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Rotator 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 topicSalter–Harris Classification — Physeal (Growth Plate) Injuries
Type I: Through physis only (slip) — good prognosis; often in younger children. Type II: Through physis and metaphysis (Thurston–Holland fragment) — most common; good prognosis. Type III: Through physis and epiphysis into joint — needs anatomic reduction (articular). Type IV: Through metaphysis, physis, and epiphysis — high risk of growth arrest; ORIF often required. Type V: Crush injury to physis — rare, poor prognosis; often diagnosed retrospectively by growth arrest. Extended: Rang VI–IX (per...
Open topicSanders CT Classification — Calcaneus
I: nondisplaced posterior facet; II: two-part; III: three-part; IV: comminuted (>3 parts). Type correlates with outcome; II–III often ORIF; IV has poorest prognosis.
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 topicScaphoid Fracture — Diagnosis & Treatment
Most common carpal fracture, usually waist (70%). Blood supply retrograde to proximal pole → high risk of AVN. Clinical: anatomical snuffbox tenderness, pain on axial loading of thumb. Investigations: X-ray may be normal; MRI is sensitive for occult fracture. Treatment: cast for undisplaced, screw fixation for displaced, vascularized bone graft for nonunion.
Open topicSCFE — Loder Classification & Fixation
Loder classification: **Stable** (able to walk, even with aids) vs **Unstable** (non‑ambulatory) — strongest predictor of AVN. Typical patient: obese adolescent (boys > girls), endocrine risk (hypothyroid, GH therapy). Imaging: AP pelvis and frog‑leg lateral; Klein’s line, Trethowan sign; quantify slip by **Southwick angle**. Treatment: **In‑situ single‑screw fixation** for stable slips; **urgent gentle reduction and pinning** for unstable slips in theater with minimal manipulation. Consider **c...
Open topicSchatzker Classification — Tibial Plateau
I split lateral; II split+depression; III pure depression; IV medial; V bicondylar; VI metaphyseal-diaphyseal dissociation. Severity ↑ from I→VI; medial/bicondylar often need dual plating/ex-fix; restore joint surface to avoid arthritis.
Open topicScoliosis — Cobb Angle & Surgical Indications
Cobb angle measures curve magnitude; progression risk relates to age, Risser stage, menarchal status, and curve size. Bracing indicated for skeletally immature curves 25–40° with documented progression; surgery typically considered for >45–50°. Pre‑op planning includes flexibility (bending) films, sagittal alignment, and neurologic monitoring readiness. Posterior spinal fusion with segmental pedicle screws is standard; anterior approaches reserved for specific curves. Pulmonary considerations cr...
Open topicScrews in Orthopaedic Surgery — Types, Biomechanics & Clinical Applications
Comprehensive guide to orthopaedic screws covering screw anatomy and geometry, cortical and cancellous screws, lag screws and the lag technique, locking screws, cannulated screws, headless compression screws, malleolar and positional screws, bioabsorbable screws, and screw failure mechanisms with clinical applications across fracture fixation.
Open topicSeinsheimer Classification — Subtrochanteric Femur
Types I–V: nondisplaced to highly comminuted/segmental by number/configuration of fragments. Most require IM nailing; higher types have longer healing and alignment challenges.
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 topicShaft Humerus — Radial Nerve Palsy
Primary neurapraxia occurs in ~10–15% closed fractures; most recover spontaneously by 3–4 months. Immediate exploration for open fractures, vascular injury, high‑energy with suspected transection, or secondary palsy after manipulation/fixation. Expectant management: splint, serial exams/EMG at 6–12 weeks; consider exploration if no recovery by 3–4 months. Fixation choices: functional bracing vs ORIF/IM nailing based on pattern and patient factors.
Open topicShaft of Femur Fractures — Reamed Nailing
Gold standard for adult diaphyseal femur. Reaming adds biology + bigger nail. Supine position, piriformis/trochanteric entry. Complications: fat embolism, malrotation, knee pain.
Open topicShock and Resuscitation in Orthopaedics
Types: hypovolemic (hemorrhagic), distributive (septic, neurogenic), cardiogenic, obstructive. Initial approach: ATLS (Airway with C‑spine, Breathing, Circulation, Disability, Exposure). Hemorrhagic shock is most common in trauma; control bleeding + balanced transfusion (1:1:1) + permissive hypotension until hemorrhage control (except TBI). Resuscitation targets: lactate clearance, base deficit, urine output, MAP appropriate to context. Adjuncts: TXA within 3 hours of injury; damage control surg...
Open topicShoulder Arthroplasty — Indications
Hemiarthroplasty: isolated humeral head disease (e.g., AVN, head-splitting fracture). Anatomic TSA: primary OA, RA, post-traumatic arthritis with intact rotator cuff. Reverse TSA: cuff tear arthropathy, pseudoparalysis, failed TSA. Contraindications: active infection, absent deltoid (RSA). Choice depends on cuff integrity, bone stock, patient age/activity.
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 topicShoulder Instability — Revision Surgery
Recurrent instability may follow failed Bankart repair. Causes: capsulolabral failure, glenoid bone loss, engaging Hill-Sachs. Workup: MRI, CT for bone loss quantification. Revision options: repeat Bankart, remplissage, Latarjet, bone grafting. Complications: recurrence, stiffness, graft nonunion, arthritis.
Open topicShoulder Stiffness — Adhesive Capsulitis
Idiopathic or secondary; painful stiffness with capsular pattern (ER most limited). Stages: painful freezing → frozen → thawing; natural history 1–3 years. Nonoperative: NSAIDs, PT, intra‑articular steroid injections. Operative: MUA or arthroscopic capsular release for refractory cases. Rule out secondary causes (diabetes, thyroid, post‑surgical).
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 topicSkin Traction in Children
Non-invasive traction in children. Types: Gallows (
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 topicSLAP Tears — Snyder Classification & Management
Detailed review of superior labrum anterior to posterior (SLAP) tears covering Snyder classification Types I–IV and further subtypes, clinical diagnosis, MR arthrography, biceps tenodesis vs SLAP repair, and return-to-sport criteria.
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