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Boutonniere 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 topicBuckle (Torus) & Plastic Bowing — Paediatric Forearm Patterns
Buckle/Torus: Compression failure of cortex (metaphyseal) — stable; treat with short immobilization/splint. Plastic Bowing: Microfracture without discrete break; persistent deformity if not recognized and reduced. Greenstick: One cortex fails in tension, other intact — needs gentle completion or molding to correct alignment.
Open topicCalcaneal Fractures - Case Based Discussion
Introduction Calcaneal fractures are the most common fractures of the tarsal bones and typically occur following high-energy axial loading injuries such as falls from height or road traffic accidents. The calcaneus plays a crucial role in weight transmission and hindfoot biomechanics, making restoration of anatomy essential for good functional outcomes. These fractures may involve the subtalar joint and are therefore classified as intra-articular or extra-articular injuries. Intra-articular frac...
Open topicCalcaneal Fractures — Sanders & Essex-Lopresti
Sanders classification: based on CT coronal posterior facet fractures. Essex-Lopresti: tongue vs joint depression patterns. Operative indications: displacement >2 mm, malalignment, large fragment involvement. ORIF via extensile lateral or sinus tarsi approach; primary subtalar fusion in severe comminution. Complications: wound breakdown, infection, subtalar arthritis.
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 topicCementless vs Cemented Fixation in Arthroplasty
THA: cementless acetabular components standard; femoral fixation cemented (elderly) vs cementless (younger). TKA: tibial components commonly cemented; cementless options increasing with porous coatings in the young. Cemented: immediate fixation, proven longevity; risks include cement implantation syndrome. Cementless: biologic ingrowth; risk of early micromotion if poor bone stock. Choice individualized by bone quality, age/activity, and surgeon expertise.
Open topicCervical Spine Trauma — Subaxial
Follow ATLS with careful immobilization; CT is first‑line imaging for suspected injury. AO Subaxial classification guides stability and surgical approach; assess disco‑ligamentous injury and neurology. Bilateral facet dislocation: attempt awake traction reduction, then ACDF or posterior fixation depending on disc herniation and stability. Teardrop fractures and burst injuries often need anterior decompression + fixation. Early decompression in incomplete SCI may improve outcomes.
Open topicCervical Spondylotic Myelopathy — Pathophysiology & Surgery
CSM is progressive spinal cord dysfunction due to degenerative stenosis (disc osteophyte complex, ligamentum flavum hypertrophy, OPLL). Symptoms: hand clumsiness, gait imbalance, Lhermitte sign; UMN signs below level (Hoffmann, Babinski) with possible segmental LMN at level. MRI is diagnostic; assess sagittal alignment, number of compressed levels, and canal diameter. Surgery for moderate–severe or progressive CSM: anterior (ACDF/corpectomy) vs posterior (laminoplasty/laminectomy + fusion) based...
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 topicChondrosarcoma
Second most common primary malignant bone tumor in adults. Occurs age 40–70 yrs; M > F. Common sites: pelvis, femur, shoulder girdle, ribs. Variants: conventional, clear cell, mesenchymal, dedifferentiated. Chemo/RT ineffective except mesenchymal type. Treatment: wide surgical excision.
Open topicChondrosarcoma — Grades & Surgery
Second most common primary malignant bone tumor after osteosarcoma, usually >40 years. Common sites: pelvis, femur, humerus, ribs. Graded histologically (I–III); dedifferentiated and mesenchymal subtypes more aggressive. X‑ray: rings‑and‑arcs calcification, endosteal scalloping, cortical breach. Treatment: Wide surgical resection is mainstay; chemo/radiotherapy are ineffective.
Open topicClavicle Fractures — Management
Most common: midshaft fractures; assess displacement, shortening, comminution, skin tenting, neurovascular status. Nonoperative for minimally displaced; operative indications include >2 cm shortening, 100% displacement, comminution, open injury, skin compromise, floating shoulder, polytrauma. Fixation options: plate (superior/anteroinferior), intramedullary device; lateral third may need coracoclavicular augmentation. Complications: nonunion, malunion with symptomatic shortening, hardware irrita...
