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Discoid Meniscus
Congenital variant where meniscus is thickened and disk-shaped. Most common in lateral meniscus (incidence 1–3%). Clinical: snapping, pain, locking in children/young adults. Imaging: X-ray may show widened joint space; MRI confirms discoid shape. Treatment: asymptomatic—observe; symptomatic—saucerization + repair.
Open topicDislocation after THA — Risk Factors & Management
Incidence 1–3% after primary THA; higher in revision. Risk factors: posterior approach, malpositioned cup (anteversion 25°, inclination >60°). Patient factors: neuromuscular disease, dementia, noncompliance. Management: closed reduction, bracing; revision for recurrent instability. Prevention: proper cup position, posterior repair, large femoral heads.
Open topicDistal Femur Fractures
AO 33 classification. Locking plate vs retrograde nail. Principles: joint first, then shaft. Complications: nonunion, malalignment, stiffness.
Open topicDistal Radius — Colles/Smith/Barton
Colles: extra-articular, dorsal tilt; Smith: extra-articular, volar tilt; Barton: intra-articular rim fracture. Clinical deformities: dinner-fork (Colles), garden-spade (Smith). Stability factors: dorsal comminution, >20° angulation, >5 mm shortening, intra-articular involvement. Treatment: closed reduction/cast vs volar plate fixation. Complications: malunion, CRPS, post-traumatic arthritis.
Open topicDupuytren’s Contracture
Fibroproliferative disorder of palmar fascia causing fixed flexion deformity of fingers. Risk factors: male, >40 years, northern European descent, diabetes, alcoholism, smoking. Commonly affects ring and little finger; cords/nodules palpable. Hueston’s tabletop test positive (cannot place palm flat on table). Treatment: needle aponeurotomy, limited fasciectomy, collagenase injection; recurrence common.
Open topicDVT Prophylaxis in Orthopaedics
Risk high in hip/knee arthroplasty, hip fracture surgery, pelvic/acetabular trauma, prolonged immobility. Options: LMWH, DOACs (apixaban/rivaroxaban), aspirin (selected low‑risk arthroplasty), mechanical methods (IPC/stockings). Duration: 10–14 days minimum; up to 35 days after hip fracture/arthroplasty. Balance bleeding risk (neuraxial anesthesia timing) with VTE prevention.
Open topicElbow Dislocations — Terrible Triad
Terrible triad = posterior elbow dislocation + radial head fracture + coronoid fracture. Highly unstable pattern, requires surgical fixation of all components. Goal: concentric reduction + early mobilization in stable arc. Complications: stiffness, recurrent instability, arthritis, heterotopic ossification.
Open topicElbow Stiffness — Release
Functional elbow arc ≈ 30–130° flexion and 50°/50° pronation–supination (Morrey). Common causes: trauma, HO, prolonged immobilization, intra‑articular fracture, infection. Initial treatment: therapy, static/dynamic splinting, CPM; MUA in early soft‑tissue contracture. Operative options: arthroscopic or open capsular release ± HO excision ± ulnar nerve transposition. Complications: recurrence, instability, nerve injury (ulnar), HO recurrence.
Open topicEnchondroma vs Osteochondroma
Enchondroma: intramedullary cartilage tumor, common in hand phalanges. Osteochondroma: cartilage-capped exophytic lesion from metaphysis. Syndromes: Ollier, Maffucci (enchondroma); Multiple Hereditary Exostoses (osteochondroma). Malignant transformation rare in solitary lesions, higher in syndromic cases. Treatment: observation, excision if symptomatic or suspicious.
Open topicEpiphyseal Growth Plate — Zones & Regulation
Zones: reserve (resting), proliferative, hypertrophic (maturation, degeneration, provisional calcification). Regulation: Ihh/PTHrP feedback loop, GH/IGF‑1 axis, local factors (TGF‑β, BMPs, FGFs, Wnt). Hypertrophic zone is weakest → site of Salter‑Harris fractures. Vascular invasion and endochondral ossification occur at metaphyseal side. Clinical: growth arrest, bar formation, angular deformity after physeal injury; SCFE affects hypertrophic zone. Imaging: physeal widening (rickets), metaphyseal...
Open topicEvans/Jensen — Intertrochanteric Femur
Stable: intact posteromedial buttress; Unstable: posteromedial comminution, reverse obliquity, subtrochanteric extension. Stable → DHS; Unstable → cephalomedullary nail/fixed-angle device.
Open topicEwing’s Sarcoma — Protocols
Second most common malignant bone tumor in children/adolescents after osteosarcoma. Characterized by t(11;22) → EWS-FLI1 translocation. Common sites: diaphysis of long bones, pelvis, ribs. Onion-skin periosteal reaction on X-ray is classical. Treatment: multi-agent chemotherapy (VDC/IE), surgical resection ± radiotherapy. Overall survival ~70% in localized disease,
Open topicExpandable Prosthesis in Paediatric Oncology
Indicated for skeletally immature patients undergoing limb-salvage near a growth plate (e.g., distal femur/proximal tibia). Designs: minimally invasive magnetically driven expanders vs older surgical-lengthening types. Aims to maintain limb length equality during growth while preserving function and oncologic safety. Complications: infection, mechanical failure, soft-tissue problems, stiffness; multiple lengthenings required. Requires multidisciplinary follow-up through growth until maturity.
