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Ideberg 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 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 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 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 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 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 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 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 topicLisfranc Injuries
Lisfranc joint = tarsometatarsal articulation; key stabilizer = Lisfranc ligament (medial cuneiform to 2nd MT base). Mechanism: axial load with plantar flexion/twist. Diagnosis: widening between 1st–2nd MT, fleck sign; CT confirms. Treatment: stable injuries = cast; displaced = ORIF (screws/plates) or fusion. Complications: post-traumatic arthritis, chronic pain.
Open topicLumbar Disc Herniation — Classification, Diagnosis & Management
Comprehensive guide to lumbar disc herniation covering disc anatomy and pathology, morphological classification (protrusion, extrusion, sequestration), dermatomal levels, clinical syndromes by level, Macnab outcome criteria, conservative and surgical management including microdiscectomy, and cauda equina syndrome as a surgical emergency.
Open topicMalunion and Nonunion — Biology & Management
Malunion = fracture healing in unacceptable position (angulation, rotation, shortening, translation). Nonunion = failure of fracture to heal in expected time (9 months with no signs of healing for 3 months). Biological vs mechanical causes; infection as a major impediment. Hypertrophic (good biology, poor mechanics) vs atrophic (poor biology) nonunion. Workup: history, exam, radiographs, lab workup for infection; advanced imaging if required. Management: restore stability and biology — fixation,...
Open topicMalunion Correction — Principles
Malunion = fracture healed in unacceptable alignment causing functional, cosmetic, or biomechanical issues. Decision to correct depends on symptoms, joint at risk, magnitude/plane of deformity, and patient goals. Thorough planning with long‑leg alignment views, scanogram, and CT rotational profile is essential. Osteotomy at CORA restores axis with least translation; fixation by plate, nail, or circular frame. Common techniques: closing wedge, opening wedge (needs graft), dome, step‑cut, and grad...
Open topicMangled Extremity Severity Score (MESS)
Score based on skeletal/soft tissue injury, ischemia, shock, age. Ischemia >6 h doubles points. MESS ≥7 → amputation likely. Adjunct tool; not absolute.
Open topicMayo Classification — Olecranon Fractures
Type I: nondisplaced (A noncomminuted / B comminuted). Type II: displaced but stable (A/B). Type III: displaced and unstable (A/B). Type I conservative; II–III usually require fixation; III needs stability restoration.
Open topicMedial Clavicle Physeal Injury (Pseudodislocation) — Pattern
Physeal separation of medial clavicle mimics SCJ dislocation — the physis is weaker than ligaments in children. Posterior displacement threatens mediastinal structures — requires urgent reduction (often operative). CT is essential to distinguish true SCJ dislocation from physeal injury.
Open topicMetatarsal & Phalangeal Fractures
1st metatarsal fractures affect medial column; greater functional impact. 5th metatarsal: distinguish avulsion (zone 1), Jones (zone 2), and diaphyseal stress (zone 3). Multiple metatarsals/malalignment → operative fixation to restore parabola. Toe phalangeal fractures usually non-op; intra‑articular big toe injuries may need fixation. Athletes with Jones/stress fractures often benefit from early fixation.
Open topicMeyers–McKeever (± Zaricznyj) — Tibial Spine (ACL Avulsion)
Type I: Minimally displaced avulsion. Type II: Hinge of posterior fibers intact (anterior lift) — may reduce closed; fixation if interposed tissue. Type III: Completely displaced fragment — requires reduction and fixation. Type IV (Zaricznyj): Comminuted fragment — fixation with sutures/screws after debridement.
Open topicMilch / Jakob–Weiss — Lateral Condyle Humerus Fractures
Milch Type I: Fracture line lateral to trochlear groove (through capitellum–trochlear junction) — more stable. Milch Type II: Fracture line extends into trochlea — less stable (risk of displacement). Jakob/Weiss Displacement Staging: I (
Open topicMyositis Ossificans
Heterotopic ossification in muscle after trauma or neurological injury. Common sites: quadriceps, brachialis, adductors. Symptoms: painful swelling → hard mass, ↓ROM. Radiology: peripheral calcification with central lucency (zoning). Treatment: rest, NSAIDs, physio; excision after maturation (>6–12 mo).
Open topicNavicular & Cuboid Fractures
Tarsal navicular: body, tuberosity, and stress fractures; critical for medial column length and talonavicular congruity. Cuboid: 'nutcracker' fracture from forefoot abduction; lateral column length is key. Imaging: weight-bearing AP/lat/oblique + CT; MRI for stress fractures. Indications for surgery: displacement >2 mm, articular incongruity, medial/lateral column shortening, and instability with Lisfranc involvement. Fixation: screws/mini-plates for navicular; bridging plate/ex-fix for cuboid r...
Open topicNonunion — Weber & Cech Classification
Viable (hypertrophic/oligotrophic) vs non‑viable (atrophic, necrotic, defect, comminuted). Radiographic callus indicates biology; absence suggests poor biology. Guides treatment: stability alone for viable; add graft/biologics for non‑viable. viable → improve stability; nonviable → improve stability + add biology.
Open topicNonunion & Bone Transport — Ilizarov
Ilizarov fixator allows bone transport for segmental loss. Principle: distraction osteogenesis by gradual tension on callus. Indications: infected nonunion, bone loss, deformity correction. Protocol: latency 5–7 days, distraction 1 mm/day (0.25×4). Complications: pin site infection, joint stiffness, regenerate problems.
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