< Back Sickle Cell Anemia a cc Previous Next

< Back Prophylactic Antibiotics Prophylactic antibiotics are used perioperatively in orthopaedic surgery to reduce the risk of surgical site infections (SSI), especially in implant-related procedures. Key Principles: Timing is critical : Antibiotic should be given within 60 minutes before incision (vancomycin: within 120 minutes). Single-dose is often sufficient : In clean surgeries, one preoperative dose is typically enough unless prolonged surgery or excessive bleeding occurs. Redosing : Required if surgery lasts >2 half-lives of the drug or there is excessive blood loss (>1500 mL). Commonly Used Antibiotics: Cefazolin (1st generation cephalosporin): Most commonly used Vancomycin: Used in MRSA risk or beta-lactam allergy Clindamycin: Alternative for beta-lactam allergy Special Considerations: In trauma or contaminated wounds: Broader spectrum or prolonged antibiotics may be indicated In open fractures: Follow Gustilo classification to guide antibiotic type and duration Type I/II: 1st gen cephalosporin Type III: Add aminoglycoside Implant-related Surgery: Stringent prophylaxis is key (arthroplasty, internal fixation) May extend prophylaxis up to 24 hours post-op (but not recommended beyond that in routine cases) Avoid Overuse: Prolonged or unnecessary antibiotics increase risk of resistance and C. difficile infection Previous Next

< Back Thromboembolism Thromboembolism, including deep vein thrombosis and pulmonary embolism, is a significant postoperative complication in orthopaedic patients. Thromboembolic events are among the most critical complications following orthopaedic procedures, especially in patients undergoing joint arthroplasty or trauma surgery. Risk factors include prolonged immobility, hypercoagulable states, malignancy, and certain medications. Prophylaxis protocols often involve mechanical compression devices and pharmacological agents such as low molecular weight heparin or direct oral anticoagulants. Risk stratification using tools like the Caprini score helps tailor thromboprophylaxis strategies. Early mobilisation and individualised risk assessment remain key components of prevention. Previous Next

< Back Hypophosphatasia Hypophosphatasia is a rare, inherited disorder of defective bone mineralisation caused by mutations in the ALPL gene affecting alkaline phosphatase activity. Hypophosphatasia is characterised by low serum alkaline phosphatase levels and defective bone and tooth mineralisation. It presents with a broad spectrum of severity, ranging from perinatal lethal forms to mild adult-onset or odontohypophosphatasia. Clinical features may include skeletal deformities, fractures, premature tooth loss, and muscle weakness. Radiographically, it can mimic rickets or osteomalacia. Diagnosis is confirmed with low ALP levels, elevated substrates (like pyridoxal 5’-phosphate), and genetic testing. Enzyme replacement therapy (asfotase alfa) is approved for severe cases and has significantly improved outcomes. Orthopaedic care focuses on fracture management and skeletal support. Previous Next

Musculoskeletal Oncology General Principles Basic Tumor Biology Bone Tumor Classification Soft Tissue Tumor Classification Imaging Principles Biopsy Principles Staging Systems (Enneking, AJCC) Principles of Surgical Resection & Margins Benign Tumors Osteochondroma Enchondroma Unicameral Bone Cyst (UBC) Aneurysmal Bone Cyst (ABC) Giant Cell Tumor (GCT) Fibrous Dysplasia Non-Ossifying Fibroma Chondroblastoma Malignant Tumors Osteosarcoma Ewing Sarcoma Chondrosarcoma Multiple Myeloma Metastatic Bone Disease Soft Tissue Sarcomas Primary Bone Lymphoma Special Considerations Surgical Reconstruction Options Endoprosthesis Limb Salvage vs Amputation Adjuvant Therapies (Chemo, RT) Palliative Surgery Pathologic Fracture Management

