Download Key Topics in Orthopaedic Surgery (Key Topics Series (BIOS)) by J.P. Ivory, I.M. Nugent, A.C. Ross PDF

By J.P. Ivory, I.M. Nugent, A.C. Ross

Key subject matters in Orthopaedic surgical procedure is a wonderful revision and reference relief for surgeons desiring to specialize in orthopaedics. issues are offered in a uniform type making the e-book a terrific revision relief for trainees taking postgraduate examinations in orthopaedic surgical procedure.

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Example text

The knee is affected at presentation in 20%, rising to 90% when the disease is of long standing. Synovial proliferation causes damage to ligaments, cartilage and bone. There is commonly a fixed flexion deformity, marked synovitis, joint effusion and progressive instability. Instability may be 38 KEY TOPICS IN ORTHOPAEDIC SURGERY caused either by involvement of the ligaments or due to bony destruction of the tibial or femoral condyles. 5. Seronegative arthropathy. The knee is frequently involved in Reiter’s disease and the enteropathic arthropathies but less commonly in ankylosing spondylitis and psoriasis.

It starts insidiously with anteromedial pain exacerbated by climbing stairs, squatting or sitting with the knees bent. The knee frequently gives way and may ‘catch’ or ‘grate’. Examination of the lower limbs may reveal femoral neck anteversion, genu varum or valgum, external rotation of the tibia and squinting patellae. A quadriceps angle (Q) of more than 20° is abnormal. Patellar tracking should be observed from full extension to 30° of flexion as the patella enters the trochlear groove. Patellar tenderness may be elicited and patello-femoral compression is likely to be painful.

Seventy percent of patients over the age of 45 years with early rheumatoid arthritis may expect good results at 2 years after chemical synovectomy with yttrium, osmic acid or dysprosium ferric hydroxide. Open surgical synovectomy produces improvement in 75% at 2–5 years with deterioration to 55% at 9 years. Arthroscopic synovectomy produces comparable results but is less complete. Further reading Coventry MB. Current concepts review: upper tibial osteotomy for osteoarthritis. Journal of Bone and Joint Surgery, 1985; 67A:1136–40.

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