Explore orthopaedics as connected knowledge
Search verified OrthoNotes topics and open their connected cases, MCQs, resources, and atlas entries.
Filters and categories Show
Grand topic index
330 visible knowledge nodes
Osteoporosis — Pathophysiology and Management
Definition (WHO): low bone mass with microarchitectural deterioration → fragility fractures; T‑score ≤ −2.5 on DEXA. Common sites: vertebral compression, hip (femoral neck/intertrochanteric), distal radius. Risk factors: age, female sex, postmenopausal status, low BMI, glucocorticoids, smoking/alcohol, endocrine/renal disease. Workup: DEXA (hip/spine), FRAX (10‑yr risk), labs to exclude secondary causes (Ca, PO4, ALP, 25‑OH Vit D, TSH, PTH, renal/liver). Treatment: lifestyle (Ca 1000–1200 mg; Vi...
Open topicOsteosarcoma — Diagnosis & Treatment
Most common primary malignant bone tumor in adolescents (after myeloma overall). Sites: metaphysis of long bones—distal femur, proximal tibia, proximal humerus. X‑ray: sunburst periosteal reaction, Codman triangle, mixed lytic–sclerotic lesion. Work‑up: MRI for local staging, CT chest for metastasis, bone scan for skip lesions. Treatment: neoadjuvant chemotherapy → wide resection/limb salvage/rotationplasty → adjuvant chemotherapy.
Open topicOsteosarcoma — Workup & Management
High‑grade intramedullary osteosarcoma affects metaphyses of long bones in adolescents (distal femur, proximal tibia, proximal humerus). Workup: **X‑rays**, **MRI with contrast** of entire bone, **CT chest**, and **bone scan/PET‑CT**; labs (ALP, LDH). Biopsy: **planned by treating team** along resection plane to avoid contaminating compartments. Standard treatment: **neoadjuvant chemotherapy (MAP)** → **wide resection** with limb‑salvage reconstruction where feasible → **adjuvant chemotherapy**....
Open topicOsteosarcoma in a paediatric patient - Case Based Discussion
Case Presentation A 14-year-old boy presented with progressive pain and swelling around the distal thigh for the past 2 months. The pain was initially mild but gradually increased in intensity and was worse at night. Localized pain over distal femur Swelling increasing in size Pain aggravated by activity Night pain present No history of trauma On examination, a firm, tender swelling was noted over the distal femur. Movements of the knee were painful and restricted. Radiographs revealed a mixed l...
Open topicOutpatient / Day-care Joint Replacement — Safety & Protocols
Enhanced recovery protocols (ERAS) enable same-day/next-day discharge in selected patients. Selection: ASA I–II, motivated, good support, no major comorbidities or bleeding risks. Protocol: multimodal anesthesia/analgesia, tranexamic acid, early mobilization, standardized discharge criteria. Benefits: lower cost, reduced infection risk, high satisfaction; challenges include safety in high-risk groups. Telemonitoring and home PT expand feasibility.
Open topicPaediatric Radial Neck Fracture – Case Based Discussion
Introduction Radial neck fractures represent approximately 5–10% of elbow injuries in children. They commonly occur following a fall on an outstretched hand producing a valgus force across the elbow joint. The injury results in angulation of the radial neck relative to the shaft. The degree of displacement determines the appropriate management strategy. Case Presentation An 8-year-old child presented to the casualty with a history of fall on an outstretched hand while playing. The child co...
Open topicPaget’s Disease of Bone
Focal disorder of accelerated bone turnover: osteoclastic resorption followed by disorganized osteoblastic formation → enlarged, weak, vascular bone. Common sites: pelvis, spine, femur, tibia, skull; often polyostotic; usually age >55. Symptoms: bone pain, deformity (tibia/femur bowing), pathological fractures, skull enlargement, hearing loss; many asymptomatic. Labs: ↑ALP with normal Ca/PO4 (unless immobilization or hyperparathyroidism). Imaging: X‑ray with mixed lytic–sclerotic changes and bon...
Open topicPatella — Pattern-Based (AO/OTA 34)
Transverse, comminuted (stellate), polar avulsion, vertical; AO: 34-A extra-articular pole, 34-C transverse/comminuted. Displacement/extensor disruption → ORIF; minimal displacement → brace.
Open topicPatella Fractures — Tension Band Wiring
Indications: displaced transverse fractures with intact extensor. Principle: converts tensile quadriceps force into compression at fracture site. Technique: 2 parallel K-wires + figure-of-8 SS wire. Avoid in comminution → partial patellectomy/plate fixation. Complications: hardware prominence, migration, stiffness.
Open topicPatellar Dislocation — Acute
Most common acute dislocation of knee; lateral displacement of patella. Mechanism: valgus stress + external rotation with knee flexion. Clinical: sudden giving way, patella displaced laterally, hemarthrosis. Imaging: X-ray for osteochondral fracture; MRI for MPFL tear, loose bodies. Treatment: reduction + immobilization, physiotherapy; surgery if recurrent or osteochondral fracture.
Open topicPatellar Dislocation — MPFL
First‑time dislocation: non-op unless loose bodies/osteochondral fracture or gross instability. Recurrent instability → MPFL reconstruction; address bony factors (TT‑TG distance, trochlear dysplasia, patella alta). Imaging: MRI for MPFL injury/OC defects; CT to measure TT‑TG (>20 mm abnormal). Surgical pearls: Anatomic femoral tunnel at Schöttle point; avoid over‑tightening to prevent medial overload. Rehab: brace, early ROM, VMO strengthening; return to sport after strength and stability restor...
