
(ii) Try to keep your chin in tuck- in posture.
(iii) Mouse holding should be 90 degree angle at the elbow level.

STANDING:

(1) Change position often.
(2) Wear comfortable shoes with arch support.
(3) Avoid high heels.

LIFTING

(1) keep back straight, lift with your leg muscles not your back.
(2) Lift and carry things close to body.
(3) Be careful not to twist your spine.

DO THE EXERCISES REGULARLY AND KEEP OUR BODY FIT.

SUD ECK’S OSTEODYSTROPHY

Posted on: November 4th, 2015 by admin No Comments

Sudeck’s osteodystrophy is a condition of intense burning pain, stiffness, swelling, and discoloration that most often affects the hand. Arms, legs, and feet can also be affected by sudeck’s osteodystrophy.

This condition was previously known as Complex regional pain syndrome (CRPS), reflex sympathetic dystrophy, Sudeck’s atrophy, shoulder-hand syndrome, or causalgia.

CLASSIFICATION

There are two types:

1. Type 1 occurs after an illness or injury that did not directly damage a nerve in the affected area.

2. Type 2 follows a distinct nerve injury

EPIDEMIOLOGY

Sudeck’s atrophy is reasonably common – it may occur after as many as 5% of traumatic injuries. RSDS frequently occurs between the ages of 40 and 60 but also can occur in children and the elderly. It is more common among women.
Risk Factors:

1. It may occur spontaneously (i.e. without any cause) -but more commonly it follows trauma (fractures, ligament and muscle strains, nerve or soft tissue injuries) which may seem trivial.

2. It is believed to be due to prolonged immobilisation following the injury.

3. It can also be associated with medical conditions – diabetes, stroke/ heart failure, thyroid disease, cancer, infections.

CAUSES

Although the two types of CRPS can be tied to injury or illness, the exact cause of CRPS is unknown. One theory is that a “short circuit” in the nervous system is responsible. This “short circuit” causes overactivity of the sympathetic (unconscious) nervous system which affects blood flow and sweat glands in the affected area.

SIGNS & SYMPTOMS

1. Early on there is throbbing, burning pain with the site red, warm and swollen

2. After weeks or months the overlying skin may become cold, mottled, and shiny with stiffness and often underlying osteoporosis

3. Later the pain continues, with associated muscle atrophy and there may also be contractures.

DIAGNOSIS

The diagnosis is clinical, however, an x-ray may reveal osteoporosis of the underlying bone later in the process. Bone scans, and magnetic resonance imaging (MRI) scans can help your doctor make a firm diagnosis.

TREATMENT

Early diagnosis and treatment are important in order to prevent CRPS from developing into the later stages.

NON SURGICAL

1. Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), oral corticosteroids, anti-depressants, blood pressure medications, anti-convulsants, and opioid analgesics are medications recommended to relieve symptoms.

2. Injection therapy. Injecting an anesthetic (numbing medicine) near the affected sympathetic nerves can reduce symptoms. This is usually recommended early in the course of CRPS in order to avoid progression to the later stages.

3. Biofeedback. Increased body awareness and relaxation techniques may help with pain relief.

4. PhysioTherapy. Active exercise that emphasizes normal use of the affected limb is essential to permanent relief of this condition. Physical and/or occupational therapy are important in helping patients regain normal use patterns. Medications and other treatment options can reduce pain, allowing the patient to engage in active exercise.

SURGICAL

If nonsurgical treatment fails, there are surgical procedures that may help reduce symptoms.

1. Spinal cord stimulator. Tiny electrodes are implanted along your spine and deliver mild electric impulses to the affected nerves.
2. Pain pump implantation. A small device that delivers pain medication to the spinal cord is implanted near the abdomen.

Results from surgical procedures may be disappointing. Many patients with chronic CRPS symptoms benefit from psychological evaluation and counseling.

PROGNOSIS

The problem eventually settles though it takes a lot of time.

Ulnar Collateral Ligament Injuries

Posted on: October 28th, 2015 by admin No Comments

Ulnar collateral ligament gets injured due to trauma or repeated actions or stress. Ulnar collateral ligament injury is very common in athletes mainly involved in tennis, badminton, javelin throwers, etc.. Fall on an out stretched hand can also lead to ulnar collateral ligament injury

SYMPTOMS

–         Pain along the inner side of elbow

–         Associated swelling

–         Range of movements restricted

–         Patient often complaints that making a fist is painful

DIAGNOSIS

–         History and clinical examination

–         Valgus stress test

–         Crepitation

–         X- ray may show bone spurs, loose fragments, calcification

–         MRI diagnoses ligament rupture

–         Diagnostic arthroscopy

TREATMENT

Non surgical treatment:

–         Rest

–         Ice application

–         Limb elevation

–         Analgesics and anti inflammatory

SURGICAL TREATMENT

If conservative treatment fails, Arthroscopy and proceed.

Surendhar Case Summary

Posted on: October 10th, 2015 by admin No Comments

A case of poly trauma. Patient was travelling in a bus where he was hit by a lorry on 26.06.2015.Patient C/O severe pain & inability to use both lower limbs. C/O inability to stand & walk. Patient was initially treated at Govt.Hospital near Vellore where he was treated conservatively with splints, analgesics & suturing of right forearm. Patient had no H/O Loc/Ent bleed.

Patient had come at Sai ortho care hospitals for further management.

When patient was received at sai ortho care hospitals patient was observed to be in “HYPOVOLAEMIC SHOCK.” Patient was resuccitated with IV fluids & dressing of the compound wound over left femur was done. Patient was immediately shifted to ICU & was stabilized vitals was found stable. O2 support given due to de – saturation. Skin traction for both lower limbs was given. Wound swab from compound wound sent for Culture & Sensitivity.

 X – rays taken for both lower limbs. Patient was diagnosed with

  1. Fracture shaft of femur right side.
  2. Comminuted compound fracture femur left side.
  3. Fracture both bones left leg.
  4. Comminuted fracture distal tibia & fibula right side.

 

After stabilizing the patient, fracture fixation was planned as a 3 stage procedure.

Stage 1: (30.06.2015)

Intramedullary nailing of right femur & external fixator application of left femur with wound debridement done on 30.06.2015.B.K.Slab given for both legs.

Stage 2 : (05.07.2015)

External fixator removal & intramedullary nailing of left femur. O.R.I.F. for right ankle done on 05.07.2015.

Stage 3: (11.07.2015)

Closed locking & intramedullary nailing of left tibia done on 11.07.2015

Patient is very comfortable.Vitals are stable.

Active mobilization of all joints started.

Quadriceps strengthening exercises started.

Knee Pain

Posted on: October 8th, 2015 by admin No Comments

Definition

A pain occurs  in and around the knee joint.It affects people of all ages.

Caused by

1.Knee joint itself.

2.Some conditions affecting the soft tissues,ligaments,tendons and bursae,(ie-surrounded the knee joint)

Risk Factors for Knee Joint Pain

            1.Excess weight.

2.Over use /Repetitive motions

Eg- Jagging /long period of knee down)

Knee Joint Pain

May be

1.Ruputured ligament,

2.Medical conditions

(a) Arthritis-gout and infections

3.Chronic use/

(a)Osteo Arthrities

(b) Patellar syndromes,

(c) Tendinites

(d) Bursitees

Symptoms of Knee Joint Pain

1.Swelling

2.Redness

3.Difficulty to extend the knee joint

4.Unable to bend the knee joint

5.Limping

6.Difficulty in walking 

Diagnosis of Knee Joint Pain

1.Radiological tests: X-Ray(find out fractures and degenerative changes)

2.MRI: Evaluate –ligament tears,cartilage damage and muscle injuries.

3.Blood tests.

If suspected- Gout arthritis and other medical conditions.

4. Removal of it fluid: (Arthrocertesis)

The fluid is that sent to the lab for evaluation for infected knee.

5.Treatment for knee joint pain:

Varied as the conditions that can cause the pain

1.Medications

2.Physical theraphy :Strengthening the muscle and help to avoid further worsening of an injury.

3.Corticosteroids- Help arthritis and other inflammation

4.Lubricants-Can help with movement and pain.

Surgery

It from arthroscopic knee surgery to total knee replacement. The surgeons can repair many injuries and remove small pieces of loose bones and cartilage.        

Partial knee replacement: Part of the knee joint is replaced,shoter recovery than total knee replacement.

Total knee replacement: Knee is replaced with an artificial joint.

Prognosis of knee pain: Usually occurs short periods and resolve if knee joint pain be comes chronic,modern surgical techniques possible to relieve the pain and help to an active life style.

Article on Knee Replacement Surgery