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Guidelines_English_Final
 

PRINCIPLES OF ORTHOPEDICS                 *Terminology

         Two Lectures                                                 -  Varus/valgus

                                                                                      -  FD/FFD/Recurvatum

                                                                                      -  Scoliosis/kyphosis/lordosis

                                                                                      -  Malrotation/Ante-version

                                                                                      -  Pes planus, pes cavus, equinous

                                                                                      -  Geno (valgus, varus)

                                                                                      -  Halux (valgus, varus)

                                                                                      -  Cubitus (valgus, varus)

                                                                                      -  Coxa (Magna, vara, valga)

                                                                                      -  CTEV

                                                                                      -  Malunion, non-union and

                                                                                         delayed unions

-  Bone Resorption

                                                                                      -  Bone Destruction

                                                                                      -  Osteopenia

                                                                                      -  Osteoporosis

                                                                                      -  Lytic lesion

                                                                                      -  Sclerotic lesion

                                                                                      -  Monoplegia

                                                                                      -  Triplegia

                                                                                      -  Diplegia

                                                                                      -  Tetraplegia

                                                                                      -  Hemiplegia

                                                                                      -  Paraplegia

                                                                                                                                   

PRINCIPLES OF FRACTURES    (A) 45 min      *  Definition

         Four Lectures                                               *  Types (simple & comminuted)

                                                                                         (closed & open)

                                                                                    *   Mechanism of Injury

                                                                                    *   Presentations

 

                                                            (B) 45 min       *  Diagnosis             

                                                                                    *  Complications            

                                                                                    *  Healing of fracture

                                                                                    *  Types of union

                                                                                    *  Mal and non-union

 

                                                             (C) 45 min     Pathological fractures

                                                                                      -  Definition

                                                                                      -  Presentation

                                                                                      -  Investigation

                                                                                      -  Treatment

 

                                                              (D) 45 min     Fractures in children

                                                                                                                                               

GENERAL PRINCIPLES OF                       * Open vs closed treatment

FRACTURE TREATMENT                         * Conservative treatment (Tutorial)

     Two Lectures                                                        -  Traction

                                                                                       -  Manipulation

                                                                                       -  Casting (complete, slab)

                                                                                       -  Splinting

                                                                           * Operative treatment (Tutorial)

                                                                                       -  AO principles

                                                                                       -  Closed reduction + casting

                                                                                       -  Closed reduction +  pinning

                                                                                       -  Plating

                                                                                       -  I.M. nailing

                                                                                       -  Ext. fixators

                                                                                                                                               

SOFT TISSUE CARE                                      *Ligament Injuries

    Two Lectures                                                       -  ACL, collateral ligaments

                                                                                       -  Acute or delayed treatment

                                                                                       -  Rehabilitation

                                                                            *Muscle & Tendon Injuries

                                                                                       -  Open & closed injuries

                                                                                       -  Acute or later reconstruction

                                                                            *Acute Compartment Syndrome

                                                                                       -  Presentation

                                                                                       -  Diagnosis

                                                                                       -  Treatment

                                                                                       - Complication

                                                                                                                                               

MECHANICAL KNEE DISORDERS            *Etiology of different knee injuries

    One Lecture                                                  *General features (symptoms and signs)

       (Tutorial)                                                  *General examination

                                                                             *Useful investigations

                                                                             *Imaging techniques

                                                                             *Meniscal injuries

                                                                                          -  Presentation

                                                                                          -  Examination

                                                                                          -  Special tests (McMurray)

                                                                                          -  Types of meniscal injury

                                                                                          -  Complications

                                                                              *ACL

                                                                                          -  Presentation

                                                                                          -  Examination

                                                                                          -  Special tests

                                                                                              (Ant. Drawer – Lachman)

                                                                                          -  Complications

                                                                              *Arthroscopic diagnosis & treatment         

PERIPHERAL NERVE INJURIES                 *Types of nerve injuries

          One Lecture                                                        -  Neuropraxia

