Mucoepidermoid carcinoma.

#Surgery

Pseudoarthrosis=pseudo-joint bw 2 fragments of bone# with cartilage formation bw them, as a result of farcture nonunion.

Arthrodesis=(artificial syndesis or ankylosis) it is an artificial induction of joint ossification bw 2 bones by surgery used to relieve intractable joint pain which can't be managed by pain medications, splint or other treatments.(causes of such pain are #s with joint disruption, severe sprain, arthritis of spine, hand, foot)

Arthroscopy is an endoscope inserted into the joint through small incision for diagnostic or sometimes therapeutic purposes)

Arthroplasty(prosthetic replacement of the joint) indications:
-OA osteoarthrritis
-RA
-AVN avascular necrosis
-CHD congenital hip dislocation
-traumatized or malaligned joint
-Joint stiffness

Pseudoarthrosis: is a form of non-union due to formation of an adventitious bursa (i.e. bursa in an abnormal site) between the
sclerosed ends of the fragments with formation of a new joint with a new range of mobility .

Most Important Tests of Synovial Fluid:

(3 C's)

-Culture and gram stain
-Cell count and differential
-Crystal examination (protein, LDH, glucose less helpful)

#Medicine

It is Arthrocentesis:

-Aspiration of synovial joints is performed for diagnostic or therapeutic purposes.
-Synovial joints are aspirated for myriad reasons, the most common of which include:
1. To rule out infection
2. To diagnose arthropathies
3. To relieve pain.

#Surgery

Kocher criteria for Septic arthritis diagnosis.

#Surgery

Kocher's criteria of septic arthritis

A point is given for each of the four following criteria:

•Non-weight-bearing on affected side
•Erythrocyte sedimentation rate > 40
•Fever > 38.5 °C
•White blood cell count > 12,000

Score👉🏻 Likelihood of septic arthritis
1👉🏻 3%
2👉🏻 40%
3👉🏻 93%
4👉🏻 99%

This is in adults, the difference is only ESR due to age variant.

X-ray findings in Osteoarthritis:

1-Joint space narrowing "1st"
2-Subchondral sclerosis
3-Osteophytes
4-Cysts.

#Surgery

X-ray findings in case of Charcot's joint:

They are similar of osteoarthritis.
1-Bone fragmentation
2-Bone destruction
3-New bone growth
4-Loss of joint space
5-Large osteophytes may be present
6-Parrot's beak"Large curved osteophytes that present in spine".
7-Scattered chunks "pieces" of bone.

#Surgery

Talus fracture classification:

1-Lateral talar process fracture "Snowboarding injuries"
2-Posterior process fracture
3-Head fracture
4-Body fracture
5-Talar neck fracture
6-Osteochondral Talar dome fracture.

#Surgery

Pattellar dislocation Classification:

-Reduced vs Unreduced
-Congenital vs Acquired
-Acute vs Chronic
-Lateral, medial, Superior, Intra-articular.

#Surgery

Thombson test:
In Achilles tendon rupture:

-With no rupture, squeezing the calf causes active planter Flexion of the foot.

-With rupture, it's negative.

#Surgery

Q angle:

-It is the angle formed by a line drawn from the anterior superior iliac spine through the center of the patella and a line drawn from the center of the patella to the center of the tibial tubercle.


Normal:
In males:
10-14°
In females:
15-17°

Significance:
-The degree of genu valgum can clinically be estimated by the Q angle.

#Surgery

Classification of Primary breast cancer.

#Surgery

Possible x ray findings in acute pancreatitis

◼️Sentinel loop sign, represents localised ileus of intestinal loops near the inflamed pancreas.

◼️Generalised paralytic ileus, if inflammation is severe and diffuse, dilated bowel loops will be seen as intestinal obstruction.

◼️Colon cut-off sign, describes a situation in which the colon seems to abruptly "end" as shown in the figure above, it may relate to functional retraction of the phrenicocolic ligament.

