[Music] yeah [Music] you [Music] any [Music] you [Music] you [Music] okay good evening buddies I hope I'm Audible and the screen is visible can you make him a bit small please I'm I'm like I'm covering too much part of the screen by you're talking about Aliah focus on studies we can always talk about alyia later on sure budy I'll talk to you in English only don't worry the lecture will be in English only don't worry the lecture will be entirely in English am I audible to the student VG hello budy I hope I'm Audible and the screen visible I definitely I share the PDF don't worry we will have a word with sir and uh then I'll share the PDF don't worry how you can always check the link on your phone maybe that's why it's working or not I think it's working H know okay okay bu Dr Kumar sujit G I believe it will be enough I I'll try my level best to make it more than enough for you guys you don't have to worry about it I'll try to make sure that it's more than enough for you guys now let's uh not waste any more time please and uh let's get going please right if you want I can wait for another minute or two and uh then we'll start now the session uh would be for around 4 hours 4 hour sessions so around 2 hours class in the beginning then we take a small break and then another class of around 2 hours so by 10 p.m. we'll end this class by 10 p.m. we'll end this class right but 10 p.m. we'll end this class and the pattern of the notes will be like we will do an extremely rapid revision since you people are very close to your exam and Orthopedics you people consider it to be a small subject right so uh yes of course so this will be an extremely rapid revision then uh I'll share some on liners also within the notes right within the notes I'll share some one liners right okay so we'll continue first now you see first of all the important things I'll keep on tick mark I'll either tick mark it or I'll write this question that the questions have come Dr Kul Gokul G I'll try to get back to the team because I've not share the with them the PDF but I'll share this PDF as soon as we are done with the class fine now this let's say the father of the Orthopedics Nicholas Andre that question has featured in one or two examinations as of now now now buy when we start studying Orthopedics we have to study about the deformities we have to study about the deformities now if you notice fixed deformity fixed deformity at elbow joint we use the prefix cubitus similarly at the hip joint we use the word coxa at the knee joint we use the word genu at the hand that means at the wrist joint we use the word Manus at at the toe great toe we use the word helex at the foot we use the word PES or talip now the pest and TPS they can be used interchangeably they can be used interchangeably now you see here the deformity could be let's say your patient has got a deformity at the elbow right now that deformity is of two types either it is going to be cubitus vus or it is going to be cubitus verum similarly at the hip joint the deformity is going to be coxa varum or coxa wgam right we'll see that what kind of deformities and how do we see the deformities now see here so what we do here buddies somebody of you mentioned Dr me Patel G you said that please go conceptually I'll try to go as conceptually as the time permits right now whether to see our patient has got vum or verum but we always look at the distalmost part for example in the lower limb the distalmost part is the feet now this red colored line is the midline if the feet are going away from the midline we say that our patient has got vgam deformity vgam deformity you see here in the second image also the red colored line is the midline and if the feet are going away from the midline we say that our patient has got vgam deformity so if the distalmost part is going away from the midline valgum and if it is coming inwards vum deformity see the images bu first and second image now this red colored line again is the midline fine we yes Dr chanji we'll come to that fine so you see here the distalmost part is close to the midline so it is a vum deity and verum deformity is called ble now if the distal moves part are going away from the midline and the problem is at the kn joint then we say it's a vgam deformity and the vgam deformity is called knock KN vum deformity at the knee joint is called knock KN now how to check whether the knee joint is problematic or the hip joint is problematic so I have drawn this image fine now you see that's a normal hip joint and let's say that's a normal knee joint but what is I'm going to show you four Images now four Images now see here now look at this in this image the hip joint is normal and the knee joint is abnormal the feet are going away from the midline the problem is at knee joint because you see the knee joint is abnormal and because the feet are going away from the midline so we say it's a genu valgum deformity genu valgum deformity right the next image again here Buddies the hip joint is absolutely normal I'll tell you why I am calling the hip joint normal okay and the knee joint is abnormal because Buddies the knee joint is abnormal I'll call this deformity genu now you see Buddies the feet they are very close to midline they are very very close to midline so I'll call this genu veum deformity genu vum deformity now in the third image you see whates the knee joint is normal and it is the hip joint which is abnormal because the hip joint is abnormal I'll call this deformity coxa because the feet are going away from the midline I'll call this deformity Cox vum you can use it like this coxa VGA you can call it coxa valgus everything is the same there everything is the same there now again you see here the knee joint is absolutely normal and there is some problem at the hip joint so we'll call it coxa and the feet they're going inward so we'll call it coxa verum now buddy I said that the hip joint is abnormal how can I call a hip joint abnormal how can I call a hip joint abnormal let's see how do we do so but is what we will do is first we will take an x-ray then we will draw first line This is the first line which we draw now this line goes through the neck of femur then buddies we draw a second line this line goes through the shaft of femur this line goes through the shaft of femur then we measure the angle between the two we measure the angle between the two if this line if this angle is less than 120 we say that our patient has got coxa veum if this angle is more than 135 we say that our patient has got coxa vgam deformity coxa valgum deformity fine so that is how we are easily able to make out whether the hip joint is normal or abnormal fine I'll tell you more about this when we start discussing the hip joint when we start discussing the hip joint now so somebody of you mentioned about this the gum and the thing so let's say there is a sticky gum between the knees the feet will spread that is called as well gum and if there is a bottle of rum between the knees the feet will come close so that is called as way rum vum that's a way to remember fine vgam and veum this question was there in the last year examination now same thing for the elbow joint you see we have three images here A B and C this red colored line is the midline now the hand is at normal distance I'll tell you why I'm calling it normal now if the hand is closed go to the midline we call it cubitus varus if the hand the distalmost part is away from the midline we call it cubitus vus now why and how am I able to say that the image B is absolutely normal what we do here buddies we again do the same thing we'll again do the same thing what do we do here we take an x-ray we take an x-ray first of all we take an x-ray then we draw a line through the mid of arm this red line is a line through the mid of arm then buddies we draw a second line right through the mid of forarm right through the mid of forarm then we measure this angle between the two now this angle is called carrying angle angle between the arm and forearm is called carrying Angle now the normal carrying angle is 5 to 10° in males and 10 to 15° in females you see females they have got wider pelvis that is why the angle is more now if this angle is more if this angle is high it is called as cubitus vus if this angle is low this is called as cubitus virus cubitus virus let's have a look at the pictures now see here here there is some problem at the wrist joint so we say that our patient is suffering from something called as Manus virus deformity problem at the wrist feet going sorry hands going inwards now see here problem at the feet and the feet are going inward so name of the disorder is TPS virus problem at the feet and feet going outward that is called as TPS vus TPS valgus same thing occurring at the great toe now this is called helex vgas problem at the great toe that is why the name helex now the distalmost part is going outward that is why the term hu hu now if you see it correctly buddies in this patient the deformity in the right foot is different from deformity in the left foot now you see buddy in the right foot the great toe is going outward so it is a valgus deformity in the left foot you you see that the great toe is going inward so it is a varus deformity it is a varus deformity now if the patient has valgus deformity in one limb and varus in the other it is called wind sweep deformity it is called wind sweep deformity so the most common cause in children it is rates and in adults it is rheumatoid arthritis I'm discussing the most common cause of wind sweep deformity yes Dr mutra G Dr gagan G Dr me Patel G you guys are brilliant okay now speaking about the skeleton the skeletal system now the ex skeleton 80 bones now the primary role is weightbearing now what is where do we make a mistake aial skeleton hyoid bone and the ear oses they are a part of exal skeleton they are a part of exal skeleton no role in weightbearing still they are called a part of exal skeleton a pendicular skeleton a pendicular skeleton is made up of 126 bones and the predominant role is Locomotion now here where do we make a mistake clavicle is a part of a pendicular skeleton clavicle is a part of a pendicular skeleton fine now you see buddies bones they are made up of organic part and inorganic part now organic part is very very soft because it is made up of cells because it is made up of collagen because it is made up of proteins and inorganic part is the part which makes the bone hard now let's quickly read them one by one you see the organic part osteocytes they are the mature bone cells osteoblast are the cells which build bone B for blast B for build oh my God they're showing me Karina Kapoor on screen wow I like it now osteoclast are the cells which consume the bone that mean they destroy the preformed bone okay buddies I'll use the darker pen okay okay okay okay thank you so much for pointing out Dr Benjamin now the collagen bone has got type one collagen thank you so much Dr Benjamin G now apart from collagen bone also has got non-collagenous protein so it is called osteopontin osteonectin bone Calo protein if you don't want to remember these just remember this osteopontin also called as osteocalcin also called as Osteo Calin fine now the inorganic part of the bone which makes the bone hard it is made up of hydroxy appetite now what is the formula of hydroxy appetite 10 molecules of calcium six molecules of phosphate and two molecules of hydroxy two molecules of hydroxy right now cells plus protein is called osteoid in a growing bone osteoid in a growing bone now that's a unit of growing bone osteoid now in mature bone it is called as oston it is called as oston on now the parts of the bone parts of a long bone so at the end we have got epifisis epifisis what arises from here giant cell tumor the osteoclastoma favorite question of examiner for last 3 four years then in between the epifisis and diap es lies another thing called metaphysis what arises from metaphysis Osteo militis the infection of bone and Osteo saroma most common primary malignant bone tumor and what arises from diaphysis eving saroma yes sure buddies Dr jatka G okay yeah buy I'll do that don't worry now you see here let's say this is epifisis this is metaphysis and in between lies something called as fisis now the fisis is not visible W thank you buddy thank you buddy I'm so glad now periostium the outer layer of the periostium is the fibrous layer Dr Dr J some topics are already written I'll just have to dictate them now here you know but just to build up the momentum now the inner layer is called cambrium layer cambrium layer now that's the question periosteum is absent over cisoid bones it is absent over cisoid bones and it is absent over in inra arric part of the bone it is absent over intraarticular part of the bone now the compact bone and the cancellous bone so the outer part of the bone is cortical now this part is dense it is so dense that it has got very poor vascularity so that is why this part will heal very very slow after a fracture after a fracture now the inner part the cancellus bone now the cancellus bone has got less density but it has got very good vascularity now this heals very very rapidly this heals very very rapidly now buddies what happens is at metaphysis most of the bone is made up of cancelous bone so at metapas says if a fracture occurs that fracture heals so rapidly that it goes into Mal Union it goes into Mal Union that is why Buddies the Supra coniler fracture fine the that is why the inter trantric inter trantric fracture of femur now in these two places budes the Mal Union is very very common Mal Union is very very common similarly for colis fracture also the Mal Union is very very very common the reason is that these fractures they occur at metaphases these fractures they occur at metaphysis so they heal extremely rapidly they heal extremely rapidly fine so malunion will be very very common there remember Supra condar fracture sorry Supra condil fracture if there is Mal Union what will occur gun stock deformity gun stock deformity can anyone of you please tell me how do we correct the gun stock deformity now if there is colis fracture remember what kind of deformity dinner fog deformity what kind of deformity dinner fog deformity if there is neck of femur fracture which is extra capsular fine so there also occurs deform there also occurs malunion now Gunstock deformity can be corrected with the help of French osteotomy dinner folk deformity can be corrected with the help of d operation can be corrected with the help of Dar operation no Dr m g don't make this mistake fracture neck of femur butes with it intra capsul that fracture will undergo non union that fracture will undergo non union right I'll tell you the