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Galeazzi Injury
Radial shaft fracture with disruption of the distal radioulnar joint (DRUJ). Occurs in middle to distal third radius fracture. Requires ORIF of radius and stabilization of DRUJ. Called 'fracture of necessity' because surgery is mandatory in adults. Complications: DRUJ instability, chronic pain, stiffness.
Open topicGaleazzi Injury — Distal Radius + DRUJ Disruption
Distal radial shaft fracture with distal radioulnar joint (DRUJ) disruption. Unstable pattern: ORIF radius and stabilize DRUJ.
Open topicGarden Classification — Femoral Neck (Intracapsular)
I: incomplete/valgus impacted; II: complete, nondisplaced. III: complete, partially displaced (varus); IV: complete, fully displaced. I–II stable → fixation; III–IV unstable → arthroplasty in elderly (high AVN/nonunion).
Open topicGartland Classification — Supracondylar Humerus (Extension Type)
Type I: Nondisplaced — anterior humeral line intersects capitellum; treat in long arm cast. Type II: Displaced with posterior cortex intact (hinge) — often closed reduction & pinning (CRPP). Type III: Completely displaced with no cortical contact — unstable; CRPP with two or three pins. Type IV (Leitch): Multidirectional instability (both cortices incompetent) — unstable under fluoroscopy; pin spread critical.
Open topicGiant Cell Tumor — Campanacci Classification
Locally aggressive benign tumor in skeletally mature adults (20–40 yrs). Campanacci classification: Grade I (latent), II (active), III (aggressive with soft tissue extension). X-ray: eccentric lytic lesion, soap-bubble appearance. Treatment: extended curettage with adjuvants, PMMA, or wide excision. Denosumab indicated in sacral/spinal or unresectable lesions.
Open topicGustilo–Anderson — Open Fractures
I: 10 cm/high-energy or extensive damage. IIIa: adequate coverage; IIIb: periosteal stripping, needs flap; IIIc: arterial injury requiring repair. Higher grade → higher infection/nonunion; guides antibiotics, debridement, coverage.
Open topicHaemophilic Arthropathy
Caused by recurrent hemarthrosis in hemophilia A/B leading to synovitis, cartilage loss, and arthritis. Target joints: knee, ankle, elbow—recurrent bleeds produce synovial hypertrophy. Radiographic findings: squaring of patella, widened intercondylar notch, subchondral cysts. MRI: sensitive for synovial hypertrophy, hemosiderin deposition, and cartilage thinning. Treatment: prophylactic factor replacement, radiosynovectomy/arthroscopic synovectomy, arthroplasty in end‑stage.
Open topicHaemophilic Arthropathy — Evaluation & Treatment
Recurrent hemarthroses → synovial hypertrophy → cartilage damage and arthropathy (ankle, knee, elbow). Evaluation: bleeding history, factor levels/inhibitors, US/MRI for synovitis and osteochondral damage. Acute bleed management: RICE + factor replacement to target levels (VIII or IX). Chronic synovitis: radiosynovectomy/arthroscopic synovectomy; advanced arthropathy—osteotomy, arthrodesis, arthroplasty. Always coordinate with hematology for perioperative factor protocol ± antifibrinolytics.
Open topicHallux Rigidus
Degenerative osteoarthritis of the 1st MTP joint causing dorsal osteophytes, stiffness, and pain—especially with push‑off. Coughlin–Shurnas clinical–radiographic grading guides treatment (Grade 1: mild stiffness → Grade 4: severe stiffness with sesamoid involvement/near ankylosis). Cheilectomy ± Moberg (dorsal closing wedge) osteotomy for low‑grade disease; 1st MTP arthrodesis is the gold standard for advanced disease in active patients. Arthroplasty/hemicap considered selectively in low‑demand...
Open topicHardcastle–Myerson — Lisfranc Injuries
A: total incongruity; B1: medial partial; B2: lateral partial; C1: divergent partial; C2: divergent complete. Any >2 mm displacement typically requires surgical fixation/arthrodesis.
Open topicHawkins Classification — Talar Neck
I: no dislocation; II: subtalar dislocation; III: subtalar + tibiotalar; IV: plus talonavicular. AVN risk escalates I→IV; displaced types require urgent reduction and fixation.