< Back Opiates & Analgesics Opioids are potent analgesics used for acute and chronic pain, but they carry significant risks including dependency, tolerance, and side effects. Types of Analgesics: Non-opioid analgesics: Paracetamol (acetaminophen) – first-line for mild pain. Opioid analgesics: Codeine, Tramadol, Morphine, Oxycodone, Fentanyl. Mechanism: Opioids bind to mu, delta, and kappa receptors in the CNS to modulate pain perception. Orthopaedic Use: Post-operative pain (especially moderate-to-severe). Severe musculoskeletal trauma. Cancer-related bone pain. Risks & Side Effects: Respiratory depression Constipation, nausea, vomiting Sedation and dizziness Tolerance and physical dependence Opioid-induced hyperalgesia (OIH) Risk of misuse or addiction Clinical Tips: Use multimodal analgesia (combine with NSAIDs or acetaminophen). Start with lowest effective dose and shortest duration. Monitor closely in elderly and renal impairment. Consider regional anaesthesia when possible to reduce opioid need. Previous Next

Concise orthopaedic education for residents and specialists, including surgical guides, core topics, and case-based learning." Where Orthopedic Minds Meet & Share OrthoRico is a modern orthopedic education platform designed for residents and specialists, offering evidence-based content, case-based learning, and step-by-step illustrated surgical guides. Why OrthoRico ? Learning and growing in orthopedics should be collaborative, visual, and accessible. OrthoRico is a non-commercial, academic platform created by and for orthopedic professionals. Whether you're a resident preparing for exams or a surgeon looking for clear visual guidance, OrthoRico offers: Evidence-based summaries of core orthopedic topics Step-by-step illustrated surgical procedures Real clinical cases and exam-style questions A growing community of orthopedic minds sharing knowledge Everything is peer-driven. Free. And focused on practical learning. Explore Our Sections Core Orthopedic Topics Each topic aims to provide concise information and key points about the subject, serving as a guide for orthopedic assistants and specialists. Read More Surgical Guides This section offers step-by-step surgical techniques, providing detailed instructions and insights for orthopedic procedures. Read More Literature Updates This section provides the latest research, studies, and reviews in the field of orthopaedics. Stay informed with the most recent advancements and evidence-based practices. Read More Contributors & Acknowledgements This section highlights the valuable contributions of authors, researchers, and professionals who have shared their expertise to enhance the content. Read More This Week’s Highlights Optimal Tightrope Positioning for Adequate Syndesmotic Stabilization in Simulated Syndesmotic Injuries Alignment Techniques in Total Knee Arthroplasty Short-term contemporary outcomes for staged versus primary lower limb amputation in diabetic foot disease Mirels' Score for Upper Limb Metastatic Lesions: Do We Need a Different Cutoff for Recommending Prophylactic Fixation? Working With the Best Associates & Partners

< Back Bone Remodeling Overview of bone remodeling process, cellular players, and its role in skeletal health and adaptation. Bone remodeling is a continuous physiological process that replaces old or damaged bone with new bone tissue. It maintains bone strength, regulates mineral homeostasis, and adapts to mechanical stress. The process consists of four main phases: activation, resorption, reversal, and formation. Key cellular components involved include: Osteoclasts , which resorb bone matrix. Osteoblasts , which lay down new bone. Osteocytes , which sense mechanical strain and regulate remodeling. Lining cells , which cover quiescent bone surfaces. Bone remodeling is influenced by hormonal signals (e.g., parathyroid hormone, calcitonin, estrogen), mechanical loading, and local cytokines. Imbalances in remodeling can lead to conditions like osteoporosis or delayed fracture healing. Previous Next

< Back Rheumatic Diseases Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by persistent synovial inflammation, leading to joint destruction, pain, and disability if untreated. RA primarily affects small joints in a symmetrical pattern, and is associated with systemic features such as fatigue, low-grade fever, and extra-articular manifestations (e.g., interstitial lung disease, rheumatoid nodules). Early diagnosis and prompt initiation of disease-modifying antirheumatic drugs (DMARDs) are crucial to prevent irreversible joint damage. The diagnosis is supported by clinical criteria (such as morning stiffness >1 hour, joint involvement), serologic markers (RF, anti-CCP), and imaging findings (US/MRI may reveal synovitis or erosions). Previous Next

