Orthopedic Care and Consultation
Complications in fractures of proximal humerus are more likely after surgical than after nonoperative fracture care. Therefore a careful postoperative follow-up is necessary to note the complication at the earliest and intervene at the right time
Most common complications associated with fractures of proximal humerus are- [Read more...]
Diagnosis of politeal cyst is usually evident on clinical examination. Conventional radiography in the anteroposterior, lateral, and oblique projections is done to check fluid density and to rule any other lesion that might give rise to poplliteal swelling.
Ultrasonography helps in assessing th swelling and can distinguish between fluid and solid mass.Popliteal cysts are best shown by sagittal ultrasound image projection. Ultrsound can also be used o rule vascular tumours by looking at arterial pulsations. [Read more...]
The menisci in the knee joint are required for
An intact meniscus transmits 70 to 90 percent of the total load across the knee joint. Therefore, it is desirable to preserve the meniscus whenever possible.
A conservative nonoperative method of management is recommended In the treatment of discoid meniscus if pain and functional disability are minimal.
SIlent discoid menisci require no treatment. however, they should be kept under observation.
Conservative measures
Operative Measures
If the knee locking persists their is functional disability or pain partial or complete excision of the discoid meniscus is indicated.
Diagnostic arthroscopy is carried out to know the pathologic changes and the type of discoid meniscus.
Partial resection of the discoid meniscus is preferred when it is of the complete or incomplete type with minimal tearing and slight degeneration
Excision of the entire meniscus is performed when it is of the Wrisberg type or when it is torn and there is marked degenerations.
Treatment of Osteochondritis Dissecans in children under 12 years of age is nonoperative. Arthroscopy is reserved for the cases in which the fragment has become detached.
If the lesion is in a non-weight bearing area or it involved only a portion of the weight-bearing area of a joint it is observed with serial radiograms made every six to eight weeks to determine its natural course.
Protection from weight-bearing is not required unless the lesion begins to separate and symptoms persist.
In case the weight bearing is prohibited, it is resumed gradually with aid of crutches providing partial support.
Generally, a period of three months is required for healing of the lesion.
In case of suspected seapration of fragment, bone imaging with technetium-99m and computed tomographic studies should be carried out.
If osteochondritis dissecans in a child fails to respond to nonsurgical management, arthroscopic examination and drilling of the osteochondritic lesion are recommended.
Indications of arthroscopy
Arthroscopy directly visualizes the involved area and determines its exact location and size, and the degree of articular cartilage separation.
Arthroscopy is indicated in osteochondritis dissecans in patients 12 years of age and older in whom the weight-bearing area is involved with a lesion over 1 cm. in diameter.
Arthroscopic examination is also indicated in case of late diagnosis.
In children under 12 years of age arthroscopy should be done when, there is no radiographic or clinical evidence of improvement after a reasonable period of non operative treatment, or if the lesion becomes partially or completely detached.
This condition was described by Charcot, in 1868. He described it as a bizarre destruction of the knee joints with indolent swelling and instability in patients of tabes dorsalis> He proposed that the disease resulted from traumatization of a joint deprived of sensation.
Later Steindler classified the condition into the condition into the destructive, atrophic and hypertrophic proliferative forms.
Charcot-like changes in joints are seen in patients who have absence or depression of pain and proprioceptive sensation and who take part in extended continuous physical activity.
As a consequence their joints sustain repeated trauma. [Read more...]
In this condition protrusion of meninges occurs through the defect in the neural arch. Such protrusion contains only cerebrospinal fluid. So it gives rise to a cystic swelling.
Usually the duramater stops at the margin of the defect and usually the pia and arachnoid protrude. The overlying skin remains intact.
It is common in the lumbosacral region. Meningocele also occurs in the skull, where it is more common in the occipital region or at the root of the nose.
Clinical Features
Complication
Treatment
Operation should be performed as early as possible, but child’s condition and strength should be sufficient to withstand operation. This operation is often performed within a few days of birth. If the operation is delayed are:
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