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

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Presentation on theme: "Principles of Orthopedics INVESTIGATIONS Dr. Mohammed M. Zamzam Associate Professor & Consultant Pediatric Orthopedic Surgeon."— Presentation transcript:

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

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

4 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

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

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

8 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.

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

10 Chondrosarcoma

11 Osteoporosis

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

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

14 Osteochondroma

15 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

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

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

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

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

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

21 Ankle fracture

22 Scoliosis

23 Osteoporosis

24 Trochanteric Fracture Femur (Osteoporosis)

25 Osteosarcoma Giant Cell Tumor

26 Chondrosarcoma

27 Metastasis (Ca Prostate)

28 Metastasis (Ca Breast)

29 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

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

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

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34 Chondrosarcoma ( CT )

35 Giant Cell Tumor Ischium ( CT )

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

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

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39 MRI Rotator Cuff Tear

40 MRI Knee Osteochondral lesion

41 MRI Knee Meniscal Tear

42 MRI Physeal Bar

43 MRI Disc Prolapse

44 MRI Metastasis C7 Vertebra

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

46 Bone Scan of Cancer Metastasis

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