Section I Upper Extremity
1. Clavicle Fracture 3
Treatment Methods Available 4
2. Fracture of Lateral End of Clavicle 12
Clinical Diagnosis 12; Clinical Assessment of Reducibility 12;
Treatment: Non-operative 13; Indications for Internal Fixation 15;
Incision 16; Associated Injuries 18
3. Acromioclavicular Dislocation 20
Patient Position and Surgical Technique 20; Follow up and Implant Removal 21
4. Posterior Dislocation of the Shoulder 23
Case Study 23
5. Fracture Dislocation of the Shoulder 27
Cases 1 and 2 27; Few Observations 29; Message 35
6. Humerus Neck Fracture 36
Few Common Observations 36; Two-Part Fracture of Neck of Humerus 38;
Three or More Parts Impacted/Minimally Displaced Fractures 38; Locking Plate 41;
Three or More Parts Fracture of Neck of Humerus: Displaced 42;
Comment on Bone Grafting 45; Steps of Bone Grafting and Plate Fixation 46;
Postoperative Care 47; Nonunion of Fracture of Neck of Humerus 48
7. Humerus Shaft Interlock Nailing 50
Interlocking Nailing in Humerus 50; Case 1: Palliative Surgery to Alleviate Pain 50;
Case 2: Long Oblique Fracture of Upper/3 Area 50;
Case 3: Segmental Long Oblique Fracture 50; Case 4: Repeat Surgeries 52;
Case 5: Fracture in Lower/4 Area 54; Case 6: Fracture of Lower/3 Area 56;
Case 7: Fracture of Lower/4 Area 56; Case 8: 3-Part Fracture of Mid/3 57;
Conclusions from the Above Cases 58
8. Humerus Holstein and Lower Shaft Fracture 59
Holstein Fracture and Fractures in Lower/4 Humerus 59; Decades Ago 62;
Future 63
9. Humerus Lower-End Exposure 64
Posterior Exposure for Fracture of Lower/4 Humerus 64
10. Elbow Fracture Dislocation 67
Elbow Lateral Dislocation with Sectoral Fracture of Head of Radius 67
xiv Tips and Tricks in Orthopedic Surgery
11. Fracture of Medial Epicondyle of Humerus 69
Clinical Presentation 69; Treatment 69; Technique 70;
Missed Fracture of Medial Condyle of Humerus 70
12. Capitellum Fracture 72
Current Trends 72; Recommendation 74; Technique 74;
Clinical Example 75; Message 75
13. Radius Neck Fracture 76
Fracture Epiphyseal Injury to the Neck/Head of the Radius in Adolescence 76
14. Forearm Fractures 81
Fracture of Radius and Ulna 81; General Comments on Plate and IM Nail as an Implant 81;
Plate as an Implant 82; Ununited Fracture of Radius and Ulna after Plate Fixation for Both the
Bones 84; Biomechanical Differences in a Plate and a Nail 86; Nail as an Implant 89;
Instruments Required 89; Technique of Radius Nail Insertion 90; Open Reduction 91;
Technique of Ulna Nail Insertion 92; Importance of Achieving a Good Union in the Ulna 95;
After a Bone Union, Whether the Plate and the Nail Need to be Removed? 97;
The Technique of Nail Removal 99; Ulna Nail Removal 99; Radius Nail Removal 99;
Nail Removal by a Vertical Osteotomy 100; The Technique of Vertical Osteotomy 100;
Radius 105; Ulna 107
15. Bow Fracture of Forearm 108
Bow (Greenstick) Fracture of Radius and/or Ulna 108;
Untreated/Missed Bow Fracture 108; Treatment in a Fresh Case 110;
Steps in Reduction of a Bow Fracture 111
16. Refracture of Forearm 113
Fracture Healing and Refracture in Forearm Bones in Adolescence 113;
Observations 114
17. Monteggia Fracture Dislocation 116
Transverse Fracture of Olecranon with Fracture of Head of Radius and
Associated Posterior Dislocation of Elbow 116
18. Lower/3 Radius and Ulna Fracture in a Child 122
Fracture of Lower/3 Radius and Ulna in a Child 122; Which Material for the Cast? 122
19. Lower/4 Radius and Ulna Fracture in a Child 124
Case 1: Transverse Displaced Fracture of the Radius and Ulna 124;
Case 2: An Oblique Fracture of the Radius with a Serrated Fracture of the Ulna 125;
