Fracture patella :

Mechanism & management:

Direct : dashboard/fall on knee comminuted(stellate) # partial(proximal 3rd of patella intact)/total (severe communition)

patelelctomy undisplaced crack(noextensorlag): aspirate hemarthrosis & cylinder tube cast in full extension

Indirect: Avulsion # by Quadriceps femoris transverse # with displacement(extensor lag +)ORIF with tension band wiring(TBW)/figure of 8 wiring with K-wires and stinless steal wires

CRUTCH use :

Useof single crutch :

On normal side On affected side# both bone leg Hip pathology

Fracture of tibial condyles: Compression # of LATERAL tibial condyle : BUMPER # ( car striking a pedestrian) MC type : # of lateral tibial plateau

Fracture both bones of leg(tibia & fibula): Tibia – subcutaneous bone- MC #ed bone – open # Treatment: only Rx tibia #(only lower 3rd fibula # is treated)

Conservative Closed # AK POP cast x 3 weeks sarmiento PTB (patellar tendon bearing) cast

Surgery Compound # External fixatorIntramedullary nailing

Acceptable alignment after tibia # reduction: 5 degree angulation/rotation & 1 cm shortening

Sx Rx required even in asymptomatic cases: >10 dgree angulation/rotation & >2cm shortening

# in LOWER 3rd of tibia delayed union /nonunion because lower fragment becomes relatively avascular

# neck fibula injury to common peroneal nerve foot drop

An isolated # neckfibula is rare . it is always asso with serious #/ligament injury at ankle(misonneuve #):so always x-ray the ankle also

Compartment syndrome:

MC cause : #

MC cause in adults & overall : tibial diaphyseal # / MC site in adults : anterior compartementof leg

MC cause in children : # supracondylar humerus / MC site in children : flexor compartment of forearm

First muscle to be involved :FDPFPL (in UL)

First nerve to be involved : median(ant interosseus )

Injurybleeding/edema/inflammation in thight osteofacial compartment increase pressure low capillary floe muscle ischemia increase edemavicious cycle necrosis of nerve & musclefibrosis (VIC)defromity

Diagnosis :

o C.F. of ischemia : 5”P” : pain ,paresthesia,pallor,paralysis,pulselessness

o Most important symptom :pain(disproportionate)

o Most important sign : pain on passive stretching

o Volkmann’s sign : FIXED LENGTH phenomenon : on full flexion of wrist fingers can be fully extended passively

o VIC : wrist Flexion/MCP extension/IP flexed

o Mostof the classical symptom occuronly after irreversible soft tissue damage

o Intracomprtmental pressure measurement :

Only neccessory to record anterior comprtment pressure (as it is involved in all cases)

Criteria for fasciotomy :

Intracomprtmentalpressure (ICP) > 30 mm hg (normal:3-5mm hg)or

DBP-ICP < 30 mm Hg

Treatment : FASCIOTOMY/operative decompression

o Subtotal fasciotomy NEVER be done

o All 4 comprtments must be decompressed

o Threatened compartment mustbe immediately/promptly decompressed

Rx if presents after 3days (contracture has already occurred ) : physiotherapy and splints(volkman splint/turn buckle splint) or Sx : slidingof flexor origin of forearm/carpectomy