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Posterior Malleolus — Indications for Fixation
Fix if fragment >25–30% of tibial plafond, >2 mm displacement, syndesmotic instability, or posterolateral fragment involving PITFL. CT-based morphology guides approach: posterolateral approach common; direct reduction restores incisura and syndesmotic stability. Sequence: posterior malleolus first to stabilize syndesmosis, then fibula/medial malleolus. Fixation: screws posterior‑to‑anterior or buttress plate via posterolateral approach. Restoring posterior fragment reduces need for trans-syndesm...
Open topicProximal Fibula (Maisonneuve)
Maisonneuve injury = proximal fibular fracture + syndesmotic disruption + medial injury (deltoid/medial malleolus). Mechanism: external rotation with pronation. Examine entire fibula in ankle injuries; knee pain/tenderness is a clue. Management centers on syndesmotic stabilization; proximal fibula usually non-op. Avoid missing saphenous nerve injury or peroneal nerve palsy proximally.
Open topicProximal Humerus Fractures
Neer classification (parts displaced >1 cm or >45°): guides management. Non‑operative for minimally displaced; ORIF (locking plate) for displaced 2–3 part; hemiarthroplasty/RSA for unreconstructable 3–4 part or head‑split in elderly. Assess vascularity: medial hinge, calcar length; tuberosity integrity crucial for outcomes. Complications: AVN, stiffness, tuberosity nonunion/malposition, screw perforation.
Open topicProximal Tibia Metaphyseal Fractures — Pediatrics
Occurs in ages 3–6; risk of late valgus (Cozen phenomenon) due to asymmetric overgrowth. Usually metaphyseal greenstick/complete fractures from low‑energy mechanisms (trampoline, slide). Treat with long‑leg cast in slight varus; close follow‑up for 12–18 months. Most remodel; corrective osteotomy for persistent valgus >10–15° after growth potential declines. Beware associated fibular injury and compartment syndrome (rare).
Open topicProximal Ulna/Olecranon — Tension Band Wiring (TBW)
Indication: simple, non-comminuted transverse olecranon fractures (AO 21-B1) with intact dorsal cortex. Principle: converts triceps tensile force into compression at the articular fracture line during elbow flexion. Technique: two parallel K-wires + figure-of-8 wire anterior to axis. Avoid in comminution, osteoporosis, or Monteggia — plate preferred. Complications: hardware prominence, wire migration, loss of reduction, stiffness.
Open topicRadial Head & Neck Fractures (Adults & Paediatrics)
Radial head and neck fractures are common elbow injuries caused most often by a fall on an outstretched hand that transmits axial force through the forearm to the elbow. In adults, radial head fractures are typically intra-articular and are classified using the Mason classification, with treatment ranging from early mobilization for minimally displaced fractures to open reduction, fixation, or radial head replacement for displaced or comminuted injuries. In children, fractures usually occur at t...
Open topicRadial Neck Fracture - Paediatric
This X-ray demonstrates a radial neck fracture in an 8-year-old child, visible on both AP and lateral views of the elbow. The fracture occurs at the junction of the radial head and radial shaft, with angulation of the radial head relative to the shaft. In paediatric patients, the radial head is largely cartilaginous and ossifies later, making careful evaluation of alignment essential.
Open topicRadiographic Signs of Rickets
Widened physes with cupping and fraying at metaphysis; generalized osteopenia. Rachitic rosary at costochondral junction; Harrison’s sulcus due to diaphragmatic pull. Looser’s zones (pseudofractures) in osteomalacia; bowing deformities. Correct metabolic defect first; orthopedic correction after medical therapy.
Open topicRegan–Morrey Classification — Coronoid Fractures
I: tip avulsion; II: 50% height. II–III indicate elbow instability, commonly part of terrible triad → fixation required.
Open topicReverse Shoulder Arthroplasty
Indicated for cuff tear arthropathy, pseudoparalysis, massive irreparable cuff tears. Developed by Grammont: medialized & lowered center of rotation. Deltoid substitutes for deficient rotator cuff. Requires intact deltoid and axillary nerve. Complications: scapular notching, instability, acromial stress fracture.
Open topicRevision TKA — Indications & Techniques
Common indications: aseptic loosening, PJI, instability, stiffness, polyethylene wear, periprosthetic fracture, malalignment. Workup: exclude infection (ESR/CRP ± aspiration); quantify bone loss (AORI). Reconstruction: restore joint line, balance gaps; use stems, augments, cones; match constraint to ligament competence. Constraint ladder: PS → CCK → hinge; use minimum needed. Outcomes depend on accurate diagnosis and restoration of alignment/rotation/soft-tissue balance.
Open topicRheumatoid Arthritis — Hand
Autoimmune symmetric polyarthritis causing synovitis and progressive joint destruction—typical deformities in the hand: ulnar drift at MCPs, swan‑neck and boutonnière deformities, and caput ulnae syndrome. Early goal‑directed medical therapy with DMARDs/biologics is cornerstone; hand surgery addresses pain, deformity, and function (synovectomy, tendon procedures, joint arthroplasty/arthrodesis). Radiographs show periarticular osteopenia, marginal erosions, and joint space loss; ultrasound/MRI de...
