Nearly 50–60% of patients undergoing total knee arthroplasty (TKA) are obese, making obesity one of the most important factors influencing perioperative planning and outcomes. These obese patients often require TKA at a younger age. It is a major risk factor for knee osteoarthritis due to: High BMI can be classified…
Author: Dr. Sulabh Kumar Shrestha, MS Orthopedics
He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music. He is currently pursuing Fellowship in Hip, Pelvi-acetabulum and Arthroplasty at B&B Hospital.
Fellowship Blog
Fixing the Wing: ORIF of an Iliac Wing Fracture Using the Lateral Window of Anterior Approach
Today’s case involved a 63-year-old female presenting with a right iliac wing fracture (Tile A2) and a left distal radius fracture following trauma. The pelvic injury was managed with open reduction and internal fixation using reconstruction plates and a screw via the lateral window of the anterior approach. The distal…
Fellowship Blog
Learnings from a CRIF with CCS for Neck of Femur Fracture without Fracture Table
We operated on a 3-day-old left neck of femur (NOF) fracture in a 40-year-old male, performing a closed reduction and internal fixation (CRIF) with cannulated cancellous screws (CCS). The surgery was done without a fracture table, with the patient in supine position on a standard operating table. During intraoperative positioning…
Fellowship Blog
Periacetabular Osteotomy (PAO)
Synonyms: Bernese osteotomy, Ganz osteotomy Introduced by: Dr. Reinhold Ganz in 1984 in Bern, Switzerland Definition: Outcome of 1st Ganz cohort in 30 years followup: Authors Follow-up Journal No. of patients (hips) Survivorship K.A Sienbrock et.al. 10 years CORR 1999 63 (75) 80-90% Simon D et.al. 20 years CORR 2008…
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Sacral Dysmorphism
Upper sacral segment dysplasia refers to a sacral phenotype in which the size and orientation of the upper sacral segment doesn’t allow safe passage of a trans-iliac, trans-sacral screw and characterized by one or more of the following features/criteria:1 Criteria Projection Frequency Acute alar slope (qualitative criteria without cut-off value)…
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Simultaneous Bilateral Total Knee Arthroplasty (SBTKA): A Practical Perspective
Recently, we operated on a 58-year-old female patient with advanced bilateral knee osteoarthritis (OA). She underwent simultaneous bilateral total knee arthroplasty (TKA) using a medial parapatellar approach. Both femoral components were size 3, tibial components size 3, and a 10mm polyethylene insert was used on each side. Some practical considerations…
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Pediatric Pelvic Fracture Classifications
Before closure of triradiate cartilage (14 in boys and 12 in girls), pelvic bones are weaker than pelvic ligaments leading to more pubic rami and iliac wing fractures. After closure, they are more likely to sustain fractures of acetabulum, diastasis of pubic symphysis and SI joint separation. Hence, a pediatric…
Fellowship Blog
Retrograde Percutaneous Screw Fixation of Posterior Column Acetabulum Fracture : C-Arm Views & Technique
Today in the OR, I observed a retrograde percutaneous screw fixation of a left posterior column acetabular fracture in a 63-year-old male. While I wasn’t scrubbed in, it offered a fantastic opportunity to understand the precision and fluoroscopic guidance required for this minimally invasive approach. It is often said that, “Percutaneous fixation is a surgery performed…