Archive for category: Uncategorized

Core topics in orthopaedics

Unicameral Bone Cyst (UBC)

– solitary, fluid-filled cystic lesions located in metaphysis of long bones near physis in kids & adolescents
– predominantly proximal femur & proximal humerus

Signs & Symptoms:
– usu asymptomatic
– pathologic # associated with minimal trauma

Xrays:
– radiolucent, trabeculated lesion with well-defined borders surrounding by sclerotic margin
– ‘fallen leaf’ sign in pathologic #

Histology:
– lined with loose connective tissue membrane containing small numbers of fibroblasts, giant cells & hemosiderin-laden macrophages

Treatment:
– 15% will heal after # with observation alone
– treat # as you would for most #s of that region
– once # healed, aspiration & steroid injections (x 3)
– curettage & bone grafting improves healing rate & provides mechanical support

Aneurysmal Bone Cyst (ABC)

– solitary expansile lesion located in metaphysis of long bones, flat bones & vertebrae
– presents in 2nd decade
– cysts filled with blood

Signs & Symptoms:
– pain with tenderness & swelling at the site of the lesion

Xrays:
– expansile eccentric lesion surrounded by a thinned cortex with periosteal new bone formation
– CT/MRI – characteristic ‘fluid-fluid’ level
– beware of telangiectatic osteosarcoma – has fluid-fluid levels but far more aggressive looking

Histology:
– blood spaces separated by cellular septa lacking an endothelial cell lining & containing a variety of cells such as fibroblasts, multinucleated giant cells & histiocytes & metaplastic bone
– large solid cellular areas may be seen

Treatment:
– excision, curettage & bone grafting
– cryosurgery or chemical ablation may be used

Hip – medial approach
Ludloff

* position – supine with affected hip flexed, abducted & ER

* incision – long. incision on med. side of thigh starting 3 cm below pubic tubercle over add. longus

* internervous plane
– add. longus & gracilis (both innervated by ant. branch of obturator n. but receive nerve supply prox. to dissection)
– add. brevis & magnus
– add. magnus – 2 nerve supplies (post. division of obturator n. & tibial portion of sciatic n.)

* dissection
– incise subcut. tissue
– develop plane btw add. longus & gracilis
– develop plane btw add. brevis & magnus
– ID LT
– place retractor above & below LT to isolate psoas tendon

* dangers
– ant. div. of obturator n.
> lies on top of obturator ext. & runs down med. side of thigh btw add. longus & add. brevis
> supplies add. longus, gracilis, add. brevis

– post. div. of obturator n.
> lies in substance of obturator ext. & runs down thigh on add. magnus & under add. brevis
> supplies obturator ext. & add. portion of add. magnus

– med. fem. circumflex art. – passes around med. side of distal part of psoas

Glenoid Fractures

(Ideberg)
Type I-glenoid rim (often assoc. with shoulder dislocation)
Type II-separation of segment of inferior glenoid (obligue or transverse)
Type III-Assoc. With AC Joint injury
Type IV-fracture traverses glenoid and body to exit through medial border of scapula
Type V-combination of II and IV