• Pott’s disease → Tuberculosis of the spine.
• Pott’s fracture → Fracture-dislocation of the ankle joint involving both malleoli with rupture of the deltoid ligament.

🔹Tip: “Disease = TB spine; Fracture = ankle.”

• Definition: Tuberculous infection of the vertebral column caused by Mycobacterium tuberculosis (usually paradiscal).
• Pathology: Begins in cancellous bone of vertebral body → spreads to adjacent disc → vertebral collapse → angular kyphosis → possible paraplegia.
• Common sites: Dorsolumbar (D10–L2).

• Mc route – Hematogenous
• And paucibacillary
• Mc type – Paradiscal (Involved 2 vertebra)

🔹Tip: Paraplegia in Pott’s = compression myelopathy due to granulation or collapse.

🔹Tip: If patient has evening rise of temperature + kyphosis = think Pott’s.

Investigations:

• X-ray spine: Reduced disc space, anterior vertebral collapse, paravertebral shadow.
• MRI spine: Most sensitive for marrow and cord involvement.
• Blood: ↑ ESR, positive Mantoux.
• Microbiology: CBNAAT / culture from biopsy.

Management:

1. Medical (first-line):
   • ATT × 9–12 months (HRZE × 2 → HR × 7–10).
   • Rest + spinal brace (Jewett or Taylor brace).
2. Surgical (indications = Pott’s paraplegia / abscess / instability / severe deformity):
   • Anterior decompression + fusion or posterior instrumentation.

🔹Tip: “Surgery for the 4 I’s — Instability, Intractable pain, Intact cord compression, Ineffective medical therapy.”

🟢 EPIPHYSIS

Common lesions:

• Giant Cell Tumour (GCT)
• Chondroblastoma
• Tubercular osteomyelitis (rare)

Age:

• GCT → 20–40 yrs
• Chondroblastoma → 10–20 yrs

Findings:

• GCT → Expansile lytic “soap-bubble” up to sub-articular end
• Chondroblastoma → Lytic with sclerotic rim
• TB → Cold abscess / gibbus

Tip: E = End of bone → GCT & Chondroblastoma

🟠 METAPHYSIS

Common lesions:

• Osteosarcoma
• Acute Osteomyelitis
• Unicameral Bone Cyst (UBC)
• Aneurysmal Bone Cyst (ABC)

Age: 10–25 yrs

Findings:

• Osteosarcoma → Mixed lytic-sclerotic, sun-burst, Codman triangle
• Osteomyelitis → Lytic area + periosteal reaction ± sequestrum
• UBC → Central lytic, thin cortex, fallen fragment sign
• ABC → Eccentric expansile lytic, fluid-fluid levels on MRI

Tip: M = Most tumours start here

🔵 DIAPHYSIS

Common lesions:

• Ewing’s Sarcoma
• Osteoid Osteoma
• Fibrous Dysplasia

Age: 5–30 yrs

Findings:

• Ewing’s → Onion-skin periosteal reaction, fever, pain
• Osteoid Osteoma → Central nidus, pain relieved by NSAIDs
• Fibrous Dysplasia → Ground-glass matrix, bone expansion

Tip: D = Deep shaft lesions

💙 Quick Recall:
👉 Epiphysis – GCT (Soap bubble)
👉 Metaphysis – Osteosarcoma / Cysts (Sun-burst / Fluid levels)
👉 Diaphysis – Ewing’s (Onion skin)

💙 Tip:

“End = GCT ; Middle = Osteosarcoma + Cysts ; Shaft = Ewing’s.”

• Definition: Inflammation of bone and marrow due to pyogenic organisms → commonly Staphylococcus aureus.
• Types:
  1. Acute hematogenous (children)
  2. Chronic osteomyelitis (after sequestrum formation)
  3. Post-traumatic / post-operative

🔹Tip: Always mention “sequestrum + involucrum + cloaca” in chronic cases.

🔹Tip: MRI detects early marrow edema → best for early diagnosis.

Acute:

• IV antibiotics (high-dose Cloxacillin / Cefazolin).
• Drainage of pus.
• Splintage for rest.

Chronic:

• Surgical sequestrectomy + saucerization.
• Long-term antibiotics (4–6 weeks).
• Reconstruction if defect (bone graft / muscle flap).

🔹Tip: Persistent sinus in chronic osteomyelitis → biopsy to rule out SCC.

• Fibrous ankylosis → fibrous tissue unites joint (still some movement).
• Bony ankylosis → complete osseous fusion (no movement).
• False ankylosis (pseudoankylosis) → outside the joint, e.g., myositis ossificans.

🔹Tip:
Tuberculosis → fibrous ankylosis; trauma/surgery → bony ankylosis.

• Definition: Surgical fusion of a joint to achieve stability and pain relief.
• Indications:
  • Painful arthritis (post-TB, post-traumatic, rheumatoid)
  • Flail joints (neuromuscular paralysis)
  • Instability after infection / deformity.
• Common sites: Hip, knee, ankle, wrist, spine.

🔹Tip:
Arthrodesis sacrifices movement → preserves stability & function.

