Causes

Question 1

indication of scaphoid fixation

Answer 1

1. displacement of > 1mm or angulation
2. communition
3. proximal pole fracture
4. delay in diagnosis and treatment
5. lateral interscahoid angle of >35 degrees
6. DISI alignment
7. Ht to length ratio of > 0.65
8. Fracture associated with perilunate injury

Question 2

Cubital tunnel

Answer 2

Mike and Marco opened a Factory

• M – medial intermuscular septum
• A – arcade of Struthers
• M - medial epicondyle
• O – Osborn’s fascia
• A – Anconeus epitrochlearis
• F - FCU

Question 3

PIN injury

Answer 3

FLEAS o

• F –Fibrous band of radio-capitellar joint
• L – leash of henry
• E – ECRB
• A – arcade of Frosche
• S - Supinator

Question 4

AIN

Answer 4

Elbow – FLAPS ·

• F - FDS aponeurosis
• L ligament of Struthers
• A aponeurosis of biceps ( Lacertus fibrosus )
• P Pronator teres
• S Supra condylar process

Question 5

AVN

characterized by a stereotypical pattern of cell death and a complex repair process of bone resorption and formation

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596210/

Modified from Zalavras CG, Lieberman JR: Osteonecrosis of the femoral head: evaluation and treatment, J Am Acad Orthop Surg 22:455, 2014.)

Answer 5

Pathogenic Mechanisms for Osteonecrosis

Ischemia

• Vascular disruption
• Femoral head fracture
• Hip dislocation
• Surgery

Vascular compression or constriction

• Increased intraosseous pressure caused by marrow fatty infiltration
• Corticosteroids, alcohol

Vasoconstriction of arteries perfusing femoral head

• Corticosteroids, eNOS, polymorphisms

Intravascular occlusion

• Thrombosis
  
  • Thrombophilia
  • Low protein C and S
  • Activated protein
    
    • C resistance, factor V mutation
  • High homocysteine
  • eNOS polymorphisms
• Hypofibrinolysis
  
  • High PAI activity, PAI-1 polymorphisms
  • High lipoprotein(a)
• Embolization
  
  • Fat, air
• Sickle cell occlusion

Direct cellular toxicity

• Pharmacologic agents
• Irradiation
• Oxidative stress

Altered differentiation of mesenchymal stem cells

• Altered differentiation of mesenchymal stem cells
• Corticosteroids, alcohol

Question 6

Osteoporosis

Answer 6

Def - Osteoporosis is a skeletal disorder characterized by a progressive loss of bone mass and a decline in bone quality that results in increased bone fragility and a higher fracture risk. Poor bone mass acquisition during adolescence and bone loss during the sixth decade of life are the main processes responsible for osteoporosis. The various types are as follows:

Primary Osteoporosis

Primary osteoporosis is the loss of bone mass due to aging and decreased gonadal function, not to any other chronic illness.

•

Idiopathic osteoporosis: Unknown pathogenesis; may occur in children and young adults.

• Type I osteoporosis (postmenopausal women): Occurs after menopause due to an abrupt decline in estrogen production. It is characterized by accelerated and disproportionate trabecular bone loss and is associated with fractures of the spine, hip, and wrist.
• Type II osteoporosis (involutional): Occurs in both men and women aged >70 yr due to the progressively negative balance between bone formation and resorption. It is characterized by both trabecular and cortical bone loss and associated with fractures of the spine, long bones, and hip.

Secondary Osteoporosis

Secondary osteoporosis is bone loss due to another chronic condition such as

• thyroxine excess
• hyperparathyroidism,
• malignancies
• gastrointestinal disease,
• medications
• renal failure
• connective tissue diseases

Question 7

Carpal tunnel sundrome

Answer 7

Anatomy

Decrease in Size of Carpal Tunnel

• Bony abnormalities of the carpal bones
• Acromegaly
• Flexion or extension of wrist

Increase in Contents of Canal

• Forearm and wrist fractures (Colles fracture, scaphoid fracture
• Dislocations and subluxations (scaphoid rotary subluxation, lunate volar dislocation)
• Posttraumatic arthritis (osteophytes)
• Musculotendinous variants
• Aberrant muscles (lumbrical, palmaris longus, palmaris profundus)
• Local tumors (neuroma, lipoma, multiple myeloma, ganglion cysts)
• Persistent medial artery (thrombosed or patent)
• Hypertrophic synovium
• Hematoma (hemophilia, anticoagulation therapy, trauma)

Question 8

Carpal tunnel syndrome

Answer 8

Physiology

Neuropathic Conditions

• Diabetes mellitus
• Alcoholism
• Double-crush syndrome
• Exposure to industrial solvents

Inflammatory Conditions

• Rheumatoid arthritis
• Gout
• Nonspecific tenosynovitis
• Infection

Alterations of Fluid Balance

• Pregnancy
• Menopause
• Eclampsia
• Thyroid disorders (especially hypothyroidism)
• Renal failure
• Long-term hemodialysis
• Raynaud disease
• Obesity
• Lupus erythematosus
• Scleroderma
• Amyloidosis
• Paget disease

External Forces

▪ Vibration

▪ Direct pressure