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Avascular Necrosis (AVN) of the Femoral Head - Case Based Discussion
Introduction Avascular necrosis (AVN) of the femoral head, also known as osteonecrosis, is a condition characterized by death of bone tissue due to interruption of blood supply to the femoral head. The femoral head is particularly vulnerable to ischemia because its vascular supply is limited and largely dependent on the retinacular vessels arising from the medial circumflex femoral artery. Loss of blood supply leads to necrosis of trabecular bone and marrow, resulting in structural collapse of t...
Open topicAvascular Necrosis of Hip - Case Based Discussion
Case Presentation A 40-year-old male presented with progressive pain in the right hip for the past one year. The pain was initially mild but gradually increased in intensity and was aggravated by walking and prolonged standing. The patient also complained of stiffness in the hip and difficulty sitting cross-legged. Deep groin pain radiating to the thigh Progressive restriction of hip movements Difficulty in squatting and sitting cross-legged Antalgic gait No history of trauma The patient had a h...
Open topicBennett Fracture - Case Based Discussion
Introduction Bennett fracture is an intra-articular fracture at the base of the first metacarpal involving the carpometacarpal (CMC) joint of the thumb. It is an unstable fracture caused by axial loading of a partially flexed metacarpal. Due to the pull of the abductor pollicis longus tendon, the metacarpal shaft displaces proximally and dorsally while a small volar fragment remains attached to the trapezium. Case Presentation A 25-year-old male presented to the emergency department following a...
Open topicBoth Bones Forearm Fracture - Case Based Disucssion
Case Presentation A 28-year-old male presented to the emergency department following a road traffic accident with severe pain and deformity of the left forearm. The patient was unable to move the forearm due to pain. Severe pain in the forearm Visible deformity of the forearm Swelling and tenderness over radius and ulna Restricted pronation and supination Distal neurovascular status intact Radiographs of the forearm demonstrated fractures of both the radius and ulna at the middle third of the sh...
Open topicCalcaneal Fractures - Case Based Discussion
Introduction Calcaneal fractures are the most common fractures of the tarsal bones and typically occur following high-energy axial loading injuries such as falls from height or road traffic accidents. The calcaneus plays a crucial role in weight transmission and hindfoot biomechanics, making restoration of anatomy essential for good functional outcomes. These fractures may involve the subtalar joint and are therefore classified as intra-articular or extra-articular injuries. Intra-articular frac...
Open topicColles fracture | Distal Radius Fractures - Case Based Discussion
Introduction Colles fracture is a common extra-articular fracture of the distal radius typically occurring within 2–3 cm of the wrist joint. It is most commonly seen in elderly individuals following a fall on an outstretched hand with the wrist in dorsiflexion. The classic deformity is characterized by dorsal angulation and displacement of the distal fragment, often described as the “dinner fork deformity.” Although many Colles fractures can be managed conservatively, unstable...
Open topicComminuted Intertrochanteric Femur Fracture - Case Based Discussion
Introduction Intertrochanteric fractures are extracapsular fractures occurring between the greater and lesser trochanter of the proximal femur. These injuries are common in the elderly population following low-energy falls but may also occur in younger patients following high-energy trauma. The fracture pattern may range from simple two-part fractures to highly comminuted unstable fractures with loss of posteromedial and lateral wall support. Comminuted intertrochanteric fractures are considered...
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 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...
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 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 topicPeri-implant fractures - Case Based Discussion
Case Presentation A 68-year-old female presented to the emergency department following a trivial fall at home with severe pain and inability to bear weight on the left lower limb. The patient had previously undergone fixation of an intertrochanteric fracture with a Proximal Femoral Nail (PFN) two years earlier. She reported sudden pain around the distal thigh following the fall. Pain and deformity of distal thigh Inability to bear weight Previous surgical scar over proximal femur Localized tende...
Open topicPerilunate dislocation - Case Based Learning
Case Presentation A young male presented with severe wrist pain following a motorcycle accident 3 days ago. The mechanism involved a fall on an outstretched hand with the wrist in dorsiflexion. Severe wrist pain and swelling Reduced wrist movements Difficulty gripping objects Tenderness over carpal region No distal neurovascular deficit initially X-ray reveals disruption of carpal alignment suggestive of perilunate dislocation. Mechanism of Injury Perilunate dislocation typically occurs due to h...
Open topicScaphoid fracture - Case Based Fractures
Introduction Scaphoid fractures are the most common fractures of the carpal bones, accounting for approximately 60–70% of all carpal fractures. These injuries typically occur following a fall on an outstretched hand with the wrist in extension and radial deviation. The scaphoid plays a crucial role in carpal stability by linking the proximal and distal carpal rows. Because of its unique blood supply, which enters distally and travels proximally, fractures of the scaphoid are particularly p...
Open topicTuberculosis of Hip
Introduction Tuberculosis of the hip is one of the most common forms of osteoarticular tuberculosis after spinal involvement. It results from hematogenous spread of Mycobacterium tuberculosis to the synovium or bone around the hip joint. The disease leads to progressive destruction of articular cartilage, subchondral bone, and eventually the entire hip joint if untreated. Because the hip is a weight-bearing joint, tuberculous infection often results in severe functional disability. Early diagnos...
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