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Elbow Stiffness — Release
Functional elbow arc ≈ 30–130° flexion and 50°/50° pronation–supination (Morrey). Common causes: trauma, HO, prolonged immobilization, intra‑articular fracture, infection. Initial treatment: therapy, static/dynamic splinting, CPM; MUA in early soft‑tissue contracture. Operative options: arthroscopic or open capsular release ± HO excision ± ulnar nerve transposition. Complications: recurrence, instability, nerve injury (ulnar), HO recurrence.
Open topicFoot & Ankle — Hallux Valgus
Lateral deviation of great toe with medial eminence (bunion). Risk factors: female gender, footwear, ligamentous laxity, pes planus. Clinical: pain, callosities, overlapping toes. Radiology: HVA >15°, IMA >9°. Severity guides surgery. Treatment: footwear modification, orthoses, osteotomies (Chevron, Scarf, Lapidus).
Open topicFracture Healing — Biology & Timelines
Phases: inflammation → soft callus (cartilage) → hard callus (woven bone) → remodeling (lamellar). Primary (direct) vs secondary (indirect) healing; absolute vs relative stability concepts. Cell sources: periosteum (key), endosteum, marrow, surrounding soft tissues. Mechanical environment (strain theory) dictates tissue type; too much motion → nonunion. Timelines vary by bone/age/blood supply—tibia slower than femur; smokers/NSAIDs may delay.
Open topicGait Cycle and Analysis
Gait cycle: stance (~60%) and swing (~40%); double support ~20% of cycle. Rocker phases: heel rocker, ankle rocker, forefoot rocker enable forward progression. Determinants reduce vertical COM excursion: pelvic rotation/tilt, knee flexion in stance, ankle mechanism, foot mechanism. Pathological gaits: Trendelenburg, antalgic, circumduction, steppage, equinus. Clinical gait analysis: observational + instrumented (temporal‑spatial, kinematics, kinetics, EMG).
Open topicHaemophilic Arthropathy
Caused by recurrent hemarthrosis in hemophilia A/B leading to synovitis, cartilage loss, and arthritis. Target joints: knee, ankle, elbow—recurrent bleeds produce synovial hypertrophy. Radiographic findings: squaring of patella, widened intercondylar notch, subchondral cysts. MRI: sensitive for synovial hypertrophy, hemosiderin deposition, and cartilage thinning. Treatment: prophylactic factor replacement, radiosynovectomy/arthroscopic synovectomy, arthroplasty in end‑stage.
Open topicHaemophilic Arthropathy — Evaluation & Treatment
Recurrent hemarthroses → synovial hypertrophy → cartilage damage and arthropathy (ankle, knee, elbow). Evaluation: bleeding history, factor levels/inhibitors, US/MRI for synovitis and osteochondral damage. Acute bleed management: RICE + factor replacement to target levels (VIII or IX). Chronic synovitis: radiosynovectomy/arthroscopic synovectomy; advanced arthropathy—osteotomy, arthrodesis, arthroplasty. Always coordinate with hematology for perioperative factor protocol ± antifibrinolytics.
Open topicHigh Tibial Osteotomy (HTO) — Indications & Techniques
Indications: medial compartment OA with varus deformity in young active patients. Goal: shift weight-bearing axis laterally to unload medial compartment. Techniques: lateral closing wedge, medial opening wedge, dome osteotomy. Fixation: plates (TomoFix) or external fixators. Delays need for TKA in younger patients.
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 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 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 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 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 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 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 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 topicMulti-ligament Knee Injury
Involves disruption of ≥2 major knee ligaments; often from high-energy trauma. Common patterns: ACL + PCL ± collateral injuries. Associated with vascular (popliteal artery) and nerve (common peroneal) injuries. Diagnosis: clinical + MRI; check vascular status with ABI, Doppler, CTA. Management: emergent reduction, vascular repair if injured, staged ligament reconstruction.
Open topicMusculoskeletal Infections — Algorithm
Spectrum: cellulitis, abscess, septic arthritis, osteomyelitis. Principles: Early recognition, debridement, targeted antibiotics, stabilization, soft‑tissue cover. Diagnosis algorithm: suspect → labs (WBC, ESR, CRP) → imaging (X‑ray, MRI) → aspiration/biopsy for culture → tailored therapy. Surgical principles: remove necrotic tissue, maintain stability, provide vascularized soft‑tissue coverage. Antibiotics: empiric broad‑spectrum → targeted based on culture, prolonged course in bone infections.
Open topicNerve Entrapments — Cubital Tunnel Syndrome
Second most common compression neuropathy after CTS; affects ulnar nerve at elbow. Symptoms: paresthesias in ulnar digits, weakness of intrinsic hand muscles. Tests: Tinel’s at elbow, elbow flexion test, Froment’s sign, Wartenberg’s sign. Investigations: NCS/EMG confirm slowed conduction across elbow. Management: activity modification, splinting; surgical decompression/transposition if persistent.
Open topicOrthopaedic Implants — Materials & Corrosion
Common alloys: 316L stainless, cobalt‑chrome, titanium (Ti‑6Al‑4V). Corrosion mechanisms: fretting at modular junctions, crevice under plates, galvanic with dissimilar metals. Clinical sequelae: metal ion release, ALVAL, osteolysis, trunnionosis in THA. Prevention: material pairing, surface finish, avoiding fluid‑filled crevices, firm taper assembly.
Open topicOrthoses — Lower Limb (KAFO/AFO)
AFO: ankle-foot support in drop foot, CP, polio. KAFO: supports knee in quadriceps paralysis, SCI. Types: rigid, hinged, leaf-spring (AFO); locked, drop lock, offset (KAFO). Goals: prevent deformity, support gait. Complications: sores, stiffness.
Open topicOsgood–Schlatter Disease
Apophysitis of tibial tubercle in adolescents due to repetitive traction from quadriceps. Common in athletic boys (10–15 yrs). Clinical: pain, swelling, prominent tender tibial tubercle. X-ray: fragmentation and irregularity of tibial tubercle apophysis. Treatment: activity modification, stretching, NSAIDs; resolves with skeletal maturity.
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