Case 1: Femoral Shaft Fracture in a Young Motorcyclist — Intramedullary Nailing
A 24-year-old delivery rider was brought in after a head-on two-wheeler collision with a closed, displaced mid-shaft femur fracture. He was haemodynamically stable; ATLS survey revealed no other injury. After skeletal traction overnight, we performed closed antegrade intramedullary interlocking nailing the next morning — the gold standard for femoral shaft fractures in adults. The fracture was reduced on the traction table and the nail passed without opening the fracture site, preserving the healing biology.
Management
Closed antegrade femoral interlocking nail, two proximal and two distal locking bolts. Full weight-bearing by week 6.
Outcome
United at 4 months. Returned to riding at 5 months with full hip and knee motion.
Case 2: Open Tibia Fracture (Gustilo II) — Debridement First, Fixation Second
A 38-year-old pedestrian struck by a car presented with a 3 cm wound over a fractured tibial shaft, bone visible in the wound. Open fractures are orthopaedic emergencies: within an hour he received IV antibiotics, tetanus prophylaxis, and wound photography followed by sterile dressing. In the OT the wound was extended, dead tissue excised, and the fracture stabilised with an unreamed intramedullary nail after thorough lavage.
Management
Emergency debridement + irrigation, IV cefuroxime + gentamicin, primary unreamed tibial nail, delayed primary closure at 48 hours.
Outcome
No infection. Union at 6 months. Full unaided walking.
Case 3: Intertrochanteric Hip Fracture in an 82-Year-Old — Fix Within 48 Hours
An 82-year-old woman slipped in her bathroom and could not stand. X-rays showed an unstable intertrochanteric femur fracture. Her diabetes and blood pressure were optimised overnight and she was operated within 36 hours — proximal femoral nailing under spinal anaesthesia. Surgery this early is proven to reduce mortality, pressure sores, and pneumonia in the elderly.
Management
Closed reduction, proximal femoral nail (PFN). Sat out of bed day 1, walker-assisted walking day 2.
Outcome
Walking independently with a stick at 6 weeks. DEXA confirmed osteoporosis — started on bisphosphonates and vitamin D.
Case 4: Distal Radius Fracture in a Working Woman — Volar Plating
A 45-year-old teacher fell on her outstretched hand; X-rays showed a dorsally displaced, intra-articular distal radius fracture with 25° dorsal tilt. Closed reduction restored alignment but the fracture re-displaced in plaster at one week — a known behaviour of comminuted fractures. We fixed it with a volar locking plate, restoring articular congruity and radial length.
Management
Open reduction, volar locking plate through the flexor carpi radialis approach. Finger movement from day 1; wrist mobilisation at 2 weeks.
Outcome
Full grip strength by 3 months; back to writing on the blackboard at 6 weeks.
Case 5: Supracondylar Humerus Fracture in a 6-Year-Old — A True Paediatric Emergency
A 6-year-old boy fell from a swing; his elbow was grossly swollen with a Gartland III supracondylar fracture. The radial pulse was present but the hand was pale — vascular compromise until proven otherwise. He was taken to the OT within 3 hours: closed reduction under image intensifier and fixation with two lateral Kirschner wires. The hand pinked up immediately after reduction.
Management
Emergency closed reduction + percutaneous K-wire fixation, above-elbow slab, wires removed at 3 weeks in OPD.
Outcome
Full elbow range at 8 weeks; no cubitus varus at 1-year review.
Case 6: Bimalleolar Ankle Fracture-Dislocation — Reduce First, Image Later
A 52-year-old man twisted his ankle on stairs; he arrived with an obviously deformed, dislocated ankle. The joint was reduced in the emergency room before X-rays — a deformed ankle with compromised skin cannot wait. Definitive open reduction and internal fixation of both malleoli was done once swelling allowed, five days later.
Management
Immediate ER reduction + below-knee slab, elevation; delayed ORIF with fibular plate and medial malleolar screws.
Outcome
Plaster-free at 6 weeks, full weight-bearing at 8 weeks. Anatomic mortise on final X-ray.
Case 7: Clavicle Fracture in a Cricketer — When to Plate a Collarbone
A 28-year-old club cricketer landed on his shoulder diving in the field. His mid-shaft clavicle fracture was shortened 2.5 cm with a vertical fragment tenting the skin. While most clavicle fractures heal in a sling, significant shortening, comminution, and skin compromise in a throwing athlete tipped the decision to surgery.
Management
Open reduction and pre-contoured superior locking plate.
Outcome
Union at 10 weeks; return to competitive cricket at 4 months with full throwing power.
Case 8: Patella Fracture — Tension Band Wiring That Lets the Knee Move Early
A 40-year-old fell directly onto his kneecap; X-rays showed a transverse patella fracture with 8 mm separation and inability to straight-leg raise — the extensor mechanism was disrupted, an absolute surgical indication. Tension band wiring converts the pull of the quadriceps into compression at the fracture site, so motion actually helps healing.
Management
ORIF with two K-wires and figure-of-eight stainless steel tension band; knee bending started at 2 weeks.
Outcome
0–130° flexion at 3 months; united fracture; hardware removed electively at 1 year for prominence.
Case 9: Monteggia Fracture-Dislocation — The Injury You Must Not Miss
A 30-year-old labourer presented with forearm pain after a fall. X-rays showed an ulna shaft fracture — and, on careful review of the elbow, a dislocated radial head: a Monteggia injury. The radial head dislocation is missed in up to a third of cases when the elbow is not imaged. Anatomic plating of the ulna reduced the radial head automatically, as it usually does.
Management
ORIF ulna with 3.5 mm dynamic compression plate; radial head reduced closed, confirmed stable through full rotation.
Outcome
Full pronation-supination at 3 months.
Case 10: Unstable Pelvic Ring Injury — Damage Control with External Fixation
A 35-year-old was crushed between a truck and a wall, arriving with BP 80/50 and an 'open-book' pelvic X-ray. A pelvic binder was applied on arrival; after resuscitation he was taken for anterior external fixation to close the pelvic volume and tamponade venous bleeding — classical damage-control orthopaedics. Definitive anterior plating followed a week later once physiology normalised.
Management
Pelvic binder → resuscitation → anterior external fixator day 0 → symphyseal plating day 7.
Outcome
Survived; walking with crutches at 8 weeks, unaided at 4 months.
Case 11: Neglected Both-Bone Forearm Fracture — Plating a Three-Week-Old Injury
A 26-year-old farmer presented three weeks after a fall, having first tried traditional bone-setting with bamboo splints. Both radius and ulna were fractured, angulated, with early callus. Delayed presentation is still common in rural India. Surgery required freshening of the fracture ends and anatomical plating of both bones to restore the rotational geometry of the forearm.
Management
ORIF radius and ulna with 3.5 mm plates through separate incisions; early rotation exercises.
Outcome
Union at 4 months with 80% of normal rotation — good, though not the near-normal result early fixation gives.
Explore More Cases
This series is part of the OrthoChronicles Surgical Case Library — 50 real-world cases across trauma, joint replacement, spine, paediatric and sports orthopaedics.