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
84 visible knowledge nodes in general
Osteochondral Autograft Transfer (OATS)
Cartilage repair technique for focal chondral defects
Open topicOsteochondral Defects — Autologous Chondrocyte Implantation (ACI)
Cartilage defects cause pain, swelling, mechanical symptoms; poor intrinsic healing. ACI: two-stage procedure — harvest cartilage → culture chondrocytes → reimplant under periosteal flap/biomatrix. Indications: symptomatic focal cartilage defects >2 cm² in young active patients. Alternatives: microfracture, OATS, osteochondral allograft. Complications: graft hypertrophy, delamination, failure.
Open topicOsteochondritis Dissecans (OCD)
Focal subchondral bone necrosis leading to cartilage instability. Common site: lateral aspect of medial femoral condyle. Clinical: pain, swelling, catching, locking in adolescents. Imaging: X-ray shows lucency; MRI defines stability of fragment. Treatment: stable juvenile lesions—activity modification; unstable/adult—drilling, fixation, grafting.
Open topicOsteomalacia and Rickets
Defective mineralization: osteoid in adults (osteomalacia) vs physis in children (rickets). Etiologies: Vit D deficiency/resistance, phosphate deficiency (tumor‑induced, hereditary), renal tubular acidosis, CKD. Clinical: bone pain, proximal myopathy, waddling gait; in children—wrist/ankle widening, bowing, rachitic rosary, Harrison sulcus. Biochemical: Low Ca/PO4, High ALP, High PTH, Low 25‑OH Vit D (pattern varies in renal disease). Radiology: Looser’s zones; in rickets—widened physes with cup...
Open topicOsteomyelitis — Cierny–Mader Staging
Cierny–Mader classifies adult osteomyelitis by anatomic type (I–IV) and host status (A/B/C). Type I: Medullary; Type II: Superficial; Type III: Localized (cortical sequestration with stable bone); Type IV: Diffuse (circumferential). Host: A (healthy), B (systemic/local compromise), C (treatment worse than disease). Management tailored: debridement extent, stability, dead space management, local/systemic antibiotics. Principles: radical debridement, skeletal stability, soft-tissue cover, dead-spa...
Open topicOsteoporosis — 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 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 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 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 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 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 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 topicPerthes Disease — Management
Idiopathic avascular necrosis of femoral head in children 4–10 yrs. More common in boys; often unilateral. Clinical: limp, hip/knee pain, limited abduction/internal rotation. Imaging: X-ray shows increased density, fragmentation, collapse, reossification (Waldenström stages). Management: containment (bracing, osteotomy) to keep femoral head within acetabulum.
Open topicPes Planus - Flat foot
Pes planus (flatfoot) is a deformity characterized by loss or reduction of the medial longitudinal arch of the foot, resulting in hindfoot valgus, forefoot abduction, and altered biomechanics. It may be flexible or rigid, congenital or acquired, and can occur in both children and adults. Most pediatric flexible flatfeet are physiological and asymptomatic, whereas adult-acquired flatfoot is commonly associated with posterior tibial tendon dysfunction (PTTD). Diagnosis is based on clinical examina...
Open topicRadiographic Signs of Rickets
Widened physes with cupping and fraying at metaphysis; generalized osteopenia. Rachitic rosary at costochondral junction; Harrison’s sulcus due to diaphragmatic pull. Looser’s zones (pseudofractures) in osteomalacia; bowing deformities. Correct metabolic defect first; orthopedic correction after medical therapy.
Open topicRotator Cuff Tears — Overview
Supraspinatus most commonly torn; tears progress from partial to full‑thickness and can propagate posteriorly/anteriorly. Painful arc, night pain, and weakness on specific tests (Jobe, ER lag, belly‑press) are classic. MRI is investigation of choice; assess fatty infiltration (Goutallier) and tendon retraction (Patte). Treatment spectrum: physiotherapy/injections → arthroscopic repair (single/double row) → tendon transfer/SCR → reverse shoulder arthroplasty for cuff arthropathy. R...
Open topicRotator Cuff Tears — Repair Principles
Common in elderly and overhead athletes; supraspinatus most often torn. Clinical: pain, weakness in abduction/external rotation, night pain. Tests: Jobe’s, drop arm, external rotation lag sign. Imaging: MRI gold standard; USG useful. Management: physiotherapy for partial tears; repair (arthroscopic/open) for symptomatic full-thickness.
Open topicScapho-Lunate Instability
Most common carpal instability; due to disruption of scapholunate ligament. Clinical: wrist pain, weakness, clicking; positive Watson’s test. Radiology: gap >3 mm (‘Terry Thomas sign’), DISI deformity. Acute injury—repair; chronic—reconstruction or salvage (four-corner fusion). Untreated cases progress to SLAC wrist (Scapholunate Advanced Collapse).
Open topicSepsis and Surgical Site Infection — Bundle
SSI prevention bundle: preop optimization (glucose, smoking cessation), skin prep with alcohol‑chlorhexidine, timed antibiotic prophylaxis, normothermia, OR traffic control. Sepsis: life‑threatening organ dysfunction due to dysregulated host response to infection; recognize early using SOFA/qSOFA. Management: early cultures + broad‑spectrum antibiotics + source control (debridement, washout), hemodynamic resuscitation with crystalloids and vasopressors as needed. Open fractures: early IV antibio...
Open topicSeptic Arthritis — Pediatric vs Adult
Surgical emergency: cartilage can be destroyed within 24–48 hours; prompt drainage + antibiotics is critical. Children: hematogenous origin common; hip/knee frequent; Staphylococcus aureus predominant; use Kocher criteria for hip. Adults: knee most common; risks include IVDU, immunosuppression, prosthetic joint; consider gonococcal/septic bursitis mimics. Diagnosis hinges on aspiration (cell count >50,000–100,000 with PMN predominance), Gram stain/culture; CRP/ESR support; ultrasound detects hip...
Open topicShoulder Instability — Bankart/Latarjet
TUBS (Traumatic, Unidirectional, Bankart, Surgery) vs AMBRI (Atraumatic, Multidirectional, Bilateral, Rehab, Inferior capsular shift). Glenoid bone loss >20–25% → Latarjet (coracoid transfer) preferred over soft‑tissue Bankart alone. Engaging Hill‑Sachs lesions benefit from remplissage or bony procedures. Arthroscopic Bankart repair is standard for soft‑tissue instability with low bone loss; open has lower recurrence but more stiffness. CT with 3‑D en‑face view quantifies glenoid bone loss; MRI...
Open topicSinding–Larsen–Johansson Disease
Traction apophysitis at inferior pole of patella in adolescents. Similar mechanism to Osgood–Schlatter but at patellar origin of tendon. Clinical: localized pain at inferior patellar pole; aggravated by jumping. X-ray: irregular calcification/fragmentation at inferior pole of patella. Management: activity modification, stretching, NSAIDs, resolves with maturity.
Open topicSLAP Tear — Management
SLAP = Superior Labrum Anterior to Posterior tear at the biceps anchor; pain is deep, activity‑related, with mechanical clicking. Snyder classification I–IV (and extensions V–VII); Type II detachment is most common clinically; Type IV extends into biceps. Provocative tests: O’Brien/Active Compression, Crank, Biceps Load II—helpful but not definitive. MRI arthrogram is investigation of choice; arthroscopy is the diagnostic gold standard and allows treatment. Treatment is age- and demand‑based: de...
Open topic