Topics

BONE TRANSPORT

bone defects

NONUNION - MALUNION MENAGEMENT

LİMB LENGTHENING

LIMB LENGTHENING

Extensor Mechanism Ruptures

Anatomy & Biomechanics

The human spine is a complex, segmented column providing both mobility and stability for the body. It consists of 33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral, and 4 fused coccygeal segments. These vertebrae are interconnected through discs, ligaments, and muscles, forming a biomechanically dynamic structure that supports axial load, enables movement, and protects the spinal cord. Each vertebra comprises a vertebral body and a posterior arch. The body, primarily cancellous bone, functions as the main weight-bearing element. The posterior arch, composed mainly of cortical bone, includes pedicles, laminae, and spinous and transverse processes, which provide attachment points for ligaments and muscles. Between adjacent vertebral bodies lie the intervertebral discs, acting as flexible cushions that absorb compressive forces while allowing controlled motion.

Imaging in Orthopaedics

Myths and Misconceptions in Arthroplasty

Despite rapid advances in implant design, navigation, and perioperative protocols, arthroplasty surgery remains surrounded by persistent misconceptions — many of which influence both surgeon behavior and patient expectations. Understanding and debunking these myths is essential for evidence-based orthopaedic care.

Robotic Assisted UKA

Robotic unicompartmental knee arthroplasty (R-UKA) is an evolution of traditional unicompartmental knee replacement, developed to improve component accuracy, reduce outliers, and enhance short-term recovery. It is indicated for isolated medial or lateral compartment osteoarthritis (Kellgren–Lawrence grade IV) when the remaining compartments are intact. Approximately 20% of knee OA cases are unicompartmental — most involve the medial side.

Patellofemoral Arthroplasty

Ligament Balancing in TKA

• The basic aim is to get both extension and flexion gaps rectangular, equal and balanced. This balanced tension is important for implant stability and long-term survival. • Two popular knee replacement techniques currently practiced are: “measured resection” which depends on tibial and femoral bone cuts through resection guide and “balanced resection” which depends on optimising ligament tensioning. Both affect ligament balancing during the operation. • A stepwise approach for sequential ligament releases, according to the type of deformity, is essential to good outcomes.

Revision Knee Arthroplasty

Revision TKA is a complex reconstructive procedure performed to address implant failure due to infection, aseptic loosening, instability, periprosthetic fracture, or stiffness. Proper diagnosis requires a combination of clinical, radiographic, and laboratory evaluation to identify the cause of failure. Management aims to restore joint stability, mechanical alignment, and bone stock while minimizing complications. Modern evidence supports the use of modular stemmed and constrained implants to improve fixation, with either cemented or press-fit stems achieving comparable alignment outcomes. Prevention of periprosthetic joint infection (PJI) remains crucial, and intraosseous antibiotic prophylaxis provides superior local drug concentrations and lower infection rates compared to traditional intravenous administration.

Dislocation & Instability

Despite advances in implant design, surgical technique, and perioperative protocols, instability continues to challenge both surgeons and patients.Hip dislocation remains one of the most feared complications following total hip arthroplasty (THA), associated with higher morbidity, increased healthcare costs, and up to 25% of all revision procedures.

Periprosthetic Hip Fractures

Vancouver B2 fractures—those with a loose stem but adequate bone stock—remain the most debated subtype in terms of optimal management, with recent meta-analyses redefining treatment algorithms.Periprosthetic femoral fractures (PPF) represent one of the most challenging complications after total hip arthroplasty (THA). Their incidence is rising sharply worldwide, driven by increasing THA volumes, aging populations, and poor bone health, particularly osteoporosis.

Revision Hip Arthroplasty

Revision Total Hip Arthroplasty (rTHA) addresses failure or complications of primary hip arthroplasty, including aseptic loosening, periprosthetic fracture, infection, and instability. As primary THA volumes increase globally, rTHA has become more common. Outcomes depend on etiology, implant selection, and restoration of biomechanics rather than mere component replacements.

Periprosthetic Joint Infection (PJI)

Periprosthetic Joint Infection (PJI) is one of the most devastating complications of arthroplasty. Although uncommon (≈1–2%), it is a leading cause of revision surgery and implant failure. Biofilm formation on implant surfaces makes eradication difficult and often necessitates complex surgical management.

Preoperative Planning for TKA

Digital templating for TKA assists in predicting implant sizes and alignment, aiming to optimize motion and minimize stiffness or loosening. However, its impact on postoperative function and alignment remains limited.

