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Clinical Blog
The Clinical Blog Series are aimed at fellow clinicians, as well as solicitors working in the Medico-legal field. The blog aims to give an insight into the complexities of limb reconstructive surgery through the use of patient journeys.
Complex Lower Leg Injury with Significant Injury to the Knee Joint and Extensor Mechanism
A deep dive into the challenges of managing complex lower leg injuries, particularly those involving the knee joint and extensor mechanism. This series explores surgical strategies, case studies, and long-term recovery outcomes.
March 17, 2020
A complex lower leg injury with severe bone and soft tissue defects required extensive reconstruction, including the Masquelet technique, bone grafting, and external fixation. Despite initial progress, infection necessitated surgical debridement and the use of a circular frame for limb salvage. The next phase involves distraction osteogenesis to restore limb length and stability.
March 17, 2020
Progress continues in this complex limb reconstruction case using the Ilizarov apparatus. The tibial corticotomy has been completed, and bone lengthening is underway with visible regenerate formation. The proximal fracture has been disimpacted, aligned, and prepared for docking into the medullary canal. While weight-bearing remains painful, all pin sites are stable, and the next phase of treatment is set to begin.
March 17, 2020
Fracture compression and tibial lengthening progress as planned, with good bone regenerate formation. The next follow-up will assess docking progress and alignment.
Aiming in Tibio-Calcaneal Fusion Using Fine Wire Frame
A detailed case series documenting the precision, challenges, and evolving techniques in tibio-calcaneal fusion using fine wire frames. Follow the step-by-step approach to surgical planning, execution, and patient outcomes.
March 18, 2020
Achieving accurate alignment in tibio-calcaneal fusion using a fine wire frame is a significant challenge. While past successes have relied on luck, recent failures prompted a reassessment of targeting methods. With limited imaging options, a 6.5mm cannulated cancellous screw is now being explored as a surgical target marker to improve precision.
March 18, 2020
Following resection of the distal tibia and talus due to chronic osteomyelitis, bone transport using a fine wire frame was performed. However, misalignment at the docking site became evident only after frame removal. A review of similar cases suggests that the commonly used “dynamisation” period may not be a reliable test for confirming bony healing.
March 18, 2020
During revision surgery, a 6.5mm cancellous cannulated screw was carefully positioned to guide docking, though the optimal tibial docking site remains uncertain—whether on the calcaneum alone or both the calcaneum and navicular. A new foot plate was attached, but the docking site was not modified per standard procedure.
Osseointegration Series
Exploring the advancements in osseointegration surgery, this series covers patient selection, procedural techniques, post-operative care, and long-term rehabilitation outcomes for amputees undergoing osseointegration.
February 8, 2025
Osseointegration surgery is a two-stage procedure designed to provide amputees with a direct skeletal connection for their prosthesis. This post by Mr. Matija Krkovic outlines the surgical steps, from preoperative preparation to implant insertion and final integration.
Principles of Fine Wire Frame Application
An in-depth exploration of the core principles behind fine wire frame application, including biomechanics, surgical techniques, stability considerations, and patient care protocols.
March 30, 2020
Fine wire frame fixation offers a unique approach to managing complex limb injuries, providing enhanced stability and promoting weight-bearing. This guide explores key principles, indications, and challenges of this technique.
Use of Poller Screws in Complex Cases
A technical series focusing on the strategic use of poller screws in complex orthopaedic cases. This category examines how poller screws enhance fixation stability and improve surgical outcomes.
February 9, 2025
Poller (blocking) screws play a crucial role in complex fracture fixation. This blog explores their evolution, from first to third-generation techniques, discussing optimal placement, biomechanics, and their impact on stability, reduction, and healing time.
Training the Trainee
A reflective series on surgical training, covering trainee challenges, skill development, and the evolution of observational and technical abilities.
August 1, 2021
Recognizing limitations is a crucial step in both aviation and surgical training. In this first installment, Mr. Matija Krkovic reflects on his experience learning to glide and draws parallels to the challenges faced by surgical trainees. How do trainees handle setbacks, and what role does structured training play in overcoming perceived incompetence?
August 1, 2021
Observational skills develop with time and experience, but how does this apply to surgical training? In this second installment, Mr. Matija Krkovic explores the parallels between learning to glide and surgical training, highlighting the importance of filtering information and adapting teaching approaches for trainees.
August 1, 2021
Effective surgical training goes beyond just performing procedures—it’s about improving observational skills and retention. In this final installment, Mr. Matija Krkovic explores how repetition, structured learning, and exposure to multiple techniques can shape a trainee into a skilled surgeon over time.
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