19/03/2026
🌟 Systemic Surgery NRE- 1 🌟
🚨 Chapter: Orthopedic Surgery 🦴 🚨
*Rapid Fire Revision Points by Dr Malik Shehr Yar for NRE 1*
for
🔹 General Orthopedics
1. Bone is composed of cortical (compact) and cancellous (spongy) bone.
2. Osteoblasts → bone formation; osteoclasts → bone resorption.
3. Fracture healing: Inflammation → soft callus → hard callus → remodeling.
4. Secondary bone healing involves callus formation.
5. Primary healing requires rigid fixation (no callus).
6. Periosteum is essential for fracture healing.
7. Children heal faster due to thick periosteum & better blood supply.
8. Open Reduction avoided in children to prevent damage to their growth plate
9. Closed fractures have intact skin; open fractures communicate with exterior.
10. Salter Harris Classification is for fractures involving/discussing Growth Plate
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🔹 Fractures & Dislocations
11. Most common fracture: clavicle.
12. Most common long bone fracture: femur.
13. Colles fracture: distal radius, dinner fork deformity.
14. Smith fracture: reverse Colles (volar displacement).
15. Monteggia fracture: ulna fracture + radial head dislocation.
16. Galeazzi fracture: radius fracture + Distal ulna dislocation.
17. Supracondylar fracture (children) → risk of brachial artery injury.
18. Posterior shoulder dislocation: associated with seizures/electric shock.
19. Anterior shoulder dislocation: most common type.
20. Hip dislocation (posterior) → limb shortened, internally rotated.
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🔹 Complications of Fractures
21. Early complication: hemorrhagic shock.
22. Fat embolism: occurs 24–72 hrs post long bone fracture.
23. Classic triad of fat embolism: hypoxia, neurological symptoms, petechiae.
24. Compartment syndrome: increased pressure → ischemia.
25. 6 Ps: pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia.
