Surgery Two (Part Two) Orthopedics and Anesthesia
One. Classification Based on Etiology
Two. Classification Based on Displacement
Three. Classification Based on Relationship with the External Environment
Four. Classification Based on Complexity of Treatment
Five. Classification Based on Quantum of Force Causing Fracture
Six. Classification Based on Fracture Pattern
Seven. Fractures with Eponyms (Named Fractures)
Eight. Pathological Fractures
Common Causes of Pathological Fractures
Open fractures- clinical features, classification, investigations and treatment of open fractures
Clinical Features of Open Fractures
Classification of Open Fractures
One. Gustilo-Anderson Classification (Most Commonly Used)
Two. Tscherne Classification (Soft Tissue Injury-Based)
Three. AO/OTA Classification
Investigations for Open Fractures
Two. Laboratory Investigations
Treatment of Open Fractures
Phase two: Definitive Surgical Treatment
Phase three: Wound Closure and Reconstruction
Phase four: Rehabilitation
Complications of Open Fractures
Clinical Features of Compound Fractures
Classification of Compound Fractures
Two. AO/OTA Classification
Three. Tscherne Classification
Investigations for Compound Fractures
Two. Laboratory Investigations
Treatment of Compound Fractures
Phase two: Definitive Surgical Treatment
Two. Fracture Stabilization
Phase Three: Wound Closure and Reconstruction
Phase Four: Rehabilitation
Complications of Compound Fractures
Etiology and Risk Factors
Common Sites of Stress Fractures
Surgical Management (For High-Risk Fractures)
Two. Anatomy of Bone and Fracture Healing
Stages of Fracture Healing
One. Stage of Hematoma Formation (Less than seven days)
Two. Stage of Granulation Tissue Formation (Up to two to three weeks)
Three. Stage of Callus Formation (Four to twelve weeks)
Four. Stage of Remodeling (One to two years)
Five. Stage of Modeling (Many years)
Factors Influencing Fracture Healing
(c) Endocrine and Metabolic Conditions
(e) Stability of the Fracture
Complications of Fractures
One. Immediate Complications (At the Time of Injury)
Two. Early Complications (Days to Weeks After Fracture)
Three. Late Complications (Months to Years)
· Healing in an abnormal position, causing deformity or limb shortening.
Three. Treatment of Fractures: General Principles
Composition and Chemistry
Indications for Plaster of Paris Use
Types of Plaster of Paris Casts and Their Uses
Application of Plaster of Paris Cast
Step Two: Mixing and Application
Step Three: Drying and Setting
Complications of Plaster of Paris Application
One. Tight Cast Syndrome (Compartment Syndrome)
Four. Joint Stiffness and Muscle Atrophy
Disadvantages of POP Casts
Comparison: POP vs. Fiberglass Casts
Indications for External Fixation
Types of External Fixation
Two. Circular Ring Fixators (Ilizarov Frame)
Four. Pelvic External Fixators
Procedure for External Fixation
Tightening and Stabilization
Advantages of External Fixation
Disadvantages of External Fixation
Complications of External Fixation
Pin Site Care and Patient Management
Measurement of the Thomas Splint
Uses of the Thomas Splint
Care of a Patient in a Thomas Splint
Advantages of the Thomas Splint
Four. Splints and Tractions
Uses of Böhler-Braun Splint
Advantages of Böhler-Braun Splint
Care of a Patient in a Böhler-Braun Splint
Indications for Skin Traction
Application of Skin Traction
Advantages of Skin Traction
Disadvantages and Complications
Care of a Patient in Skin Traction
Indications for Skeletal Traction
Types of Skeletal Traction
Two. Kirschner Wire Traction
Four. Upper Tibial Pin Traction
Application of Skeletal Traction
Advantages of Skeletal Traction
Complications of Skeletal Traction
Care of a Patient in Skeletal Traction
Five. Recent Advances in the Treatment of Fractures
Pathophysiology of Fracture Disease
Three. Osteoporosis - Prolonged immobilization results in bone resorption, making the bone weak and prone to fractures.
Stages of Fracture Disease
One. Stage of Acute Swelling
Two. Stage of Stiffness and Atrophy
Three. Stage of Recovery or Deformity
Prevention of Fracture Disease
One. Early Joint Mobilization
Two. Muscle Strengthening Exercises
Three. Functional Bracing
Four. Weight-Bearing Activities
Five. Proper Immobilization Techniques
Treatment of Fracture Disease
One. Physiotherapy and Rehabilitation
Three. Surgical Interventions
Complications of Fracture Disease
One. Permanent joint stiffness and deformity - Loss of normal joint function.
