collabORTHO

Introducing Our Committee: Dr. Mariana Rufino.

Mariana is a foundation year one doctor pursuing her medical training in the UK.

Paediatric knee radiographs are commonly encountered in the emergency department and vary from adult knee radiographs. Younger knees have open growth plates, ossification centre development and display unique injury patterns. Growth plates are areas of weakness, susceptible to fracture and injuries can result in development deformity in leg length and alignment.

Ossification
Check the ossification centres are present.
-Distal femur: 3-6 months
-Patella: 3-5 years
-Tibial plateau: present at birth
-Tibial tuberosity:10-12 years
-Fibular head: 2-4 years

Alignment
Check the tibio-femoral alignment:
draw a line down the margin of the lateral femoral condyle tibial should line up within 0.5 cm if it does not, consider a tibial plateau fracture

Check patella height using the Insall-Salvati ratio
Look at lateral knee x-ray with knee 30 degrees flexed measure the patella tendon length and divide it by the patella length normal ratio is 0.8-1.2 if it is >1.2 consider a patella tendon rupture alternatives: Blackburne-Peel ratio or Caton-Deschamps index

Effusion
There are two fat pads in the knee (reliably seen on the lateral view):
- Suprapatellar fat pad
- Prefemoral fat pad
Soft tissue density between the two fat pads indicates an effusion.

Bone cortex
Check around the cortex of every bone on the film fibular head, tibia, femur and patella

Credits

Introducing our Marketing Officer: Dr. Hoosai Manyar.

Hoosai is about to start Core Surgical Training in the KSS deanery, aiming towards a career in Trauma and Orthopaedics.

The odontoid process, or dens, is a superior projecting bony element from the second cervical vertebrae (C2, or the axis). The first cervical vertebrae (atlas) rotates around the odontoid process to provide the largest single component of lateral rotation of the cervical spine. Fracture of the odontoid process is classified into one of three types, which are type I, type II, or type III fractures, depending on the location and morphology of the fracture.

Type I Odontoid Fracture

A type I odontoid fracture occurs when the rostral tip of the odontoid process is avulsed (broken or torn off). This injury commonly occurs due to pulling forces from the apical ligament attachment to the odontoid process. The apical ligament attaches the tip of the odontoid process to the foramen magnum (skull base).

Type II Odontoid Fracture

A type II odontoid fracture is a fracture through the base of the odontoid process. This injury occurs most typically when there is an excessive extension of the cervical spine, and the anterior arch of C1 pushes dorsally (backward) with sufficient force on the odontoid process (dens) to fracture the odontoid process at its base. Type II odontoid fractures can also occur with hyperflexion of the neck and the transverse ligament, pushing the odontoid process forward to the point of fracture.

Type III Odontoid Fracture

A type III odontoid fracture is a fracture through the body of the C2 vertebrae and may involve a variable portion of the C1 and C2 facets. Type III odontoid fractures occur secondary to hyperextension or hyperflexion of the cervical spine in a similar manner to type II odontoid fractures. The difference is where the fracture line occurs.

Credits

Introducing our Secretary: Dr. Siddarth Raj.

Foundation Year 2 - Trauma and Orthopaedics at University Hospitals Coventry and Warwickshire NHS Trust.

Interested in pursuing a career in T&O.

T&O rep for International Virtual Medical Conference.

Wrist trauma is a common presentation to the emergency department and X-ray is typically the first-line investigation used to identify bony injuries. This guide provides a step-by-step approach to interpreting wrist X-rays and includes examples of the key pathology you may come across.

The main bones of the forearm are the ulna (medially, at the side of the little finger) and radius (laterally, at the side of the thumb). The wrist (carpus) is composed of 8 bones as remembered by the mnemonic ‘Some Lovers Try Positions That They Can’t Handle’:

- Scaphoid (proximal row)
- Lunate (proximal row)
- Triquetrum (proximal row)
- Pisiform (proximal row)
- Trapezium (distal row)
- Trapezoid (distal row)
- Capitate (distal row)
- Hamate (distal row)

Lateral View XRs (normal findings):
- The long axis of the radius, lunate, capitate and the third metacarpal bone should align

- The palmar/volar cortex of the pisiform bone should lie between the scaphoid and capitate bones

- The radial surfaces should appear smooth

- There should be a volar tilt of between 10°- 25°

- The volar tilt (palmar tilt) is a measurement made on the lateral view. This is the angle between a line along the distal radial articular surfaces and a line perpendicular to the longitudinal axis of the radial shaft. The average volar tilt is approximately 11° and can range from 2°-20°.1

Tip: the lunate can be identified by its moon-shaped appearance and the scaphoid and capitate can be identified by their association.