Preoperative Planning for THA

Infection in Tumor Surgery

Treatment Algorithm and Prognostic Factors

Brachial Plexus Injuries and Current Surgical Approaches

Complications and Salvage Strategies

Includes; Incorrect biopsy Contaminated surgical fields Inadequate reconstruction Mechanical complications Despite advances in limb-salvage techniques, failure remains a major challenge, often leading to repeated surgeries, functional loss, and even amputation. Tumor failure must be evaluated as a multidisciplinary problem — not just a mechanical one.

Tumor Board Decision Making   

Effective management requires: Radiological assessment Histopathological diagnosis Systemic therapy planning Functional reconstruction strategy Multidisciplinary tumor boards are central to: Accurate diagnosis Proper staging Individualized treatment decisions In bone and soft tissue sarcomas, key decisions such as: Biopsy planning Surgical margins Neoadjuvant therapy Reconstruction methods are determined through tumor board discussions.

Tibial Plafond (Pilon) Fractures

Tibial Plateau Fractures

·       Associated soft-tissue injuries (meniscus and ligamentous injuries) are frequent and influence management and outcomes. ·       Diagnosis is made with initial radiographs; CT is used for fracture characterization and surgical planning, and MRI is useful for evaluating associated meniscal/ligament injuries when indicated. ·       Treatment is selected based on fracture displacement, stability, alignment, and soft-tissue status; ORIF is preferred when soft tissues permit, while staged fixation (external fixation followed by ORIF) or circular fixation (Ilizarov) may be used when soft tissues are compromised.

Fixation Methods

The selection of an appropriate bone fixation method is a critical step in lower-limb deformity correction that must be preceded by a thorough geometric analysis of the skeletal abnormality. Surgeons typically choose between internal fixation, such as plates or intramedullary nails, and external fixation systems, with the choice primarily dictated by whether the correction is to be performed acutely or gradually. Adherence to established planning principles and the correct application of the chosen hardware are essential to ensure successful collinear realignment and prevent the occurrence of secondary deformities.

Principles of Osteotomy

Osteotomy is the surgical cutting or division of bone, and its therapeutic use dates back to Hippocrates. It began to be used in bone lengthening surgery with Ilizarov`s description of distraction osteogenesis. Low-energy osteotomies are preferred in bone lengthening surgery; they promote bone healing by preserving periosteal and endosteal circulation.

Distal Radius and Distal Ulna Fractures

Distal forearm fractures are a cornerstone of orthopedic traumatology. They range from simple extra-articular fractures to complex intra-articular injuries that threaten the functional integrity of the wrist and the Distal Radioulnar Joint (DRUJ).

Boutonniere Deformity

Legg-Calve-Perthes Disease

Pediatric Septic Arthritis

Bacterial infection of a synovial joint causing acute purulent effusion and progressive articular cartilage destruction     A true orthopaedic emergency — irreversible glycosaminoglycan loss begins within 8 hours of onset

Scaphoid Fractures- Hand Surgeon Perspective

The scaphoid is a critical, yet notoriously difficult-to-treat bone in the wrist. Often referred to as the "CEO of the carpal bones" because of its role in wrist stability and motion, a fracture here is a significant event that requires expert management

Carpal Bone Fractures

Carpal fractures represent approximately 18% of all hand fractures, with the scaphoid being the most significant in terms of frequency and clinical complications. Because these bones form the complex, multi-jointed architecture of the wrist, anatomical restoration is critical for maintaining grip strength and range of motion.

Vertebral Compression Fractures (VCFs)

Distal Tibial Osteotomy (DTO) / Supramalleolar Osteotomy (SMO)

High Tibial Osteotomy (HTO)

Distal Femoral Osteotomies (DFO)

Distal femoral osteotomy (DFO) is a joint preservation procedure that corrects genu valgum deformities and patellofemoral maltracking, thereby restoring kinematics and unloading contact pressures in the lateral tibiofemoral and patellofemoral compartments.