reason when we start discussing the hip joint when we start discussing the hip joint fine now we are done with it till now do you have any query if you have any query do let me know otherwise kindly allow me to proceed to the next topic there so the next thing is the rickets next thing is the rickets now so rates that's the background you see the bones are soft because of organic part it is the inorganic part which makes the bones hard now which makes who makes the bone hard the calcium and phosphate how do we get them from the diet now you see what are the sources of vitamin D what one is from the diet second is from the skin now skin has got vitamin D precursors when UV rays fall on them in that case vitamin D they will be formed now which UV rays remember UV a rays are for aging UV B rays are for I mean they cause Burns they build vitamin D fine and they can also cause melanoma so real culprit are UV B Rays now UV C Rays they don't reach Earth so UVB rays are necessary for building vitamin D but their excess can cause Burns as well as melanoma now what is there in the skin calero is formed in the skin what do we get from diet Argo calero now these are useless unless the liver converts them into into calci diol which is also useless so ultimately your patient will get something called as caly triol now calcy triol is biologically active form of vitamin D biologically active form of vitamin D now in India the poor diet is most common cause of deficiency of vitamin D calci ium and phosphate whereas lack of sun exposure is the cause of rickets in in Western countries we'll see the clinical feature one by one so craniotes is the earliest clinical feature seen in your patient so what is that softening of the skull at suture line softening of the skull at suture line that is the Earth earliest clinical feature seen in rates now the skull is deformed buddies that is called as frontal bossing frontal bossing the deformed skull that is called as frontal bossing chest is also deformed and a line appears between chest and abdomen but is this line is called Harrison sulcus this line is called Harrison sulcus you can call it Harrison sulcus you can call it Harrison Groove remember the costochondral joint is deformed costochondral joint is deformed your patient will experience something which is called as ritic Rosary something which is called as retic Rosary it appears like this retic rosary now the rosary appears in another disease also scurvy how to differentiate retic Rosary will occur in riet scerotic Rosary will occur in scurvy retic Rosary is round and uh you know it is non- tender scoic Rosary is pointed angular and it is very tender to touch you touch the points and the child starts crying child starts crying then you see what is your patient has got multiple deformities your patient has got multiple deform ities like galum called as no gum called as B leg gum called as B leg now what is in adults in adults osteoarthritis it causes genum and rheumatoid arthritis it causes genu Val now in retes the wind sweep deformity also occurs wind sweep deformity also occurs so you see rickets the most common cause of wind stream deformity in children whereas an adult it is the rheumatoid arthritis rheumatoid arthritis speaking about the investigation we know that the serum calcium is low or uh maybe even normal don't forget buddies that 1% of the body calcium is in blood and 99% is in skeletal system is in skeletal system phosphate levels they will be low now remember bues our patient is a growing child bones are being formed so that means there will be too many osteoblast now these are the cells which are rich in alkaline phosphates which are rich in alkaline phosphatase no harison sulcus is not seen in scurvy so the alkaline phosphatase levels would be very very high nowbody is on x-ray you'll see something called as cupping so if this is normal bone then cupping would be like this sping means widening fraying means the rough edges rough edges now see here buddies I'll erase this for you so that you're able to appreciate there now see buddies this is normal let's say now you see it is going deep so that is cupping now fraying means rough edges see here let me show you again now if you can see the fra fra means rough edges sping means widening widening right again you see here buddies you can see everything here you can see widening that is called as spaying you can see deepening that is called as cupping you can see rough edges that is called as fraying that is called as Fray You need to give your patient too much of vitamin D because mother's milk is very poor source of vitamin D only 2 to 40 international units are present per liter now in contrast the dairy milk which we buy from the market that is 45 400 to like 400 international units per liter so treatment is either you give 6 lakh international units intra muscular or you can divide it into six oral dosages you can divide this into six oral dosages of one lakh unit each six oral dosages of one lakh unit each Dr musan your your patient of rades can have at least 10 or 15 clinical features not all clinical features may be present because you know at times your patient may seek treatment all the clinical features gone your patient uh develops the genov valgum verum deformity when your the patient starts walking suppose your patient seeks treatment then it will be gone fine so the followup has to be done with 2 to 5,000 ,000 international units per day of vitamin D and this has to be given orally you need to give it for 6 to 8 weeks at least minimum now phosphate levels they begin Rising within 96 hours this is how you check whether the treatment is working or not radiological healing is working it is seen within 6 to 7 weeks in 100% of the patient what is the radiological healing line of Frankle so that is zone of calcification now but is it is earliest seen around wrist joint earliest it is seen around wrist joint hello Dr RS I'm glad I'm I'm I'm actually glad to be with you guys I'm also not able to contain my happiness of being with you all now in rickets there is increased risk of himango parisoma himango paroma same to you Dr sham G now because I know your time is extremely precious so I'm trying to move at your pace now the Rick osteomalacia we also call it adult onset Rick kids now this is seen in women of developing country seen in the women's of developing countries glad buddies glad buddies why buddies because they remain covered and they have got poor diet poor diet fine now the clinical features here are not very important still I'll mention one your patient will have low back ache your patient will have low back ache and poly myalgia poly myalgia now x-ray will show you something called as pseudo fracture which are also called as Milkman fracture Milkman fracture now they are basically insufficiency fracture and they are dis described as impression of pulsating blood vessels on the soft bones pulsating blood vessels on the soft bone right this is how they look see this is how they look now they are most commonly seen in the lower limb where do you get to see them in the neck of femur now in the Upper Limb they are seen in the ribs and infraglenoid region that is in the scapula so this is an important question for fmg this is an important question for kn right so in the pelvis what we get to see we get to see something called as Tri radiate pelvis we also call it ooto pelvis we also called as utop pelvis Dr me Patel G pathological fracture by definition is that fracture which occurs in a bone made Weak by a disease disease so this is insufficiency fracture basically an incomplete fracture an incomplete fracture fine or 60,000 international units every week for 10 weeks is the treatment now this point is important for neat PG when your patient is taking some of the drugs like antiepileptics phenin carbamazine fine phenobarbitone now these drugs they interfere with vitamin D metabolism fine so you should give your patient vitamin D coli styring then at anti-tubercular therapy which one refampin it interferes with vitamin D metabolism steroids gluco corticoids they also interfere with vitamin D metabolism fine then we have got aluminium containing anets so when your patient is taking these in that case you should give your patient extra vitamin D now how do we get a definitive diagnosis we get a definitive diagnosis by transc bone biopsy transc bone biopsy just keeping up with the pace so that uh I mean as little of your time I consume we move to the next topic so osteoporosis now osteoporosis what happens here in osteomalacia the bone has got very good volume but bone has got very low density in osteoporosis bone has got low volume as well as low density volume is also low density is also low so here in osteomalacia the bone is soft in osteoporosis the bone is soft as well as smaller in volume smaller in volume that's a difference between uh Osteo malatia and osteoporosis now primary osteoporosis that means your patient has no other disease your patient has no other disease now it is of two type type one post menopausal type two senile anyone who is young today after a few years he or she will become old so senile osteoporosis is considered to be most common is considered to be most common secondary osteoporosis that means any other disease is causing osteoporosis now it most commonly occurs with gluco corticoids your patient is taking external steroids it is also seen in rheumatoid arthritis enyoing spondilitis and tuberculosis enyoing spondilitis and tuberculosis fine now clinical features most common is low back ache low back ache your patient moves bending forward now that is called dager hump deformity now Dr pel G pathological fracture is the fracture which occurs in bone made weak by a disease right buddies now the most common cause is Osteo porosis but is the second most common cause is secondary tumors most common site is Lumber vertebrae in both osteoporosis as well as secondary tumor coming to the X-ray finding so x-ray finding what we get to see we get to see something called as fish mouth vertebrae fish mouth vertebrae like this fish mouth vertebrae fine this is how the mouth of fish looks like fish mouth vertebrae right now the fish mouth vertebrae they are seen when 30% of the bone mass is 30% of the bone mass is lost at that time we get to see fish mouth vertebrae at that time we'll get to see fish mouth vertebrae right so the normal vertebra is like this the fish mouth vertebra would be like this see how much reduced volume now in between them this is the fish mouth fish mouth fine yeah codfish vertebra fish mouth vertebra you can call them by any name Dr prianka G it seems your fond of the codfish okay so it is seen in other diseases also I believe this is common U this is a question which might be important in uh neat or in so you see it is seen primarily in osteoporosis it might be seen in sickle cell disease hereditary spherocytosis homoy Ura renal osteodystrophy and osteogenesis imperfecta my kind and humble request to my fmg friends see the examination is going to be the same for all we used to believe that it is slightly easy it is but very very slightly easy my kind and humble request that everyone should at least remember it is seen in sickle cell disease also sickle cell disease also shows cod fish vertebra okay now the gold standard investigation is dual energy x-ray absoro metry we can call it dexa scan we can call it dexa scan now see the peak bone mass is seen at 25 to 30 years of age and after that it declines at the rate of 0.5% every year every year now now t-core we get t-core when bone mineral density of the patient is compared with race and gender matched young individual you see t t stands for teacher if the bone mineral density of an old teacher is compared with bone mineral density of a young student that will be called as tcore now the value of the tcore it can vary it can vary from you see here Min -4 to + 4 now if the value is between - 2.5 to -4 we say that the patient has got osteoporosis Osteo porosis now bone mineral density Zed score bone mineral density of the patient when it is compared with bone mineral density of race gender and age matched individual now see bues there are two females in your clinic Mrs X Mrs y both of them are 65 year old both of them are North Indian if you compare their bone mle density you will get something called as Zed score now if you compare the bone mineral density of a 30y old North Indian male with the bone mineral density of your patient who is a 65 year Old North Indian male you will get t score yes yes yes exactly the density of young with the density of old if you compare you get something called as T scores now what is about the treatment there are some drugs which act on osteoclast that mean they ask Osteo class to stop destroying the bone now the first drug class is bisphosphonate so we have got alendronate rrate once a week dose second ibandronate once a month dose third zolendronic acid once a year dose once a year dose another is calcitonin remember calcitonin what does it do so it will shift the calcium from blood to bone we can give our patient estrogen as a part of hormone replacement therapy we can give our patient selective estrogen receptor modulator like tamoxifen we can also give our patient denosumab now this prevents rank from accepting uh you know activating the receptor rank on the surface of Osteo class so denosumab is basically a mono clonal antibody then butes we have drugs which act on Osteo blast so they increase bone production they increase bone production now so teriparatide is basically synthetic parathyroid hormone so if given at low doses it forms bone if given at high doses it destroys bone then we have got drugs like strum ranelate which are dual action they act on osteoblast as well as osteoclast now why they are not used because they are nephrotoxic now the surgical treatment is to repair the bones is to make the bone Strong by using liquid bone bone cement liquid bone cement what is the formula polymethyl methacrylate acetate that is the formula so what we do is let's say the patient comes to us and we have got weak bone we will inject bone cement and the same bone will become super strong same bone will become super strong osteoporosis this topic is also over we move to the next topic there that is osteogenesis imperfecta acondroplasia and pet disease now remember osteogenesis imperfecta is also called as Britt bone disease why because the bones are so weak that they break super easily they break super easily now this is a genetic defect the defect name is call 1 A1 and call 1 A2 fine so collagen type one is most commonly affected most commonly affected that is why the bone formed is small and weak multiple