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Sternoclavicular Injuries
SC joint dislocations: anterior (more common, often stable after reduction) vs posterior (rare but life‑threatening due to mediastinal compression). Posterior dislocation red flags: dyspnea, dysphagia, venous congestion, neurologic symptoms—urgent reduction under anesthesia with cardiothoracic standby. Imaging: CT with contrast preferred; plain X‑rays often inadequate. Management: sling and rehab for sprain/anterior dislocation; posterior often requires closed/open reduction and stabilization (f...
Open topicSubtrochanteric Femur — Fixation
Deforming forces: flex-abd-ER proximal; add distal. Implant: CMN gold standard. Reduction aids: Schanz, cerclage, clamps. Entry point crucial (piriformis/trochanteric). Complications: malreduction, implant failure.
Open topicSupraspinatus — Anatomy & Clinical Tests
Origin: supraspinous fossa; insertion: superior facet of greater tuberosity; innervation: suprascapular nerve (C5–6). Action: initiates abduction, contributes to humeral head depression and centering. Blood supply: suprascapular artery; critical zone of hypovascularity near tendon insertion (degeneration site). Impingement & tears: subacromial impingement (Neer), degenerative & traumatic tears; clinical tests for integrity. Tests: Jobe (empty can), full can, drop‑arm, external rotation lag (for...
Open topicSwan Neck Deformity
Hyperextension of PIP with flexion of DIP joint. Caused by RA (most common), trauma, chronic mallet finger, spasticity. Clinical: finger looks like swan neck, loss of grip strength. Treatment: splints, silver rings, tendon balancing procedures, arthrodesis in severe cases. Differentiate from boutonniere (opposite deformity).
Open topicSyme's amputation
Syme's amputation is a through-ankle amputation in which the foot is removed while preserving the heel pad and distal tibia-fibula, allowing end-bearing ambulation. Originally described by James Syme in 1843, it provides a durable weight-bearing stump with minimal limb-length discrepancy compared with more proximal amputations. The procedure is most commonly indicated for severe foot trauma, infection, congenital deformities, and selected diabetic foot conditions when the heel pad and posterior...
Open topicSynovial Sarcoma
High-grade soft tissue sarcoma, often near large joints of extremities (knee, ankle). Affects adolescents and young adults (15–40 years). Histology: biphasic (epithelial + spindle cells) or monophasic; SYT-SSX fusion gene (t[X;18]). Imaging: calcification may be seen on X-ray; MRI shows heterogeneous mass. Treatment: wide excision with radiotherapy; chemotherapy (ifosfamide, doxorubicin) improves survival in advanced cases.
Open topicTalar Neck Fractures — Hawkins
Hawkins classification I–IV based on displacement/dislocation. AVN risk increases with stage: I 90%. Urgent reduction and fixation critical to preserve talar blood supply. Fixation: screws/plates, often dual incision approach. Hawkins sign (subchondral lucency) = revascularization on X-ray at 6–8 weeks.
Open topicTarsal Tunnel Syndrome
Entrapment neuropathy of the posterior tibial nerve under the flexor retinaculum behind the medial malleolus. Symptoms: burning dysesthesia/paresthesia in plantar foot, worse at night or with prolonged standing; positive Tinel’s sign posterior to medial malleolus. Etiologies: space‑occupying lesions (ganglion, varicosities), tenosynovitis, trauma, hindfoot valgus/flatfoot causing traction, systemic neuropathies. NCS/EMG supports diagnosis; ultrasound/MRI detects masses and tendon pathology. Trea...
Open topicTB Hip
Second most common osteoarticular TB after spine; insidious monoarthritis progressing through stages. Typical deformity: flexion, adduction, external rotation; muscle spasm and night cries common in children. Shanmugasundaram radiographic stages (synovitis → arthritis → advanced arthritis → ankylosis) guide treatment. Diagnosis: ESR/CRP, MRI for early synovitis/marrow edema; confirm with biopsy/AFB smear/culture/GeneXpert. Treatment: ATT for 9–12 months; traction/physiotherapy early; synovectomy...
Open topicTB Knee
Common site of osteoarticular TB after spine and hip; presents with chronic monoarthritis. Phemister triad on X‑ray: peri‑articular osteopenia, marginal erosions, gradual joint‑space narrowing. MRI shows synovitis, cartilage loss, and bone marrow edema—useful for early disease. Confirm by biopsy/AFB/GeneXpert; ESR/CRP typically raised. Treatment: ATT 9–12 months; synovectomy in persistent synovitis; arthrodesis/arthroplasty after disease quiescence for end‑stage joints.
Open topicTendon Healing and Rehabilitation
Phases: inflammatory (days 1–7), proliferative (days 3–21), remodeling (weeks–months). Intrinsic (tenocyte) vs extrinsic (synovial/paratenon) healing; adhesion formation from extrinsic fibroblasts. Early controlled mobilization enhances tensile strength and reduces adhesions in flexor tendons. Suture techniques: core locking (e.g., 4–6 strand) + epitendinous running improves gap resistance. Rehab protocols: Kleinert, Duran (flexor); early active motion in selected repairs.
