Consultant Orthopedic Surgeon Dr Muhammad Rehman

03/10/2026

The clinical presentation and radiologic images illustrate a classic application of Damage Control Orthopedics (DCO) for a complex, high-energy lower extremity peri-articular injury (distal tibia/pilon or ankle fracture-dislocation).

​Key Technical Observations

​Construct Configuration & Span:

​Ankle-Spanning Delta-Frame: Uses proximal Schanz pins in the tibial shaft and a distal transfixion pin through the calcaneus (or combination of calcaneal and midfoot/metatarsal pins) connected via carbon fiber/metal rods and universal clamps.
​Triangulated Structural Rigidity: The triangular ("delta") arrangement provides multi-planar stability to maintain axial alignment, correct length, and neutralize deforming forces across the ankle joint.

​Supplementary Fixation: Radiographs demonstrate K-wires maintaining articular alignment or reduction of the distal fragment prior to frame application.

​Soft Tissue & Clinical Status:

​Pin sites appear well-placed outside the zone of injury, maintaining clean margins.
​Mild visible ecchymosis and localized edema at the distal lower leg/ankle region highlight why early definitive open reduction and internal fixation (ORIF) would present a high risk for soft tissue necrosis or wound dehiscence.

​Management Framework & Next Steps

​Soft Tissue Monitoring:
​Monitor for the appearance of the "Wrinkle Sign" (indicating adequate subsidence of edema) before planning definitive reconstruction.
​Routine monitoring of distal neurovascular status and pin-site care.

​Definitive Planning:
​Obtain a post-distraction CT scan (with the ex-fix in place) to evaluate articular surface comminution, articular step-off, and spatial orientation of fracture fragments (e.g., Chaput, Volkmann, or medial malleolar fragments) for definitive ORIF blueprinting.

​Timing of Definitive Surgery:

​Typically staged 10 to 14 days post-fixation, depending on soft tissue envelope recovery and systemic resuscitation status.

02/09/2026

30/08/2026

Case Summary:
Delayed (3-Day-Old) Complex Right Acetabular Fracture-Dislocation with Femoral Neck Fracture

​Patient Presentation:
High-energy trauma presenting 3 days post-injury with a neglected right hip posterior dislocation.

​Radiographic & 3D CT Findings:
​Acetabulum: Posterior column and posterior wall fracture complex with osteochondral fragment displacement and loss of posterior wall support.

​Femur:
Fully displaced intracapsular (transcervical) femoral neck fracture with complete dissociation and superior-posterior migration of the dislocated femoral head fragment outside the true acetabulum.

​Surgical Urgency & Challenges:

​3-Day Delay Considerations:
High likelihood of total femoral head avascular necrosis (AVN) due to complete retinacular vessel transection combined with delayed reduction and capsular tamponade.

​Soft-Tissue Factors:
Early fibrous organization and muscle contracture complicate closed or simple open reduction; sciatic nerve assessment is mandatory before intervention.

​Management Plan Considerations:

​Young/Physiologically Active Patient:
Attempt head preservation via Kocher-Langenbeck (KL) approach: anatomical ORIF of the posterior column/wall with reconstruction plates, open reduction of the femoral head, and rigid fixation of the femoral neck (counseling patient on high risk of secondary THA due to AVN/nonunion).

​Older Patient / Severe Cartilage Damage: Primary Total Hip Arthroplasty (THA):
Posterior wall/column reconstruction (plating ± augments) to construct a stable acetabular cup bed, paired with a dual-mobility or constrained acetabular liner to mitigate severe postoperative instability risks.

13/08/2026

Keep Moving Forward, Pain-Free.
ڈاکٹر محمد رحمان
اسیسٹنٹ پروفیسر
ایم بی بی ایس، ایف سی پی ایس
ماہرامراض ہڈی، جوڑ، پٹھہ
قیصر عباسی ھسپتال مری روڈ بھارہ کہو اسلام آباد
For Appointment
0512303944

21/07/2026

Pediatric Distal Radius & Ulna Fractures
​Account for ~40% of pediatric fractures. Management is guided by the exceptional remodeling potential of the distal radial physis (~80% of radial length).
​1. Fracture Classification
​Torus (Buckle):
Stable cortex impaction; intact periosteum.
​Greenstick:
Unicortical disruption with plastic deformation.
​Complete:
Both cortices disrupted; prone to translation/rotation.
​Salter-Harris (Physeal):
Type II is most common. Low risk of growth arrest if managed gently.
Key Rule: Rotational malalignment does not remodel and must be corrected manually.

​3. Management Strategy
​Non-Operative
​Torus: Removable splint or short arm cast for 3–4 weeks.
​Displaced/Angulated: Closed reduction \rightarrow long arm cast with 3-point molding for 4–6 weeks. Check X-rays weekly for 2–3 weeks.

