One month following an index TBW procedure (using 4 K‑wires + cerclage), our patient sustained a refracture of the patella after a fall. There was no high-energy direct trauma. This case typifies early failure of a classic TBW construct. Failure Factors Identified in Literature Revision Fixation Alternate Techniques Key Takeaways…
Category: Fellowship Blog
Fellowship Blog
Tibial Shaft Fracture Fixation in Osteogenesis Imperfecta – Lessons from a Challenging ORIF
A 15-year-old male with osteogenesis imperfecta sustained a left tibial shaft fracture. We performed open reduction and intramedullary interlocking nailing (IMIL nail 8 mm). Intraoperatively, we encountered multiple iatrogenic fractures and longitudinal splits due to the brittle nature of OI bone. On postoperative review, the entry point appeared slightly lateral…
Fellowship Blog
Approach to Pelvic Ring Injury Classification
Introduction Existing Young-Burgess (YB), Tile & AO/OTA classification systems for pelvic ring fractures demonstrate inconsistent and often only fair-to-moderate inter-observer reliability (kappa = 0.30–0.79), creating diagnostic variability that can impact treatment planning and communication among orthopedicians.1 A clear, stepwise, unified algorithm could improve trainee education, standardize radiographic interpretation, and aid…
Fellowship Blog
The 0-3-6-9 rule in Mechanical Alignment Total Knee Arthroplasty (MA-TKA)
The goal of MA-TKA is to restore the normal mechanical axis. In contrast to kinematic axis alignment, which attempts to recreate native knee joint line (3° tibial varus and 3° femoral valgus), in MA-TKA, the distal femur and the tibia are cut to be perpendicular (0°) to the mechanical axis….
Fellowship Blog
Approach to Neuromuscular Hip Dysplasia in Children with Cerebral Palsy : Principles of management and Long-term Radiographic Outcome
Dr. Sulabh Kumar Shrestha1, Dr. Rajendra Aryal2, Dr. Nitesh Raj Pandey2, Dr. Bibek Banskota21AKBEF Fellow, 2Unit-1 (Hip, Pelvi-acetabulum & Arthroplasty), B&B HospitalPoster presentation at Orthocon 2026 Introduction Progressive hip subluxation is a common orthopedic problem in children with cerebral palsy (CP), with strong correlation to Gross Motor Function Classification System…
Fellowship Blog
Normal Hip Development
4-6 weeks of gestation: By 7 weeks of gestation: By 11 weeks of gestation: Late gestation: Postnatal: The acetabulum is deepened by the natural pressure from the developing femoral head on the acetabulum. Hips in newborns with developmental dysplasia are not just normal hips with capsular laxity; they are structurally…
Fellowship Blog
A THR After Acetabular ORIF and the 9 Intraoperative Tests That Matter
Today was one of those surgeries that stays with you not just for the technical challenge, but for what it teaches you as a growing orthopedic surgeon. Our patient was a 30-year-old male with painful AVN of the femoral head, years after an acetabular fracture that had been treated with…
Fellowship Blog
When Locking Screws Refuse to Budge – Techniques for Removing Jammed or Stripped Screws
Written on August 10, 2025 And once again, today’s case reminded me that removing orthopedic implants can be more challenging than inserting them – especially when faced with a stubborn, stripped or jammed locking screw. We operated on a 25-year-old female with a united distal radius fracture, aiming to remove…