integrated 2

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1

A professional football player, 28 years of age, during asoccer match, felt and heard a click from his left knee.

The player was trying to kick the ball by his right foot

and on doing so he twisted with his body on his left knee.

The player couldnt continue and asked for medical help.

The medical team hurried to the player, and found that his

left knee was swollen , when compared to the right side,

severely painful, and decided that the player shouldnt

complete the game.

The player was transferred to a specialized medicalcenter where the left knee was properly examined.

Plain X-ray was free. Magnetic resonance imaging of the

left knee revealed torn medial meniscus of the left knee.


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Knee injuries

-bony- soft tissue


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Extensions of tibia, serve to deepen articulation with femur Proximal surface concave, distal flat

Medial meniscus

Semicircular, comma 3.5cm in length Posterior horn larger Transverse ligament connects posterior fibers of anterior horn medial meniscus

to lateral meniscus Femoral and tibial attachment s enlarged by deep fibers MCL

Lateral meniscus

Almost circular Covers a larger portion of tibia than medial meniscus Anterior and posterior horns same width Anterior (Humphrey) and posterior (Wrisberg) meniscofemoral ligaments attach

posterior horn to MFC= these ligaments pass anterior and posterior to the PCL

Anterior to Posterior: M anterior horn of medial meniscus A ACL L anterior horn lateral meniscus L posterior horn of lateral meniscus M medial meniscus P PCL


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Anterior cruciate ligament


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Injuries of the meniscus


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2

70 years old lady, fell on her outstretched right hand, at home.She felt sever pain and couldnt move her right wrist and within

few minutes the wrist region became swollen as well as the

back of her right hand and fingers.

She presented to the causality, and when examined, her right

wrist looked from the side as a dinner fork, with markedswelling of the right hand and fingers. Also the lower part of

her right forearm was freely movable and a crepitus could be

heard when trying to move it.

As a first aid, a splint was applied to her right wrist and

forearm, and plain X-ray of the right wrist region wasrequested.

X-ray revealed fracture of the lower inch of the right radius.

(Colles fracture)


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Anatomy

Bony

Scaphoid fossa Lunate fossa

Sigmoid notch

DRUJ


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Anatomy

TFCC major

stabiliser of ulnar

carpus & radioulnarjoint

Articulates with both

the lunate and

triquetrum


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Anatomy

Normal movement

-150 deg flex/ext

-50 deg radial/ulnardeviation

-150 deg pron/sup

Axial load-80% radius-20% TFCC


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Radiological Parameters

2312mm


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Radiological Parameters

11


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Wrist bones


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Fracture lower radius


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Fracture lower radius


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Fracture Healing (callus formation)1 Inflammation (Haematoma)

Bleeding occurs from Bone ends BM Vessels Periosteum Damaged soft tissues

Forms # haematoma between bone ends & beneath elevated periosteum

Infiltration

Inflammatory mediators & low O attract inflamm cells Inflammatory cells migrate in

PMN 1st

Then M'phages & Lymphocytes Mediators

Organisation

Fibrin scaffold forms Neoangiogenesis & fibroblasts form from Granulation Tissue


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2 Repair Osteoprogenitor Cells Origin

1 Transformed Endothelial cells

2 Periosteum3 Osteogenic Induction of Mesenchymal cells in surrounding ST

Resorption Removed by

O'clasts

M'phages Soft (Primary) Callus

Consists of: Fibrous tissue Cartilage

Woven bon

3 Remodelling Woven bone replaced by lamellar bone

Haversian Systems laid down along lines of stress

integrated 2

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