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CTEV : congenital talipes equino varus ( club foot )


INTRODUCTION :
Clubfoot can be classified as (1) postural or positional or (2) fixed or rigid. Postural or positional clubfeet are not true clubfeet. Fixed or rigid clubfeet are either flexible (ie, correctable without surgery) or resistant (ie, require surgical release, though this is not entirely true according to the Ponseti experience1, 2, 3).
The Pirani, Goldner, Di Miglio, Hospital for Joint Diseases (HJD), and Walker classifications have been published, but no classification system is

Gustilo's classification of open fractures





Gustilo Classification
I
Low energy, wound less than 1 cm
II
Wound greater than 1 cm with moderate soft tissue damage
III
High energy wound greater than 1 cm with extensive soft tissue damage
IIIA
Adequate soft tissue cover
IIIB
Inadequate soft tissue cover
IIIC
Associated with arterial injury

Enneking staging of bone tumors


Enneking System for Staging Benign and Malignant Musculoskeletal Tumors
BENIGN


1.   
Latent



2.   
Active



3.   
Aggressive

MALIGNANT
Stage
Grade
Site
Metastases
IA
Low
Intracompartmental
None
IB
Low
Extracompartmental
None
IIA
High
Intracompartmental
None
IIB
High
Extracompartmental
None
III
Any
Any
Regional or distant metastases

Mangled Extremity Severity Score


*LIMB SALVAGE Vs AMPUTATION :

*To predict which limbs will be salvageable after trauma, available scoring systems include the predictive salvage index, the limb injury score, the limb salvage index, the mangled extremity syndrome index, and the mangled extremity severity score. Of these, the Mangled extremity severity score was found to be most useful.

*This system, which is easy to apply, grades the injury on the basis of the energy that caused the injury, limb ischemia, shock, and the patient's age.

*The system was subjected to retrospective and prospective studies, with a score of 6 or less consistent with a salvageable limb. With a score of 7 or greater, amputation was the eventual result.

*Although we do not strictly follow these guidelines in all patients, we do calculate and document a mangled extremity severity score in the chart whenever we are considering primary amputation versus a complicated limb salvage.

*Mangled Extremity Severity Score
Type Characteristics Injuries Points
1 Low energy Stab wounds, simple closed fractures, small-caliber gunshot wounds 1
2 Medium energy Open or multiple-level fractures, dislocations, moderate crush injuries 2
3 High energy Shotgun blast (close range), high-velocity gunshot wounds 3
4 Massive crush Logging, railroad, oil rig accidents 4
Shock Group
1 Normotensive hemodynamics BP stable in field and in OR 0
2 Transiently hypotensive BP unstable in field but responsive to intravenous fluids 1
3 Prolonged hypotension Systolic BP <90 mm Hg in field and responsive to intravenous fluid only in OR 2
Ischemia Group
1 None Pulsatile limb without signs of ischemia 0[*]
2 Mild Diminished pulses without signs of ischemia 1[*]
3 Moderate No pulse by Doppler, sluggish capillary refill, paresthesia, diminished motor activity 2[*]
4 Advanced Pulseless, cool, paralyzed, and numb without capillary refill 3[*]
Age Group
1 <30 y
0
2 >30 – <50 y
1
3 >50 y
2

BP, blood pressure; OR, operating room.


*
Points × 2 if ischemic time exceeds 6 hours

Differences between Gout and Pseudogout


GOUT
PSEUDOGOUT
1.       Smaller joints
1.       Large joints
2.       Intense pain
2.       Moderate pain
3.       Joint inflamed
3.       Joint swollen
4.       Hyperuricemia
4.       Chondrocalcinosis
5.       Uric acid crystals
5.       Calcium pyrophosphate crystals
6.       Rod shaped crystals
6.       Rectangular shaped crystals
7.       Negatively bisfringent
7.       Positive bisfringence

Causes of Pseudoarthrosis


*Pseudoarthrosis is a false joint, that may develop after a fracture that has not united properly.

*It may be idiopathic.

*Causes of Pseudoarthrosis (in decreasing order of frequency are) :
1. Non union of a fracture - including pathological fracture.
2. Congenital - in the middle to lower third of the tibia with or without fibula. 50% present in the first year. Later there may be cupping of the proximal bone and pointing of the distal bone end.
3. Neurofibromatosis - seen in 50% of patients with pseudoarthrosis.
4. Osteogenesis imperfecta
5. Cleidocranial dysplasia - congenitally in the femur
6. Fibrous dysplasia
7. Ankylosing spondylitis - in the fused bamboo spine .

Causes of Osteolytic and Osteoblastic metastases


*Causes of Osteolytic metastasis :
- Kidney (expansile) and Thyroid : Expansile lytic osseous metastasis are characteristic of Renal cell carcinoma (kidney) and Thyroid .
- Lung
- Gastrointestinal tract (GIT)
- Breast (occasionally)
- Less commonly melanoma, carcinoma of bronchus and pheochromocytoma may also present with Expansile lytic lesions.

*Causes of Osteoblastic metastasis :
- Prostate
- Breast (may be mixed)
- Seminoma
- Carcinoid 
- Neurogenic tumors
- Uterus 
- Ovary
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