Open topicExtensor Mechanism Failure after TKA
Includes quadriceps tendon rupture, patellar fracture, patellar tendon rupture, patellar component failure. Risk factors: previous surgery, patellar resurfacing, malalignment, steroid use. Presentation: extensor lag, inability to extend knee, palpable gap. Management: direct repair (acute), augmentation with graft/allograft (chronic). High failure rates with chronic repairs — need reinforcement.
Open topicExternal Fixators — Concepts
Types: uniplanar, biplanar, circular. Biomechanics: stiffness ↑ with larger pins, more pins, wider spread, closer frame. Indications: open fractures, polytrauma, infected nonunion, limb lengthening. Advantages: minimal soft tissue stripping, adjustability. Disadvantages: pin site infection, stiffness, bulky frame.
Open topicFat Embolism Syndrome
Classically 24–72 h after long‑bone/pelvic fractures or IM reaming; triad: hypoxemia, neurological signs, petechiae. Diagnosis is clinical; supported by Gurd’s criteria (1 major + 4 minor) or Schonfeld score (>5). ABG hypoxemia, CXR fluffy infiltrates; brain MRI 'starfield' pattern on DWI. Prevention: early stabilization of long bone fractures; careful reaming/venting. Management: supportive (oxygen/PEEP, fluids), avoid overload; steroids controversial.
Open topicFemoral Neck Fracture — Garden/Pauwels
Garden I–II = non-displaced, III–IV = displaced. Pauwels I 50° vertical shear. Young = urgent reduction + fixation (CS/DHS). Elderly = arthroplasty if displaced. Complications: AVN, nonunion.
Open topicFemoroacetabular Impingement (FAI) — Cam, Pincer & Mixed
Comprehensive guide to femoroacetabular impingement (FAI) covering cam, pincer, and mixed morphologies, alpha angle measurement, Tönnis grading, clinical assessment, conservative and surgical management including hip arthroscopy.
Open topicFibrous Dysplasia — Shepherd’s Crook
Developmental fibro‑osseous lesion replacing normal bone with fibrous tissue. Types: monostotic (70%), polyostotic; associated with McCune–Albright (café‑au‑lait, endocrine). X‑ray: ground‑glass appearance, expansion, cortical thinning; Shepherd’s crook deformity of proximal femur. Histology: irregular woven bone trabeculae (‘Chinese letters’) in fibrous stroma. Treatment: bisphosphonates for pain, corrective osteotomies, internal fixation for deformity.
Open topicFloating Joints — Floating Knee, Floating Elbow & Floating Shoulder
Comprehensive guide to floating joint injuries covering floating knee (Fraser classification, ipsilateral femur and tibia fractures), floating elbow (ipsilateral humerus and forearm fractures in children), and floating shoulder (ipsilateral clavicle and scapular neck fractures, superior shoulder suspensory complex), with management principles, surgical indications, and complications for each pattern.
Open topicFoot & Ankle — Hallux Valgus
Lateral deviation of great toe with medial eminence (bunion). Risk factors: female gender, footwear, ligamentous laxity, pes planus. Clinical: pain, callosities, overlapping toes. Radiology: HVA >15°, IMA >9°. Severity guides surgery. Treatment: footwear modification, orthoses, osteotomies (Chevron, Scarf, Lapidus).
Open topicFracture Healing — Biology & Timelines
Phases: inflammation → soft callus (cartilage) → hard callus (woven bone) → remodeling (lamellar). Primary (direct) vs secondary (indirect) healing; absolute vs relative stability concepts. Cell sources: periosteum (key), endosteum, marrow, surrounding soft tissues. Mechanical environment (strain theory) dictates tissue type; too much motion → nonunion. Timelines vary by bone/age/blood supply—tibia slower than femur; smokers/NSAIDs may delay.
Open topicFrykman Classification — Distal Radius
Types I–VIII: extra- vs intra-articular, DRUJ involvement, and ulnar styloid fracture. Intra-articular (III–VIII) have higher arthritis risk; often require ORIF.
Open topicGait Cycle and Analysis
Gait cycle: stance (~60%) and swing (~40%); double support ~20% of cycle. Rocker phases: heel rocker, ankle rocker, forefoot rocker enable forward progression. Determinants reduce vertical COM excursion: pelvic rotation/tilt, knee flexion in stance, ankle mechanism, foot mechanism. Pathological gaits: Trendelenburg, antalgic, circumduction, steppage, equinus. Clinical gait analysis: observational + instrumented (temporal‑spatial, kinematics, kinetics, EMG).
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