Nerve Injuries 00:29:35

Card test Egawa fan test Froment sign/ Wartenburg sign

Adduction test Abduction test Book holding test Hyperabduction of
Adductor policies function digiti minimi d/t
assessment ulnar n. #
Wartenburg syndrome :
Ulnar nerve supplies :
Point : Radial cut. N #
• Adductor policis(graveyard of ulnar n.)
A - Axillary n. # Wardenburg syndrome :
• Palmar interossei(PAd)
B - Radial n. # White forelock +
C - Ulnar n. # • Dorsal interossei(DAb)
heterochromia iridis +
• Medial lumbricals(3/4)
SNHl
• Hypothecated muscles
Medial epicondyle - pointed, trochlea
 FDP tendons seen
along the muscle Knuckle bender
Lumbricals splint : claw
Palmar interossei Dorsal interossei Origin-FDP tendon hand
Adduct Abduct 1,2: Unipennate Median n.
3,4: Bipennate Ulnar n.
Unipennate Bipennate Function: Flexion @ MCP;
Absent on middle finger Absent on thumb & little Extension @ IP
finger
If # : Claw hand
C8/T1 # a.k.a Klumpke’s paralysis :
Cockup
Complete Claw hand
splint
Radial N palsy MC # nerve, best prognosis, extensor palsy
High (Axilla)- Elbow, wrist, finger drop + sensory loss
Low (spiral groove)- Wrist, finger drop + sensory loss
PIN (Monteggia/Radial head)- PIN(pure motor)# - only finger
drop
 Ape hand Upon making a fist, Pen test Weak Ok sign(Kiloh nevine sign)
medial fingers flex but
Thenar atrophy AIN #(FPL & FDP weakness)
lateral fingers don’t
Adducted thumb
• oschner clasp
deformity
• Benediction pope
sign
• Pointing index
finger
Median nerve supplies :
• thenar muscles(except Add. Pollicis)
• lateral half of FDP/FDS(lateral 3 fingers)
Nerve Injuries and Compression 00:01:57
00:46:33

• Shoulder dislocation, Neck of humerus: Axillary nerve Axillary nerve Deltoid 15-90; Abduction
• Quadrangular space: Axillary nerve T.Minor ER
• Holstein Lewis #: Radial nerve Lat arm sensation Regimental
badge sign
• Monteggia #: PIN(Post. Interosseous N.)
• Supracondylar #: AMRU(AIN>Median>Radial>Ulnar) ROTATOR CUFF TENDONS:
• Elbow dislocation: Ulnar nerve Supraspinatus - 0-15 abductor Suprascapular nerve
• Cubital tunnel, Guyon’s canal (hook of hamate #): Ulnar nerve Infraspinatus
Teres minor External rotation Axillary nerve
• Wrist dislocation: Median nerve
• Carpal tunnel, Pronator syndrome: Median nerve Subscapularis Adduction & IR Subscapular nerve
• Supinator syndrome: Radial nerve Empty can test Suprainatus
• Cheralgia paraesthetica / Wartenberg syndrome:Radial cut. n. Forgotten tendon, Lift off test:Subscapularis
• Meralgia paraesthetica: Lateral cut. n. of thigh(McRobert position/Shoulder dystocia) Painful arc syndrome:60-120
• Piriformis syndrome: Sciatic nerve
• Tarsal tunnel : Posterior tibial nerve
• Neck of fibula fracture: Common peroneal nerve(also # in Lithotomy)
Deep>Supf. Peroneal n.

Supplies dorsiflexor of ankle

Toe raising splint
Foot drop Foot drop(High steppage gait)
 Felon —> Pulp
Important hands and fingers Paronychia —> Nail bed 00:57:01
00:01:57

Street Food of Delhi(SFD)

MCC Staph. aureus

Osteoarthritis
Diabetic Swan neck deformity Kanavel sign
DH BP
cheroarthropathy in RA; flexion @ DIP & Suppurative tenosynovitis
DIP - Heberdan nodes
Prayer sign Extension @ PIP PIP - Bouchard nodes

