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Episode 35 - Pediatric Orthopedics - Emergencymedicinecases.Com
EPISODE 35 - PEDIATRIC ORTHOPEDICS - EMERGENCYMEDICINECASES.COM KNEE INJURIES: Check the X-ray for a Segond fracture, a vertically oriented In general, children’s ligaments are avulsion fracture off the lateral stronger than their bones, thus proximal tibia. This is highly fractures are more likely than associated with ACL and meniscal sprains. Have a low threshold for tears. (See page 4 for a picture.) imaging if suspicious. Management of ACL tears: The same ACL-injury mechanism (sudden deceleration - pain management in acute phase of distal leg with forward and (NSAIDs, tylenol, morphine) rotatory movement) will cause a - short term immobilization (splint EPISODE 35: tibial spine fracture in a as needed, +/-crutches), but PEDIATRIC ORTHOPEDICS younger child, and an ACL tear in atrophy of quadriceps occurs WITH DR. SANJAY MEHTA & a teenager or adult. (See page 4 for quickly, so start range of motion in DR. JONATHAN PIRIE a photo of a tibial spine fracture.) 2–3 days. Some experts Patellar subluxations: the child Lachman test for ACL tear recommend weight bearing as may feel a “pop”, from the kneecap involves pulling the proximal tibia tolerated immediately. subluxing, and feel unstable on the anteriorly while holding the knee in - Surgical repair is delayed until leg. First time patella dislocations flexion. It has good sensitivity (>80% range of motion has recovered. and non-displaced fractures do and specificity of 95%) (1). The Refer to outpatient orthopedics. need knee immobilization, pivot shift test (valgus force and with weight bearing as tolerated. internal rotation to extended leg, Displaced fractures or fractures with which is then flexed to feel Additional X-ray views: an impaired extensor mechanism subluxation) is also sensitive for ACL - patellar injury requires a “skyline need urgent orthopedic tear. -
Ottawa Knee Rule: Investigating Use and Application in a Tertiary Teaching Hospital
Open Access Original Article DOI: 10.7759/cureus.8812 Ottawa Knee Rule: Investigating Use and Application in a Tertiary Teaching Hospital Abubakr Mohamed 1 , Elkhidir Babikir 1 , Mohamed Kamal Elbashir Mustafa 2 1. Emergency Medicine, University Hospital Galway, Galway, IRL 2. Vascular Surgery, University Hospital Galway, Galway, IRL Corresponding author: Abubakr Mohamed, [email protected] Abstract Background Knee injuries are encountered commonly in the emergency departments (EDs) in Ireland. Validated clinical decision rules such as Ottawa knee rule (OKR) can be used in acute knee injury settings to reduce the number of unnecessary radiography. Clinical judgment can be used to distinguish between suspected fractures and non-fractures in many cases; however, radiography is still routinely requested. Objectives We evaluated the OKRs in a high-volume tertiary teaching hospital in Ireland to determine whether the rule could be safely used to decide whether patients with acute blunt knee trauma should undergo radiography. Methods This was an observational study conducted in the ED over a three-month period in a tertiary referral hospital. A total of 110 patients with acute knee injuries were examined using OKR. Inclusion criteria included patients with acute knee injuries due to blunt trauma or twisting injury and patients with lacerations or contusions. Open fractures and fractures due to penetrating injury were excluded from the study. Results Fractures were seen in 12 (13.2%) of the 110 patents who met the inclusion criteria. The OKR predicted all 12 fractures. Sensitivity was 100%, and specificity was 39%. Conclusions Received 06/04/2020 Review began 06/18/2020 The OKR is highly sensitive for fracture in this setting and can be safely used to decide whether Review ended 06/21/2020 patients with acute blunt knee trauma should undergo radiography. -
Postoperative Imaging of the Ankle: a Review