Case 3: Late Presentation of Case 1 126; Case 4: Late Presentation of Case 2 127;
Case 5: Greenstick Fracture of Radius Only 129; Case 6: Greenstick Fracture of Both
Radius and Ulna 129; Case 7: Redisplacement in an Oblique Fracture I 129;
Case 8: Re-Displacement in an Oblique Fracture II 130; Message 130
20. Malunited Fracture of Lower/4 Radius in a Child 133
Malunited Fracture of Lower/4 Radius 133
21. Inferior RU Dislocation in a Child 136
Inferior Radioulnar (RU) Joint Dislocation 136
Contens xv
22. Colles’ Fracture 137
Undisplaced Colles’ Fracture 137; Typical Cases 141
23. Comminuted Fracture of Lower Radius 153
Comminuted Fracture of Lower-End of Radius 153
24. Fracture of Neck of 5th Metacarpal 155
The Technique 156; Postoperative Immobilization 157
25. Emergency Room Technique 158
Emergency Room Care 158
Section II Lower Extremity and Pelvis
26. Pelvis and Acetabulum Fractures 175
27. Fracture of Neck of Femur 190
Intracapsular Fracture of Neck of Femur 190; Impacted Fracture of Neck of Femur 191;
Impacted Fracture in the 3rd Decade of Life 195; Fracture of Neck of Femur in the
Middle Age 195; Basi-Trochanteric Fracture 198; Ipsilateral Fracture of Neck and Shaft of
Femur 200; Fracture of Neck of Femur in Adolescence 206; Osteotomy in Fracture of
Neck of Femur 209; Stress Fracture 215; Types of Partial Hip Replacement 215;
First Aid on Arrival and Diagnosis 217; Important Steps in a Bipolar Replacement 218;
Few Technical Things 221
28. Fracture of Trochanter 226
Problems of Internal Fixation 227; Fracture Morphology 227;
Assessment of a Fracture 228; Method of Internal Fixation 228;
Timing and Factors for Surgery 228; Choice of Implant 228; Patient Position 229;
Fracture Reduction 229; Fracture Reduction and Implant Position 229;
Technique of DHS 229; Tricks in Fracture Reduction and Plate Fixation 231;
Lesser Trochanter Fixation 242; Primary Bone Grafting 244;
Fracture Collapse and Medialization 244; Medialization after a Lateral Wall Osteotomy/
Fracture 246; Trochanteric Stabilization Plate 248; Special Situation in Inter-Trochanteric
Fractures 250; Long Medial Beak 253; When Further Medialization and Telescoping is
Expected 255; Mechanical Complications 259;
95 Degree DCS in Trochanteric Fracture 264;
Intracapsular and Extracapsular Fracture 264; Few Unfortunate Situations 265;
Technique and Observations in a Bipolar Replacement in a Failed DHS 265;
Re-Attachment of Greater Trochanter 268
29. Fracture of Subtrochanteric Area 270
Subtrochanteric Fracture and Jewett Nail Plate 270; Limb Length 271;
Few Case Studies 271; Subtrochanteric Fracture: DHS Fixation 274;
Observations and Suggestions 277; Subtrochanteric Fracture: DCS 279;
Technique of the Screw Insertion in the Calcar 280; Intramedullary Device in
Subtrochanteric Fracture 286
30. Fracture of Femur Shaft 290
The Operation Room at Any Time 291; Non-operative Methods 292;
Fracture of Femur Shaft in Infants and Adolescence 293;
xvi Tips and Tricks in Orthopedic Surgery
Technique to Assess Rotary Alignment in a Shaft Fracture 294;
Typical Cases 301; Periprosthetic Fracture 317;
Special Situations in Removal of Femur Nail and/or a Plate 322
31. Ipsilateral Femur and Tibia Fractures 324
On Arrival 324
32. Fracture of Patella 326
Incision and Exposure 326; Timing of Surgery 326; Anesthesia 326;
Instrumentation 327; Implants 327; Principles 328; Technique 329;
Late Presentation of Fracture of Patella 330; Fracture of Patella of Different Patterns 331
33. Post-Stiffness Fractures 340
34. Fracture of Anterior Tibial Eminence 345