Types of Splints and Their Uses
One. Common Orthopedic Splints
One. Intra-Medullary Splinting
Two. Extra-Medullary Splinting
Four. External Splinting, External Fixator
Combination of Compression and Splinting
Modern Splinting Concepts
Care of a Patient in a Splint
Disadvantages and Complications
Six. Approach to a Patient with Limb Injury
Non-union - Definition, etiology, pathophysiology, investigations, treatment
Two. Hypertrophic Non-Union
One. Patient-Related Factors
Two. Fracture-Related Factors
Three. Treatment-Related Factors
Pathophysiology of Non-Union
One. Disruption of Blood Supply
Two. Inadequate Stability
Three. Failure of Cellular Activity
Four. Persistent Infection
Investigations for Non-Union
Two. Radiological Investigations
Bone Scintigraphy (Bone Scan)
Compartment Pressure Measurement
One. Conservative Management (For Early Non-Unions)
c) Ilizarov Technique (Ring Fixator)
d) Plate Fixation with Bone Grafting
f) Vascularized Bone Grafting
Three. Treatment of Infected Non-Union
Complications of Non-Union
Etiology (Causes) of Malunion
One. Patient-Related Factors
Two. Fracture-Related Factors
Three. Treatment-Related Factors
Three. Translational Malunion
Four. Shortening Malunion
Five. Malunion with Joint Deformity
Clinical Features of Malunion
Investigations for Malunion
Four. Limb Length Discrepancy Measurement
Five. Functional Assessment
One. Non-Surgical Management
Two. Surgical Management (Osteotomy and Realignment)
b) Osteoclasis (Refracturing the Bone)
d) Lengthening Procedures (Ilizarov Technique)
e) Joint Reconstruction (For Articular Malunion)
Complications of Malunion
Three. Genetic and Idiopathic Causes
Four. Miscellaneous Causes
Two. Osteogenic Differentiation
3. Progressive Ossification
Five. Biopsy (Rarely Needed)
Treatment of Myositis Ossificans
Two. Avoiding Aggressive Physiotherapy
Three. Surgical Management (For Severe Cases)
Etiology (Causes of Compartment Syndrome)
One. Trauma-Related Causes
Two. Post-Surgical Causes
Three. Medical Conditions and Other Causes
Pathophysiology of Compartment Syndrome
Two. Reduced blood supply (ischemia)
Three. Cellular hypoxia and necrosis
Four. Vicious Cycle of Pressure and Ischemia
Nine. Fractures in Children
Muscles Supplied by the Radial Nerve
One. Before the Radial Groove:
Two. In the Radial Groove (Posterior Arm):
Three. Below the Radial Groove (Forearm and Hand):
Three. Neuropathic Causes:
Clinical Features of Wrist Drop
One. Clinical Examination:
Three. Nerve Conduction Studies:
One. Conservative Management (For Neuropraxia and Mild Injuries):
Two. Surgical Management (For Severe Cases):
Three. Mechanical and Compressive Causes
Four. Neuromuscular Disorders
Five. Tests for Foot Drop
Two. Electrodiagnostic Studies
Three. Surgical Treatment
Two. Trauma and Compression
Three. Neurological Conditions
Four. Tumors or Mass Lesions
Four. Special Tests for Ulnar Nerve Dysfunction
Two. Electrodiagnostic Studies
Three. Surgical Management
Eleven. Deformities and their Management
Indications for Osteotomy:
One. Correction of Deformities:
Three. Leg Length Discrepancy:
Four. Trauma and Malunions:
Five. Special Indications:
One. Angulation Osteotomy:
Two. Displacement Osteotomy:
Three. Derotation Osteotomy:
Four. Bone Shortening or Lengthening Osteotomy:
Commonly Performed Osteotomies and Their Indications:
One. Non-union or Delayed Union: Failure of bone healing at the osteotomy site.
V Subtrochanteric Osteotomy
Indications for Subtrochanteric Osteotomy:
Two. Management of Osteoarthritis and Avascular Necrosis:
Three. Post-Traumatic Malunion:
Four. Leg Length Discrepancy:
Five. Femoroacetabular Impingement:
Types of Subtrochanteric Osteotomy:
Three. Rotational Osteotomy:
Four. Derotation Osteotomy:
Three. Postoperative Care:
Complications of Subtrochanteric Osteotomy:
Three. Leg Length Discrepancy:
Five. Vascular and Nerve Injury:
Indications for Bone Grafting:
Four. Avascular Necrosis:
Five. Arthrodesis (Joint Fusion):
Two. Allografts (From a Human Donor):
Four. Synthetic Bone Substitutes:
Surgical Technique for Bone Grafting:
Two. Harvesting the Graft:
Four. Closure and Postoperative Care:
Complications of Bone Grafting:
Three. Donor Site Morbidity:
Five. Non-Union or Delayed Union:
Indications for Tendon Transfers:
Principles of Tendon Transfer:
Thirteen. Injuries around Shoulder and Fracture
One. Anterior Dislocation (Most Common - Ninety-Five Percent)
Two. Posterior Dislocation (Two to Four Percent)
Three. Inferior Dislocation (Luxatio Erecta)
Four. Superior Dislocation (Rare)
Four. Rotator cuff tears - More common in elderly patients.
Three. Post-reduction X-ray
· Surgical Management: Open reduction and internal fixation with a plate or nail in cases of:
Fourteen. Injuries around the Elbow
Three. Wrist and Hand Region
Supracondylar Fracture of the Humerus
One. Gartland Classification (Most commonly used for pediatric fractures)
Two. Based on Displacement Direction
Neurological and Vascular Assessment
One. Injury to the Brachial Artery:
Early Complications (Within two to three Days)