http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878259/

http://www.smith-nephew.com/new-zealand/healthcare/treatment-options/wound-bed-preparation1/

Bone Tumor

Supracondylar

http://www.rch.org.au/clinicalguide/guideline_index/fractures/Supracondylar_fracture_of_the_humerus_Emergency_Department/

Radial

http://www.orthogate.org/articles/hand-and-wrist/radiological-evaluation-of-distal-radius-fracture-azegami

http://www.slideshare.net/UthamalingamMurali/shock-pathophysiology-types-management?from_m_app=android

gout vs pseudogout

http://mynotes4usmle.tumblr.com/post/44710061423/gout-vs-pseudogout

P  seudogout

• >50yo
• Deposition of calcium P yrophosphate crystals.
• Joint aspiration: P ostive birefringent, Polygonal (romboid shaped or rectangular) crystals.
• Knee is the most involved.
• Associated with: hypothyroidism, DM, ochronosis
• Mimic osteoarthritis, RA

Xray

http://teachmeanatomy.info/
 http://www.wikiradiography.net/


Zebra stripe sign - horizontal lines of dense bone progressing away from the growth plate in children with osteogenesis imperfecta treated with cyclical bisphosphonate therapy.

Nursemaid elbow, x-ray

NE (or babysitter’s elbow, pulled elbow, radial head subluxation) occurs when the radial head slips under the annular ligament and is displaced downward. 

This ligament is weaker in children and consequently increases the risk of radial head subluxation, as seen in the image.

NE is a common childhood injury that occurs when a child’s arm is pulled up and out.

Classic history is a child with no history of trauma who suddenly refuses to use one arm, though bilateral cases can occur.

The joint can typically be easily reduced and should result in an immediate return to normal function.

Calcinosis cutis, X-ray

Calcinosis cutis refers to calcium deposition in the skin and soft tissues. It presents with subcutaneous white or pink nodules, often in the upper extremities. It is the first component of CREST syndrome, which includes

• Calcinosis cutis
• Raynauds phenomenon
• Esophageal dysmotility
• Sclerodactyly
• Telangiectasias.

CREST syndrome is a type of systemic scleroderma where anti-centromere antibodiesresult in systemic inflammatory autoimmune connective tissue pathology.

• I – S = Slip (separated or straight across). Fracture of the cartilage of the physis (growth plate)
• II – A = Above. The fracture lies above the physis, or Away from the joint.
• III – L = Lower. The fracture is below the physis in the epiphysis.
• IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.
• V – R = Rammed (crushed). The physis has been crushed.

FRACTURES

sPINAL cORD

boNE PHYSIOLOGY

Orthopedics Surgery

http://www.slideshare.net/reynel89/orthopedic-surgery?from_m_app=android

Orthopedic surgery from Reynel Dan

ASIA

Compartment Syndrome

Compartment syndrome, acute, chronic, anatomy and operation from PrAe LirVa

Type & Classifications of Fractures

Types and classification of fractures from Daaneyal Dilawar

Amputation

Dr.guruprasad amputation from sguruprasad311286

Ortho Examination

Orthopaedic examination of_a_patient from Mohammed Azharuddin

Screws And Plate

Screws and plates fixation from BaHuong

Plates form and function from Gaurav Deshwar

Compartment

Hamstring Muscle

Femur Fracture

Documentation

<Documentation>

INformed dr X regarding current XXXX planned to allow oraly

Dr X noted

AM/PM/ON Review

<AM REVIEW>
47yo/malay/male
+ smoke
U/L:

▲ Open fracture distal Right radius 
    -POD2 Plating ↓ (under) GA
    -PTD4: alleged MVS (MB vs CAr), pt fall blablabla
▲ 


OR

▲ B/L knee pain x 4/12 worsen for past 2/52 
     wheelchair ambulation due to pain
    pain aggravates on standing, walking
     relieved by rest


Currently pt appears: stable, comfortable,


c/o Pain over b/l knee more on left side, afebrile, no sob, no chest pain, no urti, nil symptom, PU present, tolerat orally


o/e:
-alert
-conscious
- no tachypnoe
-not tachycardic
v/s
lungs: clear
cvs: s1s2 heard, no murmur
P/A: soft non tender

Examintaion on b/l lower limb
- dressing soaked?
- swelling?
-tender?
-wound clean?
CRT?
DPA, PTA?
ROM
Sensation
erythematous
warm

Lab:
Xray
USG:


Plan
1.


