Cadmore media player playing video Slipped Capital Femoral Epiphysis for Orthopaedic Exams
Video Player
Accessibility
Using forms mode, you can utilize keyboard shortcuts to make usability more efficient.
Space bar will play and pause the video. Pressing escape will close all displays and pressing it again will jump to the end of the player.
You can press A to open the Keyboard Shortcut Dialog which also provides an audio description of the player and all of its features.
Language
1x
Play Speed
Adjust Volume
Transcript
Search
Result Count
of
Click to jump to result
Search
Re-center
Segments
Result Count
of
Click to jump to result
Search
Name:
Slipped Capital Femoral Epiphysis for Orthopaedic Exams
Description:
Slipped Capital Femoral Epiphysis for Orthopaedic Exams
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/a756fefb-3a9d-4fbe-9bb8-3c1d9cc959f0/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H27M17S
Embed URL:
https://stream.cadmore.media/player/a756fefb-3a9d-4fbe-9bb8-3c1d9cc959f0
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/a756fefb-3a9d-4fbe-9bb8-3c1d9cc959f0/Slipped Capital Femoral Epiphysis for Orthopaedic Exams.mp4?sv=2019-02-02&sr=c&sig=ORulc1v44mxNqbkZ7M%2BsFVaPxvpLK18jde7dcDKP%2Fww%3D&st=2024-11-21T17%3A58%3A32Z&se=2024-11-21T20%3A03%3A32Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Topic I'm going to present is from pediatric orthopedics. So this is a sort of a picture that you can be presented with to start the wider discussion as well. Now looking at this picture, there are a few things that you can pick it up that the leg is short and that is externally rotated so immediately. There are few things that can come into your mind. And if you are fully prepared just by looking at this picture, you can take the whole wiwa.
And that is the main trick in the examination that you should anticipate the questions that will be coming next. OK similarly, you can be presented with an X-ray as an opening question and comment on these X-rays. So the topic I'm going to discuss today is about slipped upper femoral epiphytes, and that topic was asked from me as well.
The important point in this is that sometime they can present you with an X ray, which is just an AP view, and you won't be able to see much. And in this examination, it is very unlikely that you will be presented with an X ray, which has got normal findings. So just keep this in mind. So always ask for the other view, which is the lateral view or any other further imaging.
So this thing happened to me in two occasions, one in this and also another X ray, which was the shoulder X-ray and the X-ray was pretty normal on the AP view. OK so keep this in mind is the fellowship exam. It is very unlikely that you will be presented with the normal X-ray. OK so coming to a Sufi definition everyone should be aware of that is a disorder of the proximal femoral metaphysics that leads to the slippage of the metaphors, anteriorly and operatively.
And it is relative to the epiphytes which remains anatomically positioned. So basically, the head stays in the position. It is the proximal femur, which displays this and therefore we get this presentation or this condition. I have highlighted these important bits or important buzzwords that you need to say in the read that will inform the or tell the examiner that you are aware of what you're talking about.
OK there are few facts to remember. Again, it is more for the. Written part, but still in the discussion, you can come if you get asked, you can be. You can throw this information to the examiners. It is more common in boys, more common in African and Polynesian descent. It is more common on the left side and it is associated with an increased weight with femoral integration.
And there are hormonal conditions which are associated such as hypothyroidism and just a few more. So a typical presentation of Sufi is an overweight child with localized groin, thigh or knee pain, and he is limping. There may be a history of minor trauma. And the usual age of presentation is between 11 to 14 years, and on the clinical examination, the leg is shortened and externally rotated.
There is restriction of movement, especially flexion abduction and internal rotation. And there may be additional external rotation when you try to flex the hip. Investigations are pretty straightforward. Plane X-ray AP and the true lateral views. People don't recommend doing a frog lateral view because it can further displace, so therefore plain AP and a lateral views are enough to get the diagnosis.
There are fewer radiological features that you can. You are looking for, such as positive sign is also called cleanse 9 degrees epimysium height. This is a subtle sign, so you have to be careful or you have to be mindful when you are looking at these X-rays. There may be increased distance between the teardrop and the femoral neck metathesis. And there can be widening and irregularity of the Pfizer line.