fractures are common bone formed is small and weak ligaments they are LAX that means loose because the ligaments are loose dislocations are common the teeth they are very very small the Clea is so thin very very thin that the choid is visible the blue colored choid you can easily see behind the Scara see here Buddies the blue colored choid you can easily see behind the sca you see the blue colored choid you can easily see behind the sca so this is CA you can easily see the choid behind the sca bones are weak so they can be easily deformed so you see the foren they are also def formed foramen are also deformed foramen are the holes in the skull through which cranial nerves move out cranial nerves move out of the skull so your patient can have multiple cranial nerve pulses so they are crushed in the foren there are pneumonic I'm sure you must have got these pneumonics so what are the clinical features remember bones are small fine bones are small your patient can have deafness fine then uh your uh patient can have blue Scara the nerve compression then these are the most common structure affected skin tendon and teeth now there's another pneumonic there clinical features blue scera Dental abnormalities sense of hearing impaired and multiple fractures if you want to go slightly more there these patients are very prone to malignant hyper thermia these patients are very prone to malignant hyper thermia malignant hyperthermia treatment the drug of choice is bisphosphonate surgical treatment is Sofi Miller osteotomy so you see here the bone is like this you insert a rod and make it straight make it straight now this when you insert a rod it looks like this you see buddies there is a rod over here so that is why it is called as seik Kebab osteotomy that is why it is called as seek kebbab osteotomy now acondroplasia it is considered the most common cause of dwarfism now it is autosomal dominant it is autosomal dominant so there is a mutation in fibroblast growth factor what is the name of mutation fgfr3 now 80% of the cases they are fresh mutation that means buddies there is no family history now these patients they don't get to marry when they won't get to marry they'll not have children the disease will not be passed on disease will not be passed on to their children they'll not get married they'll not have babies simple as that now now the clinical features first of all naturally they have got short height and short arm span short arm span but if they have got star fish hands all the fingers they are of equal size all the fingers they are of equal size you see the the starfish hands all the fingers they are of same size fine then what is they have you see this starfish hands then they have Simeon crease they have got Simeon crease so that's a single prominent line single prominent Lin seen on their hand single prominent line seen on their hand see here so this is Simeon crease Simeon crease now they have trient hand you'll notice there is very wide separation between the middle finger and ring finger Tri Dent hand so their hands they look like this 1 2 3 1 2 3 three Tri Dent hands trient hand now when you look at the X-ray you get to see that the pelvis is very broad but the pelvis is not very tall that is typically called as champagne glass pelvis champagne glass pelvis now that's a concept slightly difficult for us to understand because you know we people don't have different glasses for different drinks in college remember the Disposable glass everything goes in that disposable glass right from Coca-Cola beer other drinks they all go in the Disposable glass we don't have separate glasses for champagne beer and all so on the X-ray we get to see something called as bullet shaped vertebra bullet shaped vertebra bullet shap vertebra those who have got bigs yeah yeah yeah you know uh the time is nearing 8:00 and I don't want to name that drink because you know otherwise someone from deep inside me will start calling that Malik it is the time Malik it is the time to have a drink or two now risom milic micromelia that means shortening of the bones shortening of the bone is prominent in proximal bones Dr Karthik G yes Dr Priyanka exactly Dr Karthik G Tri radiate pelvis will look like this like a triangle like this Tri radiate whereas the champagne glass pelvis would look like this would look like this fine you see you will be very easily able to differentiate now if you look at the tri radiate pelvis you see the length the height is perfectly normal now here the length is substantially reduced right in the champagne glass pelvis now the next last disorder here ped disease also called as osteitis deforman after this topic we'll see some of the x-rays okay genetic defect what is the genetic defect sqstm1 mutation where is it it present 5 Q35 QT 5 Q35 QT those of you who say that Orthopedics we don't want to invest too much energy just remember this sqstm1 now three phases litic phase bone is destroyed litic phase bone is destroyed blastic phase bone is formed and then in the last we have got sclerotic phase now in the litic phase too much of bone is destroyed too much of the bone is destroyed now what is when the bone is destroyed what occurs what are formed hydroxy prolin so level of hydroxy prolin and deoxy pinoline they will be very very high because large amount of bone is being formed what do we get to see on x-ray we get to see something called as osteoporosis circumscripta osteoporosis circum scripa but is please notice in the X-ray you see here everywhere the bone is normal everywhere the bone is normal but you see here the bone is destroyed the bone is destroyed right similarly here everywhere the bone is normal but here you see Buddies the bone is destroyed the bone is destroyed now in the long bones you get to see candle flame sign so you see up till this point the bone is normal and Beyond this line you see the bone is abnormal the bone is abnormal bone is abnormal so a candle flame can very easily sit inside this very easily sit inside this blade of grass can very easily sit inside this that is why in the long bone we get to see blade of grass or candle flame sign now in the mix stage the second stage what happens is too much bone is formed who forms osto blast now when the osteoblast are there that level of hydroxy prolin will be high bone is being formed bone is being destroyed also so the level of deoxy pinoline and hydroxy prolin that will also be high if you see the X-ray there will be increased thickness of the skull increased thickness of the the skull but is that is called as cotton wool skull now these bones are vascular they demand more blood so what happens is blood of brain is shunted to shunted means spared moved is shunted to Bone now that is called as vascular steel syndrome now in the vertebra you get to see something called as pet spine pet spine fine now that is picture frame vertebra now in the later half later part of the disease your patient will get Ivory vertebra in the late stage the third stage what happens is is that the skull size it goes on increasing every year patient has to buy a new cap so he will buy this cap now this cap automatically adjust to the size of the head automatically adjust to the size of the head what is the name of this cap this cap is called Tam O center cap cap or Tam O Center H hat sign Dr Daniel I welcome you on behalf of all my friends there so most common clinical feature in All Phases is the bone pain most common age is around 50 years is around 50 years now if we talk about the most common bone most common bone it is the pelvis and the long bone most common is the femur most common long bone is the femur now due to thickening of the bone cranial nerves may be compressed cranial nerves may be compressed now which cranial nerves are commonly involved 2 5 7 and8 your patient can have hearing loss hearing loss transverse fractures also called as banana fractures are very very common see buddies if we break the banana like this now same way the fracture can occur in bone fracture can occur in bone the transverse fracture the bone biopsy is going to show you mozac bone disorganized bone yes Dr musangi definitely the splints will keep on coming in the mid also but then we'll we'll revise treatment in the early stage is bis phosphonates in the late stage we'll have to cut the bone that is osteotomy osteotomy teriparatide should not be given because it increases the risk of Osteo saroma it increas increases the risk of osteosarcoma fine now osteopetrosis last disorder I forgot about this so it is called as marble bone disease it is called as Eber skonberg disease Ebert skonberg disease so what is the pathology defective Carbonic anhydr pump where on the osteoclast on the osteoclast autosomal dominant disease presence in adult and is mild autosomal recessive disease present in children and it is very very severe large amount of bone accumulates and there is no space for bone marrow no space for bone marrow because there is no Spain for space for bone marrow blood forms in the liver and spleen so your patient will have hipat spleno megali hipat speno magali now your patient will have multiple infections and bleeding Tendencies bleeding Tendencies when we get the X-ray done we get to see Arin mayor flask deformity this is the Arland May flask and you see Buddies the bones they look look like this Arin mayor flask Arin mayor flask right now in the X-ray the cortical bone is only present near intervertebral disc that is very very similar to rugger Jersey spine but here we like to call it sand wi vertebrae we like to call it sandwich vertebrae sandwich vertebrae now treatment bdes is stem cell transplant stem cell transplant I'm moving at my own pace my dear friends so if there is anything I mean if there there is anything which I could not make it clear then please do let me know when the well the time we are shifting you can always ask me you can always ask me now let's see a few fractures yes yes Dr Karthik G hap Hazard Arrangement is called Mozza bone now you see here let's say buddies this is femur this is tibia so that that means this is knee joint if you see a small chip of bone over here if you see a small chip of bone you see here now at this point you can see a small chip of bone now this fracture is called SE gone fracture this fracture is called SE gone G fracture C gone fracture right now the fracture around the ankle fracture around the ankle you see buddies if there is fracture of lateral mulus also there is fracture of medial malus your patient has got fracture on both bones that is called as by Mal ular fracture by mular fracture so the word by means to by mular fracture the name is pot fracture now if you see that the posterior part of tiia is also broken it becomes Tri Mal fracture and the name is now cotton fracture name is now now cotton fracture cotton fracture fine now if you get to see such a fracture here in the tus bone now that is called shord fracture that is called as shefer fracture C Sheffer fracture that will generally come as an image based question only me Zoom it up a bit see here so you see one part of the bone second part of the bone Sheffer fracture shefer fracture right then TS fracture TS fracture now tillock fracture when you see that the medial part of the bone is fractured medial part of the sorry the it will be the lateral part I'm sorry the lateral part of the bone is fractured that is called as toog fracture now they will come as an image based question only you have to look for the fracture line and then you have to just identify you have to just identify it we come to this when we'll discuss now if you see a fracture in the femur if you see a fracture in the distal femur now this is called haa fracture this is called haa fracture haa fracture distal femur so haa fracture is present at distal femur now what is if you see a fracture in the proximal tiia that is called as bumper fracture that is called as bumper fracture bumper fracture now similarly the Jones fracture fifth metatarsal base here if you see a fracture that is called as Jones fracture that is called as Jones fracture fifth merasal fracture that is called as Jone fracture now this is an interesting fracture calal fracture is called as lover fracture is called as lover fracture so someone is is fleeing from the window fine and the husband of the lady comes out of nowhere so that lover will sustain something called as lover fracture that is called as lover fracture amitra G Dr amitra G thank you so much so stand after jumping from a window lover fracture right of these fractures uh speaking of the fractures but is if you allow me just two three minutes because you know we are we are discussing fracture so let's quickly see another important fracture another important set of fractures rather I want to call it uh forarm fractures because you know these fractures often they are like very confusing now something called as defense fracture now defense fracture is also called as night stick fracture so let's say this is going to be your patient he's being hit by a policeman so this stick will hit the alna of the patient so isolated fracture that means there is no other fracture or dislocation fine no other fracture or dislocation now we have got this fracture montagia fracture dislocation now this was given by Giovani monia Dr Giovani monia monia fracture dislocation now often there are many confusing things we have to study these three fractures montagia fracture dislocation galy fracture dislocation and reverse galy fracture dislocation now see what is I developed my own pneumonic in the year 2019 elections were held and Modi G won with thumping majority many bad things happened between 2014 to 2019 even then Modi G won because he was close to the hearts of people he was close to the hearts of people when we stand like this it is the Ala which is closed to our body so let's say buddies we stand like this so ala is the bone which is closed to our bodies so somewhere here must be my heart if I'm standing here which part of the alna is close to my body it is the proximal part of alna which is close to my body so M for Monte Gia M for monia fracture monia fracture will occur at proximal ala now all his political career Modi G has done his politics against one family G for gandhis so G for galizi which is also known as reverse monia now this will affect distal radius now somebody prompted prompted one of the gandhis to be in the line to become Prime Minister which Gandhi RG Rahul Gandhi with all due respect so reverse galizi fracture it affects the distal alna there are other ways to remember also multiple pneumonics GFR glomular filtration rate gesy fractures radius gesy fractures radius but is when we are reading ABC Zed comes at end so galesi