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Aseptic Loosening in Arthroplasty
Most common cause of late arthroplasty failure. Pathophysiology: particle-induced macrophage activation → cytokine release → osteolysis. Risk factors: polyethylene wear, malalignment, micromotion, poor cementing technique. Clinical: pain, progressive radiolucent lines, migration. Management: revision arthroplasty with improved fixation and bearing surfaces.
Open topicAtlantoaxial Instability — Pediatric & RA
Causes: congenital anomalies (Down syndrome), os odontoideum, trauma, and rheumatoid arthritis with transverse ligament incompetence. Measure atlantodental interval (ADI): >3 mm in adults or >5 mm in children suggests instability; consider dynamic flexion–extension views. Symptoms: neck pain, myelopathy signs, vertebrobasilar symptoms; intubation risks in RA. Surgery: posterior C1–C2 fusion (Goel‑Harms C1 lateral mass–C2 pedicle/pars screws) ± transarticular screws; consider odontoidectomy for i...
Open topicAvascular Necrosis (AVN) Hip — Ficat & ARCO
AVN = ischemic necrosis of femoral head → collapse and arthritis. Risk factors: steroids, alcohol, trauma, sickle cell, Gaucher’s, idiopathic. Ficat staging I–IV; ARCO integrates imaging and lesion size/location. MRI is most sensitive investigation (double-line sign). Management: early—bisphosphonates, core decompression; late—osteotomy, resurfacing, THA.
Open topicAvascular Necrosis (AVN) of the Femoral Head - Case Based Discussion
Introduction Avascular necrosis (AVN) of the femoral head, also known as osteonecrosis, is a condition characterized by death of bone tissue due to interruption of blood supply to the femoral head. The femoral head is particularly vulnerable to ischemia because its vascular supply is limited and largely dependent on the retinacular vessels arising from the medial circumflex femoral artery. Loss of blood supply leads to necrosis of trabecular bone and marrow, resulting in structural collapse of t...
Open topicAvascular Necrosis of Hip - Case Based Discussion
Case Presentation A 40-year-old male presented with progressive pain in the right hip for the past one year. The pain was initially mild but gradually increased in intensity and was aggravated by walking and prolonged standing. The patient also complained of stiffness in the hip and difficulty sitting cross-legged. Deep groin pain radiating to the thigh Progressive restriction of hip movements Difficulty in squatting and sitting cross-legged Antalgic gait No history of trauma The patient had a h...
Open topicBado Classification — Monteggia Fracture-Dislocations
I: anterior radial head dislocation (ulna angulated anterior). II: posterior; III: lateral; IV: both bones fractured with radial head dislocation. ORIF ulna restores radial head reduction; direction predicts associated patterns.
Open topicBado Classification (Paediatric) — Monteggia & Equivalents
Type I: Anterior radial head dislocation with anterior angulated ulnar fracture — most common in children. Type II: Posterior/posterolateral dislocation; Type III: Lateral/anterior-lateral dislocation; Type IV: Both-bone fractures + radial head dislocation. Equivalents: Variants with plastic deformation or isolated ulna fracture + radial head dislocation; must realign ulna to reduce radius.
Open topicBearing Surfaces in Hip Arthroplasty (MoM, MoP, CoC, CoP)
Main bearing couples: Metal-on-Polyethylene (MoP), Metal-on-Metal (MoM), Ceramic-on-Ceramic (CoC), Ceramic-on-Polyethylene (CoP). MoP: gold standard; risk of wear/osteolysis; improved with highly crosslinked PE. MoM: large heads, low wear but metal ions, ALTR, pseudotumors; largely abandoned. CoC: lowest wear; risk of squeaking, fracture. CoP: good compromise — low wear, no squeaking; increasingly preferred.
Open topicBennett Fracture - Case Based Discussion
Introduction Bennett fracture is an intra-articular fracture at the base of the first metacarpal involving the carpometacarpal (CMC) joint of the thumb. It is an unstable fracture caused by axial loading of a partially flexed metacarpal. Due to the pull of the abductor pollicis longus tendon, the metacarpal shaft displaces proximally and dorsally while a small volar fragment remains attached to the trapezium. Case Presentation A 25-year-old male presented to the emergency department following a...
Open topicBiceps Pathology — SLAP Lesions
SLAP = Superior Labrum Anterior to Posterior tear involving biceps anchor. Mechanism: overhead throwing, fall on outstretched hand. Types I–IV (Snyder classification). Clinical: pain, clicking, instability; O’Brien’s, crank, biceps load tests. Management: conservative first; arthroscopic repair/debridement in symptomatic tears.
Open topicBiomaterials in Orthopaedics
Metals: stainless steel (316L), cobalt‑chrome, titanium alloys; differences in modulus, corrosion resistance, MRI artifacts. Polymers: UHMWPE (arthroplasty bearings), PMMA (bone cement), PEEK (spacers). Ceramics: alumina/zirconia (bearings), hydroxyapatite/tricalcium phosphate (coatings, bone graft substitutes). Surface engineering: porous coatings, grit‑blast, plasma spray HA for osseointegration. Failure modes: wear (PE oxidation), corrosion (fretting, crevice, galvanic), fatigue fracture, ost...