Open topicPatellar Instability — MPFL Reconstruction
Patellar instability often due to MPFL rupture after lateral patellar dislocation. Risk factors: trochlear dysplasia, patella alta, increased TT-TG distance. Clinical: recurrent dislocation, apprehension sign, medial tenderness. Imaging: MRI confirms MPFL injury, evaluates trochlear morphology; CT for TT-TG. Treatment: MPFL reconstruction using hamstring autograft; correct bony factors if severe.
Open topicPatellar Resurfacing in TKA — Controversies
Controversial: to resurface or not during TKA. Resurfacing: reduces anterior knee pain, avoids secondary resurfacing procedures. Non-resurfacing: avoids patellar complications (fracture, maltracking, loosening). Selective resurfacing based on patellar status increasingly practiced. Registry data show mixed outcomes; no universal consensus.
Open topicPatellar Tendinopathy — Jumper’s Knee
Overuse injury of patellar tendon, common in jumping athletes (basketball, volleyball). Pain localized to inferior pole of patella; worse with jumping, squatting, stairs. Histology: degenerative tendinosis, not acute inflammation. Clinical: localized tenderness, decline squat test positive. Management: eccentric strengthening, activity modification, NSAIDs, PRP; surgery for refractory cases.
Open topicPatellofemoral Complications in TKA
Commonest source of dissatisfaction after TKA. Includes anterior knee pain, maltracking, subluxation/dislocation, fracture, loosening of patellar component. Risk factors: malrotation of femoral/tibial components, improper patellar preparation, soft tissue imbalance. Investigation: clinical exam, skyline view radiographs, CT for malrotation. Management: physiotherapy, lateral release, component revision, patellar resurfacing as indicated.
Open topicPatellofemoral Instability
Common in young females; often after acute lateral dislocation. Risk factors: trochlear dysplasia, patella alta, increased TT-TG distance, ligamentous laxity. Clinical: recurrent dislocation, apprehension sign, medial tenderness. Imaging: MRI shows MPFL injury, chondral damage; CT for TT–TG. Management: conservative after first dislocation; MPFL reconstruction ± tibial tubercle osteotomy for recurrent cases.
Open topicPatellofemoral Pain Syndrome (PFPS)
Common cause of anterior knee pain in young adults, esp. females (‘runner’s knee’). Etiology: maltracking due to Q-angle increase, muscle imbalance, overuse. Clinical: diffuse anterior knee pain, aggravated by stairs, squatting, prolonged sitting (‘movie sign’). Imaging: usually normal; MRI may show chondromalacia patella. Treatment: activity modification, physiotherapy, VMO strengthening, taping; surgery rarely indicated.
Open topicPathological Fractures — Workup
Stage before biopsy: define lesion (X‑ray/MRI) and search for primaries (CT CAP, bone scan/PET). Adult common cause is metastasis (BLT KP) or myeloma; in children, benign lesions (UBC/ABC, fibrous dysplasia). Biopsy tract must align with planned incision; core biopsy preferred; avoid contaminating compartments. Stabilize impending/complete fractures with nails/plates ± cement; endoprosthesis for major destruction. Adjuvant systemic therapy and radiotherapy per histology; bisphosphonates/denosuma...
Open topicPatient-Specific Instrumentation in Arthroplasty
PSI uses preop MRI/CT to fabricate custom cutting jigs. Goal: improve accuracy, reduce OR time/inventory; evidence shows marginal accuracy gains without clear functional benefit. Limitations: cost, imaging/manufacture time, error propagation if imaging off. Best reserved for complex deformity or limited instrument settings. Distinguish PSI (custom guides) from custom implants (rare).
Open topicPauwels Classification — Femoral Neck (Shear Angle)
Type I: 50° (most vertical → highest shear). Higher angle = higher shear → instability, nonunion risk; stronger fixation needed.
Open topicPCL Injuries — Diagnosis & Management
PCL resists posterior tibial translation. Mechanism: dashboard injury, fall on flexed knee with foot plantarflexed. Clinical: posterior sag sign, posterior drawer test, quadriceps active test. Isolated low-grade PCL often treated nonoperatively. High-grade or multi-ligament injuries need reconstruction.
Open topicPCL Injury
PCL prevents posterior tibial translation; stronger than ACL. Mechanism: dashboard injury (posterior force on tibia), hyperflexion. Clinical: posterior sag sign, posterior drawer test. Imaging: MRI confirms tear; X-ray for avulsion fracture. Management: Grade I–II partial tears—conservative; Grade III/chronic—surgical reconstruction.
Open topicPediatric Supracondylar Humerus Fracture
Gartland I–III (± IV for multidirectional instability). Complications to watch: **brachial artery injury**, **median/anterior interosseous nerve palsy**, **compartment syndrome**, **cubitus varus**. Radiographic checks: **Baumann angle**, **anterior humeral line** intersecting capitellum, and **medial comminution** (varus risk). Preferred fixation: **crossed pins** for maximal stability vs **lateral‑entry 2–3 pins** to avoid ulnar nerve injury—technique‑dependent choice. Urgent reduction/pinning...
Open topicPelvic Ring Injuries — ATLS & Tile
ATLS: binder early for unstable pelvis; hemorrhage control is priority. Tile A stable, B rotationally unstable, C rot + vertical unstable. Hemorrhage control: binder, ex-fix, C-clamp, packing, angio. Fixation: anterior plating/ex-fix, posterior SI screws/lumbopelvic. Complications: hemorrhage, urethral/bladder, neuro injury.
Open topic