Fixation with a Circlage Wire 345; Fracture of the Anterior Tibial Eminence with
Associated Fracture of Tibial Condyle 346; Clinical Examples 346
35. Fracture of Posterior Tibial Eminence 351
An Isolated Injury 351
36. Fractures of Tibial Condyle 356
Introduction to the Fracture of Tibial Condyle 356; Fracture Morphology and
Site of Fracture 357; The Incision for a Good Exposure 360; Fracture of Tibial Condyle in a
Neuropathic Joint 361; Bicondylar Fracture of Tibia 361; Options Possible 365;
Choice of a Plate for Fracture of Tibial Condyle 373; Technique of Fracture Fixation 375;
How Can One Achieve This? 377; Diagnosis and Missed Fracture of Tibial Condyle 377;
Treatment 380; Contusion Fracture of Lateral Tibial Condyle 382; Fracture of Lateral
Tibial Condyle in the Elderly 382; Widening of the Lateral Tibial Condyle 383;
Fracture of Anterior Tibial Eminence and Undisplaced Fracture of Lateral Condyle 383;
Incorrect History and Fasciotomy 384; Fracture of Lateral Tibial Condyle 384;
A Split Fracture of Lateral Condyle with Minimum Displacement 384; Lateral Condyle
Elevation from Medial Side 389; Implant Removal 393; Learning from Cases 393;
Medial Tibial Condyle Fracture 404; Nonunion in Fracture of Tibial Condyle 410;
Post-Stiffness Fracture of Tibial Condyle 412; Posteromedial and Posterolateral
Condyle Fracture of Tibial Plateau 413; Clinical Examples 414
37. Fractures of Tibial Shaft 424
Non-operative Method 429
38. External Fixator 436
Review of the Principles and Technique of Application of External Fixation 436;
The Components of Assembly 437; Uniplaner, Unilateral Fixator 440;
Prestressing and Final Fixation 441; Triangularization 443;
Case Examples: Use of an External Fixator 444;
Lessons Learnt from the Above Cases 447
39. External Fixator in Open Fracture of Tibia 450
Fixation of Fibula 450; Refracture after External Fixator Removal 457
40. Tibia Interlock Nailing 459
Few Preferences 459; Few Practical Observations in Tibia Interlock Nailing 460;
Segmental Fracture of Tibia 466
Contens xvii
41. Stress Fracture of Tibia 469
42. Tibia Plate Fixation 475
Width of a Tibia Plate 475; Which Surface of Tibia? 475; Message 480
43. Tibia Lower MIPO Plate 481
How would I Plan? 483; MIPO Technique: Must Obtain a Good Reduction! 485;
Long Segment of Tibia with Comminution 487
44. Ankle Injuries 491
Introduction 491; Management in General 491; Could This have been Avoided? 493;
The Outcome 495; Medial Malleolus Fixation 495; Reduction Technique and Which
Implant? 495; Ankle Lateral Malleolus 500; Level of Fracture of the Fibula 502;
X-ray Views and Positioning 502; Timing of Surgery 503; Patient Positioning 504;
Implants for the Lateral Malleolus 505; Non-operative Method: Protocol 507;
Complications after a Fracture of Lateral Malleolus 509; Late Presentation 510;
Tibio-Fibular Diastasis 512; Adduction Fracture of Ankle 513;
Trimalleolar Fracture of Ankle 518; Ankle: What to Avoid? 522;
Ankle: Medial and Posterior Malleolus Large Fragments 529;
Lateral Column Segmental Fracture 529; Ankle Open Fracture 530;
Suggested Steps 531; Ankle External Fixation 531; Ankle Fractures and Diabetes 533;
Ankle Fracture in Treated Case of Clubfoot 538; Ankle Refracture 538;
Childress Procedure 539; Ankle Injuries in Children 540; Tillaux Injury 542;
Ankle Fusion after Bimalleolar Fracture 542; Bone Cuts 543
Follow-up Care 545; Cast Removal 545; Case Examples 545
45. Foot Injuries 547
Stress Fracture of Metatarsals 547; Not to Do
548; Fracture of Distal Part of 5th Metatarsal 548
46. Tips for Better Care 551
Index 553
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