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Achilles Tendinopathy & Rupture
Achilles tendon is most frequently injured tendon; common in athletes and middle-aged weekend warriors. Tendinopathy: degenerative process due to overuse, poor vascularity, fluoroquinolone/steroid use. Acute rupture: sudden pop, pain, inability to plantarflex; positive Thompson test. Imaging: USG/MRI confirm diagnosis, assess tendon gap/degeneration. Management: Tendinopathy—eccentric exercises, activity modification, PRP/shockwave. Rupture—conservative functional bracing or surgical repair depe...
Open topicACL Injury — Workup & Reconstruction
ACL is critical stabilizer against anterior translation and rotational instability. Mechanism: non-contact pivoting injury; pop and immediate swelling (hemarthrosis). Clinical: Lachman test most sensitive; pivot shift for dynamic instability. Imaging: MRI confirms tear and associated injuries (meniscus, cartilage). Treatment: physiotherapy in low-demand; reconstruction with autograft (BTB, hamstring) in active patients.
Open topicAdult Acquired Flatfoot — Posterior Tibial Tendon Dysfunction (PTTD)
Most common cause of adult acquired flatfoot; due to PTT degeneration/rupture. Stages I–IV (Johnson & Strom classification). Clinical: medial ankle pain, progressive collapse of medial arch, hindfoot valgus. Imaging: MRI shows tendon degeneration; weight-bearing X-rays show arch collapse. Treatment: Stage I—orthoses, NSAIDs; Stage II—tendon transfer + osteotomy; Stage III/IV—arthrodesis.
Open topicAmputation — Levels & Prosthetics
Level selection balances wound healing potential, prosthetic energy cost, and function. Upper limb: transmetacarpal, wrist disarticulation, trans‑radial, elbow disarticulation, trans‑humeral, shoulder disarticulation. Lower limb: Syme, transtibial (BKA), knee disarticulation, transfemoral (AKA), hip disarticulation/hemipelvectomy. Flap design: long posterior flap (BKA), myodesis over myoplasty for power and stability. Prosthetics: suspension (suction, pin‑lock), sockets (PTB, TSB), feet (SACH, d...
Open topicAntibiotic Prophylaxis in Orthopaedics
Standard: cefazolin within 60 min before incision (2 g; 3 g if >120 kg). Add vancomycin if MRSA colonized/high prevalence or severe β‑lactam allergy; start 120 min pre‑incision due to infusion time. Redose if procedure >3–4 h or blood loss >1500 mL; discontinue within 24 h for clean cases. Open fractures: start immediately; broaden by Gustilo grade.
Open topicArches of the Foot — Anatomy
Three arches: medial & lateral longitudinal, and transverse (anterior/posterior). Keystone bones: talus (medial longitudinal), cuboid (lateral), intermediate cuneiform (transverse). Static supports: plantar fascia (central band), spring ligament, long/short plantar ligaments, interosseous ligaments. Dynamic supports: tibialis posterior/anterior, peroneus longus, FHL/FDL, intrinsic plantar muscles via windlass mechanism. Functions: shock absorption, distribution of load across hindfoot–midfoot–fo...
Open topicAvascular Necrosis (AVN) Hip — Ficat & ARCO
AVN = ischemic necrosis of femoral head → collapse and arthritis. Risk factors: steroids, alcohol, trauma, sickle cell, Gaucher’s, idiopathic. Ficat staging I–IV; ARCO integrates imaging and lesion size/location. MRI is most sensitive investigation (double-line sign). Management: early—bisphosphonates, core decompression; late—osteotomy, resurfacing, THA.
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 topicBiceps Pathology — SLAP Lesions
SLAP = Superior Labrum Anterior to Posterior tear involving biceps anchor. Mechanism: overhead throwing, fall on outstretched hand. Types I–IV (Snyder classification). Clinical: pain, clicking, instability; O’Brien’s, crank, biceps load tests. Management: conservative first; arthroscopic repair/debridement in symptomatic tears.
Open topicBiomaterials in Orthopaedics
Metals: stainless steel (316L), cobalt‑chrome, titanium alloys; differences in modulus, corrosion resistance, MRI artifacts. Polymers: UHMWPE (arthroplasty bearings), PMMA (bone cement), PEEK (spacers). Ceramics: alumina/zirconia (bearings), hydroxyapatite/tricalcium phosphate (coatings, bone graft substitutes). Surface engineering: porous coatings, grit‑blast, plasma spray HA for osseointegration. Failure modes: wear (PE oxidation), corrosion (fretting, crevice, galvanic), fatigue fracture, ost...
Open topicBone & Joint Infections in HIV
HIV patients prone to bacterial (Staph aureus), mycobacterial (TB), fungal infections. Salmonella is a classic cause of osteomyelitis in HIV, especially with sickle cell disease. Clinical: insidious bone/joint pain, fever, constitutional symptoms; consider atypical presentations. Investigations: cultures, biopsy, imaging (MRI sensitive for marrow involvement). Treatment: prolonged targeted antibiotics, ATT/antifungals as needed, surgical debridement, optimize HAART.
Open topicBone Grafts and Substitutes
Autograft is gold standard: osteogenic + osteoinductive + osteoconductive (iliac crest). Allograft provides scaffold (osteoconductive) ± growth factors; immune & disease transmission risks minimized by processing. Substitutes: calcium phosphates (HA/TCP), calcium sulfate, bioactive glass; mainly osteoconductive. Biologics: BMP‑2/7, PRP (controversial), bone marrow aspirate concentrate. Applications: nonunion, defects, spinal fusion; match graft biology to defect needs.
