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OR Orthopedics Amedeo Falsetto and Scott Kim, chapter editors Hasaan Chaudhry and Nardin Samuel, associate editors Alex Cressman and Shany Gertzbein, EBM editors Dr. Jeremy A. Hall and Dr. Herbert P. von Schroeder, staf editors Acronyms .............................. 2 Hip .................................. 27 Hip Dislocation Basic Anatomy Review ................... 2 Hip Fracture Arthritis of the Hip Differential Diagnosis of Joint Pain ......... 4 Hip Dislocation Post-Total Hip Arthroplasty Fractures – General Principles ............. 4 Femur ................................. 31 Fracture Description Femoral Diaphysis Fracture Approach to Fractures Distal Femoral Fracture Fracture Healing General Fracture Complications Knee .................................. 32 Evaluation of Knee Articular Cartilage .......................6 Cruciate Ligament Tears Collateral Ligament Tears Orthopedic X-Ray Imaging ................ 7 Meniscal Tears Quadriceps/Patellar Tendon Rupture Orthopedic Emergencies ................. 8 Dislocated Knee Trauma Patient Workup Open Fractures Patella ................................ 35 Cauda Equina Syndrome Patellar Fracture Compartment Syndrome Patellar Dislocation Osteomyelitis Patellofemoral Syndrome Septic Joint Tibia .................................. 37 Shoulder ............................. 11 Tibial Plateau Fracture Shoulder Dislocation Tibial Shaft Fracture Rotator Cuff Disease Acromioclavicular Joint Pathology Ankle .................................. 38 Clavicle Fracture Evaluation of Ankle and Foot Complaints Frozen Shoulder Ankle Fracture Ligamentous Injuries Humerus ............................. 16 Proximal Humeral Fracture Foot .................................. 39 Humeral Shaft Fracture Talar Fracture Calcaneal Fracture Elbow ................................ 17 Achilles Tendonitis Supracondylar Fracture Achilles Tendon Rupture Radial Head Fracture Plantar Fasciitis (Heel Spur Syndrome) Olecranon Fracture Bunions (Hallux Valgus) Elbow Dislocation Metatarsal Fracture Epicondylitis Pediatric Orthopedics .................... 42 Forearm .............................. 18 Fractures in Children Radius and Ulna Shaft Fractures Stress Fractures Monteggia Fracture Evaluation of the Limping Child Nightstick Fracture Epiphyseal Injury Galeazzi Fracture Slipped Capital Femoral Epiphysis Developmental Dysplasia of the Hip Wrist ................................ 20 Legg-Calvé-Perthes Disease (Coxa Plana) Colles’ Fracture Osgood-Schlatter Disease Smith’s Fracture Congenital Talipes Equinovarus (Club Foot) Complications of Wrist Fractures Scoliosis Scaphoid Fracture Bone Tumours .......................... 46 Hand ...............................PL26 Benign Active Bone Tumours Benign Aggressive Bone Tumours Spine ................................ 23 Malignant Bone Tumours Fractures of the Spine Cervical Spine Common Medications ................... 50 Thoracolumbar Spine References ............................ 51 Pelvis ................................ 27 Pelvic Fracture OR1 Orthopedics Toronto Notes 2016 OR2 Orthopedics Acronyms/Basic Anatomy Review Toronto Notes 2016 Acronyms AC acromioclavicular FOOSH fall on outstretched hand ORIF open reduction internal fixation ACL anterior cruciate ligament GA general anesthetic PCL posterior cruciate ligament AIN anterior interosseous nerve HO heterotopic ossification PE pulmonary embolism AP anterior posterior I&D incision and drainage PIN posterior interosseous nerve ARDS acute respiratory distress syndrome IM intramedullary RA rheumatoid arthritis AVN avascular necrosis LCL lateral collateral ligament ROM range of motion CA coracoacromial MCL medial collateral ligament RSD reflex sympathetic dystrophy CC coracoclavicular MT metatarsal SCFE slipped capital femoral epiphysis CRPS complex regional pain syndrome MTP metatarsophalangeal SLAP superior lateral, anterior posterior DDH developmental dysplasia of the hip MVC motor vehicle collision SN sensitivity DRUJ distal radioulnar joint NVS neurovascular status THA total hip arthroplasty DVT deep vein thrombosis NWB non-weight bearing WB weight bearing EtOH ethanol/alcohol OA osteoarthritis # fracture FAI femoroacetabular impingement Basic Anatomy Review C5 C7 C6 C8 C7 T1 C8 T1 Coracobrachialis Musculocutaneous nerve Biceps brachii Median Ulnar nerve nerve Medial cutaneous Brachialis nerve of the arm Lateral cutaneous (sensory) nerve of forearm (sensory) Pronator teres Pronator teres Flexor carpi radialis Flexor carpi Flexor digitorum ulnaris Palmaris longus profundus (medial 4,5 digits) Medial cutaneous Flexor pollicis nerve of the forearm longus Flexor digitorum (sensory) superficialis Dorsal cutaneous Flexor digitorum branch (sensory) Pronator profundus quadratus (lateral 2,3, digits) Palmar cutaneous branch (sensory) Adductor Thenar pollicis Palmar interossei muscles Palmaris brevis 2, 3 lumbricals Hypothenar muscles Dorsal interossei 4,5 Palmar sensory lumbricals branches of median nerve Superficial terminal branches (sensory) ters 2005 Wa ANTERIOR VIEW © Lori Figure 1. Median, musculocutaneous, and ulnar nerves: innervation of upper limb muscles OR3 Orthopedics Basic Anatomy Review Toronto Notes 2016 C5 C6 C7 Axillary C8 Subclavian Deltoids Subscapularis Posterior Circumflex Teres major humeral Thoracoacromial Anterior Axillary nerve Lateral thoracic Latissimus Subscapular dorsi Brachial Upper cutaneous Radial nerve Profunda artery nerve of the arm brachii (sensory) Triceps brachii (long head) Superior ulnar collateral Triceps brachii (medial head) Inferior ulnar Brachioradialis collateral Extensor carpi radialis longus Radial Extensor carpi recurrent radialis brevis Anterior and posterior Supinator ulnar recurrent Radial Posterior Ulnar interosseous nerve Extensor carpi ulnaris Extensor digiti minimi Anterior interosseous Abductor pollicis longus Extensor digitorum Abductor Extensor indicis pollicis brevis Superficial Deep palmar arch radial nerve (sensory) Superficial palmar arch ters 2005 Wa ANTERIOR VIEW POSTERIOR VIEW © Lori Figure 2. (Left) Blood supply to the upper limb, (Right) Axillary and radial nerves: innervation of the upper limb Table 1. Sensory and Motor Innervation of the Nerves in the Upper and Lower Extremities Nerve Motor Sensory Nerve Roots Axillary Deltoid/Teres Minor Lateral Upper Arm (Sergeant’s Patch) C5, C6 Musculocutaneous Biceps/Brachialis Lateral Forearm C5, C6 Radial Triceps Lateral Dorsum of the Hand C5, C6, C7, C8 Wrist/Thumb/Finger Extensors Medial Upper Forearm Median Wrist Flexors and Abductors Volar Thumb to Radial half of 4th Digit C6, C7 Flexion of the 1st-3rd Digits Ulnar Wrist Flexors and Adductors Medial Forearm C8, T1 Flexion of the 4th-5th Digits Medial Dorsum and Volar of Hand (Ulnar half of 4th and 5th Digit) Tibial Ankle Plantar Flexion Sole of Foot L5, S1 Knee Flexion Great Toe Flexion Superficial Peroneal Ankle Eversion Dorsum of Foot L5, S1 Deep Peroneal Ankle Dorsiflexion and Inversion 1st Web Space L5, S1 Great Toe Extension Sural Lateral Foot S1, S2 Saphenous Anteromedial Ankle L3, L4 OR4 Orthopedics Basic Anatomy Review/Fractures – General Principles Toronto Notes 2016 ANTERIOR VIEW POSTERIOR VIEW Common iliac artery Lateral cutaneous nerve of the thigh Femoral nerve Superior gluteal nerve External iliac artery Internal iliac artery Deep circumflex iliac artery Inferior gluteal nerve Superficial circumflex iliac artery Sciatic nerve Medial cutaneous Posterior cutaneous nerve of the thigh nerve of the thigh Lateral circumflex femoral Lateral circumflex artery femoral artery Obturator nerve Medial circumflex femoral artery Profunda femoris artery Profunda femoris artery Femoral artery Descending branch Femoral artery Intermediate cutaneous nerve of the thigh Hiatus in adductor magnus Tibial nerve Common fibular (peroneal) nerve Saphenous nerve Popliteal artery Common fibular (peroneal) nerve Deep fibular (peroneal) nerve Posterior tibial artery Superficial fibular Anterior tibial artery (peroneal) nerve Anterior tibial artery Sural nerve Dorsalis pedis artery Calcaneal branch Medial plantar nerve Medial plantar artery Lateral plantar nerve Lateral plantar artery Plantar artery © Barbara Brehovsky 2012 Figure 3. Nerves and arteries of lower limbs Fractures – General Principles Fracture Description 1. Name of Injured Bone 2. Integrity of Skin/Soft Tissue • closed: skin/sof tissue over and near fracture is intact • open: skin/sof tissue over and near fracture is lacerated or abraded, fracture exposed to outside environment signs: continuous bleeding from puncture site or fat droplets in blood are suggestive of an open fracture OR5 Orthopedics Fractures – General Principles Toronto Notes 2016 3. Location • epiphyseal: end of bone, forming part of the adjacent joint • metaphyseal: the fared portion of the bone at the ends of the shaf • diaphyseal: the shaf of a long bone (proximal, middle, distal) • physis: growth plate 4. Orientation/Fracture Pattern • transverse: fracture line perpendicular to long axis of bone; result of direct high energy force • oblique: angular fracture line; result of angular or rotational force Displacement Refers to position of the distal fragment • butterfy: fracture site fragment which looks like a butterfy relative to the proximal fragment • segmental: a separate segment of bone bordered by fracture lines; result of high energy force • spiral: complex, multi-planar fracture line; result of rotational force, low energy • comminuted/multi-fragmentary: >2 fracture fragments • intra-articular: fracture line crosses articular cartilage and enters joint
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