Open topicRickets — Orthopaedic Sequelae
Failure of mineralization at the growth plate → metaphyseal cupping, fraying, and splaying with genu varum/valgum. Differentiate **nutritional vitamin D deficiency** from **X‑linked hypophosphatemic rickets (XLH)** and renal rickets; labs guide diagnosis. Medical therapy first: vitamin D and calcium for nutritional; **phosphate + active vitamin D** (calcitriol) for XLH; burosumab in select cases. Orthopaedic: guided growth hemiepiphysiodesis for coronal deformity; corrective osteotomy when sever...
Open topicRobotic-Assisted Joint Replacement — Current Evidence
Robotics assists bone preparation and implant positioning (mostly semi-active systems). Potential: improved accuracy, reproducibility, individualized alignment strategies. Limitations: cost, time, learning curve; uncertain long-term functional advantage. Evidence: improved radiographic accuracy; PROMs and survivorship similar in short- to mid-term. Use case: complex deformity, kinematic alignment strategies, teaching environments.
Open topicRockwood Classification — AC Joint Injuries
I: sprain; II: AC torn, CC intact; III: AC+CC torn with superior displacement. IV: posterior displacement; V: marked superior displacement; VI: inferior displacement (rare). I–II non-op; III individualized; IV–VI require surgery.
Open topicRotator Cuff Impingement — Neer and Bigliani Classification
Comprehensive guide to subacromial impingement syndrome covering Neer staging, Bigliani acromial morphology, clinical tests, conservative management, subacromial decompression and outcomes.
Open topicRotator Cuff Repair
Rotator cuff provides dynamic stability and elevation of shoulder. Tears: acute traumatic vs degenerative. Indications for repair: symptomatic full-thickness tear, acute traumatic tear in young, failed conservative treatment. Techniques: open, mini-open, arthroscopic. Complications: re-tear, stiffness, infection, deltoid detachment (open).
Open topicRotator Cuff Tears — Overview
Supraspinatus most commonly torn; tears progress from partial to full‑thickness and can propagate posteriorly/anteriorly. Painful arc, night pain, and weakness on specific tests (Jobe, ER lag, belly‑press) are classic. MRI is investigation of choice; assess fatty infiltration (Goutallier) and tendon retraction (Patte). Treatment spectrum: physiotherapy/injections → arthroscopic repair (single/double row) → tendon transfer/SCR → reverse shoulder arthroplasty for cuff arthropathy. R...
Open topicRotator Cuff Tears — Repair Principles
Common in elderly and overhead athletes; supraspinatus most often torn. Clinical: pain, weakness in abduction/external rotation, night pain. Tests: Jobe’s, drop arm, external rotation lag sign. Imaging: MRI gold standard; USG useful. Management: physiotherapy for partial tears; repair (arthroscopic/open) for symptomatic full-thickness.
Open topicSalter–Harris Classification — Physeal (Growth Plate) Injuries
Type I: Through physis only (slip) — good prognosis; often in younger children. Type II: Through physis and metaphysis (Thurston–Holland fragment) — most common; good prognosis. Type III: Through physis and epiphysis into joint — needs anatomic reduction (articular). Type IV: Through metaphysis, physis, and epiphysis — high risk of growth arrest; ORIF often required. Type V: Crush injury to physis — rare, poor prognosis; often diagnosed retrospectively by growth arrest. Extended: Rang VI–IX (per...
Open topicSanders CT Classification — Calcaneus
I: nondisplaced posterior facet; II: two-part; III: three-part; IV: comminuted (>3 parts). Type correlates with outcome; II–III often ORIF; IV has poorest prognosis.
Open topicScapho-Lunate Instability
Most common carpal instability; due to disruption of scapholunate ligament. Clinical: wrist pain, weakness, clicking; positive Watson’s test. Radiology: gap >3 mm (‘Terry Thomas sign’), DISI deformity. Acute injury—repair; chronic—reconstruction or salvage (four-corner fusion). Untreated cases progress to SLAC wrist (Scapholunate Advanced Collapse).
Open topicScaphoid fracture - Case Based Fractures
Introduction Scaphoid fractures are the most common fractures of the carpal bones, accounting for approximately 60–70% of all carpal fractures. These injuries typically occur following a fall on an outstretched hand with the wrist in extension and radial deviation. The scaphoid plays a crucial role in carpal stability by linking the proximal and distal carpal rows. Because of its unique blood supply, which enters distally and travels proximally, fractures of the scaphoid are particularly p...
Open topicScaphoid Fracture — Diagnosis & Treatment
Most common carpal fracture, usually waist (70%). Blood supply retrograde to proximal pole → high risk of AVN. Clinical: anatomical snuffbox tenderness, pain on axial loading of thumb. Investigations: X-ray may be normal; MRI is sensitive for occult fracture. Treatment: cast for undisplaced, screw fixation for displaced, vascularized bone graft for nonunion.
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