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Femoral Neck Fracture — Garden/Pauwels
Garden I–II = non-displaced, III–IV = displaced. Pauwels I 50° vertical shear. Young = urgent reduction + fixation (CS/DHS). Elderly = arthroplasty if displaced. Complications: AVN, nonunion.
Open topicFemoroacetabular Impingement (FAI) — Cam, Pincer & Mixed
Comprehensive guide to femoroacetabular impingement (FAI) covering cam, pincer, and mixed morphologies, alpha angle measurement, Tönnis grading, clinical assessment, conservative and surgical management including hip arthroscopy.
Open topicFibrous Dysplasia — Shepherd’s Crook
Developmental fibro‑osseous lesion replacing normal bone with fibrous tissue. Types: monostotic (70%), polyostotic; associated with McCune–Albright (café‑au‑lait, endocrine). X‑ray: ground‑glass appearance, expansion, cortical thinning; Shepherd’s crook deformity of proximal femur. Histology: irregular woven bone trabeculae (‘Chinese letters’) in fibrous stroma. Treatment: bisphosphonates for pain, corrective osteotomies, internal fixation for deformity.
Open topicFloating Joints — Floating Knee, Floating Elbow & Floating Shoulder
Comprehensive guide to floating joint injuries covering floating knee (Fraser classification, ipsilateral femur and tibia fractures), floating elbow (ipsilateral humerus and forearm fractures in children), and floating shoulder (ipsilateral clavicle and scapular neck fractures, superior shoulder suspensory complex), with management principles, surgical indications, and complications for each pattern.
Open topicFoot & Ankle — Hallux Valgus
Lateral deviation of great toe with medial eminence (bunion). Risk factors: female gender, footwear, ligamentous laxity, pes planus. Clinical: pain, callosities, overlapping toes. Radiology: HVA >15°, IMA >9°. Severity guides surgery. Treatment: footwear modification, orthoses, osteotomies (Chevron, Scarf, Lapidus).
Open topicFracture Healing — Biology & Timelines
Phases: inflammation → soft callus (cartilage) → hard callus (woven bone) → remodeling (lamellar). Primary (direct) vs secondary (indirect) healing; absolute vs relative stability concepts. Cell sources: periosteum (key), endosteum, marrow, surrounding soft tissues. Mechanical environment (strain theory) dictates tissue type; too much motion → nonunion. Timelines vary by bone/age/blood supply—tibia slower than femur; smokers/NSAIDs may delay.
Open topicFrykman Classification — Distal Radius
Types I–VIII: extra- vs intra-articular, DRUJ involvement, and ulnar styloid fracture. Intra-articular (III–VIII) have higher arthritis risk; often require ORIF.
Open topicGait Cycle and Analysis
Gait cycle: stance (~60%) and swing (~40%); double support ~20% of cycle. Rocker phases: heel rocker, ankle rocker, forefoot rocker enable forward progression. Determinants reduce vertical COM excursion: pelvic rotation/tilt, knee flexion in stance, ankle mechanism, foot mechanism. Pathological gaits: Trendelenburg, antalgic, circumduction, steppage, equinus. Clinical gait analysis: observational + instrumented (temporal‑spatial, kinematics, kinetics, EMG).
Open topicGaleazzi Injury
Radial shaft fracture with disruption of the distal radioulnar joint (DRUJ). Occurs in middle to distal third radius fracture. Requires ORIF of radius and stabilization of DRUJ. Called 'fracture of necessity' because surgery is mandatory in adults. Complications: DRUJ instability, chronic pain, stiffness.
Open topicGaleazzi Injury — Distal Radius + DRUJ Disruption
Distal radial shaft fracture with distal radioulnar joint (DRUJ) disruption. Unstable pattern: ORIF radius and stabilize DRUJ.
Open topicGarden Classification — Femoral Neck (Intracapsular)
I: incomplete/valgus impacted; II: complete, nondisplaced. III: complete, partially displaced (varus); IV: complete, fully displaced. I–II stable → fixation; III–IV unstable → arthroplasty in elderly (high AVN/nonunion).
Open topicGartland Classification — Supracondylar Humerus (Extension Type)
Type I: Nondisplaced — anterior humeral line intersects capitellum; treat in long arm cast. Type II: Displaced with posterior cortex intact (hinge) — often closed reduction & pinning (CRPP). Type III: Completely displaced with no cortical contact — unstable; CRPP with two or three pins. Type IV (Leitch): Multidirectional instability (both cortices incompetent) — unstable under fluoroscopy; pin spread critical.