will fracture the bone where it ends that is distal r radius similarly monteia a a a so ABC starts at a montagia fracture will occur the start of the bone where the bone starts proximal alna mugger is another pneumonic montagia will fracture the alna and galesi will fracture the radius similarly we have got another name monic grimus galesi will fracture radius at inferiormost part must monia will fracture the Ala at Superior most part monia fracture dislocation now you see what is here this bone is radius and this bone is alna as you can see buddies there is a fracture over here and you see here if you see that both the bones are separated away from each other both the bones if you see are separated away from each other so as they are separated away from each other we get to see uh dislocation we get to see a dislocation so this is monia fracture dislocation montagia fracture dislocation that means fracture of proximal alna plus dislocation of radio alner joint dislocation of radio alner joint similarly galesi fracture was given by Ricard galesi this is important probably for in C not even for neat galesi fracture dislocation so distal radius fracture with radio [Music] alner dislocation now you see here bues again the same thing this is radius this is ala and as you can see both of the bones are separated from each other are separated from each other galesi fracture dislocation now the same fracture is also known as reverse montagia reverse montagia then we have what is galesi equivalent fracture both of the bones both the bones are fractured but there is no dislocation both the bones are fractured but there is no dislocation galesi equivalent fracture galy galy equivalent fracture both of the bone will be fractured but there will be no dislocation so treatment of all of these in adults open reduction and internal fixation while in the children we'll use po cast we can use po cast yes yes yes Dr Karthik G if Dr Karthik G listen to me carefully buddy if there is no dislocation and a fracture of alna that is called as night stick fracture if there is fracture of alna and dislocation of radio alar joint only then we will call it montagia fracture only then we will call it monia fracture right what is speaking of that I know this this is slightly irksome for you this is slightly difficult for you but let's see the next fracture Coles fracture now you see buddies outer part of any bone is cortical blue colored inner part of any bone is cancellus yellow colored thing which I have shown over here now correct me if I'm wrong you see this point this line is at cortico cancellus Junction so if a fracture occurs over here this fracture is called colis fracture colis fracture whereas gesy fracture will occur at distal 1/3 of radius colis fracture will occur at distal most part of radius distal most part of radius that is the difference here that is the difference here so if the galesi fracture is occurring here then col's fracture would be occurring at the distalmost part that is a difference what is the mechanism the mechanism is fall on the outstretch hand in elderly now this mechanism Foos fall on the outstretch hand in children it will cause Supra condil fracture of humorus in young adults it will cause scaphoid fracture in elderly it will cause colis fracture please tell me uh please allow me to call you by your names Dr KARK madav G Dr amitra Janan G Dr musan G Dr gagan G Dr Priyanka G Dr Daniel Dr Shivani uh Dr me Patel G Foos can it cause anything else apart from these three fractures which I have mentioned can it cause anything else but is it can also cause posterior dislocation of shoulder it can also cause posterior dislocation of shoulder so if your patient has colis fracture he or she will come to your office like this he or she will come to your your office like this right now first of all you see what is the different names of the different surfaces it's very difficult but if you understand it once it will be super easy for you so let's say my hand is like this this is what you get to see so the normal position of the body is like this so what you see right now is anti ior be I can enlarge up my image I think I can I think I can oh you shift to that okay right done I'm visible on full screen full screen okay yes okay now see bues what you get to see right now this is the anterior surface of my body anterior now this anterior is also called as voer is also also called as voler also called as ventral also called as flexer so anterior ventral wer flexor what you see right now that is called as dorsal extensor posterior fine so anterior ventral vlar flexor dors seror extensor fine the different surface the different surfaces of the body fine okay beim G I want to get back to my original size beam G Dr Paris is there Dr Paras remember tomorrow we have got the loud music alert Dr G just remember fine don't think too much just keep on studying okay now you see buddies and uh Dr G uh we have got some meditation center we've got some uh meditation sessions at my house on my rooftop Dr Paris will be there I will be there maybe we can give you some sessions over uh a cup of coffee maybe fine you're most welcome tomorrow okay so the dorsal surface is also known as posterior surface is also known as extensor surface right the opposite side is called Palmer surface B surface ventral surface anterior surface flexor surface fine the session is going to start at 8:00 so now you know what kind of meditation that would be now here in colis fracture your patient will have supination of the rest lateral deviation of the finger and the fracture will be impacted posterior displacement you'll get get to see posterior displacement of the distal fragment posterior displacement of the distal fragment right okay what is the treatment treatment is propaganda what you do here is you will fix it in the hand shake cast handshake cast clinical features are slipe treatment is propaganda from superation you will turn to pronation pronation your patient came like this dorsal angulation you'll convert it to Palmer angulation Palmer angulation from lateral deviation you will convert it to alner deviation let me show you the picture all this is done in the handshake cast now if you see what is the fingers they are moving like this that is Palmer deviation now the fingers they are moving like this that is alner deviation alner deviation now this all has to be done in the hand shake cast remember buddies let me just shade it up so you see buddies this yellow colored thing is the distal fragment this blue colored thing this is the proximal fragment now if you see it correctly Buddies the distal fragment has gone posteriorly distal fragment has gone dorsally towards the extend senser surface if you don't do the correct treatment the union will occur here only Union will occur here only see bues the distal fragment has gone posteriorly the union will occur here only and your patient will have dinner Fork deformity dinner FK deformity which looks somewhat like this you see the dinner folk deformity this occurs when the distal fragment goes posteriorly at that time your patient will suffer from dinner folk deformity remember the most common complication is not dinner folk deformity most common complication here is finger stiffness now the other common complication is extensor pocis longus extensor policis longest tendon will break now for neat PG you need to remember remember that this is a very very late complication this is not an immediate or early complication this is a late complication rupture of extensor pocis longus this is a late complication now dinner folk deformity is a very bad disabling deformity very bad and disabling deformity you need to correct it with the help help of Dar operation with the help of Dar operation now Smith fracture is totally reversed your patient will come to you like this pronation Palmer angulation and alner deviation of the fingers the treatment is from pronation will convert to superation fine from alar deviation will convert to lateral deviation from Palmer angulation will convert it to posterior shift patient came like this will convert it to something like this even then there are chances of your patient having deformity what is the name of that deformity Garden Spade deformity Garden Spade deformity Dr Karthik G it is Dar now Dr Karthik says durra now at around 8:00 don't say the word dur because you know the sound of Brea brua comes in my mind at the time of 8:00 p.m. once again a kind and humble request I was born and brought up in Umar so 8:00 p.m. is a very dangerous time for me now you see here buddies that is the first fracture which we have seen so in the first image everything is normal in the second image you see there is a fracture of distal radius in the third image also you see there is a fracture of distal radius right now if there is distal fracture and the bone goes like this dorsal angulation your patient has Coles fracture if distal fracture and Bone goes like this your patient has Smith fracture Smith fracture so col's fracture on my right hand Smith fracture on my left hand fine colis fracture on my right hand Smith fracture on my left hand so you see the blue colored thing is the fracture line you see it is very far away from the wrist joint very far away from the wrist joint so that means the fracture is extra articular extra articular that means the fracture line is away from wrist joint now you see here let's say buddies this is the wrist joint and suppose this is the fracture line now if you see it correctly Buddies the fracture line is meeting The Joint so that means the fracture is intraarticular right is intra articular I want you to watch this image from radi opedia then we'll watch a t table then we watch a table right now you see here the yellow colored line which I have drawn is the fractured line and the blue colored line which I have drawn this is the wrist joint this line is the wrist joint now you see here the fracture line is far from the wrist joint so this is an extraarticular fracture plus you can see there is dorsal angulation so this is a Coles fracture Coles fracture how does this occur by fo fall on the out stretch hand now you see here buddies this is the joint Line This is the fracture line so you see here the angulation is volar mechanism is inward turned hands inward turn hands so this is a Smith fracture Smith fracture now the third fracture again you see buddies here the hand is going like this so the dorsal angulation but you see the fracture line touches wrist joint so this kind of fracture is intraarticular what is the name of this fracture dorsal Buton same I mean similar so we have got vlar angulation now this is the joint Line This is fracture line so but is what kind of fracture is this vlar button we also call it reverse Barton reverse Barton reverse button so if you can take a screenshot my kind and humble request please take screenshot only if you have not understood this particular concept fine please do take screenshot I mean I'll share the PDF but then you also take the screenshot this particular black colored image take a picture or take a screenshot that's super important okay yes so let's say if the styloid process of the radius is fractured if the styloid process this is the styloid process if the styloid process of the radius is fractured and there is no displacement hand remains straight in the neutral position that is called as shuer fracture shuer fracture also known as heson fracture also known as backfire fracture remember in the old times we had to start the cars like this we had to start the cars like this fine here so what would happen sometimes the handle would hit the radius so bad that the styloid process would break styloid process would break so if there is fracture of the styloid process it is called as backfire fracture and if the medial side of the radius breaks down so what do you see first image everything normal second image lateral side is fractured third image medial side of the radius is fractured so you see if the medial side of the radius is fractured so you see this is lateral side you see this is mid medal side fine so if the medial side is fractured buddies it is called as D punch fracture D punch fracture this is how it occurs D punch fracture D punch fracture like this so on the first image you can see something you see the styloid process is fractured so this first image what you see is called haisan fracture backfire fracture now in the second image you see the lateral side is okay but the medial side is fractured so this is called D punch fracture D punch fracture D punch fracture so scaphoid fracture remember scoid is the most common carpal bone to undergo fracture most common carpal bone to undergo fracture most common carpal bone to undergo dislocation most common carpal bone to undergo dislocation what is that that is called as lunate that is called as lunate and what do you get to see here you get to see spilled T cup sign spelled t cup sign immobilization in the cast Dr Karthik madav G immobilization in the cast you'll just do immobilization nothing else no named cast is used scoid fracture mechanism of action fo in the young population so she is having Foos fall on the outstretch hand fall on the outstretch hands fine fall on the outstretch hand now what is most common sight is the vast in children most common site is distal pole clinical feature uh fullness that means swelling in the anatomical snuff box anatomical snuff box your patient will have pain on gripping the object pain on gripping the object treatment is immobilization in the glass holding cast how will you identify glass holding cast thumb will always be covered thumb will always be covered thumb will always be covered if the fure is displaced then the treatment is open reduction internal fixation that means you will do surgery by Herbert screw this is what we call Herbert screw Herbert screw investigation of choice is MRI because the fracture may not be visible on xray why because edema around the bone will keep both the fragments together and sticking to each other now suppose MRI is not available you will get three X-ray views AP view lateral View and oblique view oblique view is considered best complication nonunion why nonunion because there is poor vascularity and avascular necrosis avascular necrosis will not affect the distal part it will affect the the proximal part it will affect the proximal part avascular necrosis fine the distal part will be saved but the proximal part will undergo a vascular necrosis will undergo avascular necrosis fine now which other bones undergo avascular necrosis remember tail us fine and neck of femur they also undergo avascular necrosis now avascular necrosis also occurs in the