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Lisfranc 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 topicLisfranc Injury
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Open topicLisfranc Injury - Case Based Learning
Case Presentation A 32-year-old male presented with severe pain and swelling in the midfoot following a road traffic accident. The patient reported difficulty bearing weight on the affected foot. Severe midfoot pain Swelling over dorsum of foot Difficulty in weight bearing Plantar ecchymosis sign Tenderness over tarsometatarsal joints Radiographs demonstrated widening between the first and second metatarsal bases suggesting a Lisfranc injury. Anatomy of the Lisfranc Joint Complex The Lisfranc jo...
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...
Open topicMangled Extremity Severity Score (MESS)
Score based on skeletal/soft tissue injury, ischemia, shock, age. Ischemia >6 h doubles points. MESS ≥7 → amputation likely. Adjunct tool; not absolute.
Open topicMayo Classification — Olecranon Fractures
Type I: nondisplaced (A noncomminuted / B comminuted). Type II: displaced but stable (A/B). Type III: displaced and unstable (A/B). Type I conservative; II–III usually require fixation; III needs stability restoration.
Open topicMedial Clavicle Physeal Injury (Pseudodislocation) — Pattern
Physeal separation of medial clavicle mimics SCJ dislocation — the physis is weaker than ligaments in children. Posterior displacement threatens mediastinal structures — requires urgent reduction (often operative). CT is essential to distinguish true SCJ dislocation from physeal injury.
Open topicMega Prosthesis — Indications & Complications
Used for segmental bone loss after tumor resection or non-oncologic massive defects (failed revision arthroplasty, periprosthetic fractures). Common sites: distal femur replacement (DFR), proximal tibia, proximal femur replacement (PFR), proximal humerus. Advantages: immediate stability, early mobilization; modular designs allow intra-op flexibility. Complications: infection, aseptic loosening, soft tissue failure (extensor mechanism in proximal tibia), mechanical breakage. Long-term survivorshi...
Open topicMeniscal Tears — Basics
Red‑red (peripheral) zone heals best; red‑white intermediate; white‑white avascular. Vertical longitudinal (bucket handle) tears in young → repair; complex/degenerative tears in older → debride selectively. Clinical tests: McMurray, Thessaly; MRI is sensitive but clinical correlation vital. Repair techniques: all‑inside, inside‑out, outside‑in; address concomitant ACL tears. Meniscal preservation reduces risk of OA; root tears need repair to restore hoop stress.
Open topicMeniscal Tears — Types & Repair
Menisci are fibrocartilaginous structures aiding load transmission, stability, and lubrication. Types: longitudinal, horizontal, radial, flap, bucket handle, complex. Clinical: joint line tenderness, locking, McMurray/Apley tests positive. Imaging: MRI is gold standard (sensitivity >90%). Treatment: preserve meniscus if possible; repair (inside-out, outside-in, all-inside) or partial meniscectomy.
Open topicMeniscus Repair vs Meniscectomy
Meniscus vital for load transmission, shock absorption, joint stability. Repair preferred when possible (red-red, red-white tears, vertical longitudinal). Meniscectomy indicated for irreparable, degenerative tears. Repair techniques: inside-out, outside-in, all-inside devices. Meniscectomy → ↑ risk of OA long term.
Open topicMetastatic Bone Disease
Most common malignant tumor of bone overall. Primary sources: breast, prostate, lung, kidney, thyroid. Lesions: breast (mixed), prostate (blastic), lung/kidney/thyroid (lytic). Sites: spine, pelvis, proximal femur/humerus. Investigations: X-ray, MRI, CT chest/abdomen, bone scan/PET. Management: systemic therapy, bisphosphonates/denosumab, prophylactic fixation (Mirel’s >8), radiotherapy, spinal stabilization.
Open topicMetatarsal & Phalangeal Fractures
1st metatarsal fractures affect medial column; greater functional impact. 5th metatarsal: distinguish avulsion (zone 1), Jones (zone 2), and diaphyseal stress (zone 3). Multiple metatarsals/malalignment → operative fixation to restore parabola. Toe phalangeal fractures usually non-op; intra‑articular big toe injuries may need fixation. Athletes with Jones/stress fractures often benefit from early fixation.
Open topicMeyers–McKeever (± Zaricznyj) — Tibial Spine (ACL Avulsion)
Type I: Minimally displaced avulsion. Type II: Hinge of posterior fibers intact (anterior lift) — may reduce closed; fixation if interposed tissue. Type III: Completely displaced fragment — requires reduction and fixation. Type IV (Zaricznyj): Comminuted fragment — fixation with sutures/screws after debridement.
Open topicMilch / Jakob–Weiss — Lateral Condyle Humerus Fractures
Milch Type I: Fracture line lateral to trochlear groove (through capitellum–trochlear junction) — more stable. Milch Type II: Fracture line extends into trochlea — less stable (risk of displacement). Jakob/Weiss Displacement Staging: I (
Open topicModular Mega-prosthesis — Knee
Used after wide resection of distal femur/proximal tibia tumors. Modular systems allow intraoperative flexibility and immediate stability. Expandable designs used in children to accommodate growth. Advantages: early mobilization, good function; Disadvantages: high cost, infection risk. Survival: 70–80% implant survival at 10 years; complications include loosening, mechanical failure.
Open topicModular Taper Junctions & Trunnionosis
Trunnionosis = corrosion/wear at head–neck modular junction of THA. Mechanism: fretting + crevice corrosion, leading to metal ion release. Clinical: unexplained pain, swelling, adverse local tissue reaction (ALTR). Diagnosis: ESR/CRP to rule out infection; elevated cobalt/chromium; MRI (MARS) for pseudotumor. Management: revision with ceramic heads, titanium sleeves; avoid further corrosion.
Open topicMonteggia fracture - Case Based Discussion
Introduction Monteggia fracture refers to a fracture of the proximal or middle third of the ulna associated with dislocation of the radial head at the elbow. It is an important forearm injury because failure to recognize the radial head dislocation can lead to chronic instability and long-term functional impairment. The injury mechanism typically involves a fall on an outstretched hand with forced pronation or direct trauma to the forearm. Early diagnosis and anatomical reduction of the ulna are...
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