Bone remodeling involves the removal of mineralized bone by osteoclasts followed by the formation of bone matrix through the osteoblasts that subsequently become mineralized. There are 2 prominent concepts of bone remodelling: 1. Hueter-Volkmann law or Delpech’s law: It states that bone growth in the skeletally immature is inhibited in…
Tag: Orthopedics
Section Editor: Dr. Sulabh Kumar Shrestha, MBBS, PGY1 Orthopedics
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Surgical Site Infection Risk Factors : Mnemonic
Various types of surgical site infection (SSI) have been defined by CDC. Patient related factors Mnemonic: WASHING 1. Weight: Obesity (>20% of ideal body weight) 2. Antibiotic resistant skin flora: MRSA colonization 3. Advancing age 4. Smoking 5. HIV and other immune deficiency conditions 6. Infection coexisting at other sites…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Metaphyseal lesions : Differential Diagnoses
Lesions Age Demographics Site Presentation Imaging Treatment Comments Acute Osteomyelitis Bimodal (<2 years and 8-12 years) M:F = 2:1 Distal femur, Proximal tibia Pain, refusal to bear weight, erythema, warmth, fluctuance, tenderness Lags 2 weeks behindDestruction of bone, periosteal reaction (lamellated, hair on end), new bone formation 1. Antibiotics2. Surgical…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Avascular Necrosis (Osteonecrosis) of Various Bones : Stages and Management
Propensity Stages and Management Stages Hip (modified Ficat-Arlet) Shoulder (Cruess) Lunate (Lichtman) Knee (Koshino) Scaphoid (Herbert and Lanzetta) Management 0 – Silent + NWB joints – Immobilization, NSAIDs WB joints – a. Realignment osteotomyb. Core decompression +/- bone grafting or MSC therapy I – Suggestive clinically and MRI + +…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Kienbock’s Disease : Mnemonic Approach
Etiology Mnemonic: RSTUV Lichtman Classification and Management Stage Description Treatment Mnemonic: ABCD Mnemonic: ABCD I Abnormal MRI (decreased T1 intensity; variable T2 intensity) or scintigraphy Analgesics + immobilization II Bone sclerosis ± Bone breaks (fracture lines) Bony procedures:1. Negative or Neutral ulnar variance: Joint levelling procedure (Radius shortening osteotomy; Ulnar…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Zero Position of Saha
Zero Position Zero position is the position during elevation in coronal or sagittal plane or in any plane where: Zero position of shoulder The humerus is elevated to about 165° with individual variations and is in the newly acquired scapular plane (around 45° anterior to the coronal plane). The humeral…
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…
Blog 
Books to study for Orthopedics Residency
The experience of an orthopedic residency is intense, challenging, but also incredibly rewarding for those passionate about musculoskeletal health and surgery. He/she will be looking at patients in outpatient department, inpatient patients, preparing patients for surgery including fitness, assisting and performing surgeries, preparing and presenting multiple topics, journal clubs and…