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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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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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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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Salter-Harris Fractures

Introduction Salter-Harris fractures are fractures that affect the growth plate in skeletally-immature patients.  Mnemonic There is a simple mnemonic that is often used to help remember the different types of Salter-Harris Fractures, using the letters S-A-L-T-R.  Letter Type Key Word  Description S I  Straight Across The fracture traverses through the cartilage of the physis. A II Above The fracture is…

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External Fixator Component Cost List

This information is from research entitled "Damage Control Orthopaedics: Variability of Construct Design for External Fixation of the Lower Extremity and Implications on Cost." Logan et al. Partially Threaded Schanz Pin - $253   Large Ex-fix Pin Clamp (6-Position) - $673   Large Ex-fix Pin Combination Clamp - $946   Large Ex-fix Carbon Fiber Bars (300mm) - $348 References: Logan et al. 2015

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Sacral Fractures

Predicting Displacement of Sacral Fractures Based on Fracture Pattern From Bruce et al. Incomplete Sacral Fracture Displacement Rate (2.6%) No ramus fracture: 0% Ipsilateral or contralateral ramus fracture: 0% Bilateral rami fractures: 9% Complete Sacral Fracture Displacement Rate (50%) No ramus fracture: 0% Unilateral ramus fracture: 33% Bilateral rami fracture: 68% REFERENCES: OTA highlight paper predicting future displacement of nonoperatively managed lateral compression sacral fractures:…

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Complications After Spine Surgery – Review

Credit: R. Carter Cassidy, MD COMPLICATIONS AFTER SPINE INJURIES most common: UTI, wound infection, Pneumonia Most predictive: comorbidities higher grade impairment giving steroids Barriers to care multi trauma fear of harm by nursing staff complex injuries = long surgeries many details – attention to details can keep you out of trouble Complications infection, dvt/pe, pressure ulcers, pneumonia or respiratory failure,…

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