Principles of OrthopedicsINVESTIGATIONS

Dr. Mohammed M. ZamzamAssociate Professor & Consultant

Pediatric Orthopedic Surgeon

Laboratory

Blood CBC & ESR Biochemistry Serology Hormonal Essay Blood Culture

Urine Chemistry Culture

Laboratory

Joint Aspiration The procedure is often of a great help in

diagnosis of many effusions producing arthropathies

Diagnose or exclude septic arthritis Used routinely in haemoarthrosis A large-bore needle is used if the fluid is too

viscous The aspirate undergoes microscopic, chemical,

and gram stain examinations and culture & sensitivity test

Electro-diagnosis

Detect de-enervation and its degree Observe re-enervation before clinical signs Assess the progress of a lesion Localize the lesion

Electro-diagnosis

Elctromyography Poliomyelitis Muscle dystrophies Myelopathic diseases

It can provide useful information alongside clinical

examination and muscle biopsy

Electro-diagnosis

Nerve Conduction Study Acute compression neuropathy Chronic compression or entrapment neuropathy Peripheral neuropathies Traumatic nerve lesions

It is useful in differentiating between diseases of theaxons and of the anterior horn cells. It determines the level of interruption of a peripheral nerve lesion.

Histopathology

Bone Tumors Chronic Osteomyelitis Cystic lesions Osteoporosis

Chondrosarcoma

Osteoporosis

Histopathology

Soft Tissues Tumors Chronic arthritis (synovium) Myopathies (muscles) Neuropathies (nerve)

Histopathology

Needle aspiration Endoscopic biopsy Open biopsy Frozen section Excisional biopsy

Osteochondroma

Arthroscopy

Internal visual examination of joints Confirm clinical and radiological

diagnosis Extension of the surgeon’s hand Therapeutic procedures Easy record of intra-articular lesions

Arthroscopy

Knee Loose bodies Synovial membrane Articular surfaces Medial & lateral menisci Cruciate ligaments Infrapatellar fat pad

Arthroscopy

Shoulder Biceps tendon Rotator cuff Articular surfaces Glenoid labrum Capsular ligaments

Arthroscopy (rare sites)

Elbow Osteochondritis Dissecans Synovial biopsy Loose bodies

Hip Unexplained pain Loose bodies Synovial biopsy CDH

Arthroscopy (rare sites)

Ankle Difficult due to tight structures Osteochondral lesions

Wrist Still being developed Wrist pain syndrome

Skeletal Imaging

Plain Radiographs Bone

- Lysis

- Sclerosis

- Dysplasia

- Osteonecrosis Joints Soft tissues

Ankle fracture

Scoliosis

Osteoporosis

Trochanteric Fracture Femur (Osteoporosis)

Osteosarcoma Giant Cell Tumor

Chondrosarcoma

Metastasis (Ca Prostate)

Metastasis (Ca Breast)

Skeletal Imaging

ArthrographyIntra-articular injection of dye to visualize the joint Soft tissue injuries CDH

SinographyTracking the sinus in COM

MyelographyRarely used now alone, usually with CT

Skeletal Imaging

TomographyDeep seated bony lesion

Ultrasonography Infections Cystic lesions Arthritis CDH Soft tissue injuries DVT

Skeletal Imaging

Computed Tomography Bone window Soft tissue window CT with contrast

Bony tumorsSpineChronic infectionsSome fractures

Chondrosarcoma ( CT )

Giant Cell Tumor Ischium ( CT )

Skeletal Imaging

Interventional Radiology Inaccessible lesions Disc therapy Bone biopsy Muscle biopsy

Skeletal Imaging

MRI Spine Joints Tumors Tendons Osteomyelitis

MRIRotator Cuff

Tear

MRI KneeOsteochondral

lesion

MRI KneeMeniscal Tear

MRI Physeal Bar

MRI Disc Prolapse

MRIMetastasis C7 Vertebra

Skeletal Imaging

Nuclear Medicine Bone and joint infections Tumors Avascular necrosis Osteoporosis

Bone Scan of Cancer Metastasis