Proximal Femoral Osteotomies

Sports Hip Conditions

Mallet Finger

Extensor Tendon Injuries

Flexor Tendon Injuries

Elbow Stiffness

Functional arc required: Flexion–extension: 30°–130° Pronation–supination: 50°–50° Stiffness is defined as ROM below the functional range

Distal Biceps Rupture

Disruption of the distal biceps tendon insertion at the radial tuberosity. Leads to loss of: Supination strength (primary) Flexion strength (secondary)

Thumb Fractures and Ligament Injuries

Thumb injuries are unique and significantly more disabling than other finger injuries because the thumb accounts for approximately 40–50% of overall hand function due to its ability to oppose.  80% of thumb fractures involve the metacarpal base the most common pattern is extraarticular epibasal fracture Base of Thumb metacarpal fractures can be extra-articular fractures, Bennett fractures (partial intra-articular), or Rolando fractures (complete intra-articular). Treatment ranges from splint immobilization for certain extra-articular fractures to surgical fixation for displaced Bennett or Rolando fractures

Neuromuscular Scoliosis (NMS)

Spinal deformity due to neurologic or muscular imbalance Characterized by long C-shaped curves, pelvic obliquity, and poor trunk control Typically progressive and rigid

Chemotherapy For Bone Tumors

Metacarpal Fractures / Hand metacarpal fractures

Metacarpal fractures are common skeletal injuries, accounting for a significant portion of all hand fractures. They range from simple, stable injuries to complex, unstable fractures requiring surgical intervention.

Deformity Evaluation and Analysis

Lower limb defomity evaluation and radiological analysis

Pathologic Fracture Management

Pathological fractures occur in structurally weakened bone, most commonly due to metastatic disease, but also from primary tumors or metabolic bone disorders. Management begins with accurate diagnosis, staging, and biopsy planning before any surgical fixation. The femur, pelvis, and spine are typical sites, with lung, breast, thyroid, renal, and prostate cancers being leading causes. Predictive tools such as Harrington criteria, Mirel’s score, and CT-based structural rigidity analysis guide the need for prophylactic fixation.

Damage Control Orthopaedics

Hand Phalanx Fractures

Phalanx fractures are among the most common injuries of the skeletal system. While often dismissed as "minor," improper management can lead to significant functional impairment, chronic pain, and stiffness.

Aneurysmal Bone Cyst

Aneurysmal bone cyst (ABC) is a benign but locally aggressive, expansile osteolytic lesion composed of blood-filled cavities separated by fibrous septa. It primarily affects children and young adults, typically in the first two decades of life, with no clear sex predilection. Although non-malignant, it can cause significant pain, swelling, and pathological fractures due to rapid growth and cortical thinning.

Primary Bone Lymphoma

Palliative Surgery

Endoprosthesis

reconstruction is a cornerstone technique in musculoskeletal oncology, allowing immediate restoration of skeletal continuity and early mobilization after wide tumor resection. Modern modular megaprostheses, made of titanium or cobalt-chromium alloys, are designed for durability, functional recovery, and ease of revision. They are primarily indicated for periarticular or diaphyseal bone loss following tumor excision, failed fixation, or pathological fractures. Cemented fixation ensures immediate stability, while press-fit and porous-coated designs promote biological integration. Despite excellent limb salvage rates (>90%), complications such as infection, aseptic loosening, and mechanical failure remain challenges. Advances including silver-coated implants, expandable pediatric prostheses, and improved soft-tissue reattachment techniques continue to enhance long-term outcomes and quality of life for oncology patients.

Synovial Sarcoma

Synovial sarcoma is a high-grade malignant soft tissue tumor primarily affecting the extremities of young adults. Diagnosis requires MRI, histopathology, and molecular confirmation of the SS18–SSX fusion gene. Treatment is multidisciplinary, centered on complete surgical excision with limb preservation when feasible, combined with perioperative radiotherapy and chemotherapy for large, deep, or high-risk lesions. Prognosis depends on tumor size, depth, margin status, and recurrence, with lung metastasis being the most common pattern of spread. Long-term surveillance is essential due to the potential for late metastatic relapse.

Surgical Reconstruction Options

Proximal Biceps Tendon Pathology

Management of Long Head of the Biceps (LHB) and Biceps Reflection Pulley (BRP) Lesions

Limb Salvage and Amputation

Histologic Types of Soft Tissue Sarcoma

Myths and Misconceptions

Evidence-based clarification of common myths in orthopaedic oncology, highlighting diagnostic pitfalls, biopsy planning, and surgical decision-making principles.

Chordoma

   Chordoma is a rare malignant bone tumor arising from embryonic notochordal remnants.    Most common primary malignant spinal tumor in adults

Chondrosarcoma

INTERTROCHANTERIC FRACTURES

Management of Anterior Shoulder Instability

Infection in Reconstruction Surgery

Forearm Malunion & Corrective Osteotomy

Surgical procedures to correct a fracture that has healed in an abnormal position (angular, rotational, translational, or shortened). Involves re-fracturing at or near the malunion site, correcting the deformity, and stabilizing with rigid fixation. Goal: Restore the mechanically coupled unit of the radius and ulna. Improve forearm rotation, alignment, and DRUJ stability.