dislocation of hip it also occurs in Peres disease it also occurs in slipped capital femoral epifisis slipped capital femoral epifisis another one or two minutes and then we'll take a 15 minutes break now banet fracture the correct name is Benet fracture dislocation it is the most common fracture of base of thumb and is dislocated see here so this is the base of the thumb and it is dislocated because it is pulled by this muscle which muscle abductor pocis longus muscle abductor pocis longus muscle fine abductor Poes longus muscle now this muscle is a notorious muscle now if this muscle is inflamed it can give rise to a disease called dvan Tino sinovitis deuren Tino covius now what is B for Benet B for B by means two so here there will be two fragments two fragments similarly the next fracture Rolando fracture is commun fracture remember this movie rrr movie so R is written three times so there are minimum three fragments minimum three fragments 1 2 3 minimum three fragments fine you see here here also one 2 three minimum three fragments Rolando fracture now boxer fracture boxer fracture is fracture of fifth metacarpal neck fifth metacarpal neck boxer fracture fifth metacarpal neck mallet finger it is also called As baseball finger it is also called As baseball finger so when the ball hits what happens is that the extensor tendon is broken into two pieces extensor tendon is broken into two pieces like this extensor tendon will be broken into two pieces right so this is the first piece this is the second piece so it starts looking like a hammer now what is the treatment immobilization in hyperextension so one of my doctor friend he mentioned that please show us splint I'm showing the splints in between the lectures also and in the end we'll do a quick revision of all all the splints don't worry now this is called as Stacks splint Stacks splint so you see the finger is in hyper extension hyper extension this is called as Stacks splint fine now next is Jersy fingers so you see this is your patient patient the man runs away the inside of the hand of your patient will sustain injury will sustain injury so what is that rupture of flexer digitorum profundus tendon flexer digitorum Prof fundus tendon right now the clinical feature flexion treatment surgery is preferred then otherwise you can use something which is called as frog splint something which is called as frog splint please allow me to quickly show you the Frog splint see this is how a frog frog splint looks like frog splint frog splint I I'll do that buddy Dr na G I'll do that this is how the Frog splint looks like right frog splint okay coming back skier thumb and gamekeeper thumb so but skier thumb thumb is acute injury and gamekeeper thumb is chronic injury to alner collateral ligament alar collateral ligament C so this is radial C atal ligament this is alar collateral ligament alner collateral ligament radial collateral alner collateral ligament right buddies you see here gamekeeper thumb is chronic injury chronic injury so you see here in Old Time the hunters they used to kill the wild animals they used to call all wild animals game so they will break their neck with the hands inside of the hand would get damaged right now mid lung deformity not very important Club hand is absent or hypoplastic radius now what is the treatment there you can do p operation P operation not very important sync Ty is Fusion of the fingers index finger middle finger ring finger little finger so Fusion of the finger is most commonly between middle and ring finger polycal means more than five digits now a is more common this preal that means more finger on radial side more finger on the radial side Rik rashan remember two thumbs and if you have more finger on thear side not important now this man has got two middle fingers scary sprangle deformity so sprangle deformity there is a band between band between cervical spine and scapula cervical spine and scapula right so you see here this is cervical spine and this is scapula now this is characteristically seen in lipil fail syndrome what is the treatment surgery at 3 to 8 years of age pulled elbow what is the other name nurse made elbow fine it is most commonly done at I mean it occurs at 2 to 5 years of age 2 to 5 years of age the child will present like this in the prone position you just have to make it suine just have to make it supine pulled elbow now what what happens is many of you they don't come back after break so bonus just 30 seconds more and let's see the most common joints involved just 30 seconds more then we'll take a break so most common joint involved in romatoid arthritis metacarpo fenial joint and this joint is spared in osteoarthritis not involved in osteoarthritis not involved in osteoarthritis now most common joint in osteoarthritis knee joint in India hip joint around the world hip joint around the world please tell me which joint is spared in rheumatoid arthritis now in G gout metatarso fenial joint of the great toe is most commonly affected I'll repeat my question which joint is spared in romatoid arthritis now in septic arthritis which includes gonococcal and syphilitic arthritis also in pseudogout hemophilia it is the knee joint which is most commonly affected very good Dr musan so in rheumatoid arthritis diip distal inter fenial joint is spared now in pedet disease most common bone involved is pelvis followed by femur now in osteomylitis most common is lower end of femur now in rumod arthritis most common extraarticular manifestation is subcutaneous nodules which are seen at extensor surface most commonly they are seen at oanon right most common pulmonary manifestation is puitis most common cardiac manifestation is per carditis most common valvular anomaly is metal regurg ation most common hematological anomaly is normocytic normochromic anemia most common part of spine involved cervical spine most common cause of death cardiopulmonary complication that is rheumatoid arthritis for you that is rheumatoid arthritis for you pericarditis I mean we we will read rheumatoid arthritis we will read more of rheumatoid arthritis very very shortly but uh for this candy allow me to take uh quick short break of around 15 minutes then we'll uh okay so uh 8:15 by my watch will we see each other at 8:30 p.m. the class has to end at 10:00 don't worry so can you allow me to take a quick short break of around 10 15 minutes we'll assemble again the class beim G without breaking the link can we continue the class at 8:30 yes so can I get one or two yes from you guys if we can take a break right now I mean if you guys are still watching so 105 minutes break I'll assemble I mean I'll be here at my seat at 8:30 shop right thank you so much Buddies d g right bu so I'm back as promised back on time now rid arthritis we'll study the different type of arthritis four different type of arthritis and after that we'll see tenosinovitis different kind of tenosinovitis right so canly allow me to start now first we'll start with romatoid arthritis fine rheumatoid arthritis is chronic nons supera nons supera means there is no puss at all no P at all now most common age of starting is 20 to 50 years and it is more common in females now it is associated with HLA dr1 and drw4 now some of the virus like EP bar virus are also associated with this kind of arthritis associated with this kind of arthritis now what is what is the pathology pathology is body starts thinking imunoglobulin G as the antigen and it will developed IGM antibody against imunoglobulin G so the immune complexes are formed immune complexes are formed and they will activate the complement the inflammation will start fine so interlukin and tumor necrosis Factor Alpha these are the main cines these are the main cines initial inflammation is at cium and the cium is converted to panis cium is converted to panis just give me a minute so you see here IG G becomes antigen and IGM it becomes the antibody IGM becomes the antibody against the IG and the immune complexes form immune complexes form immune complexes form right now these immune complexes they activate the complement they activate the complement now first of all what will happen the cium which is very thin cium which is very moist it it becomes panis now the panus is dry panis is rough panis is inflamed kind of cium is inflamed kind of cium right your patient develops multiple deformities your patient develops multiple deformities now one of the deformity is swan neck deformity swan neck deformity so what is there in the swan neck this is swan neck deformity so you get to see flexion at the DI joint and you get to see hyper extension at the PIP joint fine you see flexion at the diip joint and hyperextension at the PIP joint hyper extension at the PIP joint then we have got Boton deformity flexion at the PIP joint and hyperextension at the diip Joint hyperextension at dip joint then we have got something called as hammer toe hammer toe fine so this is hammer toe flexion deformity of the feet fle ction deformity of the feet now somebody who is asking for a lift is called hitchhiker is called hitch hiker somebody who's asking for a lift is called hitchhiker now your patient will develop a thumb which looks like this this is called as hitchhiker thumb hitch hiker thumb hitchhiker Thum these are the different deformities then your patient will have rheumatoid ndule now they are seen at extensor surfaces of the body and the most common sight is oon most common site is oon most common site is oenol panoi sign radius and alna can move separately and independently away from each other separately and independently away from each other fine now close this so you see here most common joint as I told you is the metacarpo fenial joint most common pattern is symmetrical poly arthritis that means the joints are involved in a symmetrical fashion if I am your patient left side wrist is involved right side will also be involved fine so symmetrical polyarthritis poly means minimum four joints must be inflamed minimum four joints must be inflamed now the less common joint are hip joint temporal mandibular joint rarely affected joints are cervical spine here your patient will complain of severe headache severe headache lungs your patient will have intertial fibrosis eyes your patient will have conjuctivitis Sika simply called as dry eyes plura your patient will have puitis puitis your patient will also have myocarditis due to ongoing inflammation ESR C reactive protein levels will be very very High very very high your patient also will have PUO paria of Unknown Origin deformities we have already seen now r a factor what is r factor IGM antibody against FC portion of IG if the disease is waxing that means patient is versing then RAF Factor levels are high if the disease is veining that means the patient is improving ra Factor levels are low it is non-specific what is specific anti Cy click citrated peptide antibodies or it is also called as anti citrated peptide antibodies now on xray the first sign is JRA articular osteop IIA around the joints you will get to see decreased bone density decreased bone density you'll get to see around the joint around the joints then what is the treatment treatment nades and dards now these are the pneumonics for disease modifying anti-rheumatoid drugs many thanks to the owner of this picture now that's another pneumonic Alisa please give her methotraxate why because methotraxate is the drug of choice why her because the disease is more common in females now rheumatoid arthritis is very common in felty syndrome what is the pneumonic of felty syndrome splenomegaly anemia neutropenia thrombocytopenia and rheumatoid arthritis Santa is is the pneumonic that's what we have already studied about romatoid arthritis Now we move to the next type of arthritis osteoarthritis now you see what is osteoarthritis is common in males who are obese obese means BMI is more than 30 BMI is more than 30 fine now primary osteoarthritis when the art AG is destroyed by age secondary osteoarthritis when the cartilage is destroyed by some other disease fine and not by Aging for example the cartilage may be destroyed by septic arthritis rheumatoid arthritis and intraarticular Fracture now this can affect any joint whereas the most common joint in primary osteoarthritis is is knee joint in India why because of Indian toilets and because of our habit of sitting on the ground that is called as squatting clinical feature pain clinical feature your patient can develop something which is called as genu vum now the metacarpo fenial joint as I told you is spared it is not involved proximal inter fenial joint as I told you is inflamed and there is a swelling which is called as Bouchard node distal inter fenial joint is inflamed it has got a swelling called as he burden node have burden node on x-ray you see here but is this is the medial side this is the lateral side now if you see that the joint space is reduced joint space is reduced if you see over here the joint space is maintained so xray shows asymmetrical loss of joint space now x-ray also shows osteop fites x-ray also shows osteop phyes osteop fites osteop fyes you see here osteop arto the word Aro means joint scopy means to see to take a camera inside the joint and see what is happening arthoscopy what does it show it shows loose bodies of broken cartilage now the most common cause of loose Bodies In The Joint in elderly is osteoarthritis otherwise the most common cause is osteocondritis treatment weight reduction aades and condroitin sulfate now the gold standard treatment is joint replacement gold standard treatment is joint replacement joint replacement right but if we now move move to the second last arthritis stic arthritis now it is called arthritis mutilans destroys the bone so badly male female incidence is equal male female incidence is equal now buddies this is also associated with HLA B27 HLA B2 7 now what do we get to see we get to see silvery scale on the skin on colis means nail destruction we get to see sausage fingers we get to see sausage fingers that means the bones of the digits are swollen we get to see something which is called as opera glass hand and opera glass hands so opera glass hands what are they they are the skin folds skin folds opera glass hand osteolysis there will be bone destruction bone destruction will appear like this so when you see this bone destruction you see in the first image everything is normal normal normal and if you see in the second image the bone is destroyed bone is destroyed this is called as pencil in the cup deformity this is pencil pencil in the cup deformity pencil in the cup deformity is seen on x-ray now we also get to see telescoping of the fingers dror gagan G that's a misconception that is an absolute