26. Volkmann ischemic contracture → untreated compartment syndrome.
27. Non-union: no healing after prolonged time.
28. Malunion: healing in wrong position.
29. Avascular necrosis common in neck of femur fracture.
30. Myositis ossificans: heterotopic bone formation after trauma.
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🔹 Bone Diseases
31. Osteoporosis → decreased bone density.
32. Most common fracture in osteoporosis: vertebral compression fracture.
33. Osteomalacia: defective mineralization (Vit D deficiency).
34. Rickets: osteomalacia in children.
35. Paget disease: excessive bone remodeling.
36. Osteopetrosis: “marble bone disease” (dense but brittle bone).
37. Osteomyelitis: bone infection, commonly Staph aureus.
38. Sequestrum: dead bone fragment.
39. Involucrum: new bone around sequestrum.
40. Brodie abscess: subacute osteomyelitis.
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🔹 Bone Tumors
41. Osteosarcoma: most common primary malignant bone tumor.
42. Common site: metaphysis of distal femur.
43. Sunburst appearance on X-ray.
44. Ewing sarcoma: diaphysis, onion-skin appearance.
45. Multiple myeloma: most common malignant bone tumor overall.
46. Giant cell tumor: epiphysis, “soap bubble” appearance.
47. Osteochondroma: most common benign bone tumor.
48. Chondrosarcoma: malignant cartilage tumor.
49. Bone metastasis common from prostate, breast, lung, kidney.
50. PSA is marker for prostate metastasis to bone.
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🔹 Joint Disorders
51. Osteoarthritis: degeneration of cartilage.
52. Rheumatoid arthritis: autoimmune synovitis.
53. Avascular Necrosis in fractures of > femoral head, scaphoid, knee joint, acetabulum.
54. Morning stiffness >1 hour → RA.
55. Osteoarthritis affects weight-bearing joints.
56. Heberden nodes: DIP joints in OA.
57. Bouchard nodes: PIP joints in OA.
58. Gout: urate crystal deposition.
59. Pseudogout: calcium pyrophosphate deposition.
60. Septic arthritis: most commonly Staph aureus.
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🔹 Spine Disorders
61. Intervertebral disc prolapse commonly at L4-L5, L5-S1.
62. Sciatica: pain radiating along sciatic nerve.
63. Spondylolisthesis: forward slipping of vertebra.
64. Ankylosing spondylitis → bamboo spine.
65. HLA-B27 association with spondyloarthropathies.
66. Cauda equina syndrome: saddle anesthesia + bladder dysfunction.
67. Cervical spondylosis: degenerative disease of cervical spine.
68. Kyphosis: forward curvature.
69. Lordosis: inward curvature.
70. Scoliosis: lateral curvature.
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🔹 Pediatric Orthopedics
71. Developmental dysplasia of hip (DDH): Ortolani & Barlow tests.
72. Perthes disease: avascular necrosis of femoral head in children.
73. Slipped capital femoral epiphysis (SCFE): obese adolescents.
74. Osgood-Schlatter disease: tibial tuberosity pain.
75. Clubfoot (CTEV): talipes equinovarus.
76. Greenstick fracture: incomplete fracture in children. Fracture at one side of the bone causing bend on the other side of the bone.
77. Epiphyseal injuries classified by Salter-Harris classification.
78. Most common Salter-Harris: Type II.
79. Rickets leads to bow legs (genu varum).
80. Osteogenesis imperfecta → brittle bones.
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🔹 Nerve Injuries
81. Radial nerve injury → wrist drop.
82. Median nerve injury → ape hand deformity.
83. Ulnar nerve injury → claw hand.
84. Common peroneal nerve → foot drop.
85. Erb palsy: C5-C6 injury.
86. Klumpke palsy: C8-T1 injury.
87. Carpal tunnel syndrome → median nerve compression.
88. Tinel’s sign: nerve irritation.
89. Phalen’s test: carpal tunnel diagnosis.
90. Sciatic nerve injury → posterior thigh trauma.
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🔹 Orthopedic Infections & Misc
91. Tuberculous osteomyelitis → spine (Pott disease).
92. Cold abscess seen in TB.
93. Brodie abscess → subacute infection.
94. Septic arthritis is an emergency.
95. Prosthetic joint infection requires removal.
96. Compartment pressure >30 mmHg → fasciotomy needed. Compartment Syndrome needs urgent Fasciotomy
97. CRPS (Complex Regional Pain Syndrome) → chronic pain post injury.
98. Tendon healing slower than bone.
99. Allman Classification: Divide Clavicle in 3 Groups
100. Most sensitive imaging for bone pathology → MRI.
101. Scaphoid bone fracture can be missed on Xray & hence needs MRI or Isotope Bone Scan for diagnosis.
102. If no displacement, Conservative. If displacement, open reduction with fixation. If Osteoporosis or frail Elderly, artificial implant / hemiarthroplasty.
103. Osteomyelitis > Most commonly due to Staph Aureus. If assoc with some disease like Sickle Cell then Salmonella.
104. Volkmann Ischemia > Due to Blood Supply Compromise in Compartment Syndrome
105. Lateral fracture of clavicle > Needs open reduction
106. Shaft of Humerous Fracture > Radial Nerve Palsy
107. Shoulder Joint Dislocation > Axillary Nerve Palsy > 15-90 degree movement compromised
108. Subtrochanteric fractures > most common complication is slow healing or non union.
109. Femoral Shaft Fracture > can cause Shock due to 1000-1500 ml blood loss
110. In pelvis fracture associated with visceral injury, always repair / reduce the pelvis first & then deal with visceral injury. Pelvic fracture may cause 1500-2000 ml blood loss.
111. Fracture of Tibial Lateral Plateau > Anterial Tibial Artery damage
112. Common Peroneal Nerve damage in Tibial Shaft Fractures can lead to foot drop.
113. Acetabular fracture can lead to sciatic nerve injury, avascular necrosis of hip, and superior gluteal nerve & superior gluteal artery injury.
114. Ponsetti Method > weekly cast change for a max of 8 casts before moving to surgical correction of Club Foot
115. Achondroplasia > FGFR3 Gene Mutation > Leads to Dwarfism