Radial & Ulnar Lengthening / Shortening

Surgical procedures to restore forearm length balance by: Lengthening (distraction osteogenesis or acute grafting), Shortening (osteotomy and compression), Goal: Re-establish radioulnar relationship. 0 to slightly negative ulnar variance after shortening, and restoration of symmetry after lengthening,. Improve function, alignment, and stability,

Growth Modulation & Guided Growth

Growth modulation refers to controlled alteration of physeal growth to gradually correct deformity in skeletally immature patients. Guided growth is the most common clinical application, using temporary hemiepiphysiodesis to harness remaining growth for angular correction.

Humeral Osteotomies

Surgical realignment procedures of the humerus to correct: Deformity Malalignment Functional impairment Can be performed at: Proximal humerus Diaphysis Distal humerus

Negative Pressure Wound Therapy (NPWT)

A wound management technique applying controlled negative pressure via a sealed dressing system Promotes wound healing by: Removing exudate Reducing oedema Improving local perfusion Commonly used as a temporary bridge in orthoplastic management

Open Tibia Fractures – Orthoplastic Approach

Open fracture of the tibial shaft with associated soft tissue disruption Characterised by bone exposure and contamination Requires combined orthopaedic stabilisation + plastic surgical soft tissue management

Infection and Biofilm in Orthoplastic Surgery

Infection in orthoplastic surgery refers to microbial colonisation of bone, soft tissue, or implants, often complicated by biofilm formation, which makes bacteria resistant to antibiotics and host immunity.

Debridement Principles

Surgical removal of devitalised, contaminated, and non-viable tissue The most critical step in managing open fractures and complex limb injur

Bone Defect Management (Masquelet vs Bone Transport)

Management of segmental bone defects resulting from: Trauma Infection Tumour resection Requires restoration of: Mechanical stability Biological environment

Elbow Deformity Correction

Surgical or non-surgical management of angular, rotational, or combined deformities around the elbow Most commonly involves: Distal humerus deformities (supracondylar malunion)

Cavovarus Foot in Pediatrics

Pes cavus is defined as an abnormal elevation of the medial longitudinal arch that maintains its shape and does not flatten with weight-bearing. It is a complex deformity typically consisting of forefoot equinus, hindfoot varus, and adduction of the forefoot. The condition is often a manifestation of an underlying progressive neurological disorder.

Talus Fracture

Tibial Shaft Fractures

Proximal Humerus Fractures

HUMERAL SHAFT FRACTURES

SUBTROCHANTERIC FEMUR FRACTURES

FEMORAL NECK FRACTURES

FEMORAL HEAD FRACTURES

Damage Control Orthopaedics (DCO)

Throwing Athlete Injuries

Distal Triceps Rupture

• Rarest major tendon rupture — <1% of all tendon injuries; most common in males aged 30–50 • Mechanism: eccentric load on a contracting triceps (FOOSH, fall on elbow, direct blow) • Insertion at the olecranon tip — bony avulsion is the most common pattern (~75%) • Strong association with systemic risk factors: anabolic steroids, chronic renal failure, hyperparathyroidism, fluoroquinolone use • Clinical diagnosis: palpable gap at olecranon tip + weak or absent active elbow extension • Thompson squeeze test: squeeze triceps belly — elbow should extend; no extension = complete rupture • Complete rupture → surgical repair; partial rupture (<50%) → non-operative if extension is maintained • Repair within 2–3 weeks strongly recommended — chronic tears require tendon reconstruction

SHOULDER ANATOMY

Monteggia Fractures

Olecranon Fractures

Endoscopic Spine Surgery (ESS)

Radial Head Fractures

Fractures of the radial head, most commonly resulting from a fall on an outstretched hand (FOOSH) Frequently associated with elbow instability injuries

Rotator Cuff Tears

ELBOW ANATOMY

Acromioclavicular (AC) Joint Injury

Coronoid & Terrible Triad Injuries / Ligament Injuries (UCL, LCL)

