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Pectoralis Major Tears

Pectoralis Major Tears

Bruising most often associated with tendinous avulsion, less commonly with musculotendinous junction or intramuscular tear Pec tears are not always associated with ecchymosis They are often missed in the ER The clavicular head doesn’t tear as often as the sternal head; the defect from the sternal head will be hidden by the clavicular head when the arm is down by…

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How To Classify Pelvic Fractures, Part 2: Tile Classification

How to Classify Pelvic Fractures, Part 2: Tile Classification

Classification of Pelvic Fractures The two most common classifications of pelvic fractures are the Tile Classification and the Young-Burgess Classification. Tile Classification of Pelvic Fractures The Tile classification is based on stability. There are 3 major classifications: A (stable), B (rotationally unstable, vertically stable), and C (rotationally and vertically unstable). Tile A: Stable A1: fracture not involving the ring (avulsion…

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How To Classify Pelvic Fractures, Part 1: Young & Burgess

How to Classify Pelvic Fractures, Part 1: Young & Burgess

Classification of Pelvic Fractures The two most common classifications of pelvic fractures are the Tile Classification and the Young-Burgess Classification. Young and Burgess Classification of Pelvic Fractures The Young and Burgess classification is based on the direction of forces causing the fracture, severity of the injury and the resultant instability. It is based mostly on the initial A-P radiograph. There…

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How To Classify Acetabular Fractures

How to Classify Acetabular Fractures

Judet and Letournel Classification of Acetabular Fractures The Judet and Letournel classification is the most common and consistently used method to classify acetabular fractures. The acetabulum is made up of anterior and posterior columns of bone, which join together just above the acetabulum (supra-acetabular region). If you are looking at the face of the acetabulum, the columns resemble the Greek…

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Shoulder Arthritis

Signs of advanced shoulder arthritis decreased external rotation  crepitus Normal bony anatomy neck shaft angle 130 degrees retroversion 30 degrees from transepiocndylar distance Etiology primary OA capsulorrphay arthropathy post-traumatic osteonecrosis inflammatory arthritis History pain, stiffness, crepitation, worse at night and with activity Subjective Shoulder Value (SSV) patient’s subjective assessment of shoulder function (0-100%) patients with OA often report this value…

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Radiographic Evaluation of the Impinging Hip

Radiographic Evaluation of the Hip You can get a lot of information from the plain radiographs fractures djd (degenerative joint disease) sclerosis congruency scanogram (limb length and alignment) loose bodies osteochondroma osteoid osteoma bony prominence @ head neck junction (Cam impingement) coxa profunda protrusion  crossover sign posterior wall sign acetabular dysplasia AP Pelvis coccyx should centered 1-3 cm over pubic symphysis…

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Ankle Spanning External Fixation (Delta Frame)

Ankle-spanning external fixation, aka "Delta Frame" The ankle-spanning external fixator is a versatile external fixation construct that is useful for fractures of the tibial plafond (pilon), unstable ankle fractures, and talus fractures. It can be adapted for other injuries including midfoot fractures. CPT Code 20692 - Application of multiplanar external fixator. Tibial Schanz Pins Mark out the tibial tubercle. The most…

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Iliopsoas Tendonitis & Snapping Hip

Tendinitis probably because something is rubbing on it or tendon is overloaded because of undercoverage/dysplasia and it is stabilizing the head or maybe there is bone spur or calcified labrum rubbing it Internal Snapping Hip Syndrome probably most common cause/indication  this has to be painful to indicate surgery Associated with FAI probably secondary to spur from flexion (>90) to exntesion…

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Proximal Hamstring Repair – Surgical Tips

Tips from Dr. Busconi Nonoperative reserved for 1-2 tendon tears…look at handouts Gluteal crease incisions remember that it is more lateral than you think vertical incisions only for chronic repairs locate the sciatic and posterior lateral cutaneous n. before doing your repair final repair in 30-40 degrees of flexion, make sure knee gets out to 10 degrees of flexion hinged…

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Sciatic Nerve and Deep Gluteal Syndrome

Sciatic Nerve and Deep Gluteal Syndrome - as taught by Dr. Hal Martin differential diagnostic considerations medial to ischium - consider pudendal nerve lateral to ischium hamstring versus iliofemoral impingement 30 degree versus 90 degree active hamstring test walk them in the hallway (long stride walking) - recreate impingement piriformis active test passive piriformis test Pudendal nerve  serial nerve injections…

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Gluteus Medius Tears

Abductor tears are “rotator cuff of the hip” Clinical presentation rarely a history of a pop or injury, usually it is refractory lateral sided hip pain age > 50 females > males (10:1) failed corticosteroid injections abductor weakness trendelenburg gait/sign refractory troch bursitis vs. glut med or minimus tear - this is what you must figure out Literature shows equal…

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Greater Trochanteric Pain Syndrome

Troch bursitis is one of the bane’s of orthopaedics infrequently needs to be treated surgically much recalcitrant bursitis isn’t bursitis at all new term: “greater trochanteric pain syndrome” Signs trendelenberg stance on one leg abductor lurch shift body weight over symptomatic side, reducing forces that abductors need to keep pelvis level MRI is reliable at showing abductor pathology sometimes seen…

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Sports Medicine Infections

Sports Medicine  -50% of primary care sports medicine is due to infection Infections & Exercise mild to moderate exercise lower rates of infection Hight Intensity Exercise 70-80% Max Heart Rate or longer duration increased risk of infections symptoms usually seen 3-4 days after inoculation decreased strength, decreased stroke volume, increased fatigue, etc Fever multistep response to infection increased metabolic rate…

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Cartilage Lesions

Cartilage Lesions Incidence ICRS Grading Scale Concomitant Pathologies malalignment varus valgus patellofemoral Ligamentous Instability Patellar Instability Osteochondritis Dissecans juvenile form (open physes) adult pathophysiology Indication for Surgery impending physical closure instability  fluid behind lesion expanding lesion on imaging failed nonoperative management Fixation >85% healing rate for juvenile OCD

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Posterior Cruciate Ligament Injuries (PCL)

Mechanisms dashboard hyper flexion hyper-extension Physical Exam can present with PF pain beware of false anterior drawer, because baseline tibia is subluxed due to PCL injury quad active test positive with 2mm shift reverse pivot shift moderately specific but also can be present in uninjured knee so check other side Radiographs alignment look for tibial spine avulsion fibular head avulsion…

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Ulnar Collateral Ligament

Ulnar Collateral Ligament (Medical Collateral Ligament) of the Elbow The ulnar collateral ligament (or UCL) is an important elbow stabilizer Anterior band tightens as elbow is in extension and posterior band tightens with flexion For baseball players (pitchers), the late cocking and acceleration phase of pitching is the trouble spot high level pitchers can hyper externally rotate The kinetic chain is important Example:…

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Total Shoulder Arthroplasty (Stemless) – Pitt Technique

Indications for Total Shoulder Arthroplasty Primary glenohumeral arthritis with intact rotator cuff Young, with good bone stock to support stemless humeral prosthesis Example: A patient with avascular necrosis (AVN) secondary to sickle cell in a relatively young patient may benefit from a stemless total shoulder arthroplasty (shoulder replacement) If limited to humeral side, you could consider a hemi in this…

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