Mr Azaiddin Teaching Recap 12.30pm-2.00pm

Here's the recap of what happened today (26th Jan 2010) in Mr Aziddin's teaching. I'll try to recap what I remembered, but I do hope others who attended the teaching today to give feedback and add some that I had missed. You could leave it at the comments section, and I'll edit when I have the time. This is not just for the benefit of those who could not attend today but also for us to refresh our memory. So I'll start the ball rolling. (I came in a bit late, so might have missed some in the early part as well)

Legend:  
Black = Me (YM)
Blue  = Caryn
Violet = Jia Hui
Others = Red (With name mentioned alongside)


Input from Caryn and Jia Hui can be found from FB note of this post. n_n

In the exams, when asked to describe the features of X-Ray or anything, please do it briefly. I doubt any of us could do so since we wouldn’t really know what it’s all about.

If the question mentioned "what ARE the complications?", then name a few, not just one.

1) Radiograph showed osteoarthritis of the knee.

Student is required to describe 4 features seen in the radiograph and give a diagnosis.

Student was asked to state the x-ray changes, management, and complications of OA

2) Picture showed an open wound supracondylar fracture. (One photo and one radiograph)

Open supracondylar fracture of the right femur, Gustilo Type 3B

In describing the fracture, make sure it is done meticulously, for example, the site, pattern of fracture, type of fracture, adult/pediatrics, left or right side.


If asked on immediate management, it is preferred that you answer the orthopedic management, ranging from IV fluid, IV antibiotic, wound dressing, splinting, etc.

Definitive treatment-wise, the management of open fracture would be indicated. It was mentioned that of wound debridement and external fixation(temporary) then only internal fixation-read up on it.
The Mx is wound debridement, external fixation, wait the wound to heal/confirm the wound not contaminated, then only internal fix.
Ct Noor Zai:  if put Internal Fixation 1st, there is high risk of infection  

3) Radiograph showed fracture of distal radius in a child. It was mentioned that Colles fracture is reserved for the elderly (and some say post menopausal), so it was supposed to be some sort of Volar – Barton fracture. Read up on the types of fracture of the upper limbs, such as Galleazi and Monteggia ++ and their definitive treatment. Mr Azaiddin mentioned that Juvenile Colles is not an acceptable term of usage from Apley’s.
Colles for elderly osteoporotic bone.  NEVER say juvenile Colles, don't follow Apley's on that one.  Read up on Salter-Harris as well I guess.

Management for this would depend on AGE. For child, it may be CMR + Percutaneous K-Wire (if needed). In adults, it may be screw and platings)

4)Radiograph showed bilateral DDH (read on description). Draw a Perkin’s line and Hilgreiners’ line to form a cross of 4 quadrants. Epiphysis should lie in the inner(medial) and lower quadrant. In this radiograph, the epiphysis of both femoral head lie on the upper and outer (lateral) quadrant.

Treatment would depend on age.(read Apley’s)


5) Radiograph showed pelvic region. Identify if it’s a peds or adult pelvis (read on the characteristics). Radiograph showed destruction of right femoral head, suggestive of AVN. However, this radiograph is a peds case, so it is Perthes. Adult and Peds AVN will determine the management, since Adult AVN usually end up with total hip replacement while Perthes usually require containment (monitoring and follow up)
And corrective osteotomy if the femoral head is dislocated.  and read up on SUFE appearance as well.

6) Radiography showed a picture of what looked like mid shaft humeral fracture. However, if carefully examined, the soft tissue area is much larger than bone diameter. Therefore, this is a mid shaft femoral fracture. Remember, checking soft tissue is very important!
Spiral fracture of mid shaft of femur.  For CMR and spica.  Gallows traction.  Could be non-accidental injury or fall from height (eg buaian)


7) Radiograph of Monteggia fracture. Remember the definition of Monteggia fracture. Mnemonics given was MU – Monteggia is for Ulnar fracture.
 For CMR and casting

8)Radiograph showed AP and lateral view of fracture of radius. What is more important is that on careful inspection, there is fracture of ulna as well. There is displacement of epiphyseal plate of ulnar as seen by lateral view.
It's a Galleazi

9)Radiograph showed a supracondylar fracture of distal humerus. Remember the types ( I, II, III, etc) which describes if it’s intact, displaced, or whatsoever. (I’m not sure what classification it was). Also do know of the management.
Gartland classification of extension type supracondylar fractures of the humerus.  I only got type 1,2,3 though, couldn't find any subtypes for 3.  since it's a kid, just do CMR and above elbow POP (types 1 and 2), K-wiring for type 3.