Shoulder and Elbow Imaging

Elbow Physical Examination

Shoulder Physical Examination

Vascular Anatomy of the Ankle

Muscular Anatomy of the Lower Leg and Foot

Foot and Ankle Ligament Anatomy and Clinical Relevance

Osseous Anatomy of Foot and Ankle and Its Clinical Relevance

Ankle Fractures

Foot Puncture Wounds

⁠Anatomy, Biomechanics, and Clinical Significance of the Plantar Fascia    

Neuroanatomy of the Foot and the Ankle

Talus Fractures

Acetabular Fractures

Pelvic Ring Injuries

Diabetic Foot Disease

Plantar Fasciitis and Heel Pain

Achilles Tendinopathy (Insertional and Non-Insertional)

Ankle Arthrosis (Tibiotalar Osteoarthritis)

Hallucal Sesamoid Disorders

Lisfranc Injuries

Orthotics & Supportive Devices Biomechanical Role in Deformity Correction

Gait Analysis

Radiographic Evaluation of the Foot & Ankle

Morton’s Neuroma

Tarsal Tunnel Syndrome (TTS)

Deep Peroneal Nerve (DPN) Entrapment

Leg Nerve Entrapment Syndromes

by Alparslan Uzun

Acquired Spastic Equinovarus Deformity

by Alparslan Uzun

3D Printed Implant Solutions in Pelvic Resections

SCAPHOID FRACTURES

OPEN FRACTURES

by Abdullah Tatlı

CRUSH SYNDROME

Forearm Fractures (Diaphyseal Radius and Ulna)

Calcaneal Fractures

ANKLE FRACTURE

Acute compartment syndrome

Poliomyelitis

Thoracic Spine Fractures

Cervical Facet Dislocations

Adult Pyogenic Vertebral Osteomyelitis

Neuromuscular Scoliosis

Spinal deformity occurring in patients with underlying neuromuscular disorders Characterised by: Progressive coronal curvature Associated pelvic obliquity Results from muscle imbalance, weakness, or paralysis

Pediatric Spondylolysis and Spondylolisthesis

Spondylolysis: Defect or stress fracture of the pars interarticularis Spondylolisthesis: Forward translation of a vertebra due to bilateral pars defect Most commonly occurs at L5–S1

Cerebral Palsy

Osteogenesis Imperfecta

Tarsal Coalition

Infatile Tibia Vara (Blount’s Disease)

Acquired growth disorder of the proximal medial tibial physis Leads to progressive genu varum

DIABETIC NEUROPATHY AND CHARCOT NEUROARTHROPATHY

OSTEOCHONDRAL LESIONS OF THE TALUS (OLT)

Achilles Tendon Rupture

Phalangeal Fractures

(Toe Fractures, Intra-articular Involvement)

Metatarsal Fractures

Other then metatars base fractures

Fifth Metatarsal Base Fractures

Low Ankle Sprains (Lateral Ankle Ligament Injuries)

High Ankle Sprains -(Syndesmosis Injuries)

PILON FRACTURES (TIBIAL PLAFOND FRACTURES)

Functional Anatomy: Muscle Forces and Foot Deformities

Pes Cavus

Limb Salvage vs Amputation

Decision-making process between attempting to preserve a severely injured limb or proceeding with primary amputation

Flap Selection

Selection of appropriate soft tissue coverage technique for defects involving: Skin Muscle Bone (exposed structures) Goal: Provide durable, well-vascularised coverage to support healing and prevent infection

Timing of Soft Tissue Coverage

Refers to the optimal timing of definitive soft tissue reconstruction (flap or graft) after trauma A key determinant of outcomes in open fractures and complex limb injuri

Fix and Flap Principle

Combined approach involving: Early skeletal stabilisation (fixation) Early soft tissue coverage (flap) Typically performed in a single stage or closely timed stages Core concept in orthoplastic management of open fractures

Flap Selection for Tibial Defects

Soft tissue reconstruction in open tibial fractures is primarily guided by the location of the defect, the size of the defect, and the condition of surrounding tissues.

Orthoses

Purpose: Support function, control deformity, reduce pain Types: Static: Stabilize joint Dynamic: Facilitate movement Design principles: Simplicity, lightness, durability, aesthetics; consider rigidity/flexibility and tissue tolerance

Biomaterials

Biomaterials are synthetic substances, derived from organic or inorganic components, designed to interact with biological systems. Their properties are determined by their structure (elemental composition, atomic bonding, crystalline configuration) and their processing methods (casting, forging, extrusion, sintering, etc.).

