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Instability after TKA
Accounts for ~20% of TKA revisions. Types: extension instability, flexion instability, mid-flexion instability, recurvatum. Causes: ligament imbalance, component malposition, polyethylene wear, PCL incompetence. Diagnosis: clinical exam, stress radiographs, CT for component position. Management: revision TKA with constrained implants as per instability type.
Open topicIntercondylar Distal Humerus Fractures
T- or Y-shaped intra-articular fractures of the distal humerus. Most common in young adults (high energy) and elderly osteoporotic (low energy). Require anatomic articular reduction, stable fixation, and early mobilization. Olecranon osteotomy gives best exposure to articular surface. Fixation principles: two-column plating—orthogonal (90°) or parallel (180°).
Open topicIntertrochanteric Fractures — AO/OTA
AO 31-A: A1 simple, A2 comminuted, A3 reverse oblique. Implants: DHS for stable A1/A2, CMN for unstable A2/A3. TAD
Open topicJersey Finger
Avulsion of flexor digitorum profundus (FDP) tendon from distal phalanx. Mechanism: forced extension of DIP during active flexion (grabbing opponent’s jersey). Clinical: inability to flex DIP actively. Leddy-Packer classification (I–III) guides management. Treatment: surgical repair required in all cases.
Open topicJudet–Letournel — Acetabular Fractures
Elementary: posterior wall/column, anterior wall/column, transverse. Associated: posterior column+wall, transverse+posterior wall, T-shaped, anterior column/posterior hemitransverse, both-column. Determines approach (posterior vs anterior/Stoppa) and fixation strategy.
Open topicKienböck Disease
Avascular necrosis of lunate; affects young adults, more in men. Risk factors: negative ulnar variance, trauma, vascular anomalies. Lichtman staging I–IV guides management. Symptoms: chronic dorsal wrist pain, stiffness, grip weakness. Treatment: Stage I—immobilization; II—revascularization procedures; III—capitate shortening/limited fusion; IV—proximal row carpectomy or arthrodesis.
Open topicKirschner Wire (K-Wire) — Principles, Techniques & Applications
Comprehensive guide to Kirschner wire (K-wire) principles in orthopaedic surgery covering wire properties and sizes, biomechanical principles of fixation, insertion techniques, clinical applications by region, tension band wiring principle, complications including pin tract infection and thermal necrosis, and wire removal.
Open topicKnee Arthrodesis
Salvage procedure for irretrievable failed TKA, chronic infection, tumor resection. Techniques: intramedullary nailing, external fixation (Ilizarov), compression plating. Indications: non-reconstructible extensor mechanism, persistent sepsis, massive bone loss. Advantages: pain relief, stability; disadvantages: loss of knee motion, gait alteration. Complications: nonunion, malalignment, persistent infection.
Open topicKnee Arthroscopy — Portals, Operative Steps & Complications
Comprehensive guide to knee arthroscopy covering indications, patient positioning, standard and accessory portals with anatomical landmarks, the 10-point systematic diagnostic examination, operative steps for meniscal surgery, ACL reconstruction, and chondral procedures, and a full complication profile including neurovascular injury, instrument breakage, and post-operative stiffness.
Open topicKnee Dislocation — Vascular Workup
High-energy injury with high risk of popliteal artery injury (10–40%). Urgent reduction and splinting; check pulses + ABI. If ABI
Open topicKyphosis — Scheuermann vs Post‑TB
Scheuermann disease: rigid structural kyphosis with ≥3 adjacent vertebrae wedged ≥5° and Schmorl nodes. Post‑TB kyphosis is angular with short apex, often severe and progressive in children. Indications for surgery: progressive deformity, pain refractory to bracing, cosmetic concerns (Scheuermann >70–75°), neuro compromise (post‑TB). Surgical options range from posterior column osteotomies (SPO) to pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR) for sharp angular deformi...
Open topicLauge–Hansen Mechanism — Ankle
SA (supination-adduction): lat avulsion → vertical medial fx. SER (supination-external rotation): ATFL → fibula at level → posterior → medial (most common). PA (pronation-abduction), PER (pronation-external rotation) sequences predict associated injuries.
Open topicLegg‑Calvé‑Perthes — Staging & Prognosis
Idiopathic avascular necrosis of capital femoral epiphysis in 4–8‑year‑olds (boys > girls). Radiographic **Waldenström stages**: Initial, Fragmentation, Re‑ossification, Healed. **Prognosis/Severity**: **Catterall** (I–IV) and **Herring (lateral pillar)** (A–C); age >6 yrs and Herring C predict poorer outcomes. Goal: **containment** of the femoral head within acetabulum to maintain sphericity (abduction bracing or osteotomy). MRI detects early marrow changes; lateral extrusion (loss of containme...