Open topicBone Turnover Markers
Formation markers: bone‑specific ALP, osteocalcin, P1NP. Resorption markers: CTX (C‑telopeptide), NTX, TRAP‑5b. Uses: monitoring therapy in osteoporosis and metabolic bone disease, not for diagnosis alone. Preanalytic variability: diurnal variation (fasting morning samples), renal/hepatic function influences.
Open topicBoutonniere Deformity
Flexion of PIP joint with hyperextension of DIP joint. Caused by central slip rupture of extensor tendon at PIP. Mechanism: forceful blow, RA, laceration. Clinical: inability to extend PIP; DIP hyperextends via lateral bands. Treatment: splinting PIP in extension 6 weeks; surgery for chronic cases.
Open topicBrachial Plexus — Roots, Trunks, Cords, Branches
Brachial plexus consists of Roots (C5–T1), Trunks (upper, middle, lower), Divisions (each trunk splits into anterior/posterior), Cords (lateral, posterior, medial), and terminal Branches (musculocutaneous, axillary, radial, median, ulnar). Anatomical course: roots emerge between scalene muscles; trunks in posterior triangle; divisions under clavicle; cords encircle axillary artery and give off named nerves (e.g. lateral cord → musculocutaneous). Key relationships: the long thoracic nerve (C5-7)...
Open topicBrodie Abscess — Features & Management
Subacute osteomyelitis presenting as a localized lytic lesion with sclerotic rim (usually metaphyseal). Typical organisms: Staphylococcus aureus; culture may be negative. Symptoms: localized pain, minimal systemic signs, often night pain relieved by NSAIDs. Imaging: X‑ray—lytic cavity with sclerotic margin; MRI—rim enhancement with surrounding edema. Management: Curettage ± bone graft, culture‑directed antibiotics.
Open topicCarpal Tunnel Syndrome
Most common compressive neuropathy; due to compression of median nerve at carpal tunnel. Symptoms: nocturnal paresthesias, hand clumsiness, thenar atrophy. Tests: Phalen’s, Tinel’s, Durkan’s compression test. Investigations: Nerve conduction study (slowed conduction across wrist). Treatment: splints, NSAIDs, steroid injection, surgical release for refractory cases.
Open topicCavovarus Foot
High medial longitudinal arch with hindfoot varus and forefoot equinus/abduction. Etiology: neuromuscular disorders (CMT disease most common), trauma, idiopathic. Clinical: lateral foot pain, recurrent ankle sprains, plantar callosities. Investigations: Coleman block test differentiates flexible vs rigid hindfoot. Treatment: orthoses for flexible; osteotomies, tendon transfers, arthrodesis for rigid deformity.
Open topicCharcot Arthropathy — Neuroarthropathy
Neuropathic osteoarthropathy due to sensory/autonomic neuropathy—diabetes most common cause. Eichenholtz stages: I (fragmentation), II (coalescence), III (remodeling). Sanders–Frykberg anatomic patterns for foot involvement. Clinical hallmark: warm, swollen, relatively painless foot; plantar midfoot ulcer risk if rocker‑bottom deformity develops. Imaging: X‑ray shows fragmentation/subluxation; MRI for early marrow edema and to exclude osteomyelitis; consider WBC scan if infection uncertain. Trea...
Open topicCubital Tunnel Syndrome - Entrapment Neuropathy
Cubital Tunnel Syndrome (CuTS) is the second most common upper-limb compression neuropathy and results from compression of the ulnar nerve at the elbow, most commonly within the cubital tunnel behind the medial epicondyle. It typically presents with numbness and tingling in the little finger and ulnar half of the ring finger, often worsening with prolonged elbow flexion or pressure on the elbow. Progressive disease leads to intrinsic hand muscle weakness, reduced grip strength, positive Froment...
Open topicDevelopmental Dysplasia of Hip (DDH) — Screening & Management
Spectrum: acetabular dysplasia to frank dislocation. Risk factors: breech, female, family history, oligohydramnios. Clinical: Ortolani & Barlow tests in neonates; Galeazzi sign, limited abduction in infants. Imaging: USG (Graf classification) 18 months).
Open topicDiscoid Meniscus
Congenital variant where meniscus is thickened and disk-shaped. Most common in lateral meniscus (incidence 1–3%). Clinical: snapping, pain, locking in children/young adults. Imaging: X-ray may show widened joint space; MRI confirms discoid shape. Treatment: asymptomatic—observe; symptomatic—saucerization + repair.
Open topicDupuytren’s Contracture
Fibroproliferative disorder of palmar fascia causing fixed flexion deformity of fingers. Risk factors: male, >40 years, northern European descent, diabetes, alcoholism, smoking. Commonly affects ring and little finger; cords/nodules palpable. Hueston’s tabletop test positive (cannot place palm flat on table). Treatment: needle aponeurotomy, limited fasciectomy, collagenase injection; recurrence common.
Open topicDVT Prophylaxis in Orthopaedics
Risk high in hip/knee arthroplasty, hip fracture surgery, pelvic/acetabular trauma, prolonged immobility. Options: LMWH, DOACs (apixaban/rivaroxaban), aspirin (selected low‑risk arthroplasty), mechanical methods (IPC/stockings). Duration: 10–14 days minimum; up to 35 days after hip fracture/arthroplasty. Balance bleeding risk (neuraxial anesthesia timing) with VTE prevention.
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