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5th Metatarsal Base — Zones (Pseudo-Jones/Jones/Stress)
Zone I: tuberosity avulsion (pseudo-Jones) — usually heals conservatively. Zone II: Jones fracture at metaphyseal–diaphyseal junction — watershed area, higher nonunion → screw fixation esp. athletes. Zone III: proximal diaphyseal stress fracture — often needs surgery + graft in chronic cases.
Open topicAC Joint Injuries — Rockwood
Rockwood I–VI classification based on AC/CC ligament disruption and clavicle displacement. I–II: non-op (sling, rehab). III: controversial; IV–VI: surgery. Surgical options: hook plate, CC fixation (suture buttons), ligament reconstruction (Weaver‑Dunn/hamstring graft). Complications: hardware irritation, loss of reduction, osteolysis. Rehab: early ROM; contact sports after strength and stability return.
Open topicAcetabular Fractures — Letournel
Elementary: PW, PC, AW, AC, Transverse. Associated: PC+PW, Trans+PW, T-type, AC+PHT, Both-column. Views: Judet + CT 3D. Approaches: KL (post), Ilioinguinal/Stoppa (ant). Goal: anatomical reduction ≤2 mm dome.
Open topicAchilles Tendinopathy & Rupture
Achilles tendon is most frequently injured tendon; common in athletes and middle-aged weekend warriors. Tendinopathy: degenerative process due to overuse, poor vascularity, fluoroquinolone/steroid use. Acute rupture: sudden pop, pain, inability to plantarflex; positive Thompson test. Imaging: USG/MRI confirm diagnosis, assess tendon gap/degeneration. Management: Tendinopathy—eccentric exercises, activity modification, PRP/shockwave. Rupture—conservative functional bracing or surgical repair depe...
Open topicAchondroplasia — Orthopaedic Issues
Autosomal dominant **FGFR3** mutation → rhizomelic limb shortening with normal trunk, macrocephaly. Neonates risk **foramen magnum stenosis** and central apnea; screen in infancy. Orthopaedic: **thoracolumbar kyphosis**, **genu varum**, and **lumbar spinal stenosis** in adulthood. Management includes posture/physio, guided growth or tibial osteotomy for varus, and decompressive laminectomy when symptomatic stenosis. Discuss limb lengthening carefully—psychosocial and complication considerations.
Open topicACL Injury — Biomechanics, Diagnosis & Reconstruction Principles
Comprehensive guide to anterior cruciate ligament injury covering anatomy, biomechanics, clinical diagnosis including Lachman and pivot shift tests, graft selection, fixation methods, and evidence-based return-to-sport criteria.
Open topicACL Injury — Workup & Reconstruction
ACL is critical stabilizer against anterior translation and rotational instability. Mechanism: non-contact pivoting injury; pop and immediate swelling (hemarthrosis). Clinical: Lachman test most sensitive; pivot shift for dynamic instability. Imaging: MRI confirms tear and associated injuries (meniscus, cartilage). Treatment: physiotherapy in low-demand; reconstruction with autograft (BTB, hamstring) in active patients.
Open topicACL Reconstruction — Techniques
Gold standard for young active patients with ACL-deficient knee. Grafts: Bone–Patellar Tendon–Bone (BTB), Hamstring (STG), Quadriceps tendon, Allograft. Tunnel drilling: transtibial vs anteromedial portal vs all-inside. Fixation: interference screws, suspensory devices, cross-pins. Complications: graft failure, tunnel malposition, stiffness, infection.
Open topicAdolescent Idiopathic Scoliosis — Management
Lenke classification guides fusion levels using curve type, lumbar modifier, and sagittal modifier. Bracing is effective in skeletally immature (Risser 0–2) with 25–40° curves when worn adequately. PSF with pedicle screws is gold standard for surgical AIS; selective fusion aims to preserve motion segments. Assess sagittal profile to avoid hypokyphosis and junctional problems. Psychosocial support and cosmesis discussion are important in counseling.
Open topicAdult Acquired Flatfoot — Posterior Tibial Tendon Dysfunction (PTTD)
Most common cause of adult acquired flatfoot; due to PTT degeneration/rupture. Stages I–IV (Johnson & Strom classification). Clinical: medial ankle pain, progressive collapse of medial arch, hindfoot valgus. Imaging: MRI shows tendon degeneration; weight-bearing X-rays show arch collapse. Treatment: Stage I—orthoses, NSAIDs; Stage II—tendon transfer + osteotomy; Stage III/IV—arthrodesis.
Open topicAllman / Neer Distal Third — Clavicle
Allman: Type I midshaft; Type II distal; Type III medial third. Neer distal clavicle: Type I stable; IIA/IIB unstable (CC ligaments disrupted); Type III intra-articular; V epiphyseal. Distal (Neer IIB) has high nonunion; often operative.