Open topicBiomechanics of Fracture Fixation
Load sharing vs load bearing; absolute vs relative stability; primary vs secondary healing. Plates: compression (DCP/LCP in compression) vs bridging (relative stability); working length matters. Nails: intramedullary load‑sharing devices; reamed vs unreamed; interlocking controls length/rotation. External fixation: pin density/configuration, frame stiffness; circular frames allow controlled micromotion. Screw biomechanics: lag by technique vs design; pull‑out strength depends on cortical engagem...
Open topicBiopsy Principles in MSK Oncology
Biopsy is critical for diagnosis but must follow strict oncological principles. Plan biopsy with final surgery in mind; incision should be longitudinal and in line with resection. Avoid contamination of uninvolved compartments and neurovascular structures. Prefer core needle/incisional biopsy; excisional only for small superficial masses. Send adequate tissue for histopathology, culture, cytogenetics.
Open topicBlount’s Disease — Langenskiöld Classification
Pathologic varus from disordered endochondral growth of medial proximal tibial physis; early walkers/obesity risk. **Langenskiöld stages I–VI** describe progressive physeal/epiphyseal changes (beaking → depression → physeal bar). Differentiate from physiologic bowing using **metaphyseal–diaphyseal angle** (>11° suggests Blount). Management: **Bracing** in early Stage I–II (
Open topicBöhler Braun Splint — Set-up
Used for tibia/femur fractures with traction. Has pulleys, slings; allows elevation and adjustment. Complications: sores, stiffness, peroneal palsy.
Open topicBone & Joint Infections in HIV
HIV patients prone to bacterial (Staph aureus), mycobacterial (TB), fungal infections. Salmonella is a classic cause of osteomyelitis in HIV, especially with sickle cell disease. Clinical: insidious bone/joint pain, fever, constitutional symptoms; consider atypical presentations. Investigations: cultures, biopsy, imaging (MRI sensitive for marrow involvement). Treatment: prolonged targeted antibiotics, ATT/antifungals as needed, surgical debridement, optimize HAART.
Open topicBone Grafts and Substitutes
Autograft is gold standard: osteogenic + osteoinductive + osteoconductive (iliac crest). Allograft provides scaffold (osteoconductive) ± growth factors; immune & disease transmission risks minimized by processing. Substitutes: calcium phosphates (HA/TCP), calcium sulfate, bioactive glass; mainly osteoconductive. Biologics: BMP‑2/7, PRP (controversial), bone marrow aspirate concentrate. Applications: nonunion, defects, spinal fusion; match graft biology to defect needs.
Open topicBone Tumor Biopsy Principles
Biopsy should be performed only by definitive surgical team at referral center. Types: core needle (preferred), incisional, excisional. Incision along surgical approach, longitudinal not transverse. Biopsy tract must be excised en bloc at definitive surgery. Complications: contamination, hematoma, infection, inadequate sample.
Open topicBone Tumor Imaging — Lodwick
Lodwick classification describes patterns of bone destruction on radiographs. Type I: geographic (IA sclerotic rim, IB sharp margin, IC ill-defined). Type II: moth-eaten destruction. Type III: permeative pattern. Helps differentiate benign vs malignant and plan biopsy/management.
Open topicBone Turnover Markers
Formation markers: bone‑specific ALP, osteocalcin, P1NP. Resorption markers: CTX (C‑telopeptide), NTX, TRAP‑5b. Uses: monitoring therapy in osteoporosis and metabolic bone disease, not for diagnosis alone. Preanalytic variability: diurnal variation (fasting morning samples), renal/hepatic function influences.
Open topicBoth Bone Forearm Fractures
Simultaneous fracture of radius and ulna compromises pronation-supination. Adults: ORIF with plating is gold standard; children: closed reduction & casting. Principle: restore length, alignment, rotation of both bones. Complications: malunion, nonunion, radioulnar synostosis.
Open topicBoth Bones Forearm Fracture
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Open topicBoth Bones Forearm Fracture - Case Based Disucssion
Case Presentation A 28-year-old male presented to the emergency department following a road traffic accident with severe pain and deformity of the left forearm. The patient was unable to move the forearm due to pain. Severe pain in the forearm Visible deformity of the forearm Swelling and tenderness over radius and ulna Restricted pronation and supination Distal neurovascular status intact Radiographs of the forearm demonstrated fractures of both the radius and ulna at the middle third of the sh...
Open topicBoutonnière & Swan Neck
Define Boutonnière & Swan Neck with common etiologies and pathoanatomy. List key classifications or staging systems used in exams. Clinical features and focused examination; special tests as applicable. Imaging: first‑line and advanced; measurements that change management. Nonoperative indications and protocols. Operative indications; approach and key steps. Implant/technique options with pros/cons. Complications and how to prevent/manage them. Rehabilitation milestones and outcome expectations....
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