Master Orthopedics
for DHA

Core Concepts

Orthopedics focuses on the musculoskeletal system: bones, joints, ligaments, tendons, muscles, and nerves. Key pathologies include trauma (fractures, dislocations), degenerative conditions (osteoarthritis), inflammatory disorders (rheumatoid arthritis, spondyloarthropathies), infections (osteomyelitis, septic arthritis), metabolic bone diseases (osteoporosis), and tumors. Core principles revolve around pain management, restoring function, promoting healing, and preventing disability. Understanding bone healing (primary vs. secondary), biomechanics, and neurovascular assessment is fundamental.

Clinical Presentation

• Pain: Location, character (sharp, dull, aching), severity, aggravating/relieving factors, radiation. Often the primary complaint.
• Swelling: Localized edema, joint effusion (e.g., knee, ankle), often accompanied by warmth or redness in inflammatory/infectious conditions.
• Deformity: Visible alteration of normal anatomy (angulation, rotation, shortening, subluxation, dislocation) following trauma or chronic disease.
• Loss of Function: Reduced range of motion (active/passive), weakness, instability, inability to bear weight, locking, catching, or giving way.
• Neurovascular Compromise: Paresthesia, numbness, motor weakness (nerve injury); pallor, pulselessness, poikilothermia (vascular compromise) – critical to assess.
• Systemic Symptoms: Fever, chills, malaise (suggestive of infection or systemic inflammatory disease).

Diagnosis (Gold Standard)

Diagnosis begins with a thorough history and physical examination. Imaging is crucial:

• X-ray: Gold standard for initial assessment of fractures, dislocations, bone alignment, osteoarthritis, and basic bone lesions. Requires at least two orthogonal views.
• MRI: Gold standard for soft tissue injuries (ligament tears, meniscal tears, tendon ruptures, cartilage damage), bone marrow edema, spinal cord/nerve root compression, and occult fractures.
• CT Scan: Gold standard for complex fractures (intra-articular, pelvis, spine), detailed bony anatomy, pre-operative planning, and assessment of bone tumors.
• Ultrasound: Useful for dynamic assessment of tendons (ruptures, tenosynovitis), fluid collections, soft tissue masses, and guiding injections.
• Arthrocentesis: Gold standard for diagnosing septic arthritis (joint fluid analysis: cell count, gram stain, culture, crystal analysis).
• Blood Tests: ESR, CRP (inflammation), WBC (infection), Calcium, Phosphate, Vitamin D (metabolic bone), ANA, RF, Anti-CCP (rheumatologic conditions).
• Biopsy: Definitive diagnosis for bone and soft tissue tumors, chronic osteomyelitis.

Management (First Line)

Management is broadly categorized into non-operative and operative approaches.

• Non-Operative:
  • RICE: Rest, Ice, Compression, Elevation for acute soft tissue injuries and swelling.
  • Analgesia: NSAIDs, paracetamol, muscle relaxants. Opioids for severe acute pain (short-term).
  • Immobilization: Casts, splints, braces for stable fractures, severe sprains, or dislocations after reduction.
  • Physical Therapy: Essential for rehabilitation, restoring range of motion, strength, stability, and proprioception post-injury or surgery.
  • Injections: Corticosteroids (local inflammation), hyaluronic acid (osteoarthritis), Platelet-Rich Plasma (tendinopathies).
• Operative:
  • Fracture Fixation: Open Reduction Internal Fixation (ORIF), External Fixation for unstable or displaced fractures.
  • Arthroplasty: Joint replacement (Total Hip Arthroplasty, Total Knee Arthroplasty) for severe degenerative joint disease or certain fractures (e.g., femoral neck).
  • Arthroscopy: Minimally invasive diagnosis and treatment for intra-articular pathologies (e.g., meniscal repair/resection, ligament reconstruction, debridement).
  • Spine Surgery: Decompression (laminectomy, discectomy) and/or fusion for intractable radiculopathy, myelopathy, or spinal instability.
  • Debridement & Lavage: Urgent for septic arthritis and osteomyelitis to remove infected tissue.

Exam Red Flags