misconception that hlb27 is associated with the analing spondilitis only it is associated with multiple other diseases it is associated with multiple other diseases let me show you just give me a minute see here HLA B27 it is associated with enyoing spondilitis it is associated with reactive arthritis stic arthritis fine so it is not only associated with enal losing spondilitis but it is associated with multiple other disease for example it is associated with inflammatory bavel disease it is associated with uh uiis reactive arthritis right oh yes yes yes yes uh yes you're right huh yes it is associated with enal losing spondilitis in 90% of the cases that ways Dr gagan you are absolutely correct now see this is silvery scales on the skin in psorasis enois destruction of the nails enois now telescoping you see this is how telescope is tube number 1 2 3 when we are done using it we will close it and it will become small in size see this video when you pull the finger becomes large when you close when you leave the finger becomes small watch it again this is called telescoping telescoping right now the hands they show skin folds now these skin folds they are called opera glass hand opera glass hands opera glass hand in stic arthritis we use Casper criteria you know you don't need to remember the details just remember the name Casper criteria is used for making the diagnosis of ptic arthritis Casper criteria Casper criteria now here you know the treatment which you can use is first you can use nades fine then you can use immunosuppressant like cyclosporin like Asa thoin ASA thoin you can use cyto blockers like ITA ncept ITA ncept you can also use in flixy map you can also use INF flixy map and then another group of drug which you can use is the steroids now with this we move to the next thing there enyoing spondilitis you know it is seen in young males it is seen in young males now 90% of the cases they are associated with h b 27 fine now the word is enosis enyoing now what is enosis path ological Fusion of the bones in a joint that is en kylosis arthodesis Fusion of the bones deliberately deliberately done by the surgeon deliberately done by the surgeon now earliest joint involved here is the secro ilc joint Sacro ilc joint uh Dr akanga I believe I'll be able to cover the important topics by around let's say 10:00 fine if they want me I'll take another one now what do we get to see on x-ray we get to see squaring of vertebra now just as an McQ Point what we get to see in hemophilia in hemophilia will get to see something called as squaring of patella squaring of patella now see what is here you look at this vertebra you see the anterior border is straight this is called squaring of vertebra now if you see correctly whates in this vertebra the anterior border is slightly concave so this vertebra is absolutely normal whereas the affected vertebra the anterior border is absolutely straight anterior border is absolutely straight this is called yes buddies of course of course of course I'll discuss I mean if the time permits us and I see if I can find the pyq I I'll discuss the them here only are buddies I can do anything you guys say you just tell me and I'll do it now you see that is what we get to see this is called as bamboo spine fusion of all the vertebrae now inflamed vertebra they heal by calcification right now here something characteristic you see buddi this is the anterior part of spine and this say posterior part what is present in the posterior part of spine in the posterior part of spine there is a ligament called supraspinous ligament Supra spinus ligament Dr Karthik G next topic is tumors only I'll try to make it perfectly simple for you absolutely simple I'll try to make for you 15 minutes topic very quickly we'll cover now if you get to see a white line in the center if you get to see a white line in the center that is called as dagger sign calcification of the supraspinous ligament is called dagger sign if you get to see a white line on the sides if you get to see white lines on the side of vertebra white line on the side of vertebra this is called as railroad sign and if you get to see both white line on the side as well as a white line in the middle that is called as trolley track sign trolley track sign now you see it starts at the level of secro ilc joint right okay now what is the name of the investigation if the Sacro ilc joint has to be tested it is called gelan test what are the other test figure of four test also called as Patrick test also called as fabber test also called as Faber test right now it has got many extraarticular manifestation like uiis irido cyclitis inflammatory bavel disease Cataract and glucoma Cataract and glucoma right okay so you people are worried about tumors so let's see the tumor only let's see the tumors only now what is worrying about the tumor they ask you first of all they'll ask you the site that what is the common sight of the tumor then they will ask you the typical radiological picture they'll ask you the typical radiological pictures just give me a minute and we'll do that don't worry now I totally and fully agree with the Dr Karthik yes Dr Roy the old gamer but that is why it is called as bamboo spine now I fully agree now you see uh Dr uh Karthik G see this is the way to remember the site of origin so you have got these two neonics there they are present in the nodes fine so geomed is one pneumonic joint cell tumor arises from epifisis yes yes yes Dr Roy exactly the same so Patrick test uh just give me a minute I'll show you here only what is this figure of four test also called as Patrick test I'll show you here how do we perform that see here this is how we perform Faber test also called as Patrick test or figure of four test we make a figure of four and then we press like this so you see this is flexion abduction and external rotation Faber test Dr Roy the old gamer what this one is for you this is how we are performing Faber test also called as Patrick test also called as figure of four test now Lumber spine you know the patient will not be able to bend at the lumber spine so we will test it with the help of scobar test scob test okay so I fully agree with Dr Karthik that understanding that tumors is a bit difficult it's a tricky thing now osteochondroma it arises from metaphysis eving tumor it arises from diaphysis fine demo ECG what arises from diaphysis evening saroma what arises from metaphysis osteosarcoma and osteochondroma what arises from epifisis Codman tumor condr saroma and giant cell tumor that's a neonic yes yes yes exactly Dr Roy now this is also there in my notes from by age you can do the quick revision now what even then the problem is what Dr Karthik has mentioned that uh the tumors that they all look the same they all look the same especially the benign bone tumors they all look the same fine we'll try to differentiate them now first of all buddies most common bone tumor is [Music] secondary cancer secondary cancers from other organ secondary cancer from other organ in the males they commonly come from prostate and in the female they commonly come from breast now what is some of the cancers secondary cancer they are osteoblastic that means they help in bone formation what cancers cancer prostate carcinoid and medular carcinoma of the thyroid whenever they reach the bone they help in bone formation osteolytic they destroy the bone remember follicular carcinoma it forms pulsatile secondaries pulsatile secondaries very vascular secondaries the bone is totally destroyed carcinoma breast 80% are litic 20% are blastic right in 20 person patient it will be plastic now cancers they're rapidly growing tissue so they prefer to stay near the source of blood supply that's why the most common site is dorso Lumber spine sobody here T4 tumor T4 tuberculosis both of them they are commonly seen at dorsal Lumber spine right but tumor is seen posteriorly tuberculosis is seen anteriorly in tumor the intervertebral dis is preserved in tuberculosis the intervertebral disk is destroyed that is the difference between tumor and tuberculosis difference between tumor and tuberculosis now some cancer there is a pneumonic now my kind and humble request don't elaborate the word BBC in our time the BBC just meant British Broadcasting Corporation now BBC goes everywhere their pneumonics they go everywhere now yeah so carcinoma broncus carcinoma bladder carcinoma colog they can go to any bone they are so aggressive that they will reach anywhere they'll reach anywhere now so most common primary malignant bone tumor that means a arising from the bone only arising from the bone now this has got to be multiple Myoma multiple Myoma most common bone tumor of non hematopoesis from the bone marrow not arising from the bone marrow so most common is osteosarcoma second most common condr saroma third most common eving saroma eving saroma so we'll start with osteochondroma why because this is considered to be most common benign bone tumor Dr cartic G see this is epifisis this is metaphysis this is diaphysis the tumor is arising from diaphysis like a stock like a tree so at least this one you will be able to identify fine this one you will be able to identify now it is associated with Masada syndrome you need to remember it only if you are appearing for need PG treatment is exision now anonda N means inside so inside the bone if there is a tumor n condr so it is the most common benign tumor of hand bones most common benign tumor of hand bones right now what is this is associated with mauki syndrome and oier disease now what do you get to see here you get to see O ring sign what is O ring sign now you see you will see a very thin white line very thin white line where at the metaphases very thin white line at the metaphases in long bones O ring sign right osteoma is just born over growth so let's say if the skull my skull suppose is like this oh very bad so the skull of your patient would be like this so there will be just a swelling just a swelling now you see here just a swelling just a small bony swelling that is called as osteoma bone overgrowth nothing needs to be done it might block a sinus then you'll do surgery now osteoid osteoma it is considered to be most common true benign bone tumor now it is seen in the teenage and early 20s Now location you remember you don't remember that's perfectly okay just remember that it is present at diaphysis and the typical x-ray picture you will get to see thick thick white periphery and a dark Center see buddies so this is what you get to see thick white periphery and you get to see dark center now this patient will have pain which is so mild that it does not require higher painkillers it is just relieved by nades now this will form the body of question clinical question will definit Ely include this that pain is relieved by nades now osteoblastoma is benign but aggressive now it is more than 2 cm in size and is rapidly expanding there will be no pain relief with nades treatment is marginal exision you have to remove normal TI tissue also normal tissue also osteoclastoma so what is osteoclastoma this uh question they have been asking for several years now several years every time at least one or two questions are there so most common age 20 to 40 years most common age is 22 40 year most common site is epices of femur epices of femur now there are 5 e it will be present at the epifisis not at diaphysis Ecentric it will be present on one side and not in the center expansile rapidly increasing in size eggshell cracking it makes the bone very very thin and block excision complete removal is the treatment now x-ray will show soap bubble appearance you see at this point the bone has become so thin it is very similar to egg shell very similar to egg shell now this is important in the scenario based question bone biopsy finding multiple giant cells with 40 to 50 nucleus will be seen now the simple bone cyst bu what is cyst a fluid filled swelling is called cyst now blood white blood cells anything so what what all things can form a cyst in the bone first the the pneumonic is Beach bro abscess eosinophilic granuloma en condr and condr blastoma now these this you know table is important and only for npg what all things can form cyst now what do you see on x-ray you see on x-ray something called as Fallen Leaf sign which is also called as trap door sign also called as trap door sign so what do you get to see that at this point in the bone there will be a liquid filled cavity and there will be a bone fragment there will be a bone fragment which has fallen from the top which has fallen from the top and this is called as Fallen Leaf sign just do the excision anormal bone cyst now anormal bone cyst is a slightly problematic tumor is a slightly problematic tumor 10 to 20 years it is commonly seen at tibia it is commonly seen at tibia and where it is seen at metaphysis now this point is important not only for neat PG but uh inct also usp6 gene mutation now what happens here there is increased production of this enzyme metrix metalloprotease so the bone is destroyed bone is destroyed now you get to see a multiple septate appearance in the metaphysis see like this multiple septate appearance now sep let me show you you see this line you see this line septate so multiple fiber like things multiple soap bubble you get to see multiple soap bubble seen at the metaphases seen at the metaphases treatment is wide excision or sclerotherapy wide exision or sclerotherapy now but is osteosarcoma is the most common primary malignant tumor of non hematopoetic origin non hematopoetic origin means not arising from bone marrow now it is the most common radiation induced bone tumor most common radiation induced bone tumor right now it is the most common tumor which is malignant most common malignant bone tumor in children it is the most common radio resistant most common radio resistant tumor of the bone now it is seen in the male so most common location is metaphases of distal femur metaphases of distal femur right now the gene mutation Associated this is important p53 tp53 and herit Tre RB gene mutation now the parium is lifted up but you see this is the lifted up periostium now what are these Sharpie fibers so the bone grows along Sharpie fibers bone grows along Sharpie fibers giving rise to Sun Burst appearance giving rise to Sun Burst appearance there's something called as Sunburst appearance now sunburst appearance is a type of periostal reaction is a type of periostal reaction now let's say bu this is the bone and T stands for tumor this blue colored thing let's say is the periostium now these fibers let's say are Sharpie fibers so periostal stem cells they will try to stop the tumor so these periostal stem cells they appear as Sunburst