Dr. Ravi Teja Boddapalli - Orthopaedics

Dr. Ravi Teja Boddapalli - Orthopaedics Trauma, Sports Medicine & Joint Replacement Surgeon sharing insights for students and patinets

🔺CASE 121: VOLAR BARTON’S 🔺Intra-articular volar shear fracture with separate lunate facet and radial styloid fragment...
21/08/2026

🔺CASE 121: VOLAR BARTON’S

🔺Intra-articular volar shear fracture with separate lunate facet and radial styloid fragments. Volar plating done with a Synthes variