Random Orthopedic Stuff

Front 1

Pridie indications

Back 1

Acute chondral injury < 2 cm

Front 2

Pridie how-to

Back 2

Chondral injury
3-4 mm between holes
Sharp edges, go down to bone
No weight bearing ~ 4 months

Front 3

Methods for chondral lesions

Back 3

Pridie
Mosaic
Carbon rods
Periosteal flap
Chondrocyte transplant
...

Bentley et al 2012 - 10 year followup of RCT between mosaic and chondrocyte implantation -> 17 % failure vs 55 % failure favoring chondrocyte implantation. Mean age at surgery 31, average 1.5 surgeries prior to study.

Front 4

Beighton score

Back 4

Dig 5 > 90 degrees
Thumb - passive dorsiflexion to the flexor aspect of the forearm
Hyperextension elbows > 10 degrees
Hands flat on the floor
Hyperextension knee

4 out of 9 = laxity

Front 5

Jumpers knee

Back 5

Tendinopathy
Eccentric exercise 12 weeks

Sclerosing treatment using doppler

Front 6

SCFE

Back 6

Slipped Capital Femoral Epifysiolysis

Male
Ethnicity
Obesity
Age 10-15 (avg. 12 yo females, 13 yo males)

Southwick classification - I-III, 0-30 degrees, 30-60, 60-90

Acute (Acute on Chronic) - 2 screws
Chronic (>= 3 weeks) - 1 or 2 screws
1-2 cm long, from anterior to posterior

Bilateral advocated due to 20-40 % chance of bilateral

Complications: OA. Hip stiffness. AVN. Infections (rare). Limb-Length Discrepancy

Front 7

Leg-Calves-Perthes

Back 7

4-8 yo, > 6 yo = worse prognosis

Male:Femal 5:1
Hereditary
Abnormal birth position
Second hand smoke

Herring classification (alternative is Caterall) - lateral pillar height
I - Intact height
II - > 50 % of height
III - < 50 % of height

4 fazes:
Condensation faze (Initial) (3-6 months)
Fragmentation faze - easiest to classify acc. Herring
Reossification faze
Remodulation

Duration: years
Containment! - abd. orthosis (?), varus osteotomy, pelvic osteotomy
Neg. prognostic if lateralization of head

Stulberg classification - head deformity => OA

Front 8

DDH

Back 8

Development Dysplasia of the Hip

Risk factors:
- Breech birth
- Female gender
- Heredity
- Oligohydroamnios

Signs:
Ortolani/Barlow
Galeazzi
Skin folds

Unstable = 6 weeks treatment
Dislocatable = 3 months

Pavlik/von Rosen - abducted 70-80 degrees + flexed 90 degrees (frog)

Ultrasound - screening + verifying reduction early on
X-ray (4 months):
Hilgenreiner's line -> acetabular angle < 30 degrees
Perkin's line - perpendicular to Hilgenreiner's angle (ossification centre should be medial)
Shenton's arc - arc between collum and pelvis

Late - tenotomy + cast, osteotomy?

Follow for 1 year

Front 9

Osteomyelitis

Back 9

4 joints with high risk of septic arthritis due to intraart. physes:
Shoulder, elbow, hip + ankle

Unwilling to use extremity + tenderness

CRP rises early within 6 hours, SR later - failure to respond within 48 hours - surgical intervention - earlier if in high risk physes

Culture - bone biopsy culture has best sensitivity (blood has only 30-50 %)

IV - antibiotics until improvement then oral ab 4-6 weeks

Pathofysiology: Slow blood flow in physes, low phagocytosis -> hematogeneous spread

Bacteria: mostly S.Aureus

Front 10

Clubfoot

Back 10

PEVA - pes equinus varus adductus

Ponsetti method - 1 cast/week
Correct midfoot cacus -> adductus -> varus and last equinus (usually percutaneous tenotomy at 8 weeks)
Talus is the fulcrum

Associated with other patholgies:
hand anomalies
diastrophic dwarfism
arthrogryposis
tibial hemimelia
myelomeningocele

Front 11

Patella dislocations (adolescent)

Back 11

First time - MPF-lig. torn, treat with patella stabilizing orthosis for 6-8 weeks and thereafter during exercise. Physiotherapy and strengthen vastus medialis

Check for osteochondral fragment - excise if small or reattach with bioabsorbable nails if larger. Younger = higher risk of large chondral fragment - MRI

Risk factors for recurrence:
- High Q-angle
- - Wide pelvis (female)
- - Externally rotaded tibia
- - Valgus knee
- - Femoral anteversion
- Hypoplastic trochlea/lateral condyle
- Lax ligaments
- Patella alta (Insall-Salvati ratio)

Tests: Apprehension test, J-sign, Mobile patella

Treatment: Lateral release if patellar tilt, medialization of tuberositas tibiae, MPF-lig. reconstruction (?)

Front 12

Synthetic bone graft substitutes
- Resorption speed & types

Back 12

Calcium sulfate (fastest)
Tricalcium phosphate - Norian
Hydroxyapatatite (slowest)

Front 13

Bone graft qualities

Back 13

Osteoacondyctive (ingrowth)
Osteoinductive (BMP, mesenchymal cells)
Structural