Tag: Orthopedics

Section Editor: Dr. Sulabh Kumar Shrestha, MBBS, PGY1 Orthopedics

Emergency Medicine

Circumferential Periosteal Block (CPB)

Dr. Sulabh Kumar Shrestha, MS Orthopedics,

Use: Alternative to hematoma block in reduction of distal radius and ulna fractures Advantage: Providing distance from the fracture hematoma (no theoretical risk of converting closed fracture into open fracture) Disadvantage: Risk of neurovascular injury on volar surface of forearm Local anesthetic and volume: 10–15 ml of 1 % plain lidocaine…

PGMEE, MRCS, USMLE, MBBS, MD/MS

Extremity Amputations – Review

Epomedicine,

Indications Mnemonic: three Ds 1. Dead (or dying): Peripheral vascular disease (most common indication for amputation), Severe trauma (leading indication for amputation in younger patients), Burns, Frostbite 2. Dangerous (or deadly): Malignant tumors, Potentially lethal sepsis, Crush injury 3. Damned nuisance: Gross deformity, Recurrent sepsis, Sever loss of function Increase…

PGMEE, MRCS, USMLE, MBBS, MD/MS

Z-effect and Reverse Z-effect in PFN

Epomedicine,

‘Z-effect’ and ‘Reverse Z-effect’ are complications relating to differential migration of screws that arise from fixation of unstable proximal femoral fractures with Proximal Femoral Nail (PFN) having 2 interlocking head screws. The 4 patterns of unstable intertrochanteric fracture hip are: Z-effect: The Z-effect involves the lateral migration of the lag…

PGMEE, MRCS, USMLE, MBBS, MD/MS

Pathophysiology of Acute Compartment syndrome

Epomedicine,

Definition Mubarak and Hargens (1981) defined compartment syndrome as an elevation of the interstitial pressure in a closed osseofascial compartment that results in microvascular compromise. Pathophysiology Tissue perfusion = Capillary perfusion pressure – Interstitial fluid pressure 3 major theories for microvascular dysfunction and ischemia: Tissue survival: Vicious cycle of compartment…