Orthopedics NEET PG Image-Based Preparation

Greenstick Fracture

Greenstick fracture- only seen in children before epiphysial closure. Most commonly seen in the forearm bone- fall on an outstretched hand. Treatment- break and open the cortex at the same level then apply cast for 4-6 weeks.

Hairline/ March/ Stress/ Fatigue fracture

Hairline/march/ stress/ fatigue fracture- most commonly on the neck of the second metatarsal. Treatment: Bed rest for 3 weeks. No cast is needed.

Torus/ Buckling Fracture

Torus/ buckling fracture- most commonly in weight-bearing bone.

Treatment- cast(conservative)

Avulsion Fracture

Avulsion Fracture- the most common site is tibial tuberosity. Treatment: screw fixation.

Wedge Compression Fracture Orthopedics 

Wedge compression fracture: The most common site is the thoracic vertebra. (T 12 fracture). Pathological fracture (osteoporosis>malignancies)

Impacted Fracture

Impacted fracture- most common site is neck of femur. Can also be seen in Pilon fracture. Treatment- disimpaction done surgically.

Rotator Cuff Injuries

• Image 1: Black band- Normal rotator cuff
• Image 2: White color structure- Supra spinal distended tear
• Image 3: Retracted tendon- Completely RC tear, retracted tendon

MRI In Bone Tumors

• The T1 Weighted is important in the evaluation of bone marrow
• Most of the Bone marrow tumors will be evident as a lesion with low signal against a background of surrounding fatty marrow
• MRI helps to differentiate Benign from Malignant lesions
  • Benign lesions are usually well defined & sharply demarcated
  • Malignant lesions are extensive & involve surrounding tissue
• MRI is very useful in the local staging of bone tumors as it asses the Intramedullary extension & surrounding invasion
• Lytic Bone lesions by X-ray can be determined only when it has 50% trabecular bone destruction, but MRI may be helpful in detection without destruction
• MRI is very sensitive in detecting Skeletal Metastasis
• MRI- Investigation of choice in a suspected case of Cord compression from pathological vertebral body fractures. Since MRI doesn't involve ionizing radiation, it is an investigation of suspected bony metastasis in a pregnant woman.
• MRI can be used to assess treatment response by evaluating the size and number of osseous metastasis over time - So it has a prognostic significance

Figure-of-8 Bandage

Figure-of-8 bandage mechanism: Pulling upward of the medial two-thirds by the sternocleidomastoid is neutralized.

Anterior Shoulder Dislocation

• Absence of roundness of the shoulder
  • Loss of the deltoid contour - first sign.
• The shoulder is extended, abducted and externally rotated.
• Duga's test - only fresh dislocation
  • Inability to touch the opposite shoulder.
• Hamilton's ruler test
  • The gap between the ruler and the arm is lost.
• Callaways test
  • Inch tip used to measure the girth of the axilla.
  • Positive test: Increased girth on the affected side.
• Bryants test
  • Anterior axillary fold pushed down on the affected side.
• Regiment badge test
  • Loss of sensation over the deltoid muscle due to axillary nerve damage.

Neer's Classification

Type I One-part fracture: Fracture line involves 1 of the 4 parts and no part is displaced.

Type II Two-part fracture: Fracture line involves 2 of the 4 parts and 1 part is displaced.

Type III Three-part fracture: Fracture line involves 3 of the 4 parts and 2 parts are displaced.

Type IV Four-part fracture: Fracture line involves all the 4 parts, and 3 parts are displaced.

Displacements of Supracondylar Fracture

• Dorsal displacement (extension)
• Impaction (proximal shift)
  • Impaction of distal fragment to proximal fragment.
• Medial tilt or shift (pronation).
• Mnemonic: DIM
• All these are related to distal fragments.
• Extension type
  • Most common: 98%
  • Also called the posterior type.
  • Divided into 2 subtypes:
    • Posterior-lateral
    • Posterior-medial

Shenton's Line

• Line drawn from the superior margin of the obturator foramen to the margin of the neck.
• Gives a smooth curve.
• Breakage of Shenton's line - the smooth curve is disrupted.
  • Happens in the fracture neck of the femur.
• Differential diagnosis of broken Shenton's line
  • Fracture neck of femur
  • Posterior dislocation of hip in adults
  • Congenital dislocation of hip
  • Tom-Smith`s Arthritis
  • Tuberculosis of Hip
  • Girdlestone Excision Arthroplasty

Hawkins Classification

• Fracture angle of the talus: Hawkins angle
• Avascular necrosis of talus: Hawkins disease
• Classification of talus: Hawkins classification

Hawkin's Sign

• Radiolucent line in subchondral region - Viable
• This line is known as Hawkins's sign
• Presence of Hawkins sign - Less chances of avascular necrosis in talus
• Positive sign

Codman's Triangle

• Hazy osteolytic area Alternating with dense osteoblastic area.
• Streaks of new bone radiating outwards from cortex - Sunburst appearance.
  • Microcalcification is deposited along the Sharpey fibers, which carry blood vessels. This microcalcification is seen as a Sunburst appearance.
• Reactive new bone formation elevating the periosteum - Codman's triangle
• A CT scan is superior to an X-ray.
• Biopsy is confirmatory.

Diabetes is the most common cause - Foot

Syphilis - Involves Knee Joint

Syringomyelia - involves Shoulder joint

Leprosy - involves Hand and Foot

O'connor Classification (Depending upon the type)

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