Few things to memorize in Orthopaedic

This article is original and not a word to word translation from any book or page.   

Wartenberg sign: in ulnar nerve injury, abducted little finger of the hand caused by paralysis of the third palmar interosseous nerve (little finger adductor) and over powering of the EDM innervated by PIN.

Wartenberg syndrome: pain and paraesthesia over the dorsal of the first web space associated with injury to the superficial sensory branch of the radial nerve caused by compression between the brachioradialis and extensor carpi radialis longus muscles in pronation.

Duchenne sign: (claw hand – benediction hand) caused by ulnar never dysfunction.

Ulnar paradox: the severity of claw hand deformity appears more severe when the lunar nerve injury is distal (FDP remains innervated if the lesion is distal along the claw hand apparent). This for instance happens after a high ulnar nerve injury, when the nerve starts to recover and reinnervate the FDP, the claw hand starts to worsen.

Essex Lopresti: radial head fracture – DRUJ injury – Interosseous membrane rupture

Cotton-Loder wrist position: extreme volar and lunar deviation position (after distal radius fracture reduction and casting), it increases risk of carpal tunnel syn.

Bucket-Handle pelvic injury: lateral compression fracture with contralateral rami fracture (Tile B2-2).

Crescent fracture: pelvic fracture type LC II (lateral compression + posterior iliac fracture dislocation) based on young Burgess classification.

Hawkins sign: Talar subchondral lucency caused by subchondral hypotrophy after ankle fracture. Seen on mortise view 6-8 wk from injury. Observation is indicated and AVN is less likely.

Marjolin ulcer: malignant tumor (90% SCC – basal cell, melanoma) on a chronic osteomyelitis draining wound, burns, snake bite site, venous and decubitus ulcers.

Constant fragment: Sustentaculum tali in calcaneus fracture, FHL runs underneath it. It was called constant because it has ligamentous attachments with talus and was thought it doesn’t displace after calcaneus fracture.

Night-stick fracture: isolates ulnar shaft fracture.

Chaput fragment: the anterolateral fragment of distal tibia pilon fracture. It’s attached with anterior inferior tibiofibular ligament.

Volkman fragment is the posterolateral fragment of distal tibia. It is attached to posterior inferior tobiofibular ligament.

Wagstaff fragment: of distal fibula that attaches to anterior inferior tibiofibular ligament. It is on the other side of Chaput fragment.

Fleck sign in foot: in lisfranc injury, small avulsion fracture of the base of the second metatarsus. Represent a stable fracture.

Fleck sign in ankle seen as avulsion of posterior distal fibular ridge and represents an injury to superior peroneal retinaculum causing peroneal tendon subluxation.

Cotton test: Ankle syndesmosis test by doing lateral pull on the fibula under fluoroscopy to assess syndesmosis widening. Another syndesmosis test is by doing external rotation stress.

Cotton osteotomy: Medial cuneiform dorsal “planter flexion” opening wedge osteotomy to correct residual forefoot supination lateral column lengthening for flexible planovalgus foot deformity.

Turf toe: Big toe sprain (capsuloligament injury). Most common mechanism: while ankle in equinus (heel off ground) – hyperdorsiflexion injury of first MTP with axial load. Less common mechanism: hyperplantarflexion of MTP with valgus thrust, seen in beach volleyball players.

Hip pointer: ASIS avulsion fracture.

Hurdler fracture: Ischial tuberosity avulsion fracture.

Tug lesion: Cortical desmoid (periosteal desmoid). Located on the posteromedial distal femur / avulsive cortical irregularity (repeated microtrauma and pull on the adductor magnus or medial gastroc head. Boys >girls and one third bilaterally. Best seen on oblique radiographs. Observe , typically resolved at age 20.

Stewart-Treves syndrome: Lymphangiosarcoma in a pre-existing lymohedema. Aggressive and requires resection or amputation.

Spur sign: on obturator oblique pelvic view, indicate both column acetabular fracture.

Bankart lesion: Anterior / anterior – inferior labral lesion. (Anterior band of IGHL)

Kim lesion: Posterior inferior labral lesion. Seen in football players and indicates posterior instability. On exam: jerk test.

Bennett lesion: posterior inferior glenoid spur (mineralized labrum) seen in basketball players and pitchers.

Autocrine: Mode of hormone action to which hormons bind to receptors on to the cell and affects the cell that produces it. e.g. growth factors that stimulate cell division. 

Paracrine: describes hormone action where hormones are released from cells and bind to receptor on nearby cells and affects their function.

Endocrine: hormone action where hormones are released from cells and affect distant cells via blood

Calve’s disease: Vertebra plana caused by Eiosinophilic Granuloma (hystoctosis x).

Hand Schuller Christian disease: polyostotic langerhans cell histiocytosis with visceral involvement. Eiosinophilic Granuloma in the sella turcica (also in vertebra, skull, lover, spleen). Children with skull defects + exophthalmosis + diabetes insipidous.

Kanavel signs: most common sign in pyogenic tenosynovitis of fingers: fusiform swelling + pain with passive extension + tender to pressure + tender on flexion sheath

Vaughan Jackson syndrome: fingers and wrist extensor tendon rupture in patients with Rheumatoid arthritis. The first to rupture are EDM and EDC of the small finger then after that the ring, the middle, the index fingers and then EIP.

Bosworth fracture dislocation: fracture dislocation of distal fibula. The fibula is posteriorly displaced behind the posterolateral ridge the tibia. Closed reduction maneuvers or surgery.

Otto’s pelvis or disease (arthrokatadysis) = Idiopathic prostrusio acetabulai. Female:males (10:1), bilateral hip involvement and progress to osteoarthritis in mid adult life.

Kohler line in AP pelvis = Ilioischeal line (from lateral border of the the obturator foramen to the medial border of sciatic notch.

Notch of Harty: The ankle anterior joint line space medial to the tibialis anterior tendon.

Mannerfelt-Norman syndrome: Flexor pollicis longus tendon rupture in Rheumatoid arthritis because of scaphotrapezial arthritis. (Sudden inability to flex thumb / do OK sign).

Cozen test: for lateral epicondylitis; pain at the lateral epicondyle provoked by resisted wrist extension.

Pollock test: for ulnar nerve palsy by examination of Flexor digitorum profundus of the little finger.

Kiloh-Nevin sign: Loss of the ability to make OK with tip on tip index and thumb because of anterior interosseous nerve palsy.

Penumbra sign: MRI of subacute osteomyelitis. On T1= dark center + bright inner wall + dark outer wall. On T2 = soft tissue oedema.

Mortar and Pestle appearance of the hip (منظر دقاقة الثوم للورك): Small eroded femoral head in a wide acetabulum in TB infection.

Fairbank’s triangle: localized bone dysphasia and defect of ossification in the inferior-medial position of the femoral neck with small neck shaft angle <110 deg = Coxa vara.

Cod fish vertebra: biconcave vertebra seen in osteomalacia / rickets.

Jailhouse vertebra: seen in vertebral body heamangioma on AP/ lateral views.

Squared vertebra: seen in ankylosing spondylitis.

Looser zone (milkman lines – pseudofractures): seen in osteomalacia. Fracture lines (healed but not mineralized) seen on the concave side of the long bones.

Rucksack palsy: supraspinatus nerve palsy caused by prolonged downward traction on the shoulder and leads to wasting and weakness of the supra and infraspinatus muscles.


Leave a Reply