Open topicGiant Cell Tumor — Campanacci Classification
Locally aggressive benign tumor in skeletally mature adults (20–40 yrs). Campanacci classification: Grade I (latent), II (active), III (aggressive with soft tissue extension). X-ray: eccentric lytic lesion, soap-bubble appearance. Treatment: extended curettage with adjuvants, PMMA, or wide excision. Denosumab indicated in sacral/spinal or unresectable lesions.
Open topicGustilo–Anderson — Open Fractures
I: 10 cm/high-energy or extensive damage. IIIa: adequate coverage; IIIb: periosteal stripping, needs flap; IIIc: arterial injury requiring repair. Higher grade → higher infection/nonunion; guides antibiotics, debridement, coverage.
Open topicHaemophilic Arthropathy
Caused by recurrent hemarthrosis in hemophilia A/B leading to synovitis, cartilage loss, and arthritis. Target joints: knee, ankle, elbow—recurrent bleeds produce synovial hypertrophy. Radiographic findings: squaring of patella, widened intercondylar notch, subchondral cysts. MRI: sensitive for synovial hypertrophy, hemosiderin deposition, and cartilage thinning. Treatment: prophylactic factor replacement, radiosynovectomy/arthroscopic synovectomy, arthroplasty in end‑stage.
Open topicHaemophilic Arthropathy — Evaluation & Treatment
Recurrent hemarthroses → synovial hypertrophy → cartilage damage and arthropathy (ankle, knee, elbow). Evaluation: bleeding history, factor levels/inhibitors, US/MRI for synovitis and osteochondral damage. Acute bleed management: RICE + factor replacement to target levels (VIII or IX). Chronic synovitis: radiosynovectomy/arthroscopic synovectomy; advanced arthropathy—osteotomy, arthrodesis, arthroplasty. Always coordinate with hematology for perioperative factor protocol ± antifibrinolytics.
Open topicHallux Rigidus
Degenerative osteoarthritis of the 1st MTP joint causing dorsal osteophytes, stiffness, and pain—especially with push‑off. Coughlin–Shurnas clinical–radiographic grading guides treatment (Grade 1: mild stiffness → Grade 4: severe stiffness with sesamoid involvement/near ankylosis). Cheilectomy ± Moberg (dorsal closing wedge) osteotomy for low‑grade disease; 1st MTP arthrodesis is the gold standard for advanced disease in active patients. Arthroplasty/hemicap considered selectively in low‑demand...
Open topicHardcastle–Myerson — Lisfranc Injuries
A: total incongruity; B1: medial partial; B2: lateral partial; C1: divergent partial; C2: divergent complete. Any >2 mm displacement typically requires surgical fixation/arthrodesis.
Open topicHawkins Classification — Talar Neck
I: no dislocation; II: subtalar dislocation; III: subtalar + tibiotalar; IV: plus talonavicular. AVN risk escalates I→IV; displaced types require urgent reduction and fixation.
Open topicHemiarthroplasty Hip — Indications
Most common indication: displaced femoral neck fracture in elderly. Types: unipolar (Austin-Moore, Thompson) vs bipolar prostheses. Advantages: shorter surgery, less blood loss vs THA. Disadvantages: acetabular erosion, groin pain in long term. Choice depends on age, activity, acetabular status.
Open topicHerbert Classification — Scaphoid
A: acute stable (A1 tubercle, A2 nondisplaced waist). B: acute unstable (B1 distal oblique, B2 displaced waist, B3 proximal pole, B4 comminuted, B5 perilunate). C: delayed union; D: established nonunion. Unstable (B) often need fixation; D needs grafting + fixation.
Open topicHertel Predictors — Proximal Humerus Ischemia
Medial hinge disruption >2 mm, anatomic neck fracture, head-splitting → high AVN risk. Assists decision towards arthroplasty in ischemic patterns.
Open topicHeterotopic Ossification after Hip Arthroplasty
HO = abnormal bone formation in periarticular soft tissues after surgery or trauma. Incidence after THA: 20–50%; clinically significant in 5–10%. Risk factors: male sex, hypertrophic OA, ankylosing spondylitis, previous HO. Classification: Brooker I–IV (X-ray based). Prophylaxis: NSAIDs, radiotherapy; treatment = excision if severe functional limitation.
Open topicHigh Tibial Osteotomy (HTO) — Indications & Techniques
Indications: medial compartment OA with varus deformity in young active patients. Goal: shift weight-bearing axis laterally to unload medial compartment. Techniques: lateral closing wedge, medial opening wedge, dome osteotomy. Fixation: plates (TomoFix) or external fixators. Delays need for TKA in younger patients.
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