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Carpal 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 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...
Open topicCRPS — Budapest Criteria
Define CRPS — Budapest Criteria with common etiologies and pathoanatomy. List key classifications or staging systems used in exams. Clinical features and focused examination; special tests as applicable. Imaging: first‑line and advanced; measurements that change management. Nonoperative indications and protocols. Operative indications; approach and key steps. Implant/technique options with pros/cons. Complications and how to prevent/manage them. Rehabilitation milestones and outcome expectations...
Open topicCubital Tunnel Syndrome - Entrapment Neuropathy
Cubital Tunnel Syndrome (CuTS) is the second most common upper-limb compression neuropathy and results from compression of the ulnar nerve at the elbow, most commonly within the cubital tunnel behind the medial epicondyle. It typically presents with numbness and tingling in the little finger and ulnar half of the ring finger, often worsening with prolonged elbow flexion or pressure on the elbow. Progressive disease leads to intrinsic hand muscle weakness, reduced grip strength, positive Froment...
Open topicDanis–Weber Classification — Ankle (Fibula Level)
A: infra-syndesmotic; B: at syndesmosis; C: supra-syndesmotic (Maisonneuve possible). Instability rises from A→C; C requires ORIF with syndesmotic fixation.
Open topicDelbet–Colonna Classification — Paediatric Femoral Neck Fractures
Type I: Transepiphyseal (with/without dislocation) — highest AVN risk. Type II: Transcervical (through the neck). Type III: Cervicotrochanteric (basicervical). Type IV: Intertrochanteric. AVN risk decreases from I → IV; urgent reduction and stable fixation reduce complications.
Open topicDenis Classification — Sacral Fractures (Zones)
Zone 1: lateral to foramina (alar) — low neuro risk. Zone 2: through foramina — higher L5/S1 root risk. Zone 3: medial to foramina (central canal) — highest cauda equina risk.
Open topicDenis Three-Column — Thoracolumbar Injuries
Compression: anterior column only — usually stable. Burst: anterior + middle columns — unstable, canal compromise risk. Flexion-distraction (Chance): posterior tension failure — unstable. Fracture-dislocation: all three columns — highly unstable, neuro injury common.
Open topicDevelopmental Dysplasia of Hip (DDH) — Pavlik to Osteotomy
Early detection with Barlow/Ortolani; ultrasound (Graf) guides treatment under 6 months. Pavlik harness is first‑line for reducible dislocation under ~6 months; avoid excessive extension/abduction to reduce AVN risk. Failed Pavlik → closed reduction and spica; if unstable/obstructed, open reduction with capsulorrhaphy and femoral shortening/derotation as needed. Residual acetabular dysplasia treated with pelvic osteotomies (Salter, Pemberton, Dega) based on age and pathology. Complications: AVN...
Open topicDevelopmental Dysplasia of Hip (DDH) — Screening & Management
Spectrum: acetabular dysplasia to frank dislocation. Risk factors: breech, female, family history, oligohydramnios. Clinical: Ortolani & Barlow tests in neonates; Galeazzi sign, limited abduction in infants. Imaging: USG (Graf classification) 18 months).
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