Open topicLevine–Edwards — Hangman’s (Traumatic Spondylolisthesis of Axis)
Type I: 3 mm and/or angulation (disc injury) — traction/halo or surgery. Type IIa: flexion–distraction variant (marked angulation). Type III: with C2–3 facet dislocation — unstable, surgical.
Open topicLimb Salvage — Endoprostheses
Limb salvage is preferred over amputation when margins can be obtained and function preserved. Endoprostheses replace resected bone segment, especially around knee and proximal humerus. Types: modular, custom‑made, expandable (pediatric). Complications: infection, aseptic loosening, mechanical failure, soft tissue problems. Survival: 70–80% implant survival at 10 years; improves quality of life over amputation.
Open topicLimb Salvage Surgery in Bone Tumors
Oncologic principles: accurate diagnosis, staging (MRI, PET/CT), biopsy planning, and **wide margins**. Indications: resectable tumors with adequate soft-tissue coverage and neurovascular preservation; good chemo response when applicable. Reconstruction options: endoprosthesis (modular/mega), biological (intercalary grafts, vascularized fibula, allograft), arthrodesis. Complications: infection, flap failure, nonunion, prosthetic loosening, local recurrence. Multidisciplinary planning is essentia...
Open topicLisfranc Injuries
Lisfranc joint = tarsometatarsal articulation; key stabilizer = Lisfranc ligament (medial cuneiform to 2nd MT base). Mechanism: axial load with plantar flexion/twist. Diagnosis: widening between 1st–2nd MT, fleck sign; CT confirms. Treatment: stable injuries = cast; displaced = ORIF (screws/plates) or fusion. Complications: post-traumatic arthritis, chronic pain.
Open topicLumbar Canal Stenosis — Decompression Options
Degenerative stenosis from disc bulge, facet arthrosis, and ligamentum flavum hypertrophy causes neurogenic claudication. MRI confirms stenosis; correlate with walking tolerance and posture‑dependent symptoms (relief on flexion). Nonoperative: activity modification, PT (flexion‑based), analgesia; limited role for epidural steroid injections. Decompression alone (unroofing/undercutting) suffices when there is no instability; add fusion for instability/deformity or wide facetectomy. MIS options (m...
Open topicLumbar Disc Herniation — Classification, Diagnosis & Management
Comprehensive guide to lumbar disc herniation covering disc anatomy and pathology, morphological classification (protrusion, extrusion, sequestration), dermatomal levels, clinical syndromes by level, Macnab outcome criteria, conservative and surgical management including microdiscectomy, and cauda equina syndrome as a surgical emergency.
Open topicMadelung Deformity
Congenital or developmental deformity due to premature closure of ulnar volar physis of distal radius. More common in adolescent females; associated with Léri-Weill dyschondrosteosis, Turner syndrome. Clinical: wrist pain, cosmetic deformity, limited pronation/supination. X-ray: increased volar and ulnar tilt of distal radius, carpal wedging, positive ulnar variance. Treatment: mild—observation; severe—physiolysis, corrective osteotomy, ulnar shortening.
Open topicMallet Finger
Avulsion of extensor tendon at DIP joint; may involve bony fragment. Mechanism: sudden forced flexion of extended DIP (e.g., ball injury). Clinical: inability to extend DIP; distal finger droop. X-ray: may show avulsion fracture; subluxation if >30–50% articular surface involved. Management: extension splinting 6–8 weeks; surgery for large bony fragment or volar subluxation.
Open topicMallet Finger & Jersey Finger
Mallet: extensor tendon avulsion at DIP → inability to extend. Jersey: FDP avulsion at DIP → inability to flex. Mallet mechanism: forced DIP flexion; Jersey: forced DIP extension during flexion. Mallet management: splinting in extension; surgery if subluxation/large fragment. Jersey management: surgical repair in all cases.
Open topicMalunion and Nonunion — Biology & Management
Malunion = fracture healing in unacceptable position (angulation, rotation, shortening, translation). Nonunion = failure of fracture to heal in expected time (9 months with no signs of healing for 3 months). Biological vs mechanical causes; infection as a major impediment. Hypertrophic (good biology, poor mechanics) vs atrophic (poor biology) nonunion. Workup: history, exam, radiographs, lab workup for infection; advanced imaging if required. Management: restore stability and biology — fixation,...
Open topicMalunion Correction — Principles
Malunion = fracture healed in unacceptable alignment causing functional, cosmetic, or biomechanical issues. Decision to correct depends on symptoms, joint at risk, magnitude/plane of deformity, and patient goals. Thorough planning with long‑leg alignment views, scanogram, and CT rotational profile is essential. Osteotomy at CORA restores axis with least translation; fixation by plate, nail, or circular frame. Common techniques: closing wedge, opening wedge (needs graft), dome, step‑cut, and grad...
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