Bone Grafts, BMP, and Bone Substitutes

Clinical Research, Statistical Concepts, and Tests

Supracondylar Fracture - Pediatric

Anticoagulants

Musculoskeletal Infections and Microbiology

Cellular and Molecular Biology, Immunology and Genetics Terminology

Pediatric Diaphyseal Both-Bone Forearm Fractures

Biomechanics

Articular Cartilage: Structure, Components, and Clinical Relevance

Spot Knowledge – Articular Cartilage Composition: 95% ECM (water, collagen, proteoglycans), 5% chondrocytes Water: 65–80%, enables load-bearing, nutrient transport Collagen: >50% dry weight, mainly type II (90–95%); tensile strength Proteoglycans: 10–15% dry weight; aggrecan + GAGs provide compressive resilience Zones: Superficial (parallel collagen, friction reduction) Transitional (irregular, load distribution) Deep (vertical, compressive strength) Calcified (anchors to bone) Functions: Low-friction motion, load distribution, joint stability, resistance to forces Clinical relevance: Limited healing (avascular) Water/collagen/PG imbalance → osteoarthritis Collagen II & X defects → chondrodysplasias PG loss → elasticity ↓, cartilage breakdown

Peripheral Nerve Structure and Function

Adult Isthmic Spondylolisthesis

Timing of Surgery

Pediatric Spine Trauma

Articular Cartilage

Skeletal Muscle

Lumbar Spine Fractures

Bone and Joint Biology

Pediatric Tibia Eminence and Tubercle Fractures

Pediatric tibial eminence (spine) fractures and tibial tubercle fractures are two distinct injury patterns in growing knees. They differ in mechanism, age groups, treatment approach, and complications. Understanding classification, imaging, surgical indications, and outcomes is crucial for optimal care.

Pediatric Proximal Humerus Fractures

Pediatric Tibial Diaphyseal Fractures

Pediatric Pelvis Fractures

Peditric Femoral Shaft Fractures

Pediatric Abuse

This article provides a clinical overview of Non-Accidental Trauma (NAT), commonly referred to as orthopedic child abuse. Recognizing these patterns is critical for healthcare providers, as orthopedic injuries are the second most common presentation of child abuse after skin lesions. Child abuse is the second most common cause of death among children. Children under one year of age are reportedly the most frequently abused age group. Treatment requires reporting the abuse to the relevant authorities and hospitalisation for a multidisciplinary evaluation. Occasionally, surgical treatment of fractures may be necessary.

Pediatric Lateral Humeral Condyle / Epicondyle Fractures

Pediatric Medial Epicondyle Fractures

Pediatric Proximal Femoral Fractures

Pediatric Radial Head and Neck Fractures

Septic Arthritis

Septic arthritis can be defined as the infection of the joint space. The incidence is higher in the first years of life. It can be diagnosed with history, physical examination, laboratory studies and imaging. It is an acute surgical emergency and it needs to be diagnosed and treated rapidly.

Occipitocervical Injuries

Chance Fractures (Flexion-Distraction Injuries)

Lumbar Spinal Stenosis

Spinal Cord Monitoring

Spinal cord monitoring is an essential intraoperative tool used to prevent neurological injury during spinal surgery. The main modalities include somatosensory evoked potentials (SEP) for dorsal column function, motor evoked potentials (MEP) for corticospinal tracts, and electromyography (EMG) for nerve root integrity. SEPs are reliable and anesthetic-resistant but limited to sensory pathways, while MEPs are highly sensitive to anterior spinal ischemia yet affected by anesthesia. EMG, both spontaneous and triggered, helps identify nerve irritation or pedicle screw breaches in real time. A >50% reduction in signal amplitude or latency prolongation indicates potential cord compromise requiring immediate correction. Combined multimodal monitoring significantly improves intraoperative safety and postoperative neurological outcomes.

Spinal Cord Injury Management

Acute spinal cord injury (SCI) is a devastating condition resulting in high morbidity and long-term disability. Management focuses on rapid diagnosis, spinal immobilization, airway protection, and maintenance of perfusion with a target mean arterial pressure of ≥85–90 mmHg. The pathophysiology involves a primary mechanical insult followed by secondary injury cascades—ischemia, inflammation, and apoptosis—which are key therapeutic targets. High-dose steroids are no longer routinely recommended due to limited benefit and adverse effects. Early surgical decompression, ideally within 24 hours, has been shown to improve neurological outcomes in selected patients (STASCIS trial). Emerging therapies such as neuroprotective agents, stem cell transplantation, and neuroprosthetic technologies are under investigation. A structured multidisciplinary approach combining early stabilization, evidence-based acute care, and long-term rehabilitation remains the cornerstone of SCI management.