appearance Sunburst appearance sometimes the tumor is so aggressive that periosteum is just lifted up the stem cells don't form any new bone this is called as cord man triangle this this is called as Codman triangle Codman triangle right periosteum is just lifted up stem cells don't form any bone don't form any bone nowbody this is important when we start studying clinical mcqs you will get to see nuclear pleomorphism that means nuclei of multiple shape hyper chromatic nuclei that means rapidly dividing nucleus treatment is Neo adjoint chemotherapy and surgery chemotherapy is given first because most of the tumors most of the tumors are metastatic where does the metastatic go commonly it goes to the lungs commonly it goes to the lungs then you do the surgery then you can do the surgery now we move to the second tumor here let me just uh so even saroma most common age is 5 to 15 year most common age is 5 to 15 years long bone most common involved as femur flat bone it is the pelvis clinical feature here is the pain now x-ray will show onion peel reaction onion peel you know in scenario Bas question onion peel is also called as laminated laminated means in layers biopsy shows pseudo rates cells arranged in the form of circles cells arranged in the form of circles gene mutation fine now if you do the kot typing if you do the kot typing you will notice that there is translocation between translocation between chromosome 11 and 22 chromosome 11 and 22 also between chromosome 7 and 22 chromosome 7 and 22 if you do the imunohistochemistry you'll see the tumor is positive for cd99 treatment is radiotherapy or surgery remember surgery is preferred you can also do chemotherapy you can also do chemotherapy now multiple Myoma the last tumor here it is the most common primary malignant bone tumor of arising from red bone marrow short duration disease it kills the patient within 6 months next topic would be uh ositis Tino sinovitis x-ray shows rain drop skull so what is you will get to see multiple black spots now many of the students they ask me sir how to differentiate raindrop skull from Salt and Pepper skull but the clinical scenario now what happens is many a time you people just send me picture sir what is the diagnosis in exam it is not like that they will give you clinical history now multiple Myoma patient will be elderly so you can get a clue that if the patient age is 65 70 years and he is a male it will be mult multiple Myoma if your patient is younger fine then it will be salt and pepper skull of hyper parathyroidism now in the blood investigation you'll get to see hyper calcemia hyper calcemia now treatment is chemotherapy and what is the drug bazo me the old drug is thalidomide old drug is thalidomide now what is the most common site it is seen at Lumber vertebrae it is seen at Lumber vertebrae seen at Lumber Verte don't worry about taking the notes or not being able to write I'll definitely share with you the notes the same PDF I'll share with you absolutely no need to worry very quickly Tino sinovitis Tino sinovitis so first ositis which we are going to study is dupin contracture dupin contracture so what it is it is a type of fibromatosis the fibrous tissue of the hand is affected so there is increased collagen type 3 increased collagen type 3 you see increased collagen type 3 what happens here is that there is flexion deformity flexion deformity now so in surgery you have read about poni disease so it is associated with poni disease it is associated with planter fitis so Peroni disease is curvature of penis planter fitis is same problem occurring in the feet now what is the treatment if the flexion if the flexion exceeds 30° if the flection exceeds 30° we'll cut this band we'll cut this band if the flexion exceeds 30° now de curvine disease you see deur disease is due to inflammation of abductor pocis longer and extensor policis brevis now they are also called the snuff box tendon now there are two investigation first investigation is an old investigation see what is it was done in the year 1927 it was very uncomfortable for the patient see this is the hand of doctor this is the hand of patient so doctor what the doctor will do is doctor will twist the hand of patient like this and there will be very severe pain over here very severe pain over here right so this is not done what is the name of this test ish cough test nowbody is what we are doing we are doing something called as fle steain test fle steain test now fle steain test it is done in two steps this is the hand of doctor this is the hand of patient now what will happen we asked the patient to do alner deviation so patient does the deviation by himself in the second step we ask the patient to close the Fist and then do the alner deviation again there will be pain so this is not done by doctor but done by the patient himself done by the patient himself right so most of the time in examination they will just give you an image and they will ask you what test is being performed and what is the clinical condition for which this test is being done so you need to remember ishof test is an old test it is not done what test is done now finl Stein test now finlin test is done in two steps treatment is not important trigger fing finger stenosing but is the word stenosing means narrowing narrowing stenosing Tino sinovitis so what happens here is that the tendon sheath sheath means the covering it becomes narrow so that is why the tendon is inflamed your patient will hear a click sound on opening and closing the fingers especially on closing the fingers especially on closing the fingers you see normally let's say this is the tendon sheet and the tendon travels freely now what has happened the sheath has become narrow the tendon cannot travel inside the sheath easily so it will be injured it will be injured again the treatment is not important this clicking sound is important for clinical questions then the next thing tennis elbow so tennis elbow you see BU this is the lateral side of the elbow extensor muscles are attached here so tennis elbow is chronic tendinitis of extensor muscles origin from where they start it is common in Carpenters bike riders now this is important for in C and maybe for a neat PG also which muscle is involved extensor carpi radialis bravis muscle what is the test being performed Coen test this is the hand of the doctor this is the hand of patient we ask the patient to extend the wrist the doctor will try to stop it there will be severe pain at the common extensor muscle origin the second test is mod slate test now this test again is important for in C or neat PG you ask the patient to pick up the finger and then there will be pain here mod slay test mod slay test right treatment is we ask the patient to vear the braces normally there is too much pressure over here but when the patient wears the braces no pressure is exerted or we can ask we can inject the own blood of the patient now this blood will contain platelets and the platelets will cause was rapid healing rapid healing the opposite side the medial side if inflamed will cause golfer elbow now what is golfer elbow is also called swimmer elbow baseball elbow little lier elbow climber elbow suitcase elbow or four for hand tennis elbow the name of test is reverse Coen test just the name is important this is important for NE PG and in C only right treatment at all is not important jevin thrower elbow is acute injury acute injury to alar collateral ligament similarly carpal tunnel syndrome carpal tunnel syndrome now the median nerve will be trapped behind the flexor retinaculum median nerve will be trapped behind the flexor retinaculum right now see budy here the pneumonic important for n PG and in C pneumonic is median trap so what are the causes mioda edema diabetes mtis idiopathic acromag neoplasm for example a lipoma trauma rheumatoid arthritis amod dois pregnancy those of you who say that sir we don't want to remember this much just remember rheumatoid arthritis and mioda that these two condition can cause compression of median nerve can cause compression of median nerve compression of median nerve right now what is the investigation Fallen test f test if you ask the patient to twist the hand like this this is Palmer flexion Fallon test now if your patient does like this that is reverse felon test this is also called as prayer sign also called as prayer sign now treatment is either you do physiotherapy or you release the inoculum then in tarcal tunnel syndrome the only thing which is important is the name of nerve posterior tibial nerve posterior tibial nerve is involved in tarsal tunnel syndrome is involved in tarsel tunnel syndrome now very quickly we'll see some of the important topics in spine you see buddies we have similar sounding terms first similar sounding term is pilosis first similar sounding term is spond losis spondylosis so anything wrong happens with the spine the name is spond dilis anything happens to the spine spine the name is spondylosis fine now spond losis is anything wrong happens with the spine now spondo liis it is stress fracture that means incomplete fracture of pars inter inter articularis pars inter articularis of the spine spondo liis now this is important spondo Lis stress fracture commonly seen at L5 now this is common in the cricket players common in cheer leaders because it is a stress fracture it is not easily is seen on x-ray so investigation of choice is MRI spondo Lis treatment is immobilization immobilization spondo listesis third term spondo listesis it is slippage of one vertebra over other you see here here L5 vertebra is going to slip over S1 L5 vertebra slippage of one vertebra over the other slippage of one vertebra over the other now as you can see over here L5 vertebra has slipped over S1 spondo listhesis on this CT finding you see it is very clear L5 vertebra has slip sorry L 3 vertebra sry L5 vertebra has slipped over S1 so you see if we get to see transverse x-ray we get to see inverted Napoleon hat inverted Napoleon hat you see it is looking like this inverted Napoleon hat inverted Napoleon hat this is Napoleon hat inverted Napoleon hat if we see the sidewise view if we see the sidewise view the lateral view we get to see Scottish Terrier appearance Scottish terer that means the vertebrae they appear like dog vertebrae they appear like a dog Scottish Terrier appearance you see the vertebrae if we take the sidewise x-ray they appear like a dog that is called as Scotty dog or Scottish terer dog I hope you can see many dogs here now when there is pondis thesis there is a fracture there is a fracture there is a fracture in spondo listesis Pondo listesis there is a fracture right there is a fracture I'll Zoom it up again you see here spis thesis and normal this side is normal this side is spondo listesis spondo listesis now if you see over here this is broken spondo listhesis the neck of the dog will be broken I'll draw the dog again here this is the dog if you can see here the neck is broken if spondo listhesis is present spondo listesis if it is present the neck will be broken the neck of the dog will be broken now the hangman fracture you see the hangman fracture is a type of spondo listhesis what happens in hangman fracture is C2 slips over C3 and also breaks you see here C2 will slip over C3 and it will break C2 will slip over C3 and it will break you see here if you can see the C2 has broken down and it has gone slightly forward C2 going slightly forward with respect to C3 here at least you can see clearly that C2 has gone slightly forward with respect to C3 and if you can see it over here there is indeed a fracture there is indeed a fracture so you see here there is a fracture C2 has gone beyond C3 you see Scotty dog appearance now Scotty dog appearance is normal but but is if there is a fracture then the neck will be broken so if the neck is broken that is spondo listesis pilo listesis right spondo listesis spondilitis we have already studied now these are not important yes the different fracture Jefferson fracture is the fracture of first vertebra is a fracture of first vertebra how do we get to see open mouth or donto view this will be the X-ray open mouth or on toid view this is C2 this is C1 cervical vertebra this is open mo mouth odontoid view now what is the treatment for Jefferson fracture this is called as Halo traction or called as halo brace Halo traction or halo brace right hangman fracture we have already studied what happens in the hangman fracture C2 will slip forward and it will break and it will break Undertaker fracture Undertaker fracture is the fracture of C6 and C7 vertebra C6 and C7 vertebra clay shoveler fracture is the fracture of C7 tip C7 tip right so you see here if there is only tip fracture tip fracture this is called as clay shoveler fracture see here if this fracture is there this is called as clay shoveler fracture clay shoveler fracture now CH fracture not important vlash injury not important now skora skora is spinal cord injury with no radiological abnormality right spinal shock what happens in spinal shock the spinal cord is broken normally what happens is if everything is normal what you do you press the glance penis or vva in the females so signal will go up to the brain through the spinal cord and Signal will come down from brain through the spinal cord fine and the anal sphincter it becomes tight now bulbocavernosus reflex is the first reflex to appear that's the important thing about spinal shock only thing important about the spinal shock bulbocavernosus reflex is the first reflects to appear after the spinal shock is over after the spinal shock is over this is an important question bulbo cavernosus reflex is the first reflex to appear after the spinal shock is over then cremasteric reflex you stroke the thigh and the tests go up now now these important for n PG also for fmg just need to remember what causes Central cord syndrome so we are reading something called as incomplete spinal shock let's say this is spinal cord normal now let's say this is broken like this so this is complete spinal cord trauma we are going to read the conditions where the spinal cord is not completely damaged first is Central cord syndrome only the center of the cord will be destroyed fine center of the cord will be destroyed this occurs by extension injury when the spine goes like this extension injury Brown SE quad this only the mechanism is important this occurs by penetrating trauma somebody stabs your patient in the knife Brown C quad syndrome anterior cord syndrome now this this occurs from vascular esia vascular ischemia posterior cord syndrome this occurs by tumors right another condition in spine is PD prolapsed intervertebral disk the question most commonly where does