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: Trauma
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
When Fixing Bones Meets Nerves: A Lesson from the Cubital Tunnel
Date of writing: June 17, 2025 Day 3 of my pre-fellowship was unlike the others – not because I scrubbed in for an arthroplasty or a hip case (there weren’t any today), but because I witnessed firsthand how a routine trauma case can spiral into an anatomical and surgical challenge….
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…
PGMEE, MRCS, USMLE, MBBS, MD/MS
Spleen, Liver, Kidney Trauma
Approach to abdominal trauma has been discussed earlier. Spleen Injury Liver Injury Kidney Injury General 2nd m/c injured intra-abdominal organ in blunt trauma m/c injury requiring operative intervention in blunt trauma m/c injured intra-abdominal organ overall m/c injured intra-abdominal organ in blunt trauma m/c from blunt trauma maximum warm ischemia…
Clinical Skills and Approaches
An approach to Abdominal Trauma
Abdominal Trauma Abdominal trauma can be broadly classified into: Both of these have different approach of management. In case of any trauma, you need to go serially as per ATLS guidelines, i.e., the primary survey followed by the secondary survey. For quick recap, primary survey includes: Note: according to ATLS,…
Emergency Medicine
C-spine Clearance
C-spine clearance refers to a clinical decision suggesting the absence of acute bone related, ligamentous and neurologic abnormalities of the cervical spine based on history, physical exam and/or negative radiologic studies. NEXUS criteria for C-spine Clearance NEXUS (National Emergency X-Radiography Utilization Study) is a set of validated criteria used to decide…