< Back Bioabsorbable Materials Bioabsorbable materials are used in orthopaedic surgery to avoid permanent implants. They degrade over time and are replaced by natural tissues. Bioabsorbable materials are designed to be broken down and absorbed by the body after fulfilling their function. Commonly composed of polymers like polyglycolic acid (PGA) and polylactic acid (PLA), these materials are used in fixation devices such as screws, pins, and sutures. Previous Next

< Back Articular Cartilage Articular cartilage is a specialised connective tissue covering joint surfaces, providing a low-friction, load-bearing interface essential for joint motion and integrity. Structure and Composition: Composed of chondrocytes embedded in an extracellular matrix (ECM) of collagen (mainly type II) , proteoglycans , and water (up to 80%). Organised into four histological zones: Superficial (Tangential) Zone – flat chondrocytes, high collagen, resist shear Middle (Transitional) Zone – rounder chondrocytes, high proteoglycans Deep Zone – vertical collagen fibres, resist compressive forces Calcified Zone – anchors cartilage to subchondral bone Functions: Provides smooth articulation and shock absorption Distributes mechanical loads across the joint Lacks blood vessels, lymphatics, and nerves → limited intrinsic repair capacity Biomechanical Properties: Viscoelastic behaviour due to proteoglycan-water interaction Maintains joint congruity and lubrication Damage leads to increased friction and joint degeneration Injury and Degeneration: Can occur due to trauma , overuse , or inflammatory conditions Partial-thickness defects often do not heal Full-thickness defects may undergo limited fibrocartilage repair Assessment Modalities: MRI with cartilage-sensitive sequences (e.g., dGEMRIC, T2 mapping) Arthroscopy provides direct visualisation Scoring systems : Outerbridge classification, ICRS grading Repair Techniques: Microfracture : promotes fibrocartilage repair Osteochondral autograft/allograft transplantation Autologous chondrocyte implantation (ACI) Matrix-assisted ACI (MACI) Biologic adjuncts (e.g., PRP, stem cells) under research Orthopaedic Relevance: Central to sports injuries , osteoarthritis , and joint preservation surgery Success of cartilage procedures depends on patient age , defect size , and mechanical alignment Previous Next

< Back Medication Allergies Medication allergies are immune-mediated reactions to drugs, ranging from mild skin eruptions to life-threatening anaphylaxis, and are critical to recognise in orthopaedic practice. Overview: Allergic reactions to medications involve the immune system and differ from non-allergic (idiosyncratic or toxic) adverse effects. Commonly involved drugs in orthopaedics include antibiotics (especially beta-lactams), NSAIDs , and anaesthetic agents. Classification of Drug Reactions: Type I (Immediate): IgE-mediated (e.g., anaphylaxis, urticaria) Type II: Cytotoxic (e.g., hemolytic anaemia) Type III: Immune complex (e.g., serum sickness) Type IV (Delayed): T-cell mediated (e.g., contact dermatitis, Stevens-Johnson Syndrome) Common Culprit Medications in Orthopaedics: Penicillins/Cephalosporins → rash, anaphylaxis NSAIDs → urticaria, bronchospasm, angioedema Local anaesthetics → contact dermatitis (rarely true allergy) Opioids → pseudoallergic histamine release (not true IgE) Clinical Features: Rash, pruritus, urticaria Facial swelling, wheezing, hypotension Joint symptoms (serum sickness-like reaction) Fever, eosinophilia (DRESS syndrome) Diagnosis: Detailed drug history Skin prick and intradermal testing (limited to certain drugs) Serum tryptase (in anaphylaxis) Drug challenge in specialist settings Management: Avoidance of suspected drug Use alternatives (e.g., clindamycin or vancomycin for penicillin allergy) Premedication for mild allergy history (e.g., antihistamines, steroids) Intraoperative alert and documentation essential Desensitisation in selected cases Orthopaedic Considerations: Preoperative assessment is critical Use of allergen-free cement components , prophylactic antibiotics , or analgesics Always update electronic health records and warn the surgical team Previous Next