Orthopedic wellness center

12/06/2026

Shepherd’s Crook Deformity in Fibrous Dysplasia

This image shows the classic shepherd’s crook deformity of the proximal femur in fibrous dysplasia.

In fibrous dysplasia, normal bone is replaced by weak fibro-osseous tissue. With weight bearing, the proximal femur may bend into severe coxa vara, creating the curved shape that resembles a shepherd’s crook.

This deformity can cause pain, limp, limb-length discrepancy, and increased risk of pathological fracture.

Treatment can be difficult and may require corrective osteotomy with stable fixation to restore alignment and stability.

16/05/2026

08/05/2026

The Sauve-Kapandji Procedure

When we're dealing with chronic pain and restricted rotation at the wrist—specifically at the distal radioulnar joint (DRUJ)—the Sauve-Kapandji procedure is a powerful tool in our surgical arsenal. It’s a clever bit of "biological engineering" that addresses both stability and movement.
Here is a breakdown of how we approach this technique and what it means for patient recovery.

What is it?
The Sauve-Kapandji procedure is a "salvage" operation. We perform a fusion of the DRUJ (the joint between the radius and the ulna at the wrist) while simultaneously creating a "pseudo-joint" further up the forearm to preserve rotation.
Indications
• Arthritis: Post-traumatic or rheumatoid arthritis of the DRUJ.
• Instability: Chronic subluxation or dislocation that hasn't responded to soft tissue repair.
• Distal Radius Malunion: When a previous fracture has healed poorly, causing ulnar abutment or impingement.

The Surgical Steps
1. Preparation of the Joint: We clear the cartilage from the DRUJ to prepare for fusion.
2. Ulnar Osteotomy: A small segment of the ulna (just proximal to the head) is resected. This is the "gap" you see in the diagrams, which allows the radius to rotate around the ulna.
3. Stabilization: We fix the ulnar head to the radius using screws to ensure a solid fusion (arthrodesis).
4. Soft Tissue Interposition: We often use the pronator quadratus muscle or other local tissue to fill the ulnar gap to prevent the bone ends from clicking or hitting each other.

Pros & Cons
• Pros: Significant pain relief, preserved grip strength, and restored forearm rotation.
• Cons: It's a permanent "salvage" procedure and carries a small risk of instability in the remaining ulnar shaft.

Surgeon's Note: This isn't a "one-size-fits-all" surgery. We carefully select this for patients who need a stable, pain-free wrist for daily activities but have worn out the natural joint surfaces.

05/05/2026

"Proximal Row Carpectomy for Stage IIIB Kienböck Disease

01/05/2026

Sites of injection of local anesthesia in finger and hand surgery:
A, Volar injections. When only a sensory block of finger is required (SIMPLE technique), 2 mL are injected into the areas designated by the blue dots. To obtain hemostasis and local anesthesia for palmar finger surgery, 1% lidocaine with epinephrine 1:100,000 is injected into midline subcutaneous fat between digital nerve in each area designated by dot.

B, Dorsal injections. For hemostasis and local anes-thesia, injection is into midline subcutaneous fat in each area designated by dot. In both volar and dorsal injections, 2 mL are injected at site of blue and red dots, 1 mL at site of green dots, and 5 mL at site of the orange dots.

01/05/2026

Sites of injection of local anesthesia in finger and hand surgery:
A, Volar injections. When only a sensory block of finger is required (SIMPLE technique), 2 mL are injected into the areas designated by the blue dots. To obtain hemostasis and local anesthesia for palmar finger surgery, 1% lidocaine with epinephrine 1:100,000 is injected into midline subcutaneous fat between digital nerve in each area designated by dot.

B, Dorsal injections. For hemostasis and local anes-thesia, injection is into midline subcutaneous fat in each area designated by dot. In both volar and dorsal injections, 2 mL are injected at site of blue and red dots, 1 mL at site of green dots, and 5 mL at site of the orange dots.

27/04/2026

With Faraz'pearls For MRCP – I just got recognised as one of their top fans! 🎉