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…
Tag: Orthopedics
Section Editor: Dr. Sulabh Kumar Shrestha, MBBS, PGY1 Orthopedics
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
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…
PGMEE, MRCS, USMLE, MBBS, MD/MS
Obstacles to reduction in Developmental Dysplasia of Hip (DDH)
Extra-articular obstacles: Secondary muscle shortening due to hip in subluxed/dislocated position Intra-articular obstacles: Results in decreased volume of the acetabulum
PGMEE, MRCS, USMLE, MBBS, MD/MS
Classifications of Sequelae of Septic Arthritis of Hip in Children
Several radiological classifications have been developed to describe the long-term changes in the hip following septic arthritis and to help guide management. Hunka classification Choi classification Forlin and Milani classification Grade 1: Hips with the head or the femoral neck within the acetabulum Grade 2: Hips are dislocated Johari classification…
PGMEE, MRCS, USMLE, MBBS, MD/MS
Tonnis and IHDI (International Hip Dysplasia Institute) Classification for DDH
IHDI method is a new radiographic classification of the severity of hip dislocation in DDH. It is based on the location of the midpoint of superior part of ossified metaphysis (H-point) relative to acetabulum. In contrast to Tonnis classification method, IHDI method: Tonnis classification: It is assessed according to the…