Postoperative Imaging of the Ankle: A Review Society of Skeletal Radiology Annual Meeting, 2020 Okezika Kanu MD1, Sameh A. Labib MD2, Adam Singer MD1, Monica Umpierrez MD1, Felix Gonzalez MD1, Philip Wong MD1 1Emory University School of Medicine Department of Radiology and Imaging Sciences Division of Musculoskeletal Imaging 2Emory University School of Medicine Department of Orthopaedics Correspondence: [email protected] Objectives • To review common procedures performed in the ankle • Be come familiar with the expected postoperative appearance of the various procedures • Recognize complications associated with these procedures Posterior Ankle PROCEDURES ❑ Primary end-to-end Achilles tendon repair ❑ Achilles tendon lengthening ❑ Flexor hallucis longus (FHL) transfer ❑ Haglund excision and Achilles tendon reattachment Achilles Tendon Repair A B C 53 year old female with right posterior ankle pain after hearing a pop. (A): Sagittal PD FS of the ankle demonstrating full thickness midsubstance tear of the Achilles tendon with tendon gap of approximately 4.0 cm (bracket). (B and C): Sagittal T1 and PD FS postoperative images 3 years after primary end-to-end repair. There is expected thickening of the repaired tendon, which is intact. Linear intermediate intrasubstance signal (arrows) within the mid substance may represent minimal degeneration or postoperative changes. Additionally, there is loss of the calcaneus declination angle, indicative of possible lengthening of the Achilles. Achilles Lengthening A B C Achilles tendon lengthening procedures are typically done for patients with congenital or acquired equinus contracture. Z-lengthening Technique: (A): Illustration demonstrating the Z-lengthening technique. This is an open procedure with longitudinal incision made 2-6 cm proximal to the insertion. -
Hemi-Castaing Ligamentoplasty for the Treatment of Chronic Lateral Ankle Instability: a Retrospective Assessment of Outcome
International Orthopaedics (SICOT) DOI 10.1007/s00264-011-1284-9 ORIGINAL PAPER Hemi-Castaing ligamentoplasty for the treatment of chronic lateral ankle instability: a retrospective assessment of outcome Tim Schepers & Lucas M. M. Vogels & Esther M. M. Van Lieshout Received: 30 April 2011 /Accepted: 17 May 2011 # The Author(s) 2011. This article is published with open access at Springerlink.com Abstract augmentation (i.e. the Broström-Gould technique) and the Purpose In the treatment of chronic ankle instability, most non-anatomical repair should be reserved for unsuccessful non-anatomical reconstructions use the peroneus brevis cases after anatomical repair or in cases where no adequate tendon. This, however, sacrifices the natural ankle stabilising ligament remnants are available for reconstruction. properties of the peroneus brevis muscle. The aim of this study was to evaluate the functional outcome of patients treated with a hemi-Castaing procedure, which uses only half Introduction the peroneus brevis tendon. Methods We performed a retrospective cohort study of It has been estimated that more than 80 techniques exist for patients who underwent hemi-Castaing ligamentoplasty for the treatment of lateral ankle instability [16, 18]. One of the chronic lateral ankle instability between 1993 and 2010, earliest ideas was to prevent chronic instability from with a minimum of one year follow-up. Patients were sent a happening by early suturing of the acutely ruptured postal questionnaire comprising five validated outcome ligaments; currently, this management strategy is no longer measures: Olerud-Molander Ankle Score (OMAS), Karlsson in use [26]. Nowadays, most agree to perform surgery in Ankle Functional Score (KAFS), Tegner Activity Level Score the 15–40% of patients with recurrent instability who are (pre-injury, prior to surgery, at follow-up), visual analog scale hampered in daily or sporting activities [4, 7, 37]. -
Souvenir Programme, This Information Is Correct
1 SUBSPECIALTY INTEREST GROUP MEETINGS At time of printing this souvenir programme, this information is correct. Should there be any last minute changes, please refer to the signage outside each meeting room or enquire at the secretariat counter. SUBSPECIALTY INTEREST GROUP MEETING DATE TIME MEETINGS ROOM ASEAN OA Education Committee 21st May 2015 0830 - 1700hrs Kelantan Room Meeting Hand Subspecialty Interest Group 22nd May 2015 1030 - 1200hrs Pahang Room Foot & Ankle Subspecialty Interest Negeri Sembilan 22nd May 2015 1030 - 1200hrs Group Room Spine Subspecialty Interest Group 22nd May 2015 1130 - 1200hrs Johore Room Negeri Sembilan Paediatrics Subspecialty Interest Group 22nd May 2015 1400 - 1530hrs Room ASEAN OA Council Meeting 22nd May 2015 1400 - 1730hrs Kelantan Room Arthroplasty Subspecialty Interest 22nd May 2015 1600 - 1730hrs Pahang Room Group Negeri Sembilan Trauma Subspecialty Interest Group 22nd May 2015 1600 - 1730hrs Room Oncology Subspecialty Interest Group 23rd May 2015 1030 - 1200hrs Penang Room Sports Subspecialty Interest Group 23rd May 2015 1400 - 1530hrs Johore Room MOA Annual General Meeting 23rd May 2014 1600 - 1730hrs Johore Room 23rd May 2015 0800 - 1730hrs APOA Council Meeting Kelantan Room 24th May 2015 0800 - 1500hrs 2 INDEX PAGE NO. DESCRIPTION 2 Subspecialty Interest Group Meetings Malaysian Orthopaedic Association Office Bearers 4 45th Malaysian Orthopaedic Association Annual Scientific Meeting 2015 Organising Committee Welcome Message from President of Malaysian Orthopaedic Association and 5 Organising -