Thumb spica
Entrapment of Trigger finger
Aluminium
Adductor
cast Entrapped A1 pulley of
pollicis is k/a
Steiner
flexor tendon
lesion(Ix for
surgery)
Gamekeeper’s/Skier’s thumb Extensor tendon rupture Knee OA : medial compartment
Flexor tendon rupture
Ulnar collateral ligament Baseball/Mallet finger affected MC, genu varus MC, Vastus
Rugby/Jersey finger
avulsion @ base of thumb medialis MC #
Fractures 00:01:57
01:05:16

NONUNION: FLUTS DEFORMITIES:

i) Neck of Femur # ii) LCH # iii) Ulna # • Gunstock deformity: Cubitus varus
iv) Tibia #/Talus # v) Scaphoid # • Dinner-fork: Colle’s - dorsal
• Garden-spade: Smith - volar
MALUNION: MISC • Fish-tail: Distal humerus
i) ITF ii) SCH iii) Colle’s #/Clavicle # • Haglund Calcaneal spur @ heel(Achilles tendon)
• Madelung Distal radius abnormality
Type Characteristics
I Puncture wound < 1 cm + Minimal soft tissue
IOC for AVN: MRI damage
II Laceration >1 cm but <10 cm + Moderate soft tissue
Sites for AVN: damage
• Head of femur(MC) III A Laceration > 10 cm + Extensive soft tissue damage /
• Prox. pole of scaphoid contamination
• Body of talus Segmental/ comminuted fractures
III B Periosteal stripping and bone exposure
Primary bone healing: No callus — Plate III C Vascular injury requiring repair
Secondary bone healing: Callus +
Callus earliest: 3 weeks Antibiotics, Debridement Gustillo-Anderson
Delayed union: >6 months External fixator classification of Open #
Non-union: >9 months
HIP X-RAYS APPROACH 01:12:56
00:01:57

R/F :
steroids;
SCA;
Caisson’s ds

Crescent sign
AVN
Ficat-Arlett staging Anterior hip
Posterior hip dislocation
dislocation(MC) FABER +
Shortening + lengthening
FADIR Femoral
Sciatic nerve # nerve #

FABER:
TB Synovitis
FADIR: Septic arthritis
TB hip arthritis Iliotibial band contracture
Posterior dislocation Anterior dislocation
SHOULDER DISLOCATIONS 01:16:46
00:01:57

Bony bankart Light bulb sign

Bankart lesion Hill sach’s lesion Posterior dislocation of Inferior dislocation

Antero-inferior Posters-lateral humerus a.k.a Luxatio erecta
labrum humerus ADIR(Adduction + IR) Hyperabduction/
Recurrent Epilepsy/Electrocution hyperextension #
MC type: Anterior (Subcoracoid subtype)
Limb attitude: ABER(Abduction + ER)
MC nerve: Axillary nerve
Modified Kocher’s:
TESTS: Hamilton ruler test Traction
Ruler touched acromion and lateral epicondyle Used for treatment of
External rotation
Difficulty touching opposite shoulder Dugas test shoulder dislocation
ADduction
Increased girth Callaway test Medial rotation
Growth plate injury :
Limb length
discrepancy

Hypertrophic zone is
most commonly
affected
 UPPER LIMB FRACTURES 01:24:55
00:01:57

Gartland classification
Clavicle # for SCH#
Malunion Essex-
Lopresti

Holstein-Lewis # LCH # SCH#(MC) : Malunion; Cubitus

Radial n. Non union varus (Gunstock deformity); AMRU
Cubitus valgus Brachial artery injury
Tardy ulnar n. palsy Compartment syndrome
VIC Maissoneuve #
Neer classification: Proximal Milch classification:
AVN Axillary n. # humerus LCH# Posteromedial displacement Neck of
Fibula #
Clavicle Extension type
MC at birth, MC overall Terrible triad of elbow: Dunlop smith traction Disrupted
Medial 2/3-lateral 1/3 Elbow dislocation Baumann angle interosseous
membrane
FIGURE OF 8 bandage Radial head # 3 point maintained
Arm by side lifting shoulder Coronoid # CR + K-wire
 Boxers #
Night Stick # Greenstick # Torus fracture
Superior ulna Inferior radius 5th Metacarpal
Seen in Unicortical # cortical
# + radial head # + radio-ulnar fracture
elderly abuse buckling dislocation dislocation
and lathi 1st Metacarpal
charge Monteggia #
Piedmont #
GRIMUS Galeazzi #
Non-accidental injury/
Child abuse :
Galeazi Radius Inferior
Metaphyseal corner/ Monteggia Ulna Superior
Bucket handle fracture BADO classification: Monteggia #
2 part # 3 part #
 Colle's # Distal end of Smith # Barton's # Chauffers # Terry Thomas Spilled Coffee
Dorsal radius # Volar Intraarticular + Radial styloid # sign cup sign
displacement Extra- displacement Radiocarpal Avulsion of Scapho-lunate Lunate
articular dislocation Brachioradialis dislocation dislocation
a. k. a. Hutchinson #