And then in delayed presentation, there can be remodeling and sclerosis. OK, so this is how the cleanest is seen. So on the left side is the normal one in which you can see them in the law line is drawn through the upper end of the neck. The part of the line passes through the femoral head, but if there is slip, then that line will not pass through the femoral head, as you can see on the right side.
OK further investigations include CT scanning to find out the degree of the slap and also the version of the hip ultrasound scan can be useful for early slips and also to look at the joint effusion and MRI scan to look at the avascular necrosis. But these are all supplementary investigations in terms of diagnosis and the history, clinical presentation and plain x-rays.
Most of the time, we should be able to give you the diagnosis. The classification can be divided into functional classification. Which is divided into two types the stable and the unstable, the stable is ample, able to ambulate and bear weight. An unstable slip is a patient, is in severe pain and unable to ambulate with or without crutches.
I think in this topic, everyone should know about the loader paper. And if you are asked about this through this information as soon as that you are aware of this paper and mention it to the examiner, it tells you about the stable slip and the unstable slip. It was a multicenter trial and they look at the 54 children who had 55 slips and what they found that the avian develop in 47% of the patients with the unstable hip.
Then there can be other classifications, like neurological classification, which includes pre slap. Then it can be acute, chronic and acute and chronic. The difference between acute and chronic is the time and the duration of the symptoms. If there's an abrupt displacement in the short period of less than three weeks, it is acute sleep and the chronic sleep.
If it's the groin pain immediately pain methane and presented more than three weeks of duration and acute and chronic, as the name suggests. The symptoms are of more than three weeks duration, but then they present with sudden onset on the x-rays. You can also do the grading of these slips. Most commonly done is the southwark Southwick angle. So there are a few things again, which you should know about the athletic angle.
One, it is a difference between the two sides. So you look at the normal side and then look at the angle on the other side and then subtracted and then that's how you calculate the slap. And it is measured only lethargy on both. It was 1,000 angles divided into three types grade one, grade 2 and grade 3 grade 1 angle difference of less than 30 degrees. Grade two difference of more than between 30 and 50 degrees.
And grade 3 severe, which is a difference of over 50 degrees. OK, so more severe, the slap is more likely to be unstable. OK this is the radiological presentation of measuring the Sawchuck angle. I don't think they will ask you to draw the angle, but they would expect you to know the values of these angles.
OK now we come to the treatment of this condition. So what are the aims the aims is to prevent any further progression of the slip in without any complications. For the stable, slap is very simple and straightforward. I think there's hardly any controversy and that is spinning in situ. However, for the unstable slap, there are different school of thoughts and different people say different like treatment options.
But again, the aim is still the same to prevent any further progression of the slap and to avoid any further complications in future. Unstable hip, as we discuss early. They've got high risk of avian. And building in situ can be technically difficult because of the degree of the slip. And some people have more aggressive approach, which is open reduction of the hip.
And then there are different types of osteotomy that can be performed to reduce the hip and once they reduce the hip to stabilize the hip. OK the most commonly done is the dance osteotomy, which is the trunk, or Derek osteotomy, which is through the growth plate. OK rest of the time, I have not seen them personally myself. But again, if you look at work at different centers, the most commonly done is the osteotomy.
Now, pending in situ is something which they can ask about the surgical technique of that as well. Now the points to remember in that is the entry point is more interior than you normally think of, ok? And there are different ways to identify the entry point. One way is that you look at the position where you want to put the wood screw on the AP and the lateral view and then draw the lines and where the lines are intersect.
That is your entry point. OK so I think this is if people have not come across with that, I would suggest to go through it and have a clear plan how you if somebody asks you, how are you going to pin, have a plan in your mind positioning of the patient? What are the aims? Are you going to achieve? What type of screw are you going to put in and how many threads you will pass?
OK now, this is just a flow chart. I've taken this from a postgraduate pediatric orthopedics, and I found this book quite useful for pediatric orthopedics. That's quite a. This is, again, quite a useful chart. And if you just remember this chart, I think you can answer most of the questions again, as we discussed earlier.
It has divided this in the two main categories stables, slap and the unstable sleep. And then depending upon how severity, how severe it is, there are different treatment options. OK similarly, this graph also simplifies the treatment options. This one, I have taken it from a paper from ogulu and Clark.