this occur most commonly the disc between L5 and S1 is damage L5 and S1 is damage now this is more common in males what will it cause it will cause radiating pain pain which will go to the legs pain which will go to the legs now clinical test straight leg raising test patient cannot raise the legs Beyond 35° cannot raise the legs Beyond 35 degrees investigation of choice is MRI treatment is micro disectomy you remove the dis now this question was asked around 3 years ago what are the flag signs of back cake now due to prolonged sitting you people are studying these days you might be having back ache but then some people have back cake which is very serious so red sign means some lifethreatening or limb threatening condition is the cause of back pain it is not an ordinary back pain now if the back pain is in young patient less than 20 years more than 50 years now this back pain could be due to tumors could be due to tumors sphincter disturbances that means spinal cord compression is there spinal cord compression similarly paranal loss also means spinal cord compression Kia patient doesn't feel like eating vomits every now and then that is also a sign of tumor radiculopathy tingling and numbness due to pain now yellow flag sign that means the back pain will cause problem to the patient back pain will become chronic social isolation these are not very important emotional withdrawal and hedonia that means patient is always worried about back pain now these are not very important I'm again repeating right because of back pain your patient has started taking alcohol or steroids for medication now these are the yellow flag signs of back back pain yellow flag signs of back pain now the spinal cord where it ends the Superior part is corus medis the inferior part is Coda equina sometimes what may happen is the disk may damage the conus medular part or the qu equina part now let's say the disc comes here compresses the Kus modularis disk comes here compresses the Cod equina now long list you'll just remember whatever I tell you here so here Kus medis is bilateral C equina is unilateral C equina is unilateral right now bladder control is gone in conus medis bladder control is preserved in Coda equina is preserved in COD equina sexual function are lost in Kus medis sexual function are preserved in cord equina Kus medis is sudden and bilateral Cod equina is gradual and unilateral now this is very important topic for n PG only the Four Points which I have mentioned you need to remember you don't need to remember any other point you don't need to remember any other point right okay so with this buddies we move to the next very small topic that is the club foot everything absolutely everything is already written fine I'll just tell you which part is important now for the next two three topics everything is already written and I know I have to end the class on time don't worry now club foot first of all why it is called club foot because the feet of the affected baby they appear like golf bat fine the most common cause of this condition is idiopathic it is most commonly associated with neural tube defect it is seen in first B males what is the chief pathology hypoplastic tailor tailor that is important for need PG what is the pneumonic for deformities cave so first cavas that mean increase vertical Arc of the foot at us the for foot is very close to each other the for foot is very close to each other whereas the feet is turned inward equinus the heel is not touching the ground heel is not touching the ground diagnosis antinal 24 weeks with the help of ultrasound you can do the diagnosis at Birth also now when we do the X-ray budes we see something called as kite angle the normal value is 20 to 40 you see the kite angle is between Tor and Calum now in club foot this angle is less than 20° this angle is less than 20° right okay now what is the treatment earlier we used kite method manipulation was done by the mother it this method failed very very badly this method did not give good result now what we are do using ponet method from day day one the baby is seen and treated by doctor let's say this is how the baby comes so at the day one we'll apply the first cost it will correct cavas after one or two weeks will apply the second cast it will correct adductus and veus together then after one or two more weeks we'll apply Third cast it will correct equinus deformity it will correct the equinus deformity equinus deformity this is called as serial casting one after the other now for need PG they ask you this what is the least correctable deformity equinus now after this we make the child wear Dennis Brown splint round the clock for one year now this is Dennis Brown splint Dennis Brown splint now this is to be used for at least one year Dennis Brown splint we can use it up to 7 years of age during day time we make the child wear special ctev shoes now if the child comes to you at 1 to 4 years of age for the first time we'll do the surgery called Turco operation this is a type of posteromedial soft tissue release we just give a cut on the soft tissue we just give a cut on the soft tissue for example you see here buddy we just cut this soft tissue and we lengthen it up if the child comes to you at 4 to 8 years of age for the first time we'll do Ivan dvin operation just the name is important for need PG or in right if the child comes to you at 8 to 10 years of age you will remove a large part of the bone you just cut it and straighten it that is called veg tarsectomy If the child comes to you after 10 years of age we'll do triple arthodesis that means we'll fuse all the bones to get a stable foot now triple arthodesis which three joints now the name of the joint is very important for n PG which three joints we fuse T navicular talal calcano cuboid caleno cuboid now what is the correct order of treatment first will correct cavas second adductus and varus together this is important and then aquinus if disorder is not followed the patient will develop something which is called as rock ER bottom foot rocker bottom foot this is rocker bottom foot right now this also has got a list of uh important x-rays there important X-ray views I mean that is just for a quick revision you can do it later let's very very quickly see the knee joint the knee joint you see knee joint what is important here the patella fracture Pella fracture if it is undisplaced undisplaced means the two fragments they lie in front of each other so what is the treatment we treat it with the help of cylinder cast also called as tube cast if the fracture patella is displaced moving away from each other then what do we do we'll do tension band wiring we'll do K wire fixation K wire fixation remember this was a question last to last year kre fixation like this just give me a minute yes yes yes very good Dr Dr prusa G now if the fracture patella is communed will do partial or total patellectomy now what is the uh these words communed compound these are very similar sounding term first of all budes what is simple fracture so simple fracture is when the bone is broken into two fragments when the bone is broken into two fragments that is simple fracture when the bone is broken into more than two fragments that is called as complex fracture when the bone is broken into many fragment that is called as commun fracture complicated fracture when the bone is associated with other organ injury that is called as complicated fracture compound fracture is just another name for open fracture so make sure you know your terms very well collateral ligament injury only thing which is important is most commonly it is the medial collateral ligament which is injured lateral collateral ligament injury is very very rare very very rare here see here buddies this occurs when the knee joint of your patient is hit from outside so medial collateral ligament will break and the lateral collateral ligament will just bend will just bend medial collateral ligament break and lateral ligament it will just bend rest of things are not important anterior C cruciate ligament if you look at the knee from the side this is femur this is tibia this is anterior this is posterior now this is the anterior cruciate ligament fine G Anderson classification is a classification for open fracture Dr chenjie very very good actually it's very important we'll discuss that also now main stabilizer of the knee joint it will present prevent excess femur rotation over tibia that means it will not allow tibia to move forward with respect to femur so it will it is important for walk walking downhill as well as for uphill mechanism is twisting force clinical feature see buddies in scenario based question if you read immediate swelling buddies if you read immediate swelling let's say there has been a trauma and after trauma if it is immediate swelling it is AC injury if it is late swelling it is meniscus injury it is meniscus injury what are the clinical investigation anterior drawer test now this test is done in 90 degree flexion that is why this is only done for for chronic injuries only done for chronic injuries done for done in 90° flexion so it is done in chronic injuries chronic injuries lashman test now this test can be done in acute injury see the word is lashman can be done in acute injuries pivot shift test is considered specific test specific test L test or liver test is a comparatively new test is a comparatively new test now how we do the Reconstruction we cannot repair the ligament what will we do we'll remove a part of patellar tendon like this we'll remove a part of pellar tendon along with bone along with bone on both sides see watch the animation ACL breaks patella tendon removed along with bony plugs whole in femur whole in tiia then we fix like this so this becomes our new ACL this becomes our new ACL anterior cruciate ligament right it cannot be repaired so similarly posterior cruciate ligament posterior cruciate ligament will give you difficulty in walking uphill as well as downhill what are the tests posterior draw test or godf freay test so if you ask the patient to lie like this the tibia will go posteriorly tibia will go posteriorly that is called as sag sign investigation of choice again MRI and reconstruction is done with gracilis tendon graft meniscus injury so first of all they will ask you which meniscus is injured lateral meniscus or medial meniscus so it is the medial meniscus which is more commonly injured because it has very thin body so that means it is weak it is less it has less circular shape that means it has got more more surface area so more chance of injury now when the femur rotates over tibia the lateral meniscus is pulled away there is no such mechanism there is no such mechanism for medial meniscus so it is trapped between the two bones now medial meniscus is fixed to the capsule of knee joint that is why it cannot move anywhere it cannot move anywhere now most common pattern of tier is longitudinal which may become bucket handle which may become bucket handle type of tier so this is bucket handle type of tier investigation of choice is MRI whereas the gold standard investigation is arthoscopy now clinical feature pain and swelling will occur after 2 to three days if the tier is present in outer part of the Minar we will do the repair that is menisco refi why because the outer part is vascular it will heal if the tiar is present in the interior part we'll do menisectomy because the inner part is avascular it will not heal at all it will not heal at all now you need to remember as one liner that what is the clinical investigation of choice it is the macur test because it is done in supine position which keeps your patient absolutely comfortable it is done in supine position which keeps your patient absolutely comfortable but very quickly you see this is how you identify an Austin Mo pin atin atin Mo pin so you see it will be smooth over here whereas on the other side there will be ribs null spin smooth smooth and ribs kwire you know it Austin Mo prosthesis now this is used for hip Hemi Aro plasty so in Austin Mo you'll see that there are two holes there are at least two holes one hole second hole Austin Mo prosthesis Austin Mo prosthesis so there are two holes the name is MO two holes see this is Austin Mo this is Thomson single solid body no hole at all bipolar hip prosthesis it is present in two parts first part second part will fit inside second part will fit inside I'll tell you which traction is important so you see Buck traction Buck traction so this is the weight so Buck traction is a type of skin traction Buck traction see this is Buck traction Buck traction now you see here the leg is straight if the leg is lifted up it becomes rustle traction if the leg is lifted up it becomes russle traction rustle traction so if the leg is straight that is Buck traction if the leg is lifted up that is Russell traction Russell traction that is Bryant traction Brant traction for children also called as Gallow traction Gallow traction brine traction for children is called Gallow traction Gallow traction gallot traction not important hell traction you already seen hell traction hello traction CR wire that is just for stabilization of the fracture somi brace so if the head is not covered fine only the neck chest are covered that is somi brace tailor brace tailor brace is important because it is used for tuberculosis it is used for tuberculosis figure of f bre you know it is used for clavical fracture figure of Fate brace Aeroplane splint brachial plexus injury sugar Tong thumbs [ __ ] image based question only from here stack splint knuckle Bender splint so if you see the fingers in flexion and if you see the thumb absolutely free that is called as knuckle Bender splint used for alner nerve Injury One Rosen splint it is used for ddh developmental dysplasia of hip Dennis Brown splint you have already seen hard cervical colar also called as Philadelphia color Philadelphia collar Philadelphia colar right buddies so with this uh we'll end the class whatever topics we could not discuss nevertheless I'll send the notes for that also all the topics which we could not discuss for example we could not discuss the general consideration in fracture infections and hip joint these three topics which I could not discuss I'll definitely send the notes fine so can you allow me to end the class here and if you have any queries I'm always available you guys are tired I totally understand that at this moment you guys are tired right then uh can I please end the class if you have any queries you can always send and I'll uh send the notes as early as possible you know it will take me around 40 45 minutes to reach home and ask as soon as I'm home I'll uh share my notes on the PDF Channel G end class I