Anterior dislocation of hip

Cause
Road accident or air crash

        Mechanism
        Position when weight falls on  -legs wide apart
        Knees straight nd back bent forward

Types
1 pubic (femur head lie superiorly)
2 obturator (femur head lie inferiorly)

    Cf
    Presentation - leg lie externally rotated,abducted nd     slightly flexed.
     Shortening of leg absent   
     Hip movement impossible

X ray
AP view (see image )
Lateral view (used to resolve doubts)

AP VIEW femur head dislocated anteriorly

       Tt

       Dislocation reduction under GA

Complication

Avascular necrosis

Supracondylar Humerus Fracture

Keypoints:-
• MC elbow # in Children.
• Cause - Hyperextension

Types:-
•Extension - MC
  Distal fragment is tilted posteriorly.

Garland Type 3 Fracture

•Flexion - Distal fragment tilted anteriorly.

CF:-
• S Shaped deformity.

S Shaped deformity

• 3 point bony relation maintained.

T/t:- Gartland classification
• Type1 - Immobilization
• Type2 - Percutaneous pinning
• Type3 - Open reduction and internal fixation

Complications:-
• Early:-
▪Injury to Brachial artery (may lead to         Volkmann's Ischemic Contracture).
▪ Median nerve injruy
• Late:-
▪Malunion (MC) which results in Gun Stock Deformity.

T/t for Gun Stock Deformity- Lateral close wedge osteotomy.

This is High Tibial Osteotomy
Similar to Lateral closed Wedge Osteotomy

▪Myositis Ossificans and elbow stiffness
▪Volkmann's Ischemic Contracture.

Garland Type 1 fracture

Anterior shoulder dislocation

Keypoints:-
•MC joint to dislocate - Shoulder
•MC shoulder dislocation - Anterior (Subcoracoid)

       Cause:-

       •Abduction, Ext rotation, Extension

CF:-

The resting position after dislocation:-

Abduction and external rotation

Squared off shoulder (R)

Tests:-

• TRICK Durga Called Hamilton for Biryani and Bandage.
 Durga - Dugas test
  Called - Callway test
   Hamilton - Hamilton test
    Biryani - Bryant test
     Bandage - Regiment badage test

      Complication:-
      •Axillary Nerve injury

T/t:-
•Kocher's maneuver - TEAM
T - Traction
E - External
A - Adduction
M - Medial rotaion of arm

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Hangman Fracture / C2 Pars Interarticularis Fractures

Keywords:-
• B/L fracture of pars Interarticularis of axis.
• Spondylolisthesis of axis over C3.
• 2nd MC type of axis fracture.

Cause:-
• Extension with distraction and hyper extension.

•Death is common.
•No neurological deficit.

T/t:-
• Successful healing of C2 spondylolisthesis is about 95%.
• Undisplaced fracture - Semi rigid orthosis
• Displaced fracture - Close reduction with Halo-vest.

Jefferson Fracture / Atlas Ring Fracture

Keyfeature:-
• Fracture of Ring Of Atlas.
• Axial compression fracture.
• Most common Fracture of Atlas.

Complications:-
• No neurological damage (except pain or loss of sensation in greater occipital nerve distribution).

Diagnosis:-
• X-ray features :-
> Open mouth view - Overhanging lateral masses of C1 on C2.

• CT is defining.

T/t:-
•Mainly conservative.
> Undisplaced but stable - Semirigid cervical collar / Halo-vest
> Unstable with transverse ligament rupture - Halotraction followed by halo-vest immobilization.
> Late instability/ Non union - atlanto axial arthrodesis and atlanto occipital fusion.

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