Ortho Oracle - orthopaedic operative atlas

Knee

Management of Fibula in HTO

– Discussion:     – proximal tibiofibular joint will prevent valgus correction unless fibula is shortened or tibiofibular ligaments are removed;     – transection if tibiofibular ligamets: (preferred technique)            – performed thru same incision as for osteotomy;            – proximal tibiofibular joint capsule is disrupted … Read more

Malignant Fibrous Histiocytoma

– See: Bone Tumor Menu: – Osseous Sarcoma:     – occur less often in bone than in soft tissue;     – occurs in older patient population & may arise out of Pagets Dz or from a bone infarct (such as sickle cell);     – it usually presents as an aggressive stage IIb … Read more

Lyme Disease: Erythema chronicum migrans

Discussion deer tick (Ixodes) borne spirochetal infection leading to widespread symptoms; in U.S. Lyme disease is most prevalent in areas with heavy deer population (North East); life cycle includes larval, nymph, and adult (with the nymphal stage transmitting bacteria); infection is due to Borrelia burgdorferi spirochetes; contains several outer surface proteins that allow organism to … Read more

Lumbar Stenosis

– Discussion:     – spinal stensosis is a narrowing of the lumbar spinal canal and/or neural foramina;     – results in compression of the cauda equina and lumbar nerve roots, producing neural root ischemia and neurogenic claudication;     – compression of neural structures also compresses vascular supply of nerves so that symptoms are predominately those of … Read more

Lumbar Vertebrae

– Discussion:     – their heights are less than their horizontal diameters;     – pedicles are relatively short and project from the upper half of body;     – laminae are thick & droop below level of pedicles but do not overlap;     – spinous process is hatchet-shaped and projects horizontally, with … Read more

Low Back Pain in the Adult

– Discussion:     – low back pain is the second most common symptomatic reason for physician visits (followed by URTI)     – diff dx:     – waddel criteria: – Exam of Lumbar Spine:     – exam of C-Spine:     – neuro exam     – general assessment:       … Read more

Losee Test

– See:   – Pivot shift   – Anterior Cruciate Ligament   – Anterolateral Rotatory Instability   – Clunk Test   – Diagram   – Lachman   – Losee Test   – reverse pivot shift Test – Discussion:  – begins w/ the knee in flexion as an external rotation & valgus force are applied;  – … Read more

Longitudinal Meniscal Tear

  – longitudinal tears, which usually involve the posterior portion of the meniscus, are the most common meniscal lesions;   – in many cases, gross inspection reveals only slight irregularities in inner border of the meniscus;   – probing is necessary to establish the presence of a tear;   – the meniscus should be probed from its … Read more