Pirani socre Pirani score for assessment of clubfoot (CTEV) consists of 6 parameters (3 each in midfoot and hindfoot) which is scored as 0, 0.5 or 1 with a maximum possible score of 6. The parameters can be remembered using the mnemonic: PER TOM Posterior crease Empty heel Rigid equinus…
Tag: Orthopedics
Section Editor: Dr. Sulabh Kumar Shrestha, MBBS, PGY1 Orthopedics
Surgical Skills 
Krackow Suture Technique
The Krackow technique is a continuous locking loop suture technique commonly used in tendon repair. The classic Krackow stitch involves 3 or more locking loops placed along each side of the ligament or tendon. Starting point: 1 cm from the tendon end Suture pitch: 5 mm (space the loops 5…
Surgical Skills 
DIY Vac Dressing for Wounds
Pre-requisites for Vac Dressing Components of Vac Dressing 1. Pump for Negative Pressure: In a study, 3 closed suction drainage systems were studied – Davol Reliavac 400 Evacuator, Jackson-Pratt Closed Wound Suction Drainage System, and Snyder Hemovac 400. In all three systems, maximal negative pressures (-71 to -175 mm Hg)…
Clinical Skills and Approaches 
Mnemonic Based Approach to Joint Pain
Step 1: Arthralgia vs Arthritis Arthralgia Arthritis Symptom Diagnosis Joint pain without inflammation Joint pain with inflammation (swelling, redness, tenderness) Articular or Non-articular Articular Articular Non-articular Pain with all joint ROMs Pain with only some joint ROMs Most painful at the limit of joint ROM May not be most painful…
Clinical Skills and Approaches 
Ely’s test
Rectus femoris is the only Quadriceps muscle that cross the hip joint and act as a hip flexor and knee extensor. When the rectus femoris is shortened/tightened, it tends to pull the pelvis forward into anterior pelvic tilt and also forces the knee into hyperextension. Ely’s test: Patient is positioned…
Emergency Medicine 
Bier Block
Named after: German Surgeon August Bier (first introduced the block in 1908) Definition: It is a peripheral intravenous local anesthetic block (IVRA; Intravenous Regional Anesthesia) of the upper limb using a pneumatic cuff technique Mechanism of action: Local anesthesia diffuses into the small veins surrounding the nerves and then into…
Surgical Skills 
Orthopedic Screw Insertion Mnemonic
Don’t Marry Too Soon DRILL Choose the correct drill bit Insert the drill bit correctly in the chuck Tighten the chuck sufficiently Start the drill home perpendicular to the surface Maintain adequate pressure Maintain the proper direction Irrigation with normal saline should be commenced simultaneously with drilling Keep the drill…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Pedicle Screw Insertion Simplified
Anatomy of Vertebral Pedicle Width (narrowest transverse diameter): Narrowest at T4-T5 (4-5 mm) Above and below this level, the width gradually increases to almost double at T1 and T11 (8 mm) Narrowest for lumbar at L2 (two for tiny; 2 X 3 = 6 mm) Increases gradually to L5 (5…