Understanding of the Boutonniere and Swan neck deformity requires clear concept of the finger extensor apparatus, which has been discussed here. The extrinsic extensor tendons trifurcate giving a central slip which attaches to the middle phalanx base and two lateral slips which join with lateral band (formed by intrinsic muscles…
Tag: Orthopedics
Section Editor: Dr. Sulabh Kumar Shrestha, MBBS, PGY1 Orthopedics
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Juvenile Idiopathic Arthritis (JIA) : Mnemonic Approach
Synonym: Juvenile Rheumatoid Arthritis (JIA) Diagnosis of JIA Mnemonic: One Six Sixteen (1, 6, 16) 1: Inflammation of atleast 1 joint (joint involvement: knee > wrist/hand > ankle > hip > c-spine) 6: Lasting for atleast 6 weeks 16: Onset before 16 years age In order to confirm the diagnosis,…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Singh Index for Osteoporosis – Simplified
Pattern of bone loss in Osteoporosis Trabecular bone responds faster to metabolic changes due to greater surface are compared to cortical bone. Non-weight bearing (secondary trabeculae) are lost first. Weight bearing (primary trabeculae) may appear prominent due to loss of other trabeculae and may also become thickened due to compensatory…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Flexor Tendon Rehabilitation : Simplified
Immobilization Protocol Dorsal blocking orthosis Early stage (0-3/4 weeks) Intermediate stage (4-6 weeks) Late stage (6-8 weeks) Wrist: 20-30 degrees flexionMCP: 40-60 degrees flexionIP: Neutral ROM of elbow and shoulder Increase wrist extension (towards neutral) within splint Tendon gliding exercises (hold each position 3 seconds, repeat 10 times, do 3…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Achondroplasia Mnemonic
A: Autosomal dominant C: “Champange glass” pelvis in X-rays H: Hypotonia O: Ossification affected (Enchondral > Appositional) N: Nasal bridge small D: Disproportionate Dwarfism R: Rhizomelic (proximal i.e. humerus and femur shortening) O: Out knees (varus deformity) P: Proliferative zone quantitative defect L: Little phalanx (brachydactyly) and metacarpals with Leister…
Clinical Skills and Approaches 
Approach to Thoracic and Lumbar Spine X-ray
Views Standard: Supine AP and Latero-lateral (LL) views – thoracic or lumbar Thoracic: Lateral (Fulcrum) bending views: to determine the flexibility of curves in scoliosis Lumbar: De Seze view (Lumbopelvic view): Standing AP and LL – shows T11 to head of femur Dynamic lateral (flexion-extension) views: for instability Oblique views…
Clinical Skills and Approaches 
Thoracolumbar Metastases Management : Mnemonic Approach
The primary malignancies that commonly metastasize to the spine can be recalled using the mnemonic: PB KTL (or “Lead Kettle”. Prostate Breast Kidney Thyroid Lungs In women, 80% metastases are from lung and breast and in men, 80% are from lung and prostate. LMNOP approach A. Location/Level 80% involve well-vascularized…
Surgical Skills 
Techniques of Securing Surgical Drain to Skin (Drain Fixation)
Choice of Suture: Non-absorbable (braided suture provides slightly superior grip on tubing than monofilament sutures) Technique 1: Create a series of knots around the drain. The long end of the thread (attached to the needle) is passed through the skin directly next to the drain exit site, to create a…