Open topicHemiarthroplasty Hip — Indications
Most common indication: displaced femoral neck fracture in elderly. Types: unipolar (Austin-Moore, Thompson) vs bipolar prostheses. Advantages: shorter surgery, less blood loss vs THA. Disadvantages: acetabular erosion, groin pain in long term. Choice depends on age, activity, acetabular status.
Open topicHerbert Classification — Scaphoid
A: acute stable (A1 tubercle, A2 nondisplaced waist). B: acute unstable (B1 distal oblique, B2 displaced waist, B3 proximal pole, B4 comminuted, B5 perilunate). C: delayed union; D: established nonunion. Unstable (B) often need fixation; D needs grafting + fixation.
Open topicHertel Predictors — Proximal Humerus Ischemia
Medial hinge disruption >2 mm, anatomic neck fracture, head-splitting → high AVN risk. Assists decision towards arthroplasty in ischemic patterns.
Open topicHeterotopic Ossification after Hip Arthroplasty
HO = abnormal bone formation in periarticular soft tissues after surgery or trauma. Incidence after THA: 20–50%; clinically significant in 5–10%. Risk factors: male sex, hypertrophic OA, ankylosing spondylitis, previous HO. Classification: Brooker I–IV (X-ray based). Prophylaxis: NSAIDs, radiotherapy; treatment = excision if severe functional limitation.
Open topicHigh Tibial Osteotomy (HTO) — Indications & Techniques
Indications: medial compartment OA with varus deformity in young active patients. Goal: shift weight-bearing axis laterally to unload medial compartment. Techniques: lateral closing wedge, medial opening wedge, dome osteotomy. Fixation: plates (TomoFix) or external fixators. Delays need for TKA in younger patients.
Open topicHip Labral Tears — Classification, Diagnosis & Arthroscopic Management
Detailed guide to hip labral tears covering anatomy, Seldes/Czerny classification, clinical tests, MR arthrography, arthroscopic repair vs debridement vs reconstruction, and outcomes.
Open topicHip Resurfacing Arthroplasty
Bone-conserving alternative to THA; resurfaces femoral head with metal cap. Indicated in young, active patients with OA, good bone stock, large femoral head size. Advantages: bone preservation, easier conversion to THA, lower dislocation risk. Complications: femoral neck fracture, aseptic loosening, metal ion release (cobalt/chromium). Decline in popularity due to metal-on-metal concerns; selected patients may still benefit.
Open topicHow to Read a Hip X-Ray — Systematic Approach
A comprehensive systematic approach to interpreting hip radiographs, covering patient positioning, anatomical landmarks, key lines and angles, pathological patterns, and common hip conditions — essential for all orthopaedic surgeons and trainees.
Open topicHyperparathyroidism and Bone
Excess PTH causes cortical bone loss via RANKL-mediated osteoclast activation; classic radiology: subperiosteal resorption, salt‑and‑pepper skull, brown tumors. Primary (adenoma), secondary (CKD/vit D deficiency), tertiary (autonomous) forms dictate biochemistry and treatment. DEXA: cortical loss at one‑third radius; labs—↑PTH, ↑ALP; Ca high in primary/tertiary, low‑normal in secondary; phosphate low in primary, high in CKD. Orthopaedic issues: fragility fractures, brown tumors, tendon ruptures;...
Open topicIdeberg 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 topicIliotibial Band — Anatomy & Clinical
Thickened lateral fascia lata from iliac crest to Gerdy’s tubercle; receives fibers from TFL and gluteus maximus. Functions: lateral knee stabilization, assists hip abduction and knee extension in terminal stance. Clinical syndromes: IT band friction syndrome (runners), snapping hip (external type). Exam tests: Ober’s test (tightness), Noble compression test (pain over lateral femoral epicondyle at 30° flexion). Management: activity modification, stretching, physio focus on hip abductors/core; i...
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 topicImaging — CT & MRI Essentials
CT: excellent for cortical bone, 3D recon. MRI: excellent for marrow, soft tissue, ligaments, cartilage. CT indications: complex fractures (pelvis, acetabulum, calcaneus). MRI indications: occult fractures, marrow edema, tumors, soft tissue injury. Contraindications: CT—radiation, contrast nephropathy; MRI—pacemaker, ferromagnetic implants.
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