Open topicClavicle Nonunion — Plate vs Graft
Symptomatic nonunion: pain, cosmetic deformity, scapular dyskinesis, and weakness. Standard treatment: compression plating + autogenous iliac crest bone graft for atrophic nonunion. Superior vs anteroinferior plating—each has pros/cons (biomechanics vs soft‑tissue irritation). Segmental defects >3 cm or failed revisions may need vascularized graft (fibula). Smoking cessation and vitamin D optimization improve union.
Open topicClubfoot — Ponseti Technique
Correct deformities in **CAVE** order: **C**avus → **A**dductus → **V**arus → **E**quinus. Use **Ponseti casting** with abduction and supination around talar head; avoid pronation/forceful correction. Most require **percutaneous Achilles tenotomy** before final cast. Maintain with **foot abduction brace (FAB)** 23 h/day initially, then during sleep until 4–5 yrs to prevent relapse. Atypical/complex clubfoot needs modified slower casts; beware dorsal creases and short forefoot.
Open topicColles fracture | Distal Radius Fractures - Case Based Discussion
Introduction Colles fracture is a common extra-articular fracture of the distal radius typically occurring within 2–3 cm of the wrist joint. It is most commonly seen in elderly individuals following a fall on an outstretched hand with the wrist in dorsiflexion. The classic deformity is characterized by dorsal angulation and displacement of the distal fragment, often described as the “dinner fork deformity.” Although many Colles fractures can be managed conservatively, unstable...
Open topicComminuted Intertrochanteric Femur Fracture - Case Based Discussion
Introduction Intertrochanteric fractures are extracapsular fractures occurring between the greater and lesser trochanter of the proximal femur. These injuries are common in the elderly population following low-energy falls but may also occur in younger patients following high-energy trauma. The fracture pattern may range from simple two-part fractures to highly comminuted unstable fractures with loss of posteromedial and lateral wall support. Comminuted intertrochanteric fractures are considered...
Open topicCompartment Syndrome — Diagnosis and Management
Raised intracompartmental pressure → ischemia/necrosis. Causes: tibia/forearm fractures, crush injury, reperfusion, tight casts. Early signs: pain out of proportion, pain on passive stretch. Diagnostic criteria: CP >30 mmHg or ΔP (DBP–CP)
Open topicCompartment Syndrome — Pressure Criteria
Absolute CP >30 mmHg indicates fasciotomy. ΔP = DBP – CP; if <30 mmHg, fasciotomy indicated. Interpret with clinical signs.
Open topicComplications of Total Hip Arthroplasty (THA)
Early complications: dislocation, infection, nerve injury, DVT/PE. Late complications: aseptic loosening, periprosthetic fracture, heterotopic ossification, osteolysis, implant wear. Dislocation risk factors: posterior approach, malposition, neuromuscular disorders. Nerve injuries: sciatic > femoral; incidence ~1%. Infection: incidence 0.5–2%; requires DAIR or revision.
Open topicComputer-Assisted / Navigation-based Arthroplasty
Computer-assisted surgery (CAS) improves component alignment in TKA/THA. Techniques: imageless and CT-based navigation. Benefits: improved mechanical axis alignment, reduced outliers, useful in deformity. Limitations: longer OR time, cost, learning curve; functional/survivorship benefits inconsistent. Adjunct tool especially in complex anatomy.
Open topicCongenital Talipes Equinovarus — Relapse & Tibialis Transfer
Relapse often due to **brace non‑compliance**; dynamic supination is common in toddlers. Initial management is **re‑casting** following Ponseti principles; evaluate for residual equinus/adductus. **Tibialis Anterior Tendon Transfer (TATT)** indicated for persistent dynamic supination after walking age. Technique: split or whole TATT to lateral cuneiform (through bone tunnel or anchors) with foot held in dorsiflexion/eversion. Severe rigid relapses may require posteromedial release or external fi...
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