Neonatal Orthopaedics
NEONATAL ORTHOPAEDICS NEONATAL ORTHOPAEDICS Second Edition N De Mazumder MBBS MS Ex-Professor and Head Department of Orthopaedics Ramakrishna Mission Seva Pratishthan Vivekananda Institute of Medical Sciences Kolkata, West Bengal, India Visiting Surgeon Department of Orthopaedics Chittaranjan Sishu Sadan Kolkata, West Bengal, India Ex-President West Bengal Orthopaedic Association (A Chapter of Indian Orthopaedic Association) Kolkata, West Bengal, India Consultant Orthopaedic Surgeon Park Children’s Centre Kolkata, West Bengal, India Foreword AK Das ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD. New Delhi • London • Philadelphia • Panama (021)66485438 66485457 www.ketabpezeshki.com ® Jaypee Brothers Medical Publishers (P) Ltd. Headquarters Jaypee Brothers Medical Publishers (P) Ltd. 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd. Jaypee-Highlights Medical Publishers Inc. Jaypee Brothers Medical Publishers Ltd. 83, Victoria Street, London City of Knowledge, Bld. 237, Clayton The Bourse SW1H 0HW (UK) Panama City, Panama 111, South Independence Mall East Phone: +44-2031708910 Phone: +507-301-0496 Suite 835, Philadelphia, PA 19106, USA Fax: +02-03-0086180 Fax: +507-301-0499 Phone: +267-519-9789 Email: [email protected] Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd. Jaypee Brothers Medical Publishers (P) Ltd. 17/1-B, Babar Road, Block-B, Shaymali Shorakhute, Kathmandu Mohammadpur, Dhaka-1207 Nepal Bangladesh Phone: +00977-9841528578 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2013, Jaypee Brothers Medical Publishers All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher. -
What Is the Best Way to Evaluate an Acute Traumatic Knee Injury?
From the CLINICAL INQUIRIES Family Physicians Inquiries Network Matthew L. Silvis, MD, C. Randall Clinch, DO, MS, What is the best way and Janine S. Tillet, MSLS Wake Forest University, to evaluate an acute Winston-Salem, NC traumatic knee injury? Evidence-based answer Use the Ottawa Knee Rules. When there or ligamentous injury (SOR: C, based on is a possibility of fracture, they can guide studies of intermediate outcomes). the use of radiography in adults who Sonographic examination of a present with isolated knee pain. However, traumatized knee can accurately detect information on use of these rules in the internal knee derangement (SOR: C, pediatric population is limited (strength based on studies of intermediate of recommendation [SOR]: A, based on outcomes). Magnetic resonance imaging systematic review of high-quality studies (MRI) of the knee is the noninvasive and a validated clinical decision rule). standard for diagnosing internal knee Specific physical examination maneuvers derangement, and it is useful for both adult (such as the Lachman and McMurray tests) and pediatric patients (SOR: C, based on FAST TRACK may be helpful when assessing for meniscal studies of intermediate outcomes). Employ the Clinical commentary Ottawa Knee Rules Ottawa rules for ankles—yes, test, Drawer sign, and McMurray test to determine but they’re good for knees, too are useful in diagnosing the presence of whether plain The evidence presented here suggests internal ligamentous injuries without MRI, x-rays are needed a number of practical and useful and an ultrasound can help to detect knee to rule out fracture approaches for the evaluation of acute effusion when it is not clinically obvious. -
Tension Band Wiring Is As Effective As a Compression Screw in a Neglected, Medial Maleolus Non-Union