                                                                                          -  Axonotemesis

                                                                                          -  Neurotemesis

                                                                              *Etiology

                                                                                     Special consideration to nerve

                                                                                     entrapment syndrome and common

                                                                                     fractures causing nerve injury

                                                                              *Presentation and Diagnosis

                                                                                          -  Assessment

                                                                                          -  Investigations

                                                                                          -  EMG

                                                                                          -  NC studies

 

                                                                               *Fate and Rehabilitation

                                                                               *Examples (motor and sensory loss)

                                                                                          -  Brachial plexus (Erb’s palsy)

                                                                                          -  Carpal tunnel syndrome

                                                                                              (median nerve)

                                                                                          -  Radial nerve injury at the arm

                                                                                          -  Ulnar nerve injury

                                                                                          -  Sciatic nerve injury

                                                                                          -  Lateral popliteal nerve injury

                                                                                                                                               

UPPER LIMB FRACTURES                              *Fracture clavicle

AND DISLOCATIONS                                        *Shoulder dislocation

  Two Lectures                                                    *Humerus shaft fractures

    (Tutorial)                                                        *Supracondylar fractures in children

                                                                                *Montaggia fracture

                                                                                *Galeazzi fracture

                                                                                *Distal radial fractures

                                                                                *Fracture scaphoid

                                                                                                                                               

LOWER LIMB FRACTURES                            *Pelvic fractures

AND DISLOCATIONS                                        *Acetabular fractures

  Two Lectures                                                    *Hip dislocations

     (Tutorial)                                                       *Proximal femoral fractures

                                                                                *Femoral shaft fractures

                                                                                *Fracture tibial plateau

                                                                                *Tibial shaft fractures

                                                                                *Ankle fractures

                                                                                                                                               


PRINCIPLES OF ORTHOPEDICS (1)             *Aetiology and D/D

      One Lecture                                                           -  Congenital

                                                                                      -  Traumatic

                                                                                      -  Neurological e.g. C.P., polio

                                                                                      -  Metabolic

                                                                                       -  Infection

                                                                                      -  Tumours (soft tissues, bone)

                                                                                      -  Tumour like lesions

                                                                                          (Bone cysts)

                                                                                                                                               

PRINCIPLES OF ORTHOPEDICS (2)             *Presentation

        Two Lectures                                                    -  Pain

                                                                                       -  Swelling                           

                                                                                       -  Limp

                                                                                       -  Deformity

                                                                                       -  Loss of function (¯ ROM)

                                                                                       -  Instability

                                                                                       -  Locking

                                                                                       -  Clicking

                                                                                                                                               

PRINCIPLES OF ORTHOPEDICS (3)             *Investigations

            Two Lectures                                                  -  Lab

                                                                                             a.  Blood            

                                                                                             b.  Urine

                                                                                            c.  Joint aspiration

                                                                                       -  RADIOLOGICAL

                                                                                             1.  X-ray (Tutorial)

                                                                                             2.  Arthrograms.  Sinogram

                                                                                             3.  CT

                                                                                             4.  MRI                        

                                                                                             5.  Bone scan

                                                                                             6.  U/S

                                                                                       -  EMG and NC

                                                                                              Importance?

                                                                                              How?

                                                                                              When?

                                                                                        -  Biopsies          

                                                                                              Types

                                                                                              Indications

                                                                                        -  Arthroscopy as diagnostic tool

                                                                                        -  Others – tuberculin test

                                                                                                                                               

 


PRINCIPLES OF ORTHOPEDICS (4)               *Treatment

            Two Lectures                                            +Conservative treatment

                                                                                         -  Pain control (Medication)

                                                                                         -  Orthotics (Tutorial)

                                                                                         -  Physiotherapy(Tutorial)

                                                                                         -  Cast

                                                                                         -  Traction

                                                                                  +Operative treatment

                                                                                         -  Pain control

                                                                                                       ORIF

                                                                                                      Drainage

                                                                                                      Arthrodesis

                                                                                                      Decompression etc

                                                                                         -  Bone and joint saving

                                                                                                   ( drainage, tumor excision )

                                                                                         -  Early restoration of normal

                                                                                            function

                                                                                         -  Reconstruction

                                                                                                   ( ACL, joint replacement )

                                                                                         -  Restoration of shape and

                                                                                             mechanical axis (osteotomies)