Analgesics


Antibiotics

Clerk New Case : Ortho

1. 47yo/malay/male
2. NKMI: No Known Medical Illness or
    U/L (Underlying Disease) : DM, HPT, Dyslipidemia, CCF (Congestive Cardiac Failure)

3. P/W (Presented with) or Presented with
  - Alleged MVA, MB vs Car at Skudai ~ 7:30 pm 18/2/2016 + helmet, around 60km/h
      -Mechanism of Injury: Claimed another car hit his MB from left side & pt felt on his right side
        car hit from ?
        fell on ? site
        thrown to longkang?
  - Fall from height
     - Mechanism of injury
  - Swelling over lateral aspect left thigh
  - Pain over lumbosacral region
SOCRATES

1. Site - Where is the pain? Or the maximal site of the pain.
2. Onset - When did the pain start, and was it sudden or gradual? Include also whether if it is progressive or regressive.
3. Character - What is the pain like? An ache? Stabbing? Cramping?
4. Radiation - Does the pain radiate anywhere? (See also Radiation.)
5. Associations - Any other signs or symptoms associated with the pain?
6. Time course - Does the pain follow any pattern?
7. Exacerbating/Relieving factors - Does anything change the pain?
8. Severity - How bad is the pain?

PQRST

1. P = Provoking factors (what brought on the pain?); 
2. Q = Quality (describe the pain- i.e. stabbing, throbbing, burning); 
3. R = Radiation (does the pain radiate anywhere?); 
4. S = Severity/symptoms (how bad is the pain- rate it; are there other symptoms with the pain?); 
5. T = Timing (is it constant? What makes it better/worse?) 

4. Post Trauma

  - c/o pain at - Right forearm
                      - Shoulder & back
  - LOS?

  - RA (Retrograde Amnesia)
  - PU (Urin)/BO (Bowel Output)
  - Nausea/Vomitting
  - headchae?
  - chest pain? abd pain?
  - SOB
  - CNS Injury: Racoon eyes, BAttle Sign,
  - ENT BLeeding
  - Fever
  -Meds
  - Able to Ambulate well post RTA

5. PMHx
6. PSHx
7. Allergy & LAst Meal
8. Drugs Hx:
9. Social Hx: Smoker? Drugs? Sexual? Alcohol? MArried? Work as?
5. O/E (On Examination)
    - Alert< Conscious, GCS: EMV
    - V/s:
    - Lungs: Clear/Bilateral Crepitations/ Ronchi
    - CVS: DRNM (Dual Rhythm No Murmur)
    -P/A : SNT (Soft Non Tender)

Orthopaedic examination of_a_patient from Mohammed Azharuddin


Head to Toe
Head: Scalp Hematoma, Racoon, Battle, Wound
NEck: ROM, Cervical tenderness, NEck stiffness
Chest: Chest Spring -, Equal A/E
Pelvic Spring
ROM for arms and limb, CRT, warm peripher
DPA/PTA, Radial Pulse
PR: Intact anal tone, PR bleed -
able to move all toes
CRT
ASIA
Spine Palpation: TEnderness, Swelling, PAin
Wound: Type , Size , Location ... abrasion wound , deep laceration 3 cm with bone exposed

Findings~
Lab
X-Ray
Magnetic resonance imaging (MRI):
An MRI can identify stress fractures. It's also very useful to identify soft tissue injuries, such as:
• Muscle tears
• Hematomas
• Ligament injury
• Spinal structures
• Meniscal injury
• Tendon ruptures
• Degenerative problems
• Tumors


Again Age/Race/GEnder
Impression: Allged fall blablabla

Wound healing

http://www.slideshare.net/alshomimi/pathophysiology-of-wound-healing?from_m_app=android

Fracture healing

Pathophysiology of fracture healing from Raghavendra Gowda

Muskuloskeletal x ray

Interpretation of musculoskeletal x rays from jatinder12345

Classification of fracture

Classification and mangement of fractures from thonapa

Ilizarov

http://www.slideshare.net/mamunk56/ilizarov-external-fixator?from_m_app=android

Skin traction

Sunil from Sunil Santhosh

video: Various Surgeries, Medical Procedures

174 videos playlist

Bandage and Dressing

http://www.advancedtissue.com/different-types-wound-care-dressings/

http://www.atitesting.com/ati_next_gen/skillsmodules/content/wound-care/equipment/dressing_and_bandage_types.html

Suture

Holliday Segar ~ Infus ~ Blood Loss ~ Fluid Management

NICE Guidelines: https://www.nice.org.uk/guidance/cg174

The Holliday-Segard nomogram approximates daily fluid loss, and therefore the daily fluid requirements, as follows:

• 100 ml/kg for the 1st 10 kg of wt. He
• 50 ml/kg for the 2nd 10 kg of wt.
• 20 ml/kg for the remaining wt.