Hutchinson
• Fracture : chauffeur #
• Triad: Congenital Syphilis
Osteoporosis(R/F) Interstitial Keratitis + SNHL +
Colles’: FOOSH in Extension Peg shaped teeth
• Pupil: 3rd CN palsy (I/L dilated pupil)
Deformity: Dinner fork deformity • Sign: tip of nose involvement due to
Smith: FOOSH in Flexion V1# - Herpes Zoster Ophthalmicus
Deformity: Garden spade deformity
Hand Shaking Cast Glass holding Cast Cylindrical cast
Colles # scaphoid # Patella #
Hanging/U slab cast
Propa-gunda Dorsiflexion f/b Radial deviation Humerus#

Palmar flexion
Skyline view
Pronation
Ulnar deviation Patella# Bipartite patella

Olecranon, Patella # :
Tension band wiring
convert distractive forces
to compressive forces.
 LOWER LIMB FRACTURES 01:46:46
00:01:57

Lateral tibial Segond's Pott# Cotton # Pillon's # Waist of talus # Calcaneal #/Lovers
Condyle # Avulsion of Lateral Bi-malleolar Tri-malleolar Intra-articular #/Don Juan #
capsular ligament Comminuted tibial #
Bumper #
@ lateral tibial Aviator fracture Bohler: Decreases
epicondyle Classification: Gissane: Increases
ass/w ACL injury Hawkins
MCL Avulsion @ medial aspect of
femur : Pellagrini steida #

Schatzker classification: Jumper #: sacrum #

Tibial # Denis classification: sacrum#
Judet and letournel: Acetabulum #
Young and Burgess: Pelvic #
 Pathological VS Stress fractures:

Normal bone,
d/t underlying abnormal stress
abnormal bone
MCC osteoporosis
Tibia Fibula Metatarsal
Joggers# 2>3

Chopart # Lisfranc #
Intertarsal Tarso-metatarsal

Jones #
Mirel score
Used for pathological fracture
Pain precedes fracture
Horizontal #

Pseudo-jones(Avulsion of
P.brevis a.k.a Dancer’s #)

DANIS- WEBER:Ankle #
OTTAWA RULES::When to do XRay in ankle injury MC - ATFL
FRACTURE PROXIMAL FEMUR 01:55:38
00:01:57

NOF management:
>65yrs: Hemi-arthroplasty
<65yrs, <3weeks: CR+IF
<65yrs,>3weeks:
Augmented osteotomy

TOC : proximal Dynamic hip

More age femoral nail screw
More trauma ITF T/t
More pain
More shortening
More ER >45 degrees Partial/Hemi THR
PIPKIN, GARDEN Evan classification Acetabulum not replaced Acetabulum replaced
MALUNION: Coxa vara Thompson
NOF# Bipolar
ITF#
Non union Gives 2 plane of
Extra-capsular fracture Austin movement
Intra-articular MOOre Maximum
fracture range of motion
 SPINE FRACTURES 02:00:04
00:01:57

Burst/Jefferson #
4 part fracture of
Atlas
Stable (spinal cord
not involved)
Clay Shovellers # Burst# Chance # Hangman # Carrot Stick #
C7 spinous process # Retropulsion Through & C2-C3 subluxation Ank. spond.
through # Axial loading +
hyperextension
Minimum 4 person required
for log roll
1 person to hold neck

