Approach to a limping child General points Classification Management depends on 4 factors which can be remembered using the mnemonic SCFE. Stability and Severity a. Loder classification: b. Severity: Severity Southwick angle on frog-leg lateral view (Difference of head-shaft angle from normal side) Wilson slip % on AP or frog-leg…
Author: Dr. Sulabh Kumar Shrestha, MS Orthopedics
He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music.
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Management of Skeletal Tuberculosis – Principles
Classification Stage/Type Pott’s spine (Kumar’s) Pott’s paraplegia (Tuli) Hip and Knee Hip (Shanmugasundaram) I Predestructive (Straightening, spasm, hyperemia) Negligible (Objective plantar extensor response or ankle clonus) Synovitis (ROM 75-100%/Haziness, rarefaction)– Hip: FAbER, Apparent lengthening Normal (C) II Early destructive (Diminished space, paradiscal erosion, K<10) Mild (Subjective neuro-deficit but walks with…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Clavicle Fractures : Last Minute Revision
1. 80-85% are mid-shaft fractures (other 10-15% are lateral 3rd and 5% are medial 3rd fractures) because of: 2. Deforming forces: 3. X-ray views: 4. Allman classification: Dameron and Rockwood classification for lateral 1/3 pediatric fractures: Type I: Mild strains of ligaments or periosteal tears Type II: Complete disruption of…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Perkin’s Timetable for Fracture Healing
One needs to understand the difference between bone union and consolidation first Union Consolidation Definition Partial/Incomplete repair Full/Complete repair Callus Calcified Ossified Attempted angulation Painful Painless Fracture line in X-ray Still visible Obliterated and crossed by bony trabeculae Full weight bearing Cannot be undertaken Can be undertaken Reference: Physiotherapy in…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Osteochondroma : Mnemonics
Features of Osteochondroma Mnemonic: Six “C” Commonest benign bone tumor Continue to grow until Closure of physis Cartilage cap (appears larger clinically than in X-ray) Continuous with native bone (cortex and medullary canal) Cane (pedunculated/stalked points away from joint and sessile/broad based have higher risk of malignant degeneration) Change (mutation)…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Gout : Mnemonics
Urate Lowering Therapy (ULT) Mnemonic: 1, 2, 3, 4, 5, 6 Start Urate Lowering Therapy if: ≥1 subcutaneous tophi ≥2 flares per year ≥3 stage CKD with Serum uric acid (SUA) ≥ 9 mg/dl Other indications: Urate renal stone, Evidence of joint destruction in X-ray 4. ≥4 weeks to be…
Surgical Skills 
Percutaneous Achilles Tenotomy for CTEV
Indications Cavus, Adductus and Varus are fully corrected but ankle dorsiflexion remains <10 degrees above neutral Adequate abduction: Best sign: Ability to palpate anterior process of the calcaneus as it abducts out from beneath the talus Abduction of approximately 60 degrees Neutral or slight valgus of os calcis Technique 1….
Surgical Skills 
Hip Spica Cast
Acceptable angulation in Femoral Shaft Fractures Age Varus/Valgus (degrees) Anterior/Posterior (degrees) Shortening (mm) <2 yr 30 30 15 2-5 yr 15 20 20 6-10 yr 10 15 15 >10 yr 5 10 10 Reference: Rockwood and Wilkin’s Fractures in Children – Leg position for Hip Spica Application in Femur Shaft…