MAMCOTS | INJURY: IDENTIFY, IMMOBILIZE - Advanced Diagnostics, Clinical Decision-Making, and Therapeutics in Orthopaedics | Dr. P. S. Mamtora

This session explains how physics and different forces (such as tensile, compressive, and shear) create specific bone fracture patterns, and how understanding these patterns allows for proper diagnosis, immobilisation, and treatment to restore functionality.

The session emphasises the critical role of taking a detailed patient history to properly identify an injury, noting that true trauma or fracture pain starts immediately with an event that the patient will clearly remember. In contrast, delayed pain typically points to a non-traumatic condition requiring a completely different treatment plan.

This session outlines the clinical identification of phalangeal fractures, utilising basic signs such as swelling, tenderness, and ecchymosis, as well as a simple fist-closing test to detect rotational or angular malalignment without the need for advanced imaging.

The speaker emphasises that a "dead lateral" and "dead AP" X-ray view of the specific injured finger is essential for identifying small phalangeal and intra-articular fractures to prevent permanent movement restriction, rather than relying on standard combined hand X-rays.

This session outlines the fundamental guidelines for treating phalangeal fractures, emphasising the "5 Rs" of injury management (recognition, resuscitation, reduction, retention, and rehabilitation), the prevention of joint stiffness through correct positioning, and the identification of complex regional pain syndrome.

This session reviews various medical cases involving real examples of phalangeal fractures, explaining their diagnostic indicators, treatments, and stability

Volar plate injuries, which typically present as soft tissue swelling, faint ecchymosis, and painfully restricted flexion following a hyperextension injury, are frequently missed unless a proper physical examination and a "dead lateral" X-ray view are conducted. Management requires an extension block splint to immobilize the PIP joint in flexion for a shortened duration of three weeks to prevent the avulsion from separating.

This video discusses how fractures at the base of the proximal phalanx are commonly missed due to inadequate physical examinations or poor X-ray views, and demonstrates how to identify, evaluate, and treat these injuries—such as using buddy strapping and MCP joint flexion to correct dorsal tilt.

The video provides a clinical overview of mallet finger, detailing its diagnosis via a lack of active extension at the DIP joint, non-surgical treatment using continuous hyperextension splinting for six weeks, and indications for surgical fixation.

A jersey finger is a relatively uncommon injury caused by a large force that peels the flexor digitorum profundus off the distal phalanx, resulting in an inability to actively flex the DIP joint and typically requiring surgery due to proximal displacement.

An ulnar collateral ligament injury of the thumb's metacarpophalangeal joint is caused by hyperabduction from a fall, resulting in swelling, tenderness, joint laxity, and pain under valgus stress. Historically termed "gamekeeper's thumb" from the repetitive forces used during rabbit and hare hunting, it is treated using a thumb spica splint worn 24/7 for six weeks to prevent permanent laxity and poor pinch strength.

While undisplaced fractures at the base of the proximal phalanx can be treated with a thumb spica cast, displaced fractures may require surgery.

This video discusses fractures of the fifth metacarpal neck, which typically cause a swollen and tender knuckle that sits lower than normal, resulting in cosmetic disfigurement rather than functional issues. The speaker details treatment options, expressing a preference for a custom-moulded ulnar gutter cockup slab over pre-made online splints to allow for manual adjustments and proper healing control

A fracture at the base of the fifth metacarpal is often missed due to surrounding swelling and small cracks on X-rays, which can lead to proximal migration of the distal shaft and functional disability if not well immobilised.

The video discusses the clinical signs of phalangeal toe fractures, such as swelling, ecchymosis, and deviation, and explains how proper physical examination and X-ray analysis are essential to determine whether the injury requires buddy strapping or specialised splinting.

The video outlines the clinical differentiation, diagnosis, and crucial need for strict immobilisation and non-weight-bearing treatment to prevent recurrent instability in various ankle and midfoot ligament injuries

The speaker discusses how fifth metatarsal base fractures present with midfoot tenderness, can be missed on ankle X-rays, and are treated with a below-knee plaster cast or boot for six weeks.

The speaker explains how to identify midtarsal osseoligamentous injuries, such as calcaneocuboid and talonavicular ligament injuries, by looking for tenderness and a donor surface for avulsions, while noting that distal fifth metatarsal fractures do not require immobilisation or plaster since they are not in the weight-bearing zone.

The video explains how detailed clinical examinations and specific X-ray angles help identify often-missed TMT joint (Lisfranc) injuries, which require rigid plaster immobilisation and strict non-weight bearing.