That's the other paper, I think people, you should know about it. And again, if you're given an opportunity, mention it in the Viva. This is a review article and we consultants work around Southampton. And again, they have simplified the treatment options and explain it in quite detail that what you're expected to do if you come across with a stable slap and what are the options if you come across with an unstable slip?
OK now. A question can be asked if you are doing very well regarding the timing of the surgery. And this is something which is, again, controversial. For pending inside to again, that's not a big, big issue. You can do it as soon as possible. But again, it is not something which needs to be done in the middle of the NIPE. You can, you can plan it and then do it.
And probably in these days, probably consult the pediatric orthopedic surgeons before doing the spinning OK. Uh, there are a few papers, which I have mentioned, which which have given different opinions regarding the timing of the surgery. Loadings at all meta analysis of five studies, they looked at the unstable Sufi and then they concluded that avian risk decreased if the treatment occurred within 24 hours.
Again, keep in mind, this is again for unstable Sufi. But they also mentioned the difference was large, but it was not significant. A debt paper, Petterson, it all. They look at 91 accurate slips, and they all mentioned that early civilization was associated with less risk of avian. Loaded it all looked at their study, they showed that 87% of the people of patients developed haven't been treated within 48 hours.
But again, most of the patients were having unstable slap. OK now. The other question can be asked. What are you going to do with the other side? Which does not have any symptoms. OK, if they are symptomatic, then the answer is straightforward. You you will fix it.
But if the other side is not symptomatic, then again, it's a controversial topic. But there are certain factors that can be considered if you are planning to fix another side. Age of the patient. If the child is less than 10 years of age, it is associated with higher risk of being bilateral Sufi. If the etiology of endocrine disorder, again, they have got high incidence.
And if you feel there is a poor compliance of the child and the parents, then you can consider fixing it at their side. OK and then also nature of the current slip. If the severe if the severe slap is severe, then it may justify pinning the other side. OK that, again, I think it is important. That's why I've put this light again to know the surgical technique of doing a spinning in situ.
Normally done an aesthetic with IV antibiotics, patient, supine on the fracture table, important thing is to mark the trajectory of the screw and use the fluoroscopy. As for your advantage? OK, the entry point is quite a what you normally expect for doing a dhs? A 7.3 millimeter or 6.5 millimeter fully threaded reverse cutting screws are used. Important thing is to avoid the blind spot.
And the way to award the blind spot again, to use the fluoroscopy and use different not only AP and little, you can have oblique views as well to make sure that the screw is not going into the joint. You can also use an to crown through the screw to see if it is going into the joint. In port post-operatively, you start with partial weight bearing leading to full weight bearing. OK the complications we already discussed.
We're doing all these things to avoid avian. It can cost condolences, which is a rapid and progressive loss of articular cartilage and patient present with severe pain. There can be residual deformity. And it can develop osteoarthritis and there can be ligament discrepancy.
So I think this is a very simple topic. If if, if it's come to your Viva is the local paper and the ogulu and Clark paper. And I think if you mention all these things, I'm pretty sure you will do well. And so say there's controversy about I agree with Sean, and I think I did mention that if you are ask about this question, you do mention that you will discuss with the pediatric orthopedic.
But if they ask you about the surgical technique again, you can say that you should know the principles and that's how you will answer that. The principles are that I'm going to. These are the principles, and that's why I'm going to treat, but I will discuss it with my colleagues. OK, so I'm going to just reinstate exactly what they have is a very important topic. You guys need to know that these are the topics it should be considered gift in the exam.
And when they come, you should score high so that you can take other places. The other thing what Sean always says and I, I sickened him like no one. Whenever you say this is a specialist problem or this is a pediatric specialist problem, you say the same sentence in one breath. Please don't stop. This is a pediatric specialist problem.
However, the principle of management are please don't stop or else they will intervene. And the less the examiners talk, the better it is for you. We will talk to him. And then and then, yeah, it's all great, Fawad. I think with these presentations, guys who have read this again and again might find that it's a bit repetitive and it just repeating whatever the textbooks are saying.