Case Report Journal of Orthopaedic Case Reports 2017 Jul-Aug: 7(4):Page 72-75 Tension Band Wiring Is As Effective As A Compression Screw In A Neglected, Medial Maleolus Non-Union: A Case-Based Discussion & Literature Review Rakesh John¹, Mandeep Singh Dhillon¹, Ankit Khurana², Sameer Aggarwal¹, Prasoon Kumar¹ Learning Points for this Article: Compression screw fixation has been the workhorse implant for medial malleolar nonunions; however, tension band wiring may be a better technique for such nonunions, as seen in this rare case of isolated, medial malleolus gap nonunion. Abstract Introduction: Isolated, neglected medial malleolus nonunion cases are a rare entity in orthopedic literature. All studies (except one) have described the use of compression screws (with or without plates) for medial malleolar nonunion management. In acute fractures, tension band wiring (TBW) has shown excellent results both in biomechanical and in clinical studies. On the contrary, it has seldom been used in nonunion or in neglected cases. Case Report: We describe a 6-month-old neglected medial malleolus gap nonunion case who presented with progressive pain and limp. TBW with a monoblock, inlay, tricortical, and iliac crest bone graft for the defect was performed. The fracture united within 12 weeks and patient went back to his normal work routine; on the latest follow-up at 3 years, the patient was asymptomatic with no clinicoradiologic signs of secondary osteoarthritis of the ankle joint. Conclusion: TBW may be better than screw fixation in the management of medial malleolus nonunion as it is technically straightforward and cost-effective, can provide equal or more compression than a screw; it does not damage the sandwiched inlay bone graft, and the amount of compression is surgeon-controlled. -
Case Report Arthroscopic Removal of a Wire Fragment from the Posterior Septum of the Knee Following Tension Band Wiring of a Patellar Fracture
Hindawi Publishing Corporation Case Reports in Orthopedics Volume 2015, Article ID 827140, 5 pages http://dx.doi.org/10.1155/2015/827140 Case Report Arthroscopic Removal of a Wire Fragment from the Posterior Septum of the Knee following Tension Band Wiring of a Patellar Fracture Yasuaki Tamaki, Takashi Nakayama, Kenichiro Kita, Katsutosi Miyatake, Yoshiteru Kawasaki, Koji Fujii, and Yoshitsugu Takeda Department of Orthopedic Surgery, Tokushima Red Cross Hospital, 103 Irinokuchi, Komatsushima-cho, Komatsushima, Tokushima 773-8502, Japan Correspondence should be addressed to Yoshitsugu Takeda; [email protected] Received 25 November 2014; Accepted 22 January 2015 Academic Editor: Dimitrios S. Karataglis Copyright © 2015 Yasuaki Tamaki et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tension band wiring with cerclage wiring is most widely used for treating displaced patellar fractures. Although wire breakage is not uncommon, migration of a fragment of the broken wire is rare, especially migration into the knee joint. We describe here a rare case of migration of a wire fragment into the posterior septum of the knee joint after fixation of a displaced patellar fracture with tension band wiring and cerclage wiring. Although it was difficult to determine whether the wire fragment was located within or outside the knee joint from the preoperative plain radiographs or three-dimensional computed tomography (3D CT), we found it arthroscopically through the posterior transseptal portal with assistance of intraoperative fluoroscopy. Surgeons who treat such cases should bear in mind the possibility that wire could be embedded in the posterior septum of the knee joint. -
Health Technology Assessment Program
Health Technology Assessment Program Selected Technologies 2018 - Revised List of contents 1. Director’s selection letter - Revised 2. Topic selection background information - Revised 3. Literature update searches performed since 2017 topic selection – Addition [This page left intentionally blank.] WA – Health Technology Assessment June 14, 2018 Technologies selected Primary criteria ranking Technology Safety Efficacy Cost 1 Wearable cardiac defibrillators (WCD) Med Med/ High High Policy Context/Reason for Selection: Wearable defibrillators are externally worn devices that can monitor heart function and provide electrical shock (defibrillation) if a life-threatening cardiac arrhythmia is detected. Wearable defibrillators may offer a temporary alternative treatment to more invasive treatments or hospitalization. The topic is proposed based on concerns related to the safety, efficacy and value for wearable defibrillators. Peripheral nerve ablation (PNA) for the treatment of limb 2 pain High High Med/ High Policy context/reason for selection: Ablation, or the severing of nerves transmitting pain signals from joints or other origins, is a potential treatment for discomfort caused by osteoarthritis and other conditions. This procedure can be used for upper and lower limb pain including, pain in the shoulder or knee. Nerve ablation for osteoarthritis and other limb and joint pain appears to be an emerging medical intervention with recent publications evaluating the treatment. Initial topic scoping resulted in the addition of upper limb ablation to the topic. The topic is proposed based on concerns related to the safety, efficacy and value of the intervention for treatment. 3 Renal denervation (RDN) High High Med/ High Policy Context/Reason for Selection: Renal denervation (RDN) is a treatment for chronic high blood pressure (hypertension) that does not respond adequately to drug or other treatment. -