Even though it is correct to think about fluid requirements on a 24-hour basis, the delivery pumps used in hospitals are designed to be programmed for an hourly infusion rate. The 24-hour number is often divided into approximate hourly rates for convenience, leading to the "4-2-1" formula.

• 100 ml/kg/24-hours = 4 ml/kg/hr for the 1st 10 kg
• 50 ml/kg/24-hours = 2 ml/kg/hr for the 2nd 10 kg
• 20 ml/kg/24-hours = 1 ml/kg/hr for the remainder

So, for a 30 kg child, maintenance fluid rate would be:

• 40 ml/hr + 20 ml/hr + 10 ml/hr = 70 ml/hr

Perhitungan Tetesan INfus

Tetesan Makro 1cc = 15 tetes

Tetesan/Minit = Jumlah cairan (cc) / Lama infus (jam) x 4

Tetesan Makro 1cc = 20 tetes

Tetesan/Minit = Jumlah cairan (cc) / Lama infus (jam) x 3

Tetesan Mikro 1 cc = 60 tetes

Tetesan/Minit = JUmlah cairan (cc) / Lamanya infus (jam)

Iv fluids TYPES OF IV FLIUDS from Mohamed Elbhnasawy

Iv fluid therapy (types, indications, doses calculation) from kholeif

Amputation

Amputation from xatcon

Diabetic Foot Ulcer

CPG: Management of Diabetic Foot 

Approach to diabetic foot from Faiz Hmoud

Talipes (foot and ankle)

BUnion

Bunion: inflammatory bursa at the meda/dorsal part of 1st MTP joint. Medial bunion usually associated with hallux valgus

 Hallux valgus is considered to be a medial deviation of the first metatarsal and lateral deviation and/or rotation of the hallux, with or without medial soft-tissue enlargement of the first metatarsal head

Bed Sores

Bedsores — also called pressure sores or pressure ulcers — are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone.

1. Nonblanchable redness
2. Epidermis eg: blister, abrasion
3. Subcutaneous tissue
4. Muscle, tendon, cartilage, bone

Soft TIssue Injury

Recovery Time:

1. Pain: 3/52 (3 weeks)
2. Tendon: 6/52 (6 weeks)

Ortho: HUmerus

Kilfoyle Classification for # Medial Condyle of Humerus 

A Kilfoyle type I injury involves a greenstick fracture or crush of the medial condyle metaphysis down to, but not including, the physis; Kilfoyle also stated that these may actually be incomplete supracondyle or intracondyle fractures. 
A type II injury involves a fracture through the physeal plate and epiphysis without displacement or rotation. 
Type III is similar to type II but with moderate-to-severe displacement and rotation of the fracture fragment.


Type 1: Non displaced, extra articular
Type 2: Non displaced, intraarticular
Type 3: Displaced/Rotation

Xray for Ortho

Principles of X Ray:
2 joints,
2 views,
2 limbs (in children)
2 occasion (if no fracture seen)

Radiology Masterclass : http://radiologymasterclass.co.uk/tutorials/tutorials/

How to read x-ray : https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&cad=rja&uact=8&ved=0ahUKEwjItd2fr5DMAhVEJJQKHUdxDVEQFgguMAY&url=https%3A%2F%2Faotrauma.aofoundation.org%2FStructure%2Feducation%2Feducational-programs%2Foperating-room-personnel%2FDocuments%2F1_How%2520to%2520read%2520x-rays_Handout.pdf&usg=AFQjCNGfzRbTCxgYzG4LH24kT2YLE9kjjA&sig2=4DgLxe4z31fCS2Q_WktVbA

Describing a fracture (an approach) : http://radiopaedia.org/articles/describing-a-fracture-an-approach

X-ray sign of fracture:

1. Lucent fracture line

2. Cortical buckling

3. fat pad displacement

4. joint effusion

5. soft tissue swelling

Imaging in fractures from Muhammad Bin Zulfiqar

X-ray for Osteoarthritis

1. Localized joint space narrowing

2. subchondral sclerosis

3. Subchondral cysts/pseudocysts

4. Osteophytes

X-ray for Rheumathoid arthritis

1. Diffuse joint space narrowing

2. Osteoporosis

3. Erosions

4. Symmetrics fusiform soft tissue swelling

X-ray signs of ankylosing spondylitis

1. Sacroilliis

2. Kyphosis

3. Bamboo spine

Xray signs of gout

1. Marginal erosionwith overhanging edge

2. Assymetrics soft tissue swelling

Xray signs of Degenerative Discs

1. JOint space narrowing

2. Endplate sclerosis

3. VAcuum discs

4. Osteophytosis