But that is the importance of the exam that you need to know the basics really well. It's going through all the mundane basics that will get you to score a six. It's being able to vocalize what exactly you're going to do with this patient in any. That's how you pass the exam. That whether this patient is being able to wait better or not, so those are the key things you have to verbalize those one after the other and bring them out, and they might take you in depth of one particular thing that you've mentioned.
But that's all right. As long as you stay on track as how you're going to manage this patient in any and there are and there would be. It is. I've seen this a couple of times in courses that pediatric surgeons, because they remember there will be a pediatric specialist in the vivo table.
They're very keen to start this question on a child who is presented with an injury to the knee or knee pain. They often do this, so beware of the child presenting with knee pain. Always think of the hip. OK that's all I have to add. I think this is a very important point. Always this question always starts with knee pain.
This is and you know, I got this question and it started as knee pain. And I'm sure whoever has got this question in the exam, it would have started as knee pain and it's a minor trauma to me with the patient coming. So that's a very important point to ponder for what there are a few questions. So the first one I have answered on your behalf, but I would like to second it.
They were asking how many threads are posed to us through the Pfizer. So I say three to five dependent and 5 below the slap Cornwall. Yes and then the other question is, what is fred? Sorry? there is another point on the thread. The reason the reason why they talk about no more than three to 5 is because if you try to cross all your threads across your growth plate, you will definitely have a high incidence of reaching into the joint surface.
The other point is the reason why Freud was pointing out that it's much more anterior than you think and your fixation. Your your emphasis is now posterior to the neck, so you're not aiming to get up the neck straight. You're aiming to put the center of your screw in the center of the prefaces. So therefore you end up being anterior in the neck automatically.
So just be aware those are two things that you need to get down correct. You're aiming for center of the prefaces, not the center of the neck, and you're also aiming for the no more than three to five, depending on the age of the patient, but not to cross the entire faces with your screw. OK the other question, what they have asked is about the blind spot for what?
What is the blind spot? The blind spot is if, if you are not careful. And if you're looking at only in the view, it is possible that again, because of the slip, the screw may go into the joint and breach the articular cartilage and that you don't want to do it. Because if you breathe the articular cartilage, then the chances of condolences becomes more. And therefore, it is suggested that you do the X-rays in different views, not only in the letter inserted oblique views as well to make sure that the threads are not going into the joint.
OK, thank you very much. There is someone else ask one final question, and then I have one question for you is, how do you diagnose convalescence? I think it again is a clinical presentation. What I have seen few patients with chronic illnesses is they present with severe pain in the hip with the history of Sufi in the past. OK but in terms of investigations, again, probably x-rays and then MRI scan would be helpful.
Yeah, I would get blown or something. An enhanced contrast MRI scan that shows the facial cartilage. That's but we're all for one is, are you aware of this new controversy of an acute slap to reduce it because Southampton guys are reducing it. This is something which is new, whether come into the exam? Yeah again, as I said, there are so much controversy about the treatment of the unstable hip, but I'm not sure what the guys in Southampton are doing.
I have worked in Children's Hospital with in touch with the guys, with the patient who present to our hospital. Their policy is generally to wait. So I think I did mention in my presentation, if you decide that patient is if he's an unstable slap and you are not going to do it acutely, then you put them in a direction for about a week that will allow the things to settle, and then they plan the surgery accordingly.
And then they don't fix Du fixation in situ rather than they consider doing it. Open reduction and internal fixation, like a modified Daniel's tenotomy by Sean and very good point by him.and. So all of the mentors have a very positively contributed to this. Very positive, because positive thinking can heal the world. So I'll hand it over to France to someone, when should we remove the screw?
We should not. If possible, it's only add 10 more minutes to a future hip replacement, if need be. Yeah OK. Shall we first, should we know? Yeah, I sure do. Thank you for that for presenting. Sorry, I missed it, but it's very good of you to present and I will.
I thought it was.
Segment:0 .
Topic I'm going to present is from pediatric orthopedics. So this is a sort of a picture that you can be presented with to start the wider discussion as well. Now looking at this picture, there are a few things that you can pick it up that the leg is short and that is externally rotated so immediately. There are few things that can come into your mind. And if you are fully prepared just by looking at this picture, you can take the whole wiwa.
