Ligaments
are tough connective structures that connect bone to bone. The fundamental difference between ligament and tendon is that ligaments are weaker and not as stiff as tendons, due to a less regular collagen arrangement, because ligaments must withstand forces in varying directions, whereas the direction of force on a tendon is constant.
Composition Water makes up [...]
Wound irrigation is used to decrease the number of viable bacteria in a wound and remove debris.
Volume of irrigation
The normal volume of irrigation is 6-10L in an open fracture. Increased volume improves wound cleansing to a point but the optimum volume is unknown. Anglen in his JAAOS article recommends 3L for Grade I fractures, 6L [...]
Cellulitis
This is an infection of the subcutaneous tissues.
The infection is generally deeper and has more indistinct margins than erysipelas.
The infective organism is usually Group A strep. S.aureus is less common.
Clinical findings include erythema, warmth, tenderness, lymphangitis and lymphadenitis.
Erysipelas
This is an infection of the superficial soft tissues characterized by a progressively enlarging, well demarcated, red, raised [...]
First principle to debride all non-viable tissue.
Some adjuncts such as vital staining, Doppler flow cytometry and CT may help determine the level of bone resection.
Acute limb shortening
Relaxes soft tissue but may result is redundant tissue Limited to defects <3cm
Autologous nonvascularised cancellous bone graft
Should be delayed until 6 weeks to allow healing of any flaps any [...]
Definition
Chronic infection caused by Mycobacterium tuberculosis.
Epidemiology More common in Asians, immuno-compromised, homeless. 500 times more common in patients with HIV. The incidence doubled in the US between 1987 and 1991. Rates are higher in urban areas. Only around 5-10% of patients with TB have bone or joint involvement.
Etiology
Musculoskeletal disease is usually secondary to primary disease [...]
Definition This is a specific type of cold injury that occurs as a progression towards actual freezing of all tissues.
Epidemiology
In North America, the typical patient is characterized as an alcohol abusing male, dressed inappropriately for the conditions, and often with a psychiatric illness.
Etiology and pathology Two main causes of damage:
1. Exposure to extreme cold leads [...]
Microbiology
S.aureus is commonest pathogen.
If long standing can become superinfected, often with Pseudomonas.
Treatment principles in chronic osteomyelitis
1. Radical debridement
a. Of both affected bone and soft tissue
2. Antibiotic therapy
3. Wound closure – preferably with healthy vascularized muscle
a. Split skin grafts on healing granulation tissue
b. Local rotation flaps
c. Microvascular free flaps
4. Cancellous bone grafting
Lethal complications of [...]
Radial club hand – longitudinal failure of formation
Definition
Preaxial deformity resulting in partial or complete absence of the radius.
Epidemiology
1 in 100 000 live births. Bilateral in 50%. When unilateral the right side is affected twice as often as the left. Aetiology Most cases sporadic. Some cases related to thalidomide.
Associated abnormalities
Cardiac – Holt Oram syndrome. ASD, transmitted [...]
Incidence 1/15 000
Etiology Sporadic, no evidence of heredity CRadial club hand – longitudinal failure of formation
Definition
Preaxial deformity resulting in partial or complete absence of the radius.
Epidemiology 1 in 100 000 live births. Bilateral in 50%. When unilateral the right side is affected twice as often as the left. Aetiology Most cases sporadic. Some cases related [...]
Definition
Stenosing tenosynovitis of the A1 pulley resulting in painful clicking and locking during attempted flexion of the digit.
Epidemiology
More common in females. The ring finger is affected most often, followed by the thumb, middle, index and little fingers.
Etiology
Idiopathic Secondary to RA, gout, diabetes. May occur in association with Dupuytren’s disease, de Quervain’s tenosynovitis, HT. Dupuytren’s disease [...]
jaaos(7)4,23
Terminology Common locations for ganglions around the hand and wrist are:
1. Dorsal wrist (dorsal wrist ganglion)
2. Volar radial wrist (volar carpal ganglion)
3. DIP joint of the finger (mucous cyst)
4. Proximal digital flexion crease (volar retinacular ganglion cyst)
They can also occur in an intra-osseous location, or associated with a carpal boss of the second or third [...]
De Quervain’s disease Definition
Stenosing tenosynovitis of the first dorsal compartment, described by Fritz de Quervain, Professor of Surgery at Berne University in 1895.
Anatomy
The two muscles in the first dorsal compartment are APL and EPB. They were phylogenetically once a single muscle but divided into two muscle units with the development of a prehensile grip. Distinct [...]
Incidence and epidemiology
25-30% of patients between 45 and 64 have radiographically evident OA. 85% of individuals older than 65 have OA on x-rays.
Osteoarthritis is the leading cause of disability in middle aged and older people, and the cause of 39 million physician visits and 500 000 hospitalizations per annum in the US.
OA is twice [...]
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