                                                                                                                                               

MECHANICAL DISORDES                                 *Anatomical and physiological

OF THE SPINE                                                         overview

   Two Lectures                                                       *Differential diagnosis of LBP

     (Tutorial)                                                            (Spondylolysis-Spondylolithesis)

                                                                                   *PID

                                                                                          -  Etiology

                                                                                          -  Pathological anatomy

                                                                                          -  Clinical picture

                                                                                          -  Investigations

                                                                                              (imaging  techniques)

                                                                                          -  Treatment

                                                                                                      =Prevention

                                                                                                      =Non operative

                                                                                                      =Surgical – Indications

                                                                                                                                               

SPINAL INJURIES                                                 *Definitions

  Two Lectures                                                              -  Stable – unstable

                                                                                          -  Neurological status

                                                                                          -  Mechanism of injuries

 

                                                                                   *Pathological anatomy

                                                                                   *Causes of spinal injuries

                                                                                   


                                                                                   *Management

                                                                                           -  First aid            

                                                                                           -  Transfer of the patient

                                                                                           -  Clinical examination

                                                                                           -  Neurological assessment

                                                                                           -  Radiological assessment

                                                                                           -  Initial treatment

                                                                                           -  Definitive treatment

                                                                                           -  Post treatment care

                                                                                           -  Complications

                                                                                           -  Outcome

                                                                                                                                               

PYOGENIC BONE AND                                       *Classification

JOINT INFECTION                                                        -  Duration
  Two Lectures                                                                   Acute, subacute, chronic
    (Tutorial)                                                                    -  Route of infection
                                                                                               Hematogenous or exogenous
                                                                                            -  Host respsonse
                                                                                                Pyogenic or granulomatous


                                                                                   *Acute osteomyelitis
                                                                                            -  Incidence & organism
                                                                                            -  Source of Infection
                                                                                            -  Pathogenesis

-  Clinical picture

                                                                                            -  Investigation

                                                                                            -  Differential diagnosis

                                                                                            -  Treatment
                                                                                            -  Prognosis & complications

                                                                                   *Subacute osteomyelitis

                                                                                            -  Definition and characteristics
                                                                                            -  Radiological types
                                                                                            -  Treatment

                                                                                    *Chronic Osteomyelitis

                                                                                            -  Causes of chronicity
                                                                                            -  Types

                                                                                            -  Clinical picture
                                                                                            -  Investigation
                                                                                            -  Treatment & complications

                                                                                    *Acute septic arthritis
                                                                                            -  Organism& route of infection
                                                                                            -  Pathology & clinical picture
                                                                                            -  Differential diagnosis

                                                                                            -  Treatment

                                                                                                                                               

 

CHRONIC SPECIFIC BONE                                 *TB & Brucellosis

AND JOINT INFECTIONS                                            -  Etiology

    Two Lectures                                                              -  Pathogenesis

        Tutorial                                                                    -  Clinical pictures

                                                                                            -  Investigations

                                                                                            -  Treatment

                                                                                            -  Complications

                                                                                                                                               

CDH                                                                            *Definition

    Two Lectures                                                       *Spectrum of the disorder

                                                                                     *Etiology & risk factors

                                                                                     *Natural history

                                                                                     *Diagnosis

                                                                                     *Treatment

                                                                                              -  Non-surgical & surgical

                                                                                              -  According to age

                                                                                     *Prognosis & complications

                                                                                                                                               

CTEV                                                                          *Definition

    Two Lectures                                                       *Types of clubfoot (TEV)

                                                                                            -  Congenital

                                                                                            -  Postural

                                                                                            -  Secondary

                                                                                    Congenital Clubfoot

                                                                                     *Predisposing factors

                                                                                     *Clinical pictures

                                                                                            -  Description of deformity

                                                                                            -  Muscle wasting

                                                                                            -  Correction

                                                                                            -  Secondary changes

                                                                                            -  Back examination

                                                                                            -  Associated anomalies

                                                                                     *Treatment

                                                                                            -  Non-surgical & surgical

                                                                                            -  According to age

                                                                                     *Residual deformity

                                                                                     *Recurrence

                                                                                                                                               