And that is the main trick in the examination that you should anticipate the questions that will be coming next. OK similarly, you can be presented with an X-ray as an opening question and comment on these X-rays. So the topic I'm going to discuss today is about slipped upper femoral epiphytes, and that topic was asked from me as well.
The important point in this is that sometime they can present you with an X ray, which is just an AP view, and you won't be able to see much. And in this examination, it is very unlikely that you will be presented with an X ray, which has got normal findings. So just keep this in mind. So always ask for the other view, which is the lateral view or any other further imaging.
So this thing happened to me in two occasions, one in this and also another X ray, which was the shoulder X-ray and the X-ray was pretty normal on the AP view. OK so keep this in mind is the fellowship exam. It is very unlikely that you will be presented with the normal X-ray. OK so coming to a Sufi definition everyone should be aware of that is a disorder of the proximal femoral metaphysics that leads to the slippage of the metaphors, anteriorly and operatively.
And it is relative to the epiphytes which remains anatomically positioned. So basically, the head stays in the position. It is the proximal femur, which displays this and therefore we get this presentation or this condition. I have highlighted these important bits or important buzzwords that you need to say in the read that will inform the or tell the examiner that you are aware of what you're talking about.
OK there are few facts to remember. Again, it is more for the. Written part, but still in the discussion, you can come if you get asked, you can be. You can throw this information to the examiners. It is more common in boys, more common in African and Polynesian descent. It is more common on the left side and it is associated with an increased weight with femoral integration.
And there are hormonal conditions which are associated such as hypothyroidism and just a few more. So a typical presentation of Sufi is an overweight child with localized groin, thigh or knee pain, and he is limping. There may be a history of minor trauma. And the usual age of presentation is between 11 to 14 years, and on the clinical examination, the leg is shortened and externally rotated.
There is restriction of movement, especially flexion abduction and internal rotation. And there may be additional external rotation when you try to flex the hip. Investigations are pretty straightforward. Plane X-ray AP and the true lateral views. People don't recommend doing a frog lateral view because it can further displace, so therefore plain AP and a lateral views are enough to get the diagnosis.
There are fewer radiological features that you can. You are looking for, such as positive sign is also called cleanse 9 degrees epimysium height. This is a subtle sign, so you have to be careful or you have to be mindful when you are looking at these X-rays. There may be increased distance between the teardrop and the femoral neck metathesis. And there can be widening and irregularity of the Pfizer line.
And then in delayed presentation, there can be remodeling and sclerosis. OK, so this is how the cleanest is seen. So on the left side is the normal one in which you can see them in the law line is drawn through the upper end of the neck. The part of the line passes through the femoral head, but if there is slip, then that line will not pass through the femoral head, as you can see on the right side.
OK further investigations include CT scanning to find out the degree of the slap and also the version of the hip ultrasound scan can be useful for early slips and also to look at the joint effusion and MRI scan to look at the avascular necrosis. But these are all supplementary investigations in terms of diagnosis and the history, clinical presentation and plain x-rays.
Most of the time, we should be able to give you the diagnosis. The classification can be divided into functional classification. Which is divided into two types the stable and the unstable, the stable is ample, able to ambulate and bear weight. An unstable slip is a patient, is in severe pain and unable to ambulate with or without crutches.
I think in this topic, everyone should know about the loader paper. And if you are asked about this through this information as soon as that you are aware of this paper and mention it to the examiner, it tells you about the stable slip and the unstable slip. It was a multicenter trial and they look at the 54 children who had 55 slips and what they found that the avian develop in 47% of the patients with the unstable hip.
Then there can be other classifications, like neurological classification, which includes pre slap. Then it can be acute, chronic and acute and chronic. The difference between acute and chronic is the time and the duration of the symptoms. If there's an abrupt displacement in the short period of less than three weeks, it is acute sleep and the chronic sleep.
If it's the groin pain immediately pain methane and presented more than three weeks of duration and acute and chronic, as the name suggests. The symptoms are of more than three weeks duration, but then they present with sudden onset on the x-rays. You can also do the grading of these slips. Most commonly done is the southwark Southwick angle. So there are a few things again, which you should know about the athletic angle.
