Principles of Orthopedics INVESTIGATIONS Dr. Mohammed M. Zamzam Associate Professor & Consultant Pediatric Orthopedic Surgeon

Laboratory Blood  CBC & ESR  Biochemistry  Serology  Hormonal Essay  Blood Culture Urine  Chemistry  Culture

Laboratory Joint Aspiration  The procedure is often of a great help in diagnosis of many effusions producing arthropathies  Diagnose or exclude septic arthritis  Used routinely in haemoarthrosis  A large-bore needle is used if the fluid is too viscous  The aspirate undergoes microscopic, chemical, and gram stain examinations and culture & sensitivity test

Electro-diagnosis  Detect de-enervation and its degree  Observe re-enervation before clinical signs  Assess the progress of a lesion  Localize the lesion

Electro-diagnosis Elctromyography  Poliomyelitis  Muscle dystrophies  Myelopathic diseases It can provide useful information alongside clinical examination and muscle biopsy

Electro-diagnosis Nerve Conduction Study  Acute compression neuropathy  Chronic compression or entrapment neuropathy  Peripheral neuropathies  Traumatic nerve lesions It is useful in differentiating between diseases of the axons and of the anterior horn cells. It determines the level of interruption of a peripheral nerve lesion.

Histopathology Bone  Tumors  Chronic Osteomyelitis  Cystic lesions  Osteoporosis

Chondrosarcoma

Osteoporosis

Histopathology Soft Tissues  Tumors  Chronic arthritis (synovium)  Myopathies (muscles)  Neuropathies (nerve)

Histopathology  Needle aspiration  Endoscopic biopsy  Open biopsy  Frozen section  Excisional biopsy

Osteochondroma

Arthroscopy  Internal visual examination of joints  Confirm clinical and radiological diagnosis  Extension of the surgeon’s hand  Therapeutic procedures  Easy record of intra-articular lesions

Arthroscopy Knee  Loose bodies  Synovial membrane  Articular surfaces  Medial & lateral menisci  Cruciate ligaments  Infrapatellar fat pad

Arthroscopy Shoulder  Biceps tendon  Rotator cuff  Articular surfaces  Glenoid labrum  Capsular ligaments

Arthroscopy (rare sites) Elbow  Osteochondritis Dissecans  Synovial biopsy  Loose bodies Hip  Unexplained pain  Loose bodies  Synovial biopsy  CDH

Arthroscopy (rare sites) Ankle  Difficult due to tight structures  Osteochondral lesions Wrist  Still being developed  Wrist pain syndrome

Skeletal Imaging Plain Radiographs  Bone - Lysis - Sclerosis - Dysplasia - Osteonecrosis  Joints  Soft tissues

Ankle fracture

Scoliosis

Osteoporosis

Trochanteric Fracture Femur (Osteoporosis)

Osteosarcoma Giant Cell Tumor

Chondrosarcoma

Metastasis (Ca Prostate)

Metastasis (Ca Breast)

Skeletal Imaging Arthrography Intra-articular injection of dye to visualize the joint  Soft tissue injuries  CDH Sinography Tracking the sinus in COM Myelography Rarely used now alone, usually with CT

Skeletal Imaging Tomography Deep seated bony lesion Ultrasonography  Infections  Cystic lesions  Arthritis  CDH  Soft tissue injuries  DVT

Skeletal Imaging Computed Tomography  Bone window  Soft tissue window  CT with contrast  Bony tumors  Spine  Chronic infections  Some fractures

Chondrosarcoma ( CT )

Giant Cell Tumor Ischium ( CT )

Skeletal Imaging Interventional Radiology  Inaccessible lesions  Disc therapy  Bone biopsy  Muscle biopsy

Skeletal Imaging MRI  Spine  Joints  Tumors  Tendons  Osteomyelitis

MRI Rotator Cuff Tear

MRI Knee Osteochondral lesion

MRI Knee Meniscal Tear

MRI Physeal Bar

MRI Disc Prolapse

MRI Metastasis C7 Vertebra

Skeletal Imaging Nuclear Medicine  Bone and joint infections  Tumors  Avascular necrosis  Osteoporosis

Bone Scan of Cancer Metastasis