🔹 Definition:

CTEV (clubfoot) is a congenital deformity of the foot characterized by four components —
CAVE:

• C – Cavus (high medial arch)
• A – Adduction of forefoot
• V – Varus of hindfoot
• E – Equinus at ankle joint

💙 Tip: “CAVE = Classic deformity components of CTEV.”

🔹 Incidence & Laterality:

• 1–2 per 1000 live births
• 2:1 Male predominance
• Bilateral in 50% of cases

🔹 Etiology (Causes):

1. Idiopathic (most common)
2. Secondary causes: Neuromuscular (spina bifida, CP), syndromic, or postural

🔹 Pathoanatomy:

• Short tendo-Achilles and posterior tibial tendon
• Medial soft-tissue contracture
• Small talus, navicular medially displaced

🔹 Clinical Features:

• Inverted, adducted, and plantar-flexed foot at birth
• Heel not touching ground
• Calf muscle thinness
• Foot cannot be dorsiflexed or everted

🔹 Diagnosis:

• Clinical (mainstay)
• Pirani Scoring System used to assess severity (0–6 scale)
  • <3: Mild, >4.5: Severe
• X-ray rarely needed except pre-surgery

🔹 Treatment (Stepwise):

🎯 Goal: Make foot plantigrade, flexible, and functional

1️⃣ Conservative (Ponseti Method – Gold Standard)

• Serial manipulation & weekly plaster casts (5–6 casts)
• Sequence of correction: C → A → V → E
• Percutaneous Achilles tenotomy for equinus correction
• Foot abduction brace for maintenance (up to 3–4 years)

💙 Tip: “Ponseti corrects deformity in reverse CAVE order.”

2️⃣ Surgical (if resistant / late presentation)

• Soft-tissue release (e.g. Turco or McKay procedure)
• Bony procedures in older child (osteotomies, triple arthrodesis)

“Correct deformity in order of C → A → V → E.”

🔹 Definition:

A fracture is a break in the continuity of a bone, either complete or incomplete, usually caused by trauma, repetitive stress, or pathological weakness of bone.

🔹 Types (By completeness):

• Complete: Bone broken through its entire thickness
• Incomplete: Crack without full separation (e.g., greenstick fracture)

🔹Tip:
“Ankylosis happens, Arthrodesis is done.”

🔹 1️⃣ Union

👉 Definition: Normal healing of a fracture with restoration of bone continuity and strength.
👉 Time: Within expected period (6–12 weeks for most long bones).
👉 X-ray: Bridging callus, trabeculae crossing fracture line.

💙 Tip: “Pain-free, solid, continuous bone = Union.”

🔹 2️⃣ Malunion

👉 Definition: Fracture heals in abnormal position — angulation, rotation, or shortening.
👉 Cause: Improper reduction or premature weight bearing.
👉 Consequence: Deformity or functional limitation.
👉 Treatment: Corrective osteotomy if functionally significant.

💙 Tip: “Healed — but wrong.”

🔹 3️⃣ Non–Union

👉 Definition: Failure of fracture to unite even after expected period, with no further healing potential.
👉 Clinical: Persistent mobility at fracture site, pain on stress.
👉 X-ray: Sclerosed, rounded ends (“elephant foot” or “pencil-point”).
👉 Treatment: Debridement + bone grafting / fixation.

💙 Tip: “Not healed — and won’t heal without help.”

🩵 Quick Recall:
Union → Healed properly
Malunion → Healed wrongly
Non-union → Not healed at all

• Definition: Extra-articular fracture of lower end of radius within 2.5 cm of the wrist joint, with dorsal displacement and tilt of the distal fragment.
• Mechanism: Fall on outstretched hand (FOOSH).
• Deformity: “Dinner-fork” or “Silver-fork.”

🔹Tip: Always quote — Common in postmenopausal osteoporotic women.

Features:

• Pain, swelling, deformity at wrist.
• “Dinner-fork” appearance.
• Loss of pronation-supination.

Management:

1. Initial: Analgesia + splinting.
2. Definitive: Closed reduction (under anesthesia) → confirm with X-ray → below-elbow POP cast in palmar flexion + ulnar deviation (“Colles position”).
3. Duration: 6 weeks → physiotherapy.
4. Complications: Malunion, stiffness, Sudeck’s dystrophy, rupture of EPL tendon.

🔹Tip: “Do not immobilize in supination — causes stiffness.”

FOOSH can cause a series of fractures depending on energy & site:

• Distal radius → Colles’ fracture
• Carpal scaphoid → Scaphoid fracture
• Elbow → Supracondylar fracture (children)
• Shoulder → Anterior dislocation / clavicle fracture

🔹Tip: Always check wrist + elbow + shoulder in any FOOSH injury.

🔹Tip: “Colles = dorsal; Smith = solar (volar).”

• Definition: Injury to two or more body systems or multiple injuries causing physiological derangement and risk of death.
• Examples: Head + chest + limb fractures after RTA.
• Principles of management:
  1. ATLS protocol (ABCDE).
  2. Damage control orthopaedics:
     • Stage 1: Resuscitation + temporary stabilization (external fixator).
     • Stage 2: Definitive fixation after stabilization.

🔹Tip: “Save life first, limb later.”

🔹Tip: Watch for fat embolism triad → hypoxia + petechiae + confusion.