Credits

Introducing our Director Of
Operations: Dr André Fernandes.

Senior House Officer - Trauma and Orthopaedics.

York and Scarborough Teaching Hospital NHS
Foundation Trust.

Currently applying to ST3 Trauma &
Orthopaedics.

André has a special interest in education and
technology.

You may learn more about Dr Fernandes on his
website:

https://www.fernandesmd.com/

Introducing our Director Of Operations: Dr André Fernandes.

Senior House Officer - Trauma and Orthopaedics.

York and Scarborough Teaching Hospital NHS Foundation Trust.

Currently applying to ST3 Trauma & Orthopaedics.

André has a special interest in education and technology.

You may learn more about Dr Fernandes on his website:

https://www.fernandesmd.com/

The knee is a complex and very important weight bearing joint of the human body. Knowing how to interpret an MRI is of the uttermost importance for any practitioner. Structures you should try and identify/assess are:

1) Menisci
The medial and lateral menisci are fibrocartilage structures. They are C shaped and attached at both ends to the intercondylar area of the tibia.

2) Bursae
A bursa is synovial fluid filled sac and there are four bursae found in the knee joint:
-Suprapatellar bursa – an extension of the synovial cavity of the knee, located between the quadriceps femoris and the femur.
-Prepatellar bursa – found between the apex of the patella and the skin.
-Infra-patellar bursa – split into deep and superficial. The deep bursa lies between the tibia and the patella ligament. The superficial lies between the patella ligament and the skin.
-Semimembranosus bursa – located posteriorly in the knee joint, between the semimembranosus muscle and the medial head of the gastrocnemius.

3) Ligaments
The major ligaments in the knee joint are:
-Patellar ligament – a continuation of the quadriceps femoris tendon distal to the patella. It attaches to the tibial tuberosity.
-Collateral ligaments – two strap-like ligaments. They act to stabilise the hinge motion of the knee, preventing excessive medial or lateral movement
-Tibial (medial) collateral ligament – wide and flat ligament, found on the medial side of the joint. Proximally, it attaches to the medial epicondyle of the femur, distally it attaches to the medial condyle of the tibia.
-Fibular (lateral) collateral ligament
-Cruciate Ligaments – these two ligaments connect the femur and the tibia.
-Anterior cruciate ligament – attaches at the anterior intercondylar region of the tibia where it blends with the medial meniscus. It ascends posteriorly to attach to the femur in the intercondylar fossa.
-Posterior cruciate ligament – attaches at the posterior intercondylar region of the tibia and ascends anteriorly to attach to the anteromedial femoral condyle.

Credits:

It’s this evening! 🙌

The x teaching session, to be delivered by Miss Ann McCormack BSc, MBBS, MRCS.

We'll be going over the basics of osteoarthritis and it's relevance in the world of orthopaedics 🦴💥

Don’t forget to register, following this link:
https://docs.google.com/forms/d/e/1FAIpQLSdGubST6Yx2fpHCLuLhxZLnW7kcdAJT1XDlPabbQCQ1MFZOMA/viewform

We hope to see you soon 🔜🕖

Event sponsored by @strykercareers

The lower back comprises the lumbar spine, which is formed by vertebral bones, intervertebral discs, nerves, muscles, ligaments, and blood vessels. The spinal cord ends at the top of the lumbar spine, and the remaining nerve roots, called the cauda equina, descend down the remainder of the spinal canal.

Functions of the Lumbar Spine
The lower back performs the following important functions:

Support and stabilize the upper body. The 5 lumbar vertebrae are the largest compared to other spinal regions.1,2 In conjunction with the muscles and ligaments, these vertebrae help support the weight of the upper body, including the head and neck. The lumbar spine also transfers loads from the upper body to the legs.2
Allow truncal movements. The lower back is the primary facilitator for movements of the trunk in various directions, including front and back, side to side, and twisting movements.3 Movement mostly occurs in the last two vertebral levels.4
Protect the spinal cord and cauda equina. The upper lumbar vertebrae protect the spinal cord in their vertebral arches. The lower vertebrae provide a bony enclosure for the cauda equina nerves that descend from the spinal cord.
Control leg movements. The lumbar spinal nerves that branch off from the spinal cord and cauda equina to control movements and sensation in the legs.

Credits:

Introducing Faculty: Miss Fiona Bintcliffe

ST7 Trauma and Orthopaedics at the Kent, Surrey & Sussex Deanery.

Brighton and Sussex University Hospital .

Trainee registrar with interests in upper limb and paediatric surgery.

Miss Fiona Bintcliffe has taught on courses for medical Students from Bristol, Southampton, Exeter and Brighton Universities.