Mirel’s scoring system rates 4 criteria from 1 to 3 with maximum possible score of 12 to assess the risk of pathological fracture due to metastases and also serves as a guide for considering prophylactic fixation. The parameters of the criteria can be remembered using the mnemonic MIREL’S. M –…
Tag: Orthopedics
Section Editor: Dr. Sulabh Kumar Shrestha, MBBS, PGY1 Orthopedics
Clinical Skills and Approaches
Simplified ASIA Impairment Scale
Check S4-5 S4-5: Perianal area <1 cm lateral to the mucocutaneous junction (taken as one level) 1. Sensory (-) and Motor (-): AIS A (Complete)i.e. N-0-0-0-0-N sign (No sacral sparing) 2. Sensory (+) and Motor (-): AIS Bi.e. Sensory (+) means any sensation present in S4/S5 or anal sensation Motor…
PGMEE, MRCS, USMLE, MBBS, MD/MS
Elbow ligaments : Simplified Anatomy
Lateral collateral ligament complex Restraint to varus and posterolateral rotatory instability. Anatomy is more variable. LCL arises from lateral humeral condyle at a point through which the axis of rotation passes – it maintains a uniform tension throughout the arc of motion. Annular ligament is a “U” shaped ligament that…
Emergency Medicine
Pulled elbow reduction
Synonyms: Nursemaid’s elbow, Radial head subuluxation, Elbow subluxation Age: Commonly 1-4 years After 5 years of age, the attachment of the annular ligament to the neck of the radius strengthens Enlargement of the proximal radial epiphysis with growth may also improve stability Presentation: History of pull may be absent in…
PGMEE, MRCS, USMLE, MBBS, MD/MS
6 Ps and 3 As of Compartment Syndrome
Clinical features A. Adolescents and Adults Mnemonic: 6 Ps (by Hargens and Mubarak) Pain (may be absent in cases of nerve damage): Pain out of proportion to other physical findings (requiring increasing analgesic requirement) *: Earliest symptom Pain on passive stretch of the muscles in concerned compartment * Low sensitivity…
PGMEE, MRCS, USMLE, MBBS, MD/MS
General Principles – Pediatric Fracture Management
Children are not just mini-adults • Higher head to torso ratio: Head injury & Upper C-spine fractures • Light weight – projectile when struck • BSA to Wt. ratio – higher (rapid hypothermia) • Large cardiopulmonary reserves – normal SBP in significant hypovolemia Growth contribution by Proximal & Distal Physes…
Emergency Medicine
Kaplan’s Lesion : Complex Dorsal MCP joint dislocation
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…
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:…