Degenerative Spondylolisthesis

Degenerative spondylolisthesis is the forward or backward slip of one vertebra over another due to facet and disc degeneration, most commonly affecting the L4–L5 level in elderly women. It presents with mechanical back pain, neurogenic claudication, or radiculopathy secondary to spinal stenosis. Standing lateral radiographs confirm diagnosis and grading, while MRI assesses canal and neural compression. Conservative treatment—including physiotherapy, anti-inflammatories, and injections—is first-line for low-grade, stable cases. Surgical decompression with or without fusion is reserved for patients with persistent pain, neurological deficits, or instability, providing superior outcomes compared with nonoperative care.

Burst Fractures

A spinal burst fracture involves disruption of both the anterior and middle columns of the vertebral body under axial-compression load. Retropulsion of posterior wall fragments into the spinal canal is typical and may cause neurological injury through direct compression or secondary deformity. The thoracolumbar junction (T11–L2) is most often affected because it transitions from rigid thoracic to mobile lumbar segments. Common mechanisms include falls from height and motor-vehicle accidents.

Subaxial Cervical Spine Fractures

Subaxial cervical spine injuries (C3–C7) are common consequences of high- to moderate-energy trauma, though even low-energy mechanisms can cause significant damage in elderly or ankylosed spines. They result from flexion, extension, compression, or burst mechanisms, most frequently between C5 and C7. Diagnosis begins with ATLS evaluation and cervical immobilization, followed by neurologic assessment and imaging. Standard radiographs (AP, lateral, odontoid) are complemented by CT for fracture detail and MRI for disco-ligamentous complex (DLC) and cord evaluation. Classification systems such as AOSpine, SLIC, and Allen–Ferguson guide management. Stable compression fractures without posterior ligamentous involvement may be managed conservatively using a rigid orthosis, whereas unstable or displaced injuries—especially burst and flexion teardrop fractures—require surgical decompression and fixation. Prognosis depends on the initial neurological deficit, fragment displacement, and timing of surgery; patients with ankylosing spondylitis are at higher risk of neurological deterioration and often need long-segment stabilization.

Spine Trauma Classifications

Early systems such as Denis’ three-column model and Allen–Ferguson’s mechanism-based classification emphasized anatomical and mechanical concepts of instability. Over time, modern systems evolved to integrate neurological evaluation and clinical relevance, resulting in improved surgical decision-making. For cervical injuries, multiple region-specific classifications exist — including Anderson–Montesano for occipital condyle fractures, Traynelis for occipito–atlantal dislocation, Fielding–Hawkins for atlantoaxial rotatory fixation, and Anderson–D’Alonzo for odontoid fractures. In the thoracolumbar region, progression from Holdsworth’s two-column theory to Denis’ three-column model, followed by Magerl’s AO classification, established the foundation for contemporary systems. The Thoracolumbar Injury Classification and Severity Score (TLICS) and its evolution — the AO Spine Thoracolumbar Classification (AO TLS) — combine morphology, neurological status, and modifiers, guiding evidence-based operative versus nonoperative management.

Neurologic Assessment

Concise clinical guide covering motor, sensory, and reflex examination of spinal segments, with key diagnostic patterns, special tests, and upper vs. lower motor neuron distinctions.

Spinal Stability Principles

Osgood-Schlatter Disease

Spontaneous Osteonecrosis of the Knee (SONK)

Overuse Injuries of the Knee

Patellar Tendinitis-Iliotibial Band Friction Syndrome (ITBFS)-Prepatellar bursitis-Quadriceps Tendonitis

Anterior Cruciate Ligament Tear

Knee Dislocation

Posteromedial Corner (PMC) Injuries of the Knee

Posterolateral Corner Injury

Medial Colletaral Ligament(MCL) Injury of the Knee

 Patellar and Trochlear Osteochondritis Dissecans

Sinding-Larsen-Johansson Syndrome

Patellofemoral Instability

Basic Tumor Biology

Musculoskeletal tumours are diverse, historically classified by morphology and histology. WHO classification is the gold standard.

Soft Tissue Sarcomas

A diverse group of malignant tumours arising from mesenchymal tissues, commonly affecting extremities.

Multiple Myeloma

Multiple Myeloma is a malignant plasma cell disorder that causes bone marrow infiltration, excessive monoclonal protein production, and skeletal destruction through osteoclast activation and osteoblast suppression. It primarily affects older adults and commonly presents with bone pain, anaemia, renal dysfunction, and recurrent infections.