MISSED? Metastatic Spinal Cord Compression NA Quraishi, C Esler ∗ BMJ 342 (7805), 1023-1025
PUBLICATIONS (ABSTRACTS EXCLUDED) 2014: Metastatic spinal cord compression as a result of the unknown primary tumour. Quraishi NA, Ramoutar D, Sureshkumar D, Manoharan SR, Spencer A, Arealis G, Edwards KL, Boszczyk BM. Eur Spine J. 2014 Apr 2. Trans-oral approach for the management of a C2 neuroblastoma. Salem KM, Visser J, Quraishi NA. Eur Spine J. 2014 Feb 19. Calcified giant thoracic disc herniations: considerations and treatment strategies. Quraishi NA, Khurana A, Tsegaye MM, Boszczyk BM, Mehdian SM. Eur Spine J. 2014 Apr;23 Surgical treatment of sacral chordoma: prognostic variables for local recurrence and overall survival. Varga PP, Szövérfi Z, Fisher CG, Boriani S, Gokaslan ZL, Dekutoski MB, Chou D, Qurais NA, Reynolds JJ, Luzzati A, Williams R, Fehlings MG, Germscheid NM, Lazary A, Rhines LD. Eur Spine J. 2014 Dec 23. Expert's comment concerning Grand Rounds case entitled: "trans-oral approach for the management of a C2 neuroblastoma. (K. M. I. Salem, J. Visser, and N. A. Quraishi).Choi D. Eur Spine J. 2015 Jan;24(1):177-9. Diagnosis and treatment of a rectal-cutaneous fistula: a rare complication of coccygectomy. Behrbalk E, Uri O, Maxwell-Armstrong C, Quraishi NA. Eur Spine J. 2014 Nov 1. A cohort study to evaluate cardiovascular risk of selective and nonselective cyclooxygenase inhibitors (COX-Is) in arthritic patients attending orthopedic department of a tertiary care hospital. Bhosale UA, Quraishi N, Yegnanarayan R, Devasthale D. Niger Med J. 2014 Sep;55(5):417-22. An evidence-based medicine model for rare and often neglected neoplastic conditions. Fisher CG, Goldschlager T, Boriani S, Varga PP, Rhines LD, Fehlings MG, Luzzati A, Dekutoski MB, Reynolds JJ, Chou D, Berven SH, Williams RP, Quraishi NA, Bettegowda C, Gokaslan ZL. -
Musculoskeletal Clinical Vignettes a Case Based Text
Leading the world to better health MUSCULOSKELETAL CLINICAL VIGNETTES A CASE BASED TEXT Department of Orthopaedic Surgery, RCSI Department of General Practice, RCSI Department of Rheumatology, Beaumont Hospital O’Byrne J, Downey R, Feeley R, Kelly M, Tiedt L, O’Byrne J, Murphy M, Stuart E, Kearns G. (2019) Musculoskeletal clinical vignettes: a case based text. Dublin, Ireland: RCSI. ISBN: 978-0-9926911-8-9 Image attribution: istock.com/mashuk CC Licence by NC-SA MUSCULOSKELETAL CLINICAL VIGNETTES Incorporating history, examination, investigations and management of commonly presenting musculoskeletal conditions 1131 Department of Orthopaedic Surgery, RCSI Prof. John O'Byrne Department of Orthopaedic Surgery, RCSI Dr. Richie Downey Prof. John O'Byrne Mr. Iain Feeley Dr. Richie Downey Dr. Martin Kelly Mr. Iain Feeley Dr. Lauren Tiedt Dr. Martin Kelly Department of General Practice, RCSI Dr. Lauren Tiedt Dr. Mark Murphy Department of General Practice, RCSI Dr Ellen Stuart Dr. Mark Murphy Department of Rheumatology, Beaumont Hospital Dr Ellen Stuart Dr Grainne Kearns Department of Rheumatology, Beaumont Hospital Dr Grainne Kearns 2 2 Department of Orthopaedic Surgery, RCSI Prof. John O'Byrne Department of Orthopaedic Surgery, RCSI Dr. Richie Downey TABLE OF CONTENTS Prof. John O'Byrne Mr. Iain Feeley Introduction ............................................................. 5 Dr. Richie Downey Dr. Martin Kelly General guidelines for musculoskeletal physical Mr. Iain Feeley examination of all joints .................................................. 6 Dr. Lauren Tiedt Dr. Martin Kelly Upper limb ............................................................. 10 Department of General Practice, RCSI Example of an upper limb joint examination ................. 11 Dr. Lauren Tiedt Shoulder osteoarthritis ................................................. 13 Dr. Mark Murphy Adhesive capsulitis (frozen shoulder) ............................ 16 Department of General Practice, RCSI Dr Ellen Stuart Shoulder rotator cuff pathology ...................................