DIMS Lectures Orthopedics PDF

Here is the complete pdf lecture of orthopaedics by Dr. Tahir Malik

Introduction

Orthopedics surgery deals with traumatic injuries, fractures, dislocations, and complications affecting the musculoskeletal system. Understanding fracture classification, healing mechanisms, and surgical management is crucial for medical students and practitioners.

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1. Fractures: Types, Pathogenesis, and Management

Definition:

A fracture is a break in the bone caused by trauma, repetitive stress, or pathological weakening.

Types of Fractures:

• Closed Fracture: Bone breaks but skin remains intact.
• Open (Compound) Fracture: Bone pierces the skin, increasing the risk of infection.
• Transverse Fracture: Straight horizontal break across the bone.
• Oblique Fracture: Angulated break.
• Spiral Fracture: Twisting injury causes a helical break.
• Comminuted Fracture: Bone shatters into multiple fragments.
• Greenstick Fracture: Incomplete fracture common in children.
• Pathological Fracture: Occurs in weakened bone (e.g., osteoporosis, tumors).

Fig. Types of Bone Fractures 

Fracture Healing Process:

1. Inflammatory Phase (1-7 days): Hematoma formation, inflammatory cell migration.
2. Soft Callus Formation (2-3 weeks): Fibrocartilage bridges the fracture gap.
3. Hard Callus Formation (3-6 weeks): Mineralization of callus.
4. Remodeling Phase (Months-Years): Bone reshapes to original structure.

Complications of Fractures:

• Early Complications:
  • Hemorrhage (vascular injury), nerve damage.
  • Compartment syndrome (ischemia due to increased pressure).
  • Fat embolism syndrome (long bone fractures).
  • Infection (especially in open fractures).
• Late Complications:
  • Delayed union, malunion, or nonunion.
  • Avascular necrosis (common in femoral neck fractures).
  • Post-traumatic arthritis.

Management:

• Non-Surgical: Immobilization with casts, splints, traction.
• Surgical: ORIF (Open Reduction Internal Fixation), External Fixation.
• Rehabilitation: Physiotherapy to restore function.

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2. Dislocations and Their Management

Definition:

A dislocation occurs when the bones in a joint are forced out of alignment.

Common Sites of Dislocation:

• Shoulder (Most Common): Anterior dislocation more frequent than posterior.
• Elbow: Posterior dislocations common in falls.
• Hip: Posterior dislocation (common in trauma, dashboard injuries).
• Knee: High-energy trauma (risk of vascular injury).

Clinical Features:

• Deformity, severe pain, swelling.
• Loss of function.
• Neurovascular compromise in severe cases.

Diagnosis:

• X-ray: Confirms bone displacement.
• MRI/CT: Used for complex dislocations or associated fractures.

Management:

• Immediate Reduction: Closed reduction under sedation.
• Immobilization: Sling or cast for stabilization.
• Surgical Repair: Required if dislocation is recurrent or associated with fractures.

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3. Common Fractures of Long Bones

1. Clavicle Fracture

• Common in falls onto the shoulder.
• Treatment: Arm sling for midshaft fractures, surgery if displaced.

2. Humerus Fracture

• Proximal humerus: Common in elderly (osteoporotic fractures).
• Shaft fractures: Risk of radial nerve injury.
• Supracondylar fractures: Common in children (risk of compartment syndrome).
• Treatment: ORIF for displaced fractures, splinting for minor fractures.

3. Femur Fracture

• High-impact trauma or pathological fracture in osteoporosis.
• Complications: Fat embolism, avascular necrosis (femoral neck fracture).
• Treatment: IM nailing, ORIF, or hip replacement.

4. Tibia/Fibula Fracture

• Common in road traffic accidents (RTAs) and sports injuries.
• Open fractures require debridement to prevent infection.
• Treatment: Casting, ORIF, or external fixation.

5. Colles' Fracture (Distal Radius Fracture)

• Occurs due to a fall on an outstretched hand (FOOSH).
• Dorsal displacement of distal fragment (“dinner fork deformity”).
• Treatment: Closed reduction and casting; surgery if unstable.

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4. Pathological Fractures and Bone Disorders

Osteoporosis:

• Definition: Reduced bone mass leading to fragile bones and fractures.
• Common Fracture Sites: Vertebrae, hip, wrist.
• Diagnosis: DEXA scan (T-score ≤ -2.5).
• Treatment: Bisphosphonates, calcium + vitamin D supplementation.

Paget’s Disease of Bone:

• Definition: Disordered bone remodeling, leading to deformities.
• Clinical Features: Bone pain, skull enlargement, hearing loss.
• Treatment: Bisphosphonates, NSAIDs for pain.

Avascular Necrosis (AVN):

• Definition: Bone tissue death due to ischemia.
• Common Sites: Femoral head, scaphoid, talus.
• Diagnosis: MRI is gold standard.
• Treatment: Core decompression, joint replacement if severe.

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5.Common Orthopedic Injuries

1. Rotator Cuff Tear

• Definition: Injury to supraspinatus, infraspinatus, teres minor, or subscapularis muscles.
• Clinical Features:
  • Shoulder pain, weakness.
  • Difficulty in abduction.
• Diagnosis: MRI of the shoulder.
• Management:
  • Physical therapy, NSAIDs.
  • Surgical repair in complete tears.

2. Anterior Cruciate Ligament (ACL) Injury

• Definition: Tear of the ACL, often in sports injuries.
• Clinical Features:
  • Popping sensation, knee instability.
  • Positive Lachman’s test, Anterior drawer test.
• Diagnosis: MRI.
• Management:
  • Physiotherapy (partial tears).
  • ACL reconstruction in athletes.

Case Example:

A 30-year-old male was involved in a high-speed road traffic accident and presents with severe thigh pain and swelling. Examination reveals shortening of the limb and inability to bear weight. X-ray confirms a midshaft femur fracture.

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Diagnosis: Closed Femoral Shaft Fracture

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