Ewing Sarcoma

Ewing sarcoma is a high-grade malignant small round cell tumor of bone and soft tissue, primarily affecting children and young adults. It represents the second most common primary malignant bone tumor after osteosarcoma. The hallmark of Ewing sarcoma is a chromosomal translocation involving the EWSR1 gene, most commonly t(11;22)(q24;q12), resulting in the EWSR1–FLI1 fusion gene.

Osteosarcoma

High-grade, malignant, osteoid-producing sarcoma of bone. Most common primary bone sarcoma. Arises predominantly in metaphysis of long bones (esp. around the knee).

Giant Cell Tumor (GCT)

GCBT is an aggressive benign bone tumour, classified as intermediate (locally aggressive) in the 2020 WHO classification. Accounts for 5–10% of all primary bone tumours.

Pigmented Villonodular Synovitis

Pigmented Villonodular Synovitis (PVNS), also known as tenosynovial giant cell tumor (diffuse type), is a benign but locally aggressive proliferative disorder of the synovium, tendon sheaths, and bursae. It is characterized by hemosiderin deposition, multinucleated giant cells, and synovial villous nodular overgrowth. Although histologically benign, PVNS can cause significant joint destruction if untreated.

Fibrous Dysplasia

Fibrous dysplasia (FD) is a benign bone disorder characterized by the replacement of normal bone with fibro-osseous tissue, leading to pain, deformity, and fractures. It results from post-zygotic GNAS gene mutations that disrupt osteoblastic differentiation. FD may be monostotic (single bone) or polyostotic, the latter often occurring as part of McCune–Albright syndrome (MAS). Radiologically, it presents with a ground-glass appearance and possible deformities such as the “shepherd’s crook” in the proximal femur. Treatment is primarily symptomatic, involving bisphosphonates for pain control and surgery for deformity or fracture correction. Although benign, the disease may progress during growth and stabilize in adulthood, requiring periodic follow-up for skeletal deformity and functional assessment.

Chondroblastoma

Chondroblastoma is a rare, epiphyseal, benign bone tumor that exhibits locally aggressive behavior. It primarily affects skeletally immature individuals, most commonly males in their second decade of life. Most frequent locations include the distal femur, proximal tibia, proximal humerus, and less commonly the hip or calcaneus.

Non-Ossifying Fibroma (NOF)

Aneurysmal Bone Cyst (ABC)

Unicameral Bone Cyst (UBC)

Unicameral bone cyst (UBC) is a benign, fluid-filled intramedullary lesion typically located in the metaphysis or diaphysis of long bones in children and adolescents. It is usually unilocular and adjacent to the cortex. Pathological fracture is the most common presentation.

Enchondroma

Overview • Enchondroma is a benign hyaline cartilage tumor, accounting for 20-25% of benign bone tumors. • It arises from residual cartilage cells that fail to undergo necrosis after physeal growth. • Can be solitary or multiple (Ollier’s disease, Maffucci syndrome).

What the Pathologist Needs

Osteochondroma

Benign hamartomatous cartilaginous lesions derived from aberrant cartilage through the perichondral ring that may be in the form of solitary or associated with genetic conditions like Multiple Hereditary Exostosis (MHE) · They grow and mature according to typical enchondral ossification and do not occur in bones formed through membranous ossification (skull)

Principles of Surgical Resection & Margins

Tumour resection aims to achieve oncologic control while preserving function; margin status is critical for local recurrence risk.

Staging Systems (Enneking, AJCC)

Biopsy Principles

Imaging Principles

Plain radiography remains the first-line and often diagnostic in most bone tumors, while CT provides detailed cortical and 3D anatomical evaluation. MRI offers superior soft-tissue and marrow contrast, essential for assessing intramedullary extension and surgical margins. PET/CT assist in detecting metastases and evaluating treatment response.

Soft Tissue Tumor Classification

The WHO introduced the classification of soft tissue and bone tumors (fifth edition) in 2020. The new WHO classification of soft tissue and bone tumors, introduced in 2020 (fifth edition), has made significant improvements in classification and introduced many new diagnoses.

Bone Tumor Classification

Overview of bone tumour classification systems and key characteristics that distinguish benign from malignant lesions.

Radiotherapy For Extremity Sarcomas

Metastatic Bone Disease

Metastatic bone disease (MBD) is the most common malignant condition of the skeleton, often originating from breast, prostate, lung, kidney, or thyroid cancers. Treatment targets fracture prevention, functional maintenance and pain relief.