OSTEOARTHROSIS (O.A.)                                    *Types

    Two Lectures                                                              -  Primary & secondary

                                                                                            -  Monarticular & polyarticular                                                                         

                                                                                     *Etiology & predisposing factors

                                                                                     *Pathogenesis

                                                                                     *Clinical features

                                                                                     *Investigations

                                                                                     *Differential Diagnosis

                                                                                     *Treatment

                                                                                             -  Conservative

                                                                                             -  Surgical

                                                                                                                                               

METABOLIC BONE DISORDERS                        *Introduction

          Two Lectures                                                         - Ca & phosphorus metabolism

             Tutorial                                                                -  Nomenclatures

                                                                                      *Rickets & osteomalacia

                                                                                             -  Definition

                                                                                             -  Clinical picture

                                                                                             -  Laboratory Findings

                                                                                             -  X-ray pictures

                                                                                             -  Treatment

                                                                                      *Hyperparathyroidism

                                                                                             -  Definition

                                                                                             -  Clinical picture

                                                                                             -  Laboratory Findings

                                                                                             -  X-ray pictures

                                                                                             -  Treatment

                                                                                       *Osteoporosis

                                                                                             -  Definition

                                                                                             -  Types

                                                                                                (Idiopathic & secondary)

                                                                                             -  Clinical picture

                                                                                             -  Laboratory Findings

                                                                                             -  X-ray pictures

                                                                                             -  Prevention

                                                                                             -  Treatment

                                                                                                                                               


BONE TUMOR                                                            *General radiological features

   Two Lectures                                                           *Classification

      Tutorial                                                                  *Benign tumors and tumor

                                                                                           like conditions

                                                                                               -  Simple bone cyst

                                                                                               -  ABC

                                                                                               -  Osteoid osteoma

                                                                                               -  Osteochondroma

                                                                                               -  Enchondroma

                                                                                               -  Fibrous cortical defect

                                                                                         *Malignant Tumors

                                                                                               -  Giant cell tumor

                                                                                               -  Osteosarcoma

                                                                                               -  Ewings sarcoma

                                                                                               -  Bone metastasis

                                                                                               -  Multiple myeloma

                                                                                                                                               

NEUROMUSCULAR CONDITIONS                        *Cerebral Palsy (60 min)

         Two Lectures                                                            -  Definition

                                                                                               -  Incidence

                                                                                               -  Causes

                                                                                               -  Risk babies

                                                                                               -  Topographic Classification

                                                                                               -  Physiological Classification

                                                                                               -  Deformities in CP

                                                                                               -  Management (aim-methods)

                                                                                               -  Surgical treatment

                                                                                                   (Goal-Criteria-Options)

                                                                                          *Spina bifida (30 min)

                                                                                               -  Definition

                                                                                               -  Incidence

                                                                                               -  Classification

                                                                                               -  Deformities

                                                                                               -  Treatment

                                                                                                           General principles

                                                                                                           Goal and options

                                                                                           *Poliomyelitis (20 min)

                                                                                               -  Definition

                                                                                               -  Brief general idea about

                                                                                                      =Pathophysiology

                                                                                                      =Power grading

                                                                                                      =Deformities

                                                                                                      =Management

                                                                                                                                               


 

EXAMINATION

 

The system we are going to use is:

 

*  Look           -  Inspection

*  Feel             -  Palpation

*  Move          -  Movement

*  Do:

1.      Special tests:  for location – when required

2.      Measurements – when required

3.      Functional tests – when required

·        Always compare

·        Stand beside the limb you want to examine

 

*  Look -  Skin condition/sinuses/ulcers

  -  Position of limb

              -  Deformity

-  Swelling

-  Shortening

-  Wasting

 

*  Feel   - Superficial  - mainily for temperature

*  Skin

*  Soft tissue

            *  Peripheral pulses

*  Bone

*  Cripitus (with movement)

*  Swelling

*  Severe tenderness

           

-         Deep – tenderness please palpate, bony promenance, joint line, ligament, look for consistency, thickness of synovium, effusion.

 

*  Move

            -  Active movement – most upper limb examination is active.

