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…
Category: Surgical Skills
Surgical instruments and surgical techniques
Surgical Skills 
Anteromedial Ankle Hematoma Block
Mechanism of action of Hematoma Block Indications of Anteromedial Portal Injection Landmarks Technique
Surgical Skills 
Bilateral V-Y (Kutler) flap for finger stump closure
Indications Classically, this flap is indicated in patients with transverse or volar oblique amputations. In actuality, the patient in whom this flap is useful generally will have an amputation where there is more tissue on the radial and ulnar margins of an amputation and exposed distal phalanx. Limitations Generally, the…
Surgical Skills 
Aberdeen Knot
To end continuous suture, either a square knot, surgeon’s knot or an Aberdeen knot is required. The Aberdeen knot has been shown to be superior to a surgeon’s knot. Recommendations on number of throws: Technique/Steps:
Surgical Skills 
Running subcuticular suturing
1. Start with a buried knot at distal apex of the wound. 2. Take a bite deep to the epidermis that should curve parallel to the skin surface and exit in the same plane approximately 5-10mm along the wound, taking care to stay at the same level. 3. Continue step…
Surgical Skills 
Percutaneous Achilles Tenotomy for CTEV
Indications Cavus, Adductus and Varus are fully corrected but ankle dorsiflexion remains <10 degrees above neutral Adequate abduction: Best sign: Ability to palpate anterior process of the calcaneus as it abducts out from beneath the talus Abduction of approximately 60 degrees Neutral or slight valgus of os calcis Technique 1….
Surgical Skills 
Hip Spica Cast
Acceptable angulation in Femoral Shaft Fractures Age Varus/Valgus (degrees) Anterior/Posterior (degrees) Shortening (mm) <2 yr 30 30 15 2-5 yr 15 20 20 6-10 yr 10 15 15 >10 yr 5 10 10 Reference: Rockwood and Wilkin’s Fractures in Children – Leg position for Hip Spica Application in Femur Shaft…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Compartments, Muscles and Fasciotomy of the leg
Muscle Origin Insertion Action Innervation Anterior compartment 1. Tibialis anterior (TA) Superior 2/3 lateral surface of tibia Medial cuneiform, 1st metatarsal Dorsiflexion, foot inversion Deep peroneal nerve (L5) 2. Extensor digitorum longus (EDL) Superior 2/3 of fibula and interosseous membrane Middle and distal phalanx, lateral 4 toes Dorsiflexion, toe extension…