Open topicAllografts & Bone Banking
Bone allografts used for structural reconstruction after tumor resection. Sources: cadaveric donors; stored in bone banks (fresh-frozen, freeze-dried). Indications: intercalary defects, osteoarticular reconstruction. Complications: nonunion, fracture, infection, resorption. Alternatives: endoprosthesis, autograft, vascularized fibula.
Open topicAmputation — Levels & Prosthetics
Level selection balances wound healing potential, prosthetic energy cost, and function. Upper limb: transmetacarpal, wrist disarticulation, trans‑radial, elbow disarticulation, trans‑humeral, shoulder disarticulation. Lower limb: Syme, transtibial (BKA), knee disarticulation, transfemoral (AKA), hip disarticulation/hemipelvectomy. Flap design: long posterior flap (BKA), myodesis over myoplasty for power and stability. Prosthetics: suspension (suction, pin‑lock), sockets (PTB, TSB), feet (SACH, d...
Open topicAnderson–D’Alonzo — Odontoid (Dens) Fractures
Type I: tip avulsion (rare, stable). Type II: base of dens (common, unstable, high nonunion). Type III: into C2 body (better healing).
Open topicAneurysmal Bone Cyst
Expansile blood-filled benign tumor in children/young adults. Common sites: metaphysis of long bones, spine posterior elements. X-ray: blow-out lesion with thin shell, septations. MRI: multiple fluid–fluid levels. Treatment: curettage + graft/cement, sclerotherapy, embolization.
Open topicAnkle Fractures — Lauge-Hansen
Classification based on position of foot + force direction. Common: Supination-External Rotation (SER), Supination-Adduction (SA), Pronation-Abduction (PA), Pronation-External Rotation (PER). Each mechanism has progressive stages of injury (ligament/osseous). Guides mechanism-based diagnosis and fixation strategy. Supination-External Rotation = most common ankle injury.
Open topicAntibiotic Prophylaxis in Orthopaedics
Standard: cefazolin within 60 min before incision (2 g; 3 g if >120 kg). Add vancomycin if MRSA colonized/high prevalence or severe β‑lactam allergy; start 120 min pre‑incision due to infusion time. Redose if procedure >3–4 h or blood loss >1500 mL; discontinue within 24 h for clean cases. Open fractures: start immediately; broaden by Gustilo grade.
Open topicAO Spine Thoracolumbar Classification
Type A (compression): A1 wedge, A2 split, A3 incomplete burst, A4 complete burst. Type B (tension band): B1 posterior through bone/ligament, B2 posterior + anterior, B3 anterior hyperextension. Type C (translation/rotation): multidirectional instability. Neurologic grade (N0–N4) and modifiers guide treatment.
Open topicAO/OTA 33 — Distal Femur (Supracondylar)
33-A: extra-articular; 33-B: partial articular (e.g., Hoffa = B3); 33-C: complete articular. Articular types require anatomic joint reduction; fixation usually with locking plates or retrograde nails.
Open topicAO/OTA 41 — Proximal Tibia (Alternative to Schatzker)
41-A extra-articular; 41-B partial articular; 41-C complete articular. Complements/updates Schatzker with alphanumeric consistency across regions.
Open topicAO/OTA 42 — Tibial Shaft + Oestern–Tscherne & Gustilo
AO: 42-A simple, 42-B wedge, 42-C complex/segmental. Closed soft tissues graded by Oestern–Tscherne; open injuries by Gustilo (I–IIIC). Guides fixation strategy and antibiotics/coverage planning.
Open topicApproach to Lytic Bone Lesions
A lytic bone lesion on X-ray should be approached systematically using five steps: patient age (the single most powerful clue — under 20 favours benign lesions, over 40 mandates excluding metastasis and myeloma first), location within the bone (epiphysis, metaphysis, or diaphysis each suggest specific diagnoses), zone of transition (narrow/sclerotic rim = benign; permeative = highly aggressive), periosteal reaction (solid = benign; Codman's triangle/sunburst/onion-skin = malignant), and matrix p...
Open topicArches of the Foot — Anatomy
Three arches: medial & lateral longitudinal, and transverse (anterior/posterior). Keystone bones: talus (medial longitudinal), cuboid (lateral), intermediate cuneiform (transverse). Static supports: plantar fascia (central band), spring ligament, long/short plantar ligaments, interosseous ligaments. Dynamic supports: tibialis posterior/anterior, peroneus longus, FHL/FDL, intrinsic plantar muscles via windlass mechanism. Functions: shock absorption, distribution of load across hindfoot–midfoot–fo...
Open topicArthrofibrosis after Arthroplasty
Defined as knee stiffness after TKA, usually 10° extension loss. Incidence: 3–6% after TKA. Causes: poor rehab, malposition, infection, scar tissue formation. Management: early manipulation under anesthesia (MUA), arthrolysis, revision if mechanical cause. Prevention: adequate pain control, early physiotherapy, correct alignment.
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