probability – the briefest possible review.

P(event A) = relative frequency of Event A / large number of events (where A is possible) Conditional Probability = p(a) given that b has already happened.  P(a|b) independent events: event b has absolutely no effect on P(a).  P(a)= (a|b) if a and b are independent, P(A & B) = P(B)P(A) dependent events : P(a) [...]

Biostatistics and Epidemiological Methods

Relative Risk = ratio of rate of disease in those exposed to that rate among those not exposed.  e.g. RR(lung CA) = rate of lung CA in smokers / rate of lung CA in nonsmokers Attributable Risk = rate of disease in exposed – rate of disease in non-exposed Controlled Clinical Trial  prospective study split [...]

In case of no pulse…

Here’s the ACLS Algorithm (2005)

Rheumatoid Forefoot

Deformity   Hallux valgus  Lesser toe MTP extension and IP flexion  Distal migration of plantar fat pad When confronted with a hallux valgus deformity, look and ask about RA   Non-operative Rx  Deep shoe with metatarsal bar and cut outs for prominences Operative Rx  Dwyer procedure 1st MTP fusion  2-5 MT head excision with interposition of [...]

Elbow Arthroplasty

Constrained – used only in cases of severe bone loss due to high loosening rate Semi-constrained – eg. Coonrad-Morrey – most commonly used, sloppy hinge providing some varus & valgus motion Unconstrained – eg. Capitellocondylar – unlinked metal on poly articulation, require normal ligaments Fascial – coverage of articulation with fascia lata autograft Complications – [...]

Congenital Clubfoot overview

Trend toward nonoperative management. Ponseti Kite-Lovell Need well organized approach to surgical Rx of residual deformity forefoot adductus cavus heel valgus or varus dorsal bunion dynamic forefoot supination N.B. different clinical presentations Specific Rx recommendations for kids at different ages – in evolution ? accepted age for Tib. ant transfer conventional wisdom  =2.5 years ? [...]

Patella Fractures / Patellar Tendon Injuries

Q1: draw tension band and describe mechanism by which it works.  (will look for a picture to demonstrate this – if you have one, please email it to me)  Effect of Total Patellectomy?  20-30% decrease in strength of extensor mechanism. d/t decrease in moment arm by ~1/3 Patellar tendon avulsion Repair with Krackow stitch. Through drill holes in patella [...]

MRI – a quick review

T1 define anatomy (best signal-to-noise ratio) fat is bright look at vascularity on fat-suppressed T1 images T2 used to look for reactive edema water is bright variants include spin-echo, fast-spin echo, short tau inversion recovery fat-suppression allow better discrimination of edema from fat and soft tissue

Kienbock’s Disease

 Kienbock’s is the eponym for AVN of the lunate. Etiology is not known but thought to be related to ulnar negative variance. There is often a history of trauma Men are more commonly affected than women Age is usually 20-40 Clinical Presentation  Early: dorsal wrist pain, perhaps limited ROM Later: Synovitis, worse ROM, grip weakness [...]

Lateral approach to the Knee

Position supine sandbag under buttock tourniquet Landmarks Lateral border of patella lateral joint line Gerdy’s tubercle Incision  long hockey stick (err posterior to IT band) Internervous plane  Iliotibial band (superior gluteal n. – G.max & TFL) / Biceps Femoris (sciatic) consider identifying and protecting sciatic nerve (behind biceps femoris) and exposing through more posterior interval [...]