10) Picture showed a child on gallows traction- a form of sustained skin traction (google one to see it). Name the indication (femoral shaft fracture in very young children), the purpose( done on both sides to stabilize the fracture, more comfortable, etc) and its complications ( tapes and circular bandages may constrict circulation, thus not be used in children over 12 kg in weight).
Done for 14-21 days before changing to spica, for soft callus to form at site of fracture, as gallows traction keeps bone in neutral position, it stabilizes the fracture.  

11) Radiograph showed what may seem like a fracture of ulnar, but it is an old fracture. It is a hypertrophic non-union(read on hypertrophic and atrophic non-union along with their characteristics). Also know about the management of non-union.
Hypertrophic non-union: plating, internal fixation

12)Radiograph showed another what may seem like a supracondylar fracture.

13) Picture showed a form of external fixation on the tibia. Name its indication as well.
External fixation, indications, complications.

14)Radiograph showed the knee area which seemed normal. Careful inspection would revealed a very thin fine line suggestive a tibial plateau fracture.
That fracture was so small i totally missed it.
--> And I thought it was an artifact or scratchmarks on the film -.-"

15) Radiograph of a tricompartmental sever osteoarthritis of the knee. (3 compartments:lateral, medial and patella-femoral joint space)
With presence of subchondral cyst.

16) Radiograph showed AVN in an adult, which was confused to be OA of hip. However, in OA, the bones have clear outline, while in AVN, there is irregular surface due to bone destruction.
AVN - flattened femoral head as well.  for THR(in older patients).  if younger patients (contoh 22 year old SLE patient on long term steroids), how to manage? someone mentioned something about partial hip replacement, don't know what's that leh.

17) Radiograph of what may seem to be intertrochanteric fracture. Give the management (internal fixation?)
 Internal fixation, dynamic hip screw.

18) A photo of external(pelvic) fixation located at the abdomen. Seems to be a open wound pelvic fracture. Name it and its indication (types of pelvic fracture, etc)
External fixation for pelvic open book fracture (of the symphysis pubis diaphysis? i think i heard something like that. not sure.)

19) Photo of skin traction in an elderly. It is usually a temporary treatment until definitive treatment can be done.
Maximum 5kgs for skin traction.
-->And Prof Hassan insisted it was 10% of body weight. Told him it was 5kg or maybe 5%, but he said don't believe the books. :P
Function of skin traction: stabilize, immobilize and reduce pain

20)Radiograph of what seem to be avulsion fracture of? (Kindly fill in this part)
I think it was an olecranon fracture for tension band wiring.

21) Photo of Halovest. Indications and complications?
For upper cervical fractures (C1,2,3). Cx includes infection and temporal artery damage
Kas: Complications- Infection, temporal artery injury and pin loosening


22) Photo of body cast. Indication and complication(paralytic ileus in 2nd part of duodenum?).
Yeah and I heard something about superior mesenteric artery. Have no idea where that fits in
Kas: Photo of body cast with window. I think he said there will be paralytic ileus due to obstruction of duodenum.
Superior mesenteric artery (SMA) syndrome is characterized by compression of the third, or transverse, portion of the duodenum against the aorta by the superior mesenteric artery, resulting in duodenal obstruction. One of the cause is using body cast in the surgical treatment. (u can check this website http://emedicine.medscape.com/article/932220-overview)

23)Photo of an Ulnar Nerve palsy. Lower lesion.

24) Above shoulder cast. (Long arm cast up till shoulder)
I think he said it was a hanging cast, since it was up till the shoulder.  For lower third humeral fracture or something like that. 

In conclusion, there are a lot to read. All the best!

I think there were also a few other pictures, one of an ankylosing spondylitis patient doing a wall test, a fracture dislocation of the right shoulder joint, and one more of an OA knee with varus deformity and parapatellar + suprapatellar swelling.  
--> Yes, indeed.... It was too fast and beyond the speed of my hands and mind to copy. :P

Mr Azaiddin mentioned on hand, Knee, Osteoarthritis. And also that Spine is a favorite KFQ question. Whether if it’s true or not, no one knows until the exam comes.