Open topicTendon to Bone Fixation methods
Tendon-to-bone fixation is the process of securely attaching a tendon or ligament graft to bone using devices such as bone tunnels, suture anchors, interference screws, cortical buttons, and suspensory fixation systems until biological healing occurs. Successful repair depends on both strong initial mechanical fixation and gradual tendon-to-bone biological incorporation at the enthesis. The choice of fixation method varies according to the procedure, tendon quality, bone quality, and biomechanic...
Open topicTennis & Golfer’s Elbow
Tennis elbow = lateral epicondylitis (ECRB tendon origin degeneration). Golfer’s elbow = medial epicondylitis (flexor-pronator origin). Clinical: pain, tenderness, weakness of grip; Cozen’s, Mill’s, Maudsley’s test for tennis elbow. Investigations: clinical diagnosis; USG/MRI may show tendon degeneration. Management: rest, activity modification, NSAIDs, physiotherapy, injections; surgery if refractory.
Open topicTerrible Triad of the Elbow — Pattern (Not Graded)
Posterior elbow dislocation + radial head fracture + coronoid tip fracture. Requires concentric reduction, radial head fixation/replacement, coronoid/LCCL repair.
Open topicTFCC Injuries
TFCC stabilizes the distal radioulnar joint and dissipates ulnar‑sided load. Palpable 'fovea sign', ulnar grind, and DRUJ shift test support diagnosis. MRI useful; wrist arthroscopy remains gold standard for diagnosis and treatment. Central tears → arthroscopic debridement; peripheral tears → repair; positive ulnar variance → consider ulnar shortening osteotomy. Failure to treat instability leads to chronic pain and DRUJ arthritis.
Open topicThomas Splint — Indications & Technique
Indications: femoral shaft fractures, temporary stabilization. Provides traction + splintage. Structure: proximal ring, side bars, distal crossbar. Complications: sores, nerve palsy, inadequate traction.
Open topicThoracolumbar Burst Fractures — Load Sharing
Assess stability and neurology with TLICS; Load Sharing Classification (McCormack) predicts need for anterior support. High load‑sharing score (≥7) → consider anterior column reconstruction with corpectomy/cage in addition to posterior fixation. Posterior pedicle screw constructs (short vs long segment) are standard; add intermediate screws at the fractured level to improve stability. Canal compromise alone is not an absolute indication for laminectomy—retropulsed fragments resorb over time if P...
Open topicTibia Shaft Fractures — Compartment Risk
Tibia shaft → highest risk of compartment. Signs: pain out of proportion, stretch pain. ΔP
Open topicTibial Plateau — Schatzker
I lateral split, II split+depression, III depression, IV medial, V bicondylar, VI dissociation. Surgical principle: elevate, graft, raft screws, plate. Complications: compartment syndrome, arthritis.
Open topicTibial Spine Avulsion — Pediatrics
Pediatric equivalent of ACL tear — bony avulsion of tibial eminence. Meyers–McKeever Types I–III (and IV comminuted) guide management. Type I: cast in extension; II–III/IV: arthroscopic reduction and fixation (sutures or screws). Beware entrapped intermeniscal ligament or meniscal tissue blocking reduction. Rehab mirrors ACL protocols with protected ROM initially.
Open topicTile Classification — Pelvic Ring Stability
A: stable (posterior arch intact). B: rotationally unstable, vertically stable (open-book APC or LC injuries). C: rotationally + vertically unstable (complete posterior disruption).
Open topicTillaux (SH-III) & Triplane (SH-IV) — Distal Tibial Transitional Fractures
Tillaux: Anterolateral epiphyseal avulsion (SH-III) during asymmetric physeal closure — intra-articular; >2 mm step needs fixation. Triplane: Multi-planar SH-IV variant (sagittal epiphysis, axial physis, coronal metaphysis); 2-, 3-, or 4-part patterns. CT delineates fragments to plan screw fixation; restore joint congruity to prevent arthritis.
Open topicTLICS — Thoracolumbar Injury Classification & Severity Score
Morphology (compression 1, burst 2, translation/rotation 3, distraction 4), Posterior ligamentous complex integrity (intact 0, indeterminate 2, disrupted 3), Neurologic status (intact 0, nerve root 2, complete 2, incomplete 3). Score ≥5 → surgery; ≤3 → nonoperative; 4 = gray zone.
Open topicTotal Elbow Arthroplasty — Indications & Outcomes
Indications: rheumatoid arthritis, post-traumatic arthritis, complex distal humerus fractures in elderly, tumor resection. Implant types: linked (semi-constrained), unlinked (requires intact ligaments), convertible designs. Linked implants provide stability but ↑ stress at bone-cement interface; unlinked mimic anatomy but require ligamentous integrity. Complications: loosening, infection, triceps insufficiency, periprosthetic fracture, ulnar nerve palsy. Survivorship: 85–90% at 10 yea...
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