◼️Renal halo sign, the inflammatory exudate in the retroperitoneal space seem to enhance the perirenal fat appearing as a radiolucent halo surrounding the kidney, this may occur around both kidneys.

◼️Pleural effusion, may occur as a result of posterior disruption of inflamed pancreatic duct with subsequent formation of a pleuropancreatic fistula.

◼️Calcified radio-opaque gallstone, may point toward gallstone pancreatitis, it has to be noted that only 10% of gallstones are radio-opaque.

#Surgery

-Commonest organ failure in severe Acute pancreatitis is respiratory.

-Biliary tract disease is the commonest cause of acute pancreatitis.

-Magnitude of amylase elevation is not related to severity of the pancreatitis. It increases once symptoms appear for 12–24 hours then decreases in 6 days.

-Persistent elevation suggests complications like pseudocyst, ascites and abscess formation.

#Surgery

-Decrease serum calcium level is worst prognostic indicator of pancreatitis.

-Open surgery is the gold standard for infected pancreatic necrosis.

-Spiral CT (CECT–contrast enhanced CT) is better—gold standard.

-Serum lipase more specific than amylase.

-Serum lipase level after rise persists for longer period than amylase.

-Serum lactescence (related to triglyceride met abolism)—Most specific in hereditary hyperlipidaemia or alcohol pancreatitis.

-In Acute Pancreatitis: Sudden onset of upper abdominal pain which is referred to back. Pain is severe, agonizing and refractory. Pain may be relieved or reduced by leaning forward.

#Surgery

Radiological features helpful in diagnosis of development hip dysplasia

◼️Shenton's line, a curved line along the inferior edge of the superior pubic ramus in continuity with the femur (see above), in DDH this line is interrupted.

◼️Hilgenreiner line, a horizontal line taken through both triradiate cartilages (see above).

◼️Perkin's line, this is a vertical line perpendicular on the Hilgenreiner line drawn from the lateral edge of the triradiate cartilage, this intersection will form 4 quadrants, normally the femoral head should lie in the lower inner quadrant, whereas in DDH the femoral head lies in the upper outer quadrant.

#Surgery

Complications of splenectomy

◼️Bleeding, may occur due to slipped ligature on the splenic artery, this can cause rapid exsanguination.

◼️Injury to surrounding organs, tail of the pancreas can be injured resulting in (1)Acute pancreatitis, (2)Pancreatic abscess, (3) Pancreatic fistula, injury to the stomach can cause hematemesis, also injury to the greater curve during ligation of short gastric vessels can cause gastric fistula, acute gastric dilatation may also occur.

◼️Infection, such as wound infection or a left subphrenic abscess.

◼️Pulmonary complications, including left basal atelectasis and pleural effusion.

◼️Overwhelming post-splenectomy infections by encapsulated organisms including pneumococci, meningococci, and H.influenzae, viral influenza infections can predispose to these bacterial infections so annual influenza vaccine should be considered.

◼️Thrombocytosis, this can cause thromboembolic manifestations, if the count reach more than 1 million per microlitre, aspirin should be given.

#Surgery

Signs of vascular trauma

◼️This is an essential part to recognize, a trauma to an artery may lead to acute spasm, or formation of a subintimal hematoma or acute thrombosis, all may occlude the vessel, alternatively a trauma may cause laceration of the vessel either completely or partially, remember: Partial laceration causes more bleeding than complete laceration.

◼️The HARD SIGNS of vascular trauma include (1) Pulsatile bleeding, (2) Pulsatile hematoma, (3) Signs of acute limb ischaemia, (4) Thrill or bruit due to traumatic AV fistula or a false aneurysm, (5) Rapidly Expanding hematoma.

◼️Soft signs include (1) Non pulsatile stable hematoma, (2) Unexplained shock or falling hemoglobin, (3) Injury at an anatomical site of an artery, (4) Evidence of nerve injury in proximity to an artery, (5) History of significant hemorrhage at time of trauma and before presentation.

#Surgery