​Operative (CRPP)
​Indications:
Unstable reduction, secondary displacement, complete off-ended fractures in older children, or floating elbow.
​Fixation:
Smooth 1.6\text{ mm} or 2.0\text{ mm} K-wires. Avoid repeated passes across the physis.
​4. Primary Complications
​Loss of Reduction: Most common; usually due to poor cast index/molding.
​Physeal Arrest: Rare (7 days) or aggressive manipulation.
​Median Nerve Neurapraxia: Secondary to volar displacement or cast pressure.

In our case, this is the xrys of 7 years old deaf and dumb child of pre mainpulation amd after manipulation and splintage.

13/07/2026

Total Knee replacement is a surgical procedure to restore knee function after demage the to the knee secondary to Osteoarthritis.
The patient had excellent outcome in terms of pain reliefe and restoration of mobility.

1. Surgical Goals & Alignment
​Objective: Restore a stable, pain-free joint by resurfacing the damaged cartilage.
​Alignment: * Mechanical: Aligns the joint perpendicular to the mechanical axis (0^\circ \pm 3^\circ).
​Kinematic: Replicates the patient’s natural, pre-arthritic constitutional anatomy.
​Soft Tissue: Achieving equal, symmetric flexion and extension gaps is critical for stability.
​2. Component Selection
​Cruciate-Retaining (CR): Used when the posterior cruciate ligament (PCL) is intact.
​Posterior-Stabilized (PS): Uses a post-and-cam mechanism if the PCL is absent or sacrificed.
​Fixation: Cemented remains the standard; cementless (press-fit) is considered for optimal bone quality.
​3. Perioperative Management
​Pain & Mobility: Multimodal analgesia (e.g., adductor canal blocks, local infiltrative analgesia) to support immediate weight-bearing (Day 0–1).
​Complication Prophylaxis: Strict protocols for venous thromboembolism (VTE) prevention and perioperative antibiotics.
​4. Rehabilitation Milestones
​Early Phase (Weeks 1–6): Focus on full extension (0^\circ), functional flexion (\ge 90^\circ–120^\circ), and quadriceps activation.
​Long-Term: Strength and proprioception training, with maximum recovery typically reached by 12 months.

04/07/2026

Bilateral Capitellum Fractures:
A rere case, with reporting, less than 6 times quoted in the litrature so far and yet to publish in pakistan.
It was operated last year with excellent outcome at our setup.

Key Pearls
​Rarity & Mechanism
​Incidence:
Isolated capitellum fractures make up

03/07/2026

Understanding Bicolumnar Acetabular Fractures
​A bicolumnar (associated both-column) acetabular fracture is one of the most complex injuries in orthopedic trauma. It represents a complete disruption of the acetabulum, where both the anterior and posterior columns are fractured simultaneously, resulting in a characteristic "floating acetabulum" (the articular segment is entirely detached from the remaining axial skeleton/iliac wing).
​Anterior Column: Extends from the iliac crest down through the anterior wall, anterior acetabulum, and p***c ramus.
​Posterior Column: Comprises the greater and lesser sciatic notches, the posterior wall, the ischial spine, and the ischial tuberosity.
​The Spur Sign: On an obturator oblique pelvic radiograph, a pathognomonic "spur sign" is often visible, representing the displaced posterior ilium relative to the separated articular roof segment.
​The Role of Percutaneous Fixation
​Historically, bicolumnar fractures required extensive open reduction and internal fixation (ORIF) via demanding approaches (e.g., ilioinguinal, Kocher-Langenbeck, or the combined/extended iliofemoral approach).
​While ORIF remains the gold standard for highly displaced or comminuted fractures, percutaneous screw fixation under fluoroscopic or CT guidance has emerged as a powerful, minimally invasive alternative for selected cases.
​Patient Selection Criteria
​Percutaneous fixation is highly technical and relies heavily on precise indications:
​Undisplaced or Minimally Displaced Fractures: Fractures with

10/06/2026

Peroneus Longus Tendon (PLT) Autograft for ACL Reconstruction

​The peroneus longus tendon (PLT) is an increasingly popular autograft choice, offering a robust, high-diameter alternative to hamstring or patellar tendons with low donor-site morbidity.

​Technique & Harvest

​Exposure:
A 2–3 cm incision is made posterior to the lateral malleolus to isolate the PLT.

​Harvest:
A closed tendon st****er is advanced proximally toward the fibular neck. The graft is divided distally and stripped to obtain an 18–22 cm length.

​Preparation:
The tendon is typically doubled or quadrupled on the side table, consistently yielding a strong graft diameter (>8\text{ mm}).

​Clinical Advantages

​High Tensile Strength:
Biomechanically comparable or superior to quadrupled hamstring grafts.

​Minimal Knee Morbidity:
Avoids the anterior knee pain of patellar grafts and the flexion weakness of hamstring harvests.

​Preserved Ankle Function:
Long-term ankle eversion and stability remain unaffected as the peroneus brevis compensates.

​Revision Friendly:
Excellent autograft option when primary knee donor sites are exhausted.