SCIWORA: Spinal Cord Injury Without Obvious Radiographic Abnormality

Children MC
SKULL XRAYS-PATTERN APPROACH 02:04:25
00:01:57

Salt & pepper skull Sub-periosteal Punched out lytic Child w/ geographic Vertebra
stripping @ lesion lytic lesion + plana
HyperPTH radial aspect of Bevelled margins
phalanges Multiple myeloma > LCH
1 PTH adenoma Metastasis
IOC : Sestamibi
2 PTH : CKD Loss of
Laminate
dura
Cotton wool skull Osteoporosis Hair on end app. Tram-track skull
circumscripta(lytic Hemolytic anemia Sturge-Weber
phase) syndrome
Paget’s disease
Elderly, normal Calcium/PO4/PTH
Elevated ALP
3 phases : Lytic/Mixed/Blastic
 L4 Desiccated
disc

L5

S1
Mortar pestle
app.
Spondylitislysthesis
Slippage of one vertebra TB hip
over the other MC @ Acetabulum
Paradiscal involvement Phemister’s triad:
L4-L5 Disc Prolapse
MCC : Pott’s spine Periarticular osteopenia
IOC : CE-MRI Erosions
Exiting roots Traversing roots(MC #) Biopsy indications : Drug Reduced joint space
resistance, neurological
involvement
• Bony ankylosis: TB spine • Babcock Triangle: TB hip
• Fibrous ankylosis: TB hip/knee • Fairbank triangle: Congenital coax vara - Trendlenberg gait
• Ward triangle: Osteoporosis
 Cloaca

Sequestrum Paprika sign :

Sclerotic sign of viable Baker’s cyst
Dead bone tissue Brodie’s abscess b/w Semi-membranosus
No vascularity h/o subacute & Medial gastrocnemius
Involucrum inflammation
Ruptured cyst can
Granulation tissue
mimic DVT

Chronic Osteomyelitis

Acute OM - MCC : Staph aureus

Sickle cell : Salmonella is MCC
 BONE TUMORS EXTRA-EDGE 02:18:17
00:01:57

MC bone tumor: Metastasis

MC primary bone tumor: Multiple myeloma
MC benign bone tumor: Osteo chondroma
MC true benign bone tumor: Osteoid osteoma
Most chemo-radio sensitive: Ewing sarcoma
Physalliferou
Most chemo-radio resistant: Osteosarcoma s cells
MC radiation induced tumor:
MC mets: Lung (MC Osteosarcoma)
Clival Chordoma
MC bone to bone mets: Ewing sarcoma
CD99/mic2: Par-osteal Osteosarcoma Myositis ossificans
p53/RB/INK4/CDK4/MDM2 Cleft/string sign h/o massage
Osteosarcoma Attached to periosteum
Chromothrypsis
H3-G34W
Giant Cell Tumour
Denosumab role:
USP 6 rearrangement: Aneurysmal Bone cyst Fluid-fluid levels on MRI:
EXT1/EXT2: Exostosis • GCT
Chordoma (Sacro-iliac joint > • ABC
BRACHURY marker:
Clivus) • Metastasis
• Telengectatic OS
Blood inside tumour
INSTRUMENTS 02:23:28
00:01:57

Bone Holding Cortical screw

Forceps

Cancellous screw
Osteotome
Bone nibbler Bone cutter
Periosteal elevator
Herbert screw: Scaphoid #

Ring
sequestrum
K-wire Steinmann Denhamm pin
(2mm) pin Cancellous bone
Distraction 1mm/d Rail Road External Spanning
osteogenesis fixator fixator
Ilizarov External Ring Fixator Peri-articular #
around joint
 SPLINTS AND TRACTIONS: EXTRA-EDGE 02:27:56
00:01:57

#shaft of femur

<2yrs/<10kg

Hip spica
Thomas splint Bryant traction 2-10yr
Krammer’s splint Shaft of femur # Bauhler-Brown splint Gallow’s traction
Emergencies
Skeletal traction
Up to 20 kg

Buck’s traction
Skin traction
Russell’s traction
3-4kgs Perkins traction ITF#
>10yrs
 Turn buckle
Halos vest 4 post collar SOMI(Sterno- ASHE Taylor brace
splint(for VIC)
Occipito-Mandibular
if fails - Maxpage
Immobilisation)
surgery

Velpau’s bandage Figure of 8 bandage Dunlop-smith skeletal

Crutchfield tongs
ACL dislocation Clavicle # traction
C-spine traction
SCH#