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…
Category: Fellowship Blog
Fellowship Blog
Drill Bit Breakage During Proximal Interlocking Screw Insertion in IMIL Nailing – A Practical Lesson from the OR
In orthopedic trauma surgery, complications often come unexpectedly which must be dealt critically. even routine procedures can throw a surprise. We came across one such unexpected complication while operating on a case of 23-year-old male with bilateral closed shaft of femur fracture with antegrade intramedullary interlocking (IMIL) nail on left…
Fellowship Blog
Revision Surgery After Failed Open Reduction in Developmental Dysplasia of the Hip
Re-dislocation rate after primary open reduction: 0-14% [1] Causes and timing of failure of primary surgery: Postoperative period Causes Immediate Approach related, Technical errors Delayed (After 4-6 weeks) Inadequate capsulorrhaphy, Inadequate immobilization Late Abnormal remodeling of acetabulum and femur Across multiple studies, inadequate soft tissue release – specifically the psoas…
Fellowship Blog
Mathematical Principles in Mechanically Aligned Total Knee Arthroplasty
Mechanical Axis Concept Natural Knee Target alignment in MA-TKA Tibial cut Distal femoral cut Posterior femoral cut The 3° Compensation Rule Distal femoral and Tibial resection thickness = Implant thickness 2 mm rule in TKA References:
Fellowship Blog
Refracture of the Patella – Early TBW Failure and Re-fixation
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…
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….