            -  Passive – most examination of lower limb is passive.

            -  Abnormal   - is the joint unstable?

                                    - is there movement at an old fracture site?

            -  Painful movement

 

*  Range of movement need to be recorded by goniometer.


 

*  Do

-         Special tests – there are special tests for certain joints like the knee and hip you must do it to fulfill the examination according to the location.

 

-         Measurement

 

·        Shortening may be true or false

·        Muscle power grading.

·        Wasting

 

-    Functional – walking, limping, tiptoe, walk on heel.

 

Special test for special disease

 

Only to check the disease e.g. Barlow sign for CDH.

 

Knee Examination

 

·        Inspection – deformity, thigh and calf muscle wasting, swelling, shortening of lower limb, position of lower limb and popliteal fossa.

·        Feel   -  knee in flexion

    -  Bony land marks  - P.F. joints

    -  Joint line

·        Movement – flexion, extension (active and passive)

·        Special test

-     Stability of joint

      A.D. – Lachman test for ACL

      P.D.  – for PCL

      Valgus stress – for MCL in 250 if positive repeat in extension

      Varus stresses for LCL in 250 if positive repeat in extension

     -      Friction test – for retropatellar pain.

     -      Apprehension test for patella dislocation or subluxation.


 

Meniscal Injury - McMurray – for meniscus from full flexion to full extension

·        For effusion -  bulge test for minimal fluid

    -  Fluctuation test for huge fluid.

    -  Patella tapping for moderate.

 

Shoulder Examination

 

·        Inspection – from front, behind, side, superior, axilla, look for skin color, contour, swelling and deformity.

 

·        Palpation from front and back – front st. clav. J., clavicle,  A.C. joint, scapula

G. tuberosity, post. joint.

 

·        Movement – flexion, extension, abduction, adduction, rotation (external and internal) and circumduction.

 

Special test

 

·        Apprehension test for recurrent dislocation, impingement test for rotating cuff tendenitis.

 

Hip Examination

 

·        Inspection – skin, deformity, muscle wasting (quad. & gluteal), shortening.  If shortening is present, true or apparent do squaring pelvis and measurement.

 

·        Feel – hip is deep joint to palpate for tenderness, bony and soft tissue land marks.

 

·        Movement – flexion, extension, abduction, adduction, rotation

 

·        Gait – antalgic, trendelenburgh

 

·        Special test -  Thomas test for flexion deformity

   -  Trendelenburgh test for abductor muscle function

 

·        Length : do measurement – true/apparent.


Elbow Examination

 

·        Inspection – deformity look for carrying angle, triangular relationship, swelling, muscle wasting.

 

·        Feel – medial, lateral epicondyle and olecranon process

-         Ulnar nerve

-         Head of radius

-         Swelling and/or effusion

 

·        Movement – flexion, extension, supination and pronation (elbow in flexion and shoulder in adduction) position.

 

·        Special test for disease – tennis elbow, golf elbow.

 

Back Examination

 

·        Standing position

 

-     Inspection     From back – for scoliosis, tilting, muscle spasm

From side – for lordosis, kyphosis

 

-     Feel – for tenderness, muscle spasm and kypous

 

-     Movement – flexion, extension, lateral flexion, rotation (also rotation in standing)

 

-     Gait

 

      -     Walking on tiptoes, walking on heel

 

·        On Bed – patient prone

 

Feel for tenderness

 

Patient supine: For neurological examination

            Do       -  S.L.R./Lasaghe

                        -  Test for power

-  Dermatomes test for sensation

  -  Knee + ankle jerks

 

     Know the level of the root

 


 

Ankle

 

·        Inspection – skin, callosities, deformity, swelling

 

·        Palpation – bony land marks, subtalar, soft tissue

 

·        Movement – dorsoflexion, plantar flexion, eversion, inversion

 

·        Special test – stability

For lateral and medial ligament

 

·        Thomson signs for torn achillis tendon.

 

 

 

 

 

 

 

 


 

References

 

1.                  Fractures and dislocations by Badr and Shaheen

 

2.                  Appley’s system of Orthopaedics

 

3.                  Orthopaedic Examination by McRae.

 
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