Dynamization of intramedullary nail is the process of converting a static interlocking nail (provides better fixation & rotational control) to a dynamic locking nail (allows axial loading of fracture to stimulate bone healing). Dynamization converts a bridging mode of fixation to the splinting mode. Timing of Dynamization: Dynamization should be…
Category: Surgical Skills
Surgical instruments and surgical techniques
Surgical Skills 
Eponychial Marsupialization for Chronic Paronychia
Chronic paronychia is an inflammatory recalcitrant disorder affecting the nail folds. It can be defined as an inflammation lasting for more than 6 weeks and involving one or more of the three nail folds (one proximal and two lateral). Surgical management is only indicated in cases of chronic paronychia, which…
Surgical Skills 
Geometry and Margins of Elliptical Excision
Ends of ellipse (Apical angles): Dimension of ellipse: Axis of ellipse: Margin of excision: Lesion type Surgical margin Uncertain Consider shave or punch biopsy to delineate prior to elliptical excision or start with 1- to 2-mm margins to avoid unnecessary tissue removal. Benign Visible lesion removed BCC 3–5 mm SCC 3–6 mm…
Surgical Skills 
Swashbuckler (Modified Anterolateral) Approach to Distal Femur
Advantages: Patient position: Supine with a roll under the knee to allow knee flexion Tourniquet: Not used unless required Incision: Superficial dissection: 1. Fascia is incised in line of incision & sharply dissected off the vastus lateralis muscle laterally to its inclusion with the iliotibial band, to expose the quadriceps…
Surgical Skills 
Shoelace technique for Delayed Primary Closure
Indication: Delayed primary closure of fasciotomy wounds Sutures that can be used: Anchors: Staples (can apply 2 staples) or Metal clips Knotting pattern: The suture is attached to one side and passed through the incision to be attached on the opposite side, in a sequence that resembles a zigzag from…
Surgical Skills 
Biomechanics in MIPO (Minimally Invasive Plate Osteosynthesis)
1. Provides optimal environment for fracture healing: 2. Relative stability of fracture: 3. Acts as internal fixator: 4. Plate length and Number of screws in Bridge plate function: 5. Plate working length: References:
Surgical Skills 
Syringe Suction Vacuum Drain : Technique
1. A small stab incision is made on skin with a no. 11 Blade where the drain is anticipated. 2. A feeding tube of an appropriate size or IV set tube with side holes is placed through the skin incision site to the desired site. 3. The tube is fixed…
Emergency Medicine 
Circumferential Periosteal Block (CPB)
Use: Alternative to hematoma block in reduction of distal radius and ulna fractures Advantage: Providing distance from the fracture hematoma (no theoretical risk of converting closed fracture into open fracture) Disadvantage: Risk of neurovascular injury on volar surface of forearm Local anesthetic and volume: 10–15 ml of 1 % plain lidocaine…