One, it is a difference between the two sides. So you look at the normal side and then look at the angle on the other side and then subtracted and then that's how you calculate the slap. And it is measured only lethargy on both. It was 1,000 angles divided into three types grade one, grade 2 and grade 3 grade 1 angle difference of less than 30 degrees. Grade two difference of more than between 30 and 50 degrees.
And grade 3 severe, which is a difference of over 50 degrees. OK, so more severe, the slap is more likely to be unstable. OK this is the radiological presentation of measuring the Sawchuck angle. I don't think they will ask you to draw the angle, but they would expect you to know the values of these angles.
OK now we come to the treatment of this condition. So what are the aims the aims is to prevent any further progression of the slip in without any complications. For the stable, slap is very simple and straightforward. I think there's hardly any controversy and that is spinning in situ. However, for the unstable slap, there are different school of thoughts and different people say different like treatment options.
But again, the aim is still the same to prevent any further progression of the slap and to avoid any further complications in future. Unstable hip, as we discuss early. They've got high risk of avian. And building in situ can be technically difficult because of the degree of the slip. And some people have more aggressive approach, which is open reduction of the hip.
And then there are different types of osteotomy that can be performed to reduce the hip and once they reduce the hip to stabilize the hip. OK the most commonly done is the dance osteotomy, which is the trunk, or Derek osteotomy, which is through the growth plate. OK rest of the time, I have not seen them personally myself. But again, if you look at work at different centers, the most commonly done is the osteotomy.
Now, pending in situ is something which they can ask about the surgical technique of that as well. Now the points to remember in that is the entry point is more interior than you normally think of, ok? And there are different ways to identify the entry point. One way is that you look at the position where you want to put the wood screw on the AP and the lateral view and then draw the lines and where the lines are intersect.
That is your entry point. OK so I think this is if people have not come across with that, I would suggest to go through it and have a clear plan how you if somebody asks you, how are you going to pin, have a plan in your mind positioning of the patient? What are the aims? Are you going to achieve? What type of screw are you going to put in and how many threads you will pass?
OK now, this is just a flow chart. I've taken this from a postgraduate pediatric orthopedics, and I found this book quite useful for pediatric orthopedics. That's quite a. This is, again, quite a useful chart. And if you just remember this chart, I think you can answer most of the questions again, as we discussed earlier.
It has divided this in the two main categories stables, slap and the unstable sleep. And then depending upon how severity, how severe it is, there are different treatment options. OK similarly, this graph also simplifies the treatment options. This one, I have taken it from a paper from ogulu and Clark.
That's the other paper, I think people, you should know about it. And again, if you're given an opportunity, mention it in the Viva. This is a review article and we consultants work around Southampton. And again, they have simplified the treatment options and explain it in quite detail that what you're expected to do if you come across with a stable slap and what are the options if you come across with an unstable slip?
OK now. A question can be asked if you are doing very well regarding the timing of the surgery. And this is something which is, again, controversial. For pending inside to again, that's not a big, big issue. You can do it as soon as possible. But again, it is not something which needs to be done in the middle of the NIPE. You can, you can plan it and then do it.
And probably in these days, probably consult the pediatric orthopedic surgeons before doing the spinning OK. Uh, there are a few papers, which I have mentioned, which which have given different opinions regarding the timing of the surgery. Loadings at all meta analysis of five studies, they looked at the unstable Sufi and then they concluded that avian risk decreased if the treatment occurred within 24 hours.
Again, keep in mind, this is again for unstable Sufi. But they also mentioned the difference was large, but it was not significant. A debt paper, Petterson, it all. They look at 91 accurate slips, and they all mentioned that early civilization was associated with less risk of avian. Loaded it all looked at their study, they showed that 87% of the people of patients developed haven't been treated within 48 hours.
But again, most of the patients were having unstable slap. OK now. The other question can be asked. What are you going to do with the other side? Which does not have any symptoms. OK, if they are symptomatic, then the answer is straightforward. You you will fix it.
But if the other side is not symptomatic, then again, it's a controversial topic. But there are certain factors that can be considered if you are planning to fix another side. Age of the patient. If the child is less than 10 years of age, it is associated with higher risk of being bilateral Sufi. If the etiology of endocrine disorder, again, they have got high incidence.
