What is Kaplan’s lesion? Metacarpophalangeal (MCP) joint dislocation: Complex (Irreducible) Dorsal Mechanism of injury: Hyperextension injury Involvement: Usually occurs on border digits (Index > Little finger) Characteristic position of index finger: Hyperextended at MCP rests on dorsum of metacarpal Deviated towards middle finger Slightly flexed middle & distal phalanx with…
Tag: Orthopedics
Section Editor: Dr. Sulabh Kumar Shrestha, MBBS, PGY1 Orthopedics
Emergency Medicine 
LRINEC score for Necrotizing fascitis – Mnemonic
The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score is a tool to distinguish ordinary skin infections from necrotizing fasciitis. Mnemonic: NeC WASH Na level: <135 mmol/L: 2 points Creatinine: >1.6 mg/dl: 2 points WBC: <15,000/cu.mm: 0 points 15,000-25000/cu.mm: 1 point >25,000/cu.mm: 2 points Acute phase reactant (CRP): >/= 150:…
Clinical Skills and Approaches 
Cellulitis vs Early Osteomyelitis – Clinical features
Often, one may find difficulty differentiating cellulitis from osteomyelitis in a patient presenting with signs of inflammation localized to an extremity. There are few points that must be kept in the back of head, that will help us to differentiate these two entities. 1. Overlying skin findings: In osteomyelitis, the…
Clinical Skills and Approaches 
Finger test for Necrotizing Fascitis
Synonyms: Finger sweep test Finger test can be performed under Local anesthesia or General anesthesia in: Emergency department Bedside in wards Operation theaters Procedure: Area is infiltrated with local anesthetic A 2 cm test incision down to fascia is made in the suspected area The tissues are visually examined for:…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Skeletal Traction – Pin Insertion Sites
Site Point of insertion Direction Indications Olecranon (K-wire) 1.25 inches (3 cm) distal to olecranon tip – deep to subcutaneous border of upper ulna (avoids ulnar joint and open epiphysis) Medial to Lateral – At right angles to longitudinal axis of ulna (Avoids ulnar nerve) Supracondylar or Distal humerus fractures…
Clinical Skills and Approaches 
FARES method of Shoulder Reduction
Indication: Anterior shoulder dislocation Position of patient: Supine Position of physician: Standing on the side of the dislocated shoulder Steps: Physician holds the wrist of the patient with both the arms keeping elbow of the patient extended and forearm in neutral position Arm is slowly abducted in brief oscillating movement…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Appearance and Fusion of Ossification Centers
Upper end of humerus Mnemonic: HGL – 1,3,5 a. Head – by 1 year b. Greater tuberosity – by 3 years c. Lesser tuberosity – by 5 years All 3 centers fuse together by 6 years (1 year after the last center appears) Upper end of femur Mnemonic: HGL –…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Bruner’s Ten Rules of Pneumatic Tourniquet Use
APPLICATION: Apply only to a healthy limb or with caution to an unhealthy limb SIZE OF TOURNIQUET: Arm, 10 cm; leg, 15 cm or wider in large legs SITE OF APPLICATION: Upper arm; mid/upper thigh ideally PADDING: At least two layers of orthopaedic felt SKIN PREPARATION: Occlude to prevent soaking…