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Hip Labral Tears — Classification, Diagnosis & Arthroscopic Management
Detailed guide to hip labral tears covering anatomy, Seldes/Czerny classification, clinical tests, MR arthrography, arthroscopic repair vs debridement vs reconstruction, and outcomes.
Open topicHip Resurfacing Arthroplasty
Bone-conserving alternative to THA; resurfaces femoral head with metal cap. Indicated in young, active patients with OA, good bone stock, large femoral head size. Advantages: bone preservation, easier conversion to THA, lower dislocation risk. Complications: femoral neck fracture, aseptic loosening, metal ion release (cobalt/chromium). Decline in popularity due to metal-on-metal concerns; selected patients may still benefit.
Open topicHow to Read a Hip X-Ray — Systematic Approach
A comprehensive systematic approach to interpreting hip radiographs, covering patient positioning, anatomical landmarks, key lines and angles, pathological patterns, and common hip conditions — essential for all orthopaedic surgeons and trainees.
Open topicHyperparathyroidism and Bone
Excess PTH causes cortical bone loss via RANKL-mediated osteoclast activation; classic radiology: subperiosteal resorption, salt‑and‑pepper skull, brown tumors. Primary (adenoma), secondary (CKD/vit D deficiency), tertiary (autonomous) forms dictate biochemistry and treatment. DEXA: cortical loss at one‑third radius; labs—↑PTH, ↑ALP; Ca high in primary/tertiary, low‑normal in secondary; phosphate low in primary, high in CKD. Orthopaedic issues: fragility fractures, brown tumors, tendon ruptures;...
Open topicIdeberg Classification — Glenoid Fractures
Types I–V: rim (anterior/posterior), transverse, and complex intra-articular patterns. Large articular fragments or instability need ORIF; small rim fractures stable may be non-op.
Open topicIliotibial Band — Anatomy & Clinical
Thickened lateral fascia lata from iliac crest to Gerdy’s tubercle; receives fibers from TFL and gluteus maximus. Functions: lateral knee stabilization, assists hip abduction and knee extension in terminal stance. Clinical syndromes: IT band friction syndrome (runners), snapping hip (external type). Exam tests: Ober’s test (tightness), Noble compression test (pain over lateral femoral epicondyle at 30° flexion). Management: activity modification, stretching, physio focus on hip abductors/core; i...
Open topicIlizarov Technique — Principles
Tension‑stress effect: gradual distraction (≈1 mm/day in 4 steps) after corticotomy induces regenerate bone and soft‑tissue adaptation. Circular fixator with tensioned wires permits multiplanar stability and early weight bearing. Phases: latency (5–7 d), distraction, consolidation; rate/rhythm critical to regenerate quality. Indications: nonunion (infected), bone loss (transport), deformity correction, limb lengthening. Complications: pin site infection, joint contractures, poor regenerate, psyc...
Open topicImaging — CT & MRI Essentials
CT: excellent for cortical bone, 3D recon. MRI: excellent for marrow, soft tissue, ligaments, cartilage. CT indications: complex fractures (pelvis, acetabulum, calcaneus). MRI indications: occult fractures, marrow edema, tumors, soft tissue injury. Contraindications: CT—radiation, contrast nephropathy; MRI—pacemaker, ferromagnetic implants.
Open topicInstability 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...
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