And if you feel there is a poor compliance of the child and the parents, then you can consider fixing it at their side. OK and then also nature of the current slip. If the severe if the severe slap is severe, then it may justify pinning the other side. OK that, again, I think it is important. That's why I've put this light again to know the surgical technique of doing a spinning in situ.
Normally done an aesthetic with IV antibiotics, patient, supine on the fracture table, important thing is to mark the trajectory of the screw and use the fluoroscopy. As for your advantage? OK, the entry point is quite a what you normally expect for doing a dhs? A 7.3 millimeter or 6.5 millimeter fully threaded reverse cutting screws are used. Important thing is to avoid the blind spot.
And the way to award the blind spot again, to use the fluoroscopy and use different not only AP and little, you can have oblique views as well to make sure that the screw is not going into the joint. You can also use an to crown through the screw to see if it is going into the joint. In port post-operatively, you start with partial weight bearing leading to full weight bearing. OK the complications we already discussed.
We're doing all these things to avoid avian. It can cost condolences, which is a rapid and progressive loss of articular cartilage and patient present with severe pain. There can be residual deformity. And it can develop osteoarthritis and there can be ligament discrepancy.
So I think this is a very simple topic. If if, if it's come to your Viva is the local paper and the ogulu and Clark paper. And I think if you mention all these things, I'm pretty sure you will do well. And so say there's controversy about I agree with Sean, and I think I did mention that if you are ask about this question, you do mention that you will discuss with the pediatric orthopedic.
But if they ask you about the surgical technique again, you can say that you should know the principles and that's how you will answer that. The principles are that I'm going to. These are the principles, and that's why I'm going to treat, but I will discuss it with my colleagues. OK, so I'm going to just reinstate exactly what they have is a very important topic. You guys need to know that these are the topics it should be considered gift in the exam.
And when they come, you should score high so that you can take other places. The other thing what Sean always says and I, I sickened him like no one. Whenever you say this is a specialist problem or this is a pediatric specialist problem, you say the same sentence in one breath. Please don't stop. This is a pediatric specialist problem.
However, the principle of management are please don't stop or else they will intervene. And the less the examiners talk, the better it is for you. We will talk to him. And then and then, yeah, it's all great, Fawad. I think with these presentations, guys who have read this again and again might find that it's a bit repetitive and it just repeating whatever the textbooks are saying.
But that is the importance of the exam that you need to know the basics really well. It's going through all the mundane basics that will get you to score a six. It's being able to vocalize what exactly you're going to do with this patient in any. That's how you pass the exam. That whether this patient is being able to wait better or not, so those are the key things you have to verbalize those one after the other and bring them out, and they might take you in depth of one particular thing that you've mentioned.
But that's all right. As long as you stay on track as how you're going to manage this patient in any and there are and there would be. It is. I've seen this a couple of times in courses that pediatric surgeons, because they remember there will be a pediatric specialist in the vivo table.
They're very keen to start this question on a child who is presented with an injury to the knee or knee pain. They often do this, so beware of the child presenting with knee pain. Always think of the hip. OK that's all I have to add. I think this is a very important point. Always this question always starts with knee pain.
This is and you know, I got this question and it started as knee pain. And I'm sure whoever has got this question in the exam, it would have started as knee pain and it's a minor trauma to me with the patient coming. So that's a very important point to ponder for what there are a few questions. So the first one I have answered on your behalf, but I would like to second it.
They were asking how many threads are posed to us through the Pfizer. So I say three to five dependent and 5 below the slap Cornwall. Yes and then the other question is, what is fred? Sorry? there is another point on the thread. The reason the reason why they talk about no more than three to 5 is because if you try to cross all your threads across your growth plate, you will definitely have a high incidence of reaching into the joint surface.
The other point is the reason why Freud was pointing out that it's much more anterior than you think and your fixation. Your your emphasis is now posterior to the neck, so you're not aiming to get up the neck straight. You're aiming to put the center of your screw in the center of the prefaces. So therefore you end up being anterior in the neck automatically.
So just be aware those are two things that you need to get down correct. You're aiming for center of the prefaces, not the center of the neck, and you're also aiming for the no more than three to five, depending on the age of the patient, but not to cross the entire faces with your screw. OK the other question, what they have asked is about the blind spot for what?
