Orthopedic surgery،جراحة العظام

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جراحة العظام والكسور والفقرات.{orthopedic spine surgery}.
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أستشارات مجانية. طبيب عظام

The latest advancements in orthopedic surgery,
with advice and consultations offered to all our valued patients worldwide.

Case PresentationA 50-year-old woman presents with a history of a right distal femur fracture that was initially treated...
06/08/2026

Case Presentation

A 50-year-old woman presents with a history of a right distal femur fracture that was initially treated with internal fixation. She subsequently developed chronic osteomyelitis, requiring implant removal and multiple surgical debridements. Following failure of infection control and severe joint destruction, she underwent right knee arthrodesis (knee fusion).

She has a medical history of:

- Diabetes mellitus (DM)
- Hypertension (HTN)
- HbA1c: 9% (poor glycemic control)

She also developed a right foot drop after her last surgery, approximately two years ago.

Question:
How would you optimize and prepare this patient for conversion of a fused knee to total knee arthroplasty? What preoperative investigations, medical optimization, surgical planning, and patient counseling would you recommend?

A 5 year old male with right hip pain and limping for one month duration No fever No Truma Your approach and management?...
06/08/2026

A 5 year old male with right hip pain and limping for one month duration

No fever
No Truma

Your approach and management?
Diagnosis?

Retroverted cup
05/08/2026

Retroverted cup

Save your hip,
05/08/2026

Save your hip,

Lower Spine surgery indications
05/08/2026

Lower Spine surgery indications

Protect you child.
05/08/2026

Protect you child.

This question is impotent,A young male with recurrent anterior shoulder dislocation underwent MRI, which demonstrated a ...
05/08/2026

This question is impotent,

A young male with recurrent anterior shoulder dislocation underwent MRI, which demonstrated a Bankart lesion. CT scan showed glenoid bone loss of less than 15%. He underwent arthroscopic Bankart repair. However, he sustained a recurrent dislocation during the rehabilitation period following surgery. What would be your next step in management?

Recurrent Shoulder DislocationDefinitionRecurrent shoulder dislocation is repeated instability of the glenohumeral joint...
05/08/2026

Recurrent Shoulder Dislocation

Definition

Recurrent shoulder dislocation is repeated instability of the glenohumeral joint after an initial traumatic or atraumatic dislocation. It usually involves the anterior shoulder (95%), with posterior and inferior instability being much less common.

Anatomy and Pathophysiology

The shoulder is the most mobile joint in the body and therefore the most unstable. Stability depends on:

* Static stabilizers:
* Glenoid labrum
* Joint capsule
* Glenohumeral ligaments (especially the inferior glenohumeral ligament)
* Negative intra-articular pressure
* Dynamic stabilizers:
* Rotator cuff muscles
* Long head of biceps
* Scapular stabilizers

Following traumatic anterior dislocation, common injuries include:

* Bankart lesion – detachment of the anteroinferior labrum
* Hill-Sachs lesion – posterolateral humeral head compression fracture
* Glenoid bone loss
* Capsular stretching or insufficiency
* ALPSA, HAGL, and SLAP lesions (less common)

Failure of these structures to heal results in recurrent instability.

⸻

Risk Factors for Recurrence

Higher recurrence occurs in:

* Age

A patient has severe lower lumbar degenerative disease with spinal stenosis and is scheduled for lumbar decompression an...
05/08/2026

A patient has severe lower lumbar degenerative disease with spinal stenosis and is scheduled for lumbar decompression and fusion. The same patient also has advanced right hip osteoarthritis and is a candidate for total hip arthroplasty (THA). Which procedure should be performed first—the spine surgery or the hip replacement? Please explain the rationale behind the preferred sequence.

Broström–Gould procedure is the gold-standard surgical treatment for chronic lateral ankle instability, particularly aft...
05/08/2026

Broström–Gould procedure

is the gold-standard surgical treatment for chronic lateral ankle instability, particularly after recurrent ankle sprains that have failed conservative treatment.

Indications

Chronic lateral ankle instability
Recurrent ankle sprains despite 3–6 months of rehabilitation
Positive anterior drawer and talar tilt tests
Good-quality native ligament tissue
Active patients or athletes

Surgical steps
Make a lateral incision over the distal fibula.
Identify the torn or stretched Anterior talofibular ligament (ATFL) and, if needed, the Calcaneofibular ligament (CFL).
Repair the ligaments back to the fibula using sutures or suture anchors (Broström repair).
Reinforce the repair by advancing the inferior extensor retinaculum over the repaired ligaments (the Gould modification).
Close the wound and immobilize the ankle.

Advantages
Restores normal ankle anatomy
Preserves ankle motion
Excellent functional outcomes
High return-to-sport rate (often 85–95% in appropriately selected patients)

Contraindications
Poor ligament quality
Generalized ligamentous laxity
Severe obesity (relative)
Revision surgery after failed repair
Significant cavovarus foot deformity unless corrected

Rehabilitation
0–2 weeks: Splint or cast, non-weight bearing.
2–6 weeks: Walking boot, progressive weight bearing.
6–12 weeks: Physiotherapy with range-of-motion, strengthening, and proprioception exercises.
3–6 months: Return to sports depending on strength and stability.

The difference between the Broström and Broström–Gould procedures is that the Gould modification reinforces the repaired ligaments with the inferior extensor retinaculum, making the repair stronger while preserving normal anatomy. This reinforcement is why the Broström–Gould technique is the most commonly performed procedure for chronic lateral ankle instability today.

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