It is an alpha-numeric system of classification developed by Muller and colleagues. Step 1: 1st digit specifies bone Step 2: 2nd digit specifies segment of bone Square definition: Proximal and distal segments are defined by a square whose sides = length of widest part of epiphysis Exceptions of square definition:…
Tag: Orthopedics
Section Editor: Dr. Sulabh Kumar Shrestha, MBBS, PGY1 Orthopedics
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 
Palmar Aponeurosis or Fascia
5 components a. Central aponeurosis It is triangular in shape with apex originating at the level of flexor retinaculum as a continuation of palmaris longus and thins and fans out distally. It has 3 dimensional fiber orientation: longitudinal, transverse and vertical 1. Longitudinal: Gives 4 pre-tendinous band (PTB) in the…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Rheumatoid hand
Ulnar drift or deviation of fingers Normal anatomical factors contributing to ulnar drift of fingers at MCP joint: Normal mechanical advantage of ulnar intrinsic muscles Asymmetry and ulnar slope of metacarpal heads of index and middle fingers Greater ulnar deviation permitted by radial collateral ligament when MCP joint is flexed…
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….
Clinical Skills and Approaches 
Heel Pain : Mnemonic
Mnemonic: HEEL PAINS 1. Heel pad syndrome 2. Enthesopathy 3. Entrapment 4. Ligaments 5. Plantar fasciitis 6. Posterior tibial tendinopathy/tenosynovitis 7. Peroneal tendinopathy/tenosynovitis 8. Arthritis 9. Impingement 10. Neuroma 11. Spurs 12. Stress fracture 13. Sinus tarsi syndrome 14. Sever’s disease 15. S1 radiculopathy Condition Description Site of heel pain…
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…