< Back Alignment Techniques in Total Knee Arthroplasty Conclusion: Wide range of clinical results exist for new alignment techniques in the short term. The safe range of alignment for long-term survivorship remains unknown. Further high-quality studies should be performed to warrant the widespread use of new alignment techniques. 🧠 Key Points: • Mechanical alignment remains standard in TKA but doesn’t consider individual pre-arthritic alignment. • Newer techniques (kinematic, restricted, inverse, modified, functional alignment) aim to restore native joint line and improve satisfaction. • Most RCTs show comparable or better short-term outcomes with novel techniques. • Long-term survivorship data are still lacking; alignment “safe zones” remain debated. • Robotic and navigation systems are key tools in implementing newer alignment methods. Journal of Joint Surgery and Research (2023), Vol 1: 108–116 doi.org/10.1016/j.jjoisr.2023.02.003 Previous Next

< Back Short-term contemporary outcomes for staged versus primary lower limb amputation in diabetic foot disease Conclusion : In the setting of infected diabetic foot disease, a staged lower extremity amputation achieves quality outcomes superior to a one-stage amputation, despite the former cohort’s greater illness acuity level. SA should be considered in all diabetic patients presenting with active foot infection. 🧠 Key Points: Staged amputation (SA) was compared with primary amputation (PA) in diabetic foot patients with severe infections. • SA showed lower 30-day readmission (17% vs 27%) and 30-day unplanned reoperation (11% vs 13%). • Length of stay and major adverse cardiovascular events were similar. • SA may provide better short-term quality outcomes in selected patients. Journal of Vascular Surgery (2020) doi.org/10.1016/j.jvs.2019.10.083 Previous Next

< Back Optimal Tightrope Positioning for Adequate Syndesmotic Stabilization in Simulated Syndesmotic Injuries Use of syndesmotic suture button fixation has gained in popularity for treating an injury to the tibiofibular syndesmosis. Biomechanical fixation stability with suture button device (TightRope; Arthrex, Naples, FL) placed at 4 distances from the tibiotalar joint line (0.5, 1.5, 2.5, and 3.5 cm) and 3 trajectories (anterior, medial, and posterior) were studied using cadaveric lower extremities with created syndesmotic injuries. Fixation placed at 0.5 or 1.5 cm from the joint line in medial or posterior trajectories resulted in the lowest increases in fibular rotation. More proximal or anterior placements led to increased fibular motion and decreased rotational stability. 🧠 Key Points Syndesmotic suture button placement 0.5–1.5 cm from the joint line provides the most rotationally stable fixation. Medial and posterior trajectories are more stable than anterior placements. Proximal placements beyond 1.5 cm increase fibular motion and reduce stability. Ankle width changes were minimal but increased slightly with anterior or proximal placement. Biomechanical cadaveric testing simulates in vivo weightbearing and rotational loads. Foot & Ankle Orthopaedics (2025) DOI: 10.1177/24730114251342243 Previous Next

< Back Body Mass Index > 40 Is Not Correlated With Early Complications in Patients Undergoing Primary Total Joint Arthroplasty at an Ambulatory Surgical Center Retrospective study of 2,367 patients undergoing primary total hip or knee arthroplasty (THA/TKA) at an ambulatory surgical center. Patients were stratified by BMI groups (normal, overweight, obesity classes I–III including ≥40). Outcomes assessed: early (24h) and 1–90 day complications, perioperative times, PACU course, and pain scores. 🧠 Key Points Complication rates at 24h and 1–90 days were not significantly different across BMI groups, including BMI ≥40. Operative and pre-op times were longer in higher BMI patients, but PACU discharge was earlier . Pain scores before discharge were higher in obesity groups, but without increased adverse events. Estimated blood loss was similar across BMI groups. Conclusion: With proper preoperative optimization, BMI ≥40 should not be an exclusion criterion for outpatient TJA; outcomes are comparable to lower BMI patients. The Journal of Arthroplasty (2025) doi.org/10.1016/j.arth.2025.08.065 Previous Next

< Back Mirels' Score for Upper Limb Metastatic Lesions: Do We Need a Different Cutoff for Recommending Prophylactic Fixation? Conclusions: This study demonstrates moderate to substantial agreement between and within raters using Mirels’ score on upper limb radiographs. However, Mirels’ score had a poor ensitivity and specifity in predicting upper extremity fractures. Until a more valid scoring system has been developed, based on our study, we recommend a Mirels’ threshold of 7/12 for considering prophylactic fixation of impending upper limb pathologic fractures. This contrasts with the current 9/12 cutoff, which is recommended for lower limb pathologic fractures. 🧠 Key Points: Mirels score was originally proposed for metastatic lesions in the lower extremities; its applicability to the upper extremity has been questioned. A score of ≥7 may be sufficient to consider prophylactic fixation in upper extremity metastases. This was a retrospective study analyzing 138 cases. JSES International (2022), Vol 6(4): 675–681 DOI:10.1016/j.jseint.2022.03.006 Previous Next

< Back Quality of Life and Outcomes After Treatment Failure for Recurrent PJI of TKA Multicenter retrospective study comparing outcomes of above-knee amputation (AKA), permanent spacers, and knee arthrodesis in patients with recurrent periprosthetic joint infection (PJI) of the knee after failed revisions. A total of 86 patients (35 AKA, 43 spacer, 8 arthrodesis) were evaluated for quality of life (SF-36), pain (VAS, DN4), complications, and functional outcomes. 🧠 Key Points AKA patients had better quality of life scores (higher SF-36 general health and role-physical scores) compared to spacers. Pain relief was superior in AKA (lower VAS and DN4) than both spacer and arthrodesis. Complication and reoperation rates were highest with spacers (53% and 42%) vs. lowest with AKA (14% each). Functional mobility: AKA patients more often walked >1 mile (26% vs. 5% with spacer) and were more frequently able to drive (42% vs. 23%). Mortality and reinfection rates were similar across groups at 2 years. Conclusion: AKA should not only be a last resort —it offers better pain control, fewer complications, and improved QoL in selected patients. The Journal of Arthroplasty (2025) doi.org/10.1016/j.arth.2025.08.017 Previous Next

Orthoplastics Approach General Principles Soft Tissue Assessment Reconstructive Ladder Timing of Soft Tissue Coverage Principles of Flap Surgery Microsurgery Basics Soft Tissue Coverage Skin Grafts Local Flaps Regional Flaps Free Tissue Transfer Muscle vs Fasciocutaneous Flaps Bone Reconstruction Bone Loss Management Segmental Defects Masquelet Technique Bone Transport Vascularized Bone Grafts Special Considerations Infected Nonunion Complex Limb Salvage Compartment Syndrome Reconstruction Orthoplastic Approach in Open Fractures Amputation & Prosthetic Considerations

< Back Nerve Anatomy nerve-anatomy Previous Next

< Back Lumbar Spinal Stenosis lumbar-stenosis Previous Next

< Back Distal Radius/Ulna Distal radius fractures are among the most common upper limb injuries. Management depends on fracture pattern, displacement, articular involvement, and patient factors. Distal radius fractures are common, particularly in older adults following low-energy falls. Classification systems like AO and Frykman are useful for assessment. Treatment options include conservative casting, closed reduction with percutaneous pinning, and open reduction with internal fixation (typically volar plating). Ulnar styloid fractures or distal radioulnar joint (DRUJ) involvement should also be evaluated. distal-radius-ulna Previous Next

< Back Growth & Development growth-development Previous Next