non union

my diagnosis is n/u as evidence by--
1. abnormal mobility in all or 1 plane.
2. transmitted movement absent.
3. shortening
4. palpable gap

differance b/w supracondylar fracture and elbow dislocation

1. in sc# 3 point relationship is unaltered.
2. arm length decrease in sc# and forearm length decrease in elbow dislocation.
in chronic cases, in elbow dislocation triceps shows cord sign.
and olecranon is prominent.
there will be thickening and irregularity along both lateral and medium column.

investigation

1. x rays. 2. blood investigaton ESR, CRP 3. SINOGRAM-- to llocalise sequestrum
4. m/m-- 1. put methylene blue 1 day before to follow sinus tract.
5. sequestromy if involucrum has formed.if you think that after sequestromy bone will become unstable than wait till more involucrum forms.
6. ring sequestrum seen at amputed stumps.
7.TB-- Very little periosteal reaction. feathery sequestrum

Osteomyellitis

patient is usually a child with following points.
1.thickening and irregularity of bone.
2. scar, sinuses present.
3. h/o previous surgery.
4. wasting
X ray -- 1. sequestrum-- dead piece of bone lying in infected nidus.
2. periosteal reaction, cortical thickening.
3.changes in medullary canal
4. proximal joint involved/not involve.

DRAWER TEST

1. ANTERIOR DRAWER TEST ---- 1. LESS SENSITIVE THAN LARCHMANN
2. CAN NOT BE DONE IN ACUTE CONDITION. BECAUSE KNEE FLEXION WILL NOT BE POSSIBLE.
3.MENISCAL LOCKING EFFECT WILL BE THERE.
4. 95% SENSITIVE
5.CAN BE POSITIVE IN NORMAL PERSON ALSO SO LESS SPECIFIC.
6. HAMSTING ARE IN IDEAL POSITION TO BLOCK TIBIAL MOVEMENT.

what will you see on TB spine MRI

1. Its A T2 / T1 IMAGE.
2. helping my dignosis of TB of d8--d9 region with partial destruction of d9 vertebra.
3. Tubercular abcess seen on anterior aspect.
4. no evidence of cord compression.
5.there is no evidence of skip lesion.
6. no internal cord changes seen.
7. rest of spine appears normal.
so these are indications of doing MRI IN TB SPINE.

what you should have with you on exam's day

1. apron 2. hammer 3. measuring tape 4. marker 5.compass 6.spirit (for removing marks) 7.tunning fork 8. goniometer 9. scale 10. torch 11.plumbline 12. cotten wisp 13. pin 14. tube for transillumination test15.pen/pensil

SYNOVITIS OR ARTHRITIS

1. In synovitis terminal range of movement is possible but it is painful.
2.usually rest of range is painless.
3.no or small deformity.
4.no crepitus.
5.short duration.
in arthritis more then 70% rom restricted and associated wih pain and crepitus.
if you are not sure than you can get away with "early arthritis ". in Perthe' s you can use perte's as a diagnosis.

question related to tb

it is a difficult topic because any type of question can be asked. have a look--
1.what are culture media used in TB.
2.What are content of LJ media.
3.what is sensitivity and specificity ofPCR.
4.What is BACTEC?
5.How will you do AFB staining?
6 .Question related with AKT, doses and duration.
7.what will you see on MRI?

thomas test

1. how will you test for ffd if other hip is ankylosed?
as other hip is ankylosed so it will not allow spine to move so just extend hip to be testedand you will get ffd.
2.what if knee has ffd?
allow the knee to hang at the edge of table.
3.why you will push tested side knee ?
so to rule out that it is deformity and not attitude.
4.

some trick questions

1. false positive trandelenberg test--- costopelvic impingement
2. false negative tdbg test ---- suprapelvic muscle acting , patient tilting on one side
3.prerequisite---1.pat should be able to stand on affected side
2.there should not be any abduction or adduction deformity
3.pelvis should be free to move
4.able to flex both side up to 30 dig.
4.causes of tdb positive-- weakness in abductor --pollio
n/u tcnf #
hip dislocation, DDH, PERTHES, COXA VARA