What is the blind spot? The blind spot is if, if you are not careful. And if you're looking at only in the view, it is possible that again, because of the slip, the screw may go into the joint and breach the articular cartilage and that you don't want to do it. Because if you breathe the articular cartilage, then the chances of condolences becomes more. And therefore, it is suggested that you do the X-rays in different views, not only in the letter inserted oblique views as well to make sure that the threads are not going into the joint.
OK, thank you very much. There is someone else ask one final question, and then I have one question for you is, how do you diagnose convalescence? I think it again is a clinical presentation. What I have seen few patients with chronic illnesses is they present with severe pain in the hip with the history of Sufi in the past. OK but in terms of investigations, again, probably x-rays and then MRI scan would be helpful.
Yeah, I would get blown or something. An enhanced contrast MRI scan that shows the facial cartilage. That's but we're all for one is, are you aware of this new controversy of an acute slap to reduce it because Southampton guys are reducing it. This is something which is new, whether come into the exam? Yeah again, as I said, there are so much controversy about the treatment of the unstable hip, but I'm not sure what the guys in Southampton are doing.
I have worked in Children's Hospital with in touch with the guys, with the patient who present to our hospital. Their policy is generally to wait. So I think I did mention in my presentation, if you decide that patient is if he's an unstable slap and you are not going to do it acutely, then you put them in a direction for about a week that will allow the things to settle, and then they plan the surgery accordingly.
And then they don't fix Du fixation in situ rather than they consider doing it. Open reduction and internal fixation, like a modified Daniel's tenotomy by Sean and very good point by him.and. So all of the mentors have a very positively contributed to this. Very positive, because positive thinking can heal the world. So I'll hand it over to France to someone, when should we remove the screw?
We should not. If possible, it's only add 10 more minutes to a future hip replacement, if need be. Yeah OK. Shall we first, should we know? Yeah, I sure do. Thank you for that for presenting. Sorry, I missed it, but it's very good of you to present and I will.
I thought it was.
Form Title Download
Transcript
Form Title Bookmark
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Share
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Accessibility and Keyboard Shortcuts
The cadmore media player is a professional video and audio player experience designed to deliver media as well as relevant transcript, segmentation, and metadata. On the screen is a traditional html video player with buttons such as play, pause, forward, captioning, language and play speed selection and more. Adjacent to the video player are generally tabs, one of which shows a scrolling transcript of the video and the other shows any segmentation of the media, sometimes referred to as chapters. At the top of the video is a menu bar containing an Explore button and Tools button. The Explore button allows you to dig deeper into the video by opening up an explore dialog which contains tabs for a visual navigation of the video using thumbnails, an about tab which contains rich metadata about the media, a segments tab which contains further information about the video, and a related tab which contains links to other media related to this media. The tools button opens a menu with options for sharing the media on social media, creating bookmarking links, creating embed codes for your website, generating citations, and more.
Keyboard Shortcuts
Keyboard shortcuts only work while you are in forms mode. By entering forms mode, you will be able to quickly access portions of the media player with single key commands.
Spacebar: Play/Pause Toggle
I: Info Menu,
O: Tools Menu
T: Transcript Tab,
S: Segments Tab
F: Forward 15,
R: Rewind 15
L: Languages,
P: Playspeed
M: Mute Toggle,
V: Volume Bar
N: Video Only Toggle,
B: Full Screen Toggle
C: Captions Toggle
Escape: Closes dialogs and menus / Exits Player
Z: Next Transcript Chapter
X: Previous Transcript Chapter
Q: Next Transcript Paragraph
W: Previous Transcript Paragraph
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Embed Size
-
You Size - Responsive
-
We Size - Responsive
-
Picture Overlay Popup
-
400 x 225
-
512 x 288
-
400 x 700
-
768 x 1024
-
1024 x 512
-
1280 x 608
Form Title Cite
No citation provided.
Info
Segments
Related
Thumbnails
Exit Clip Mode
You have requested to see a portion of the video outside of the clip.
Click OK to switch to the full video or click if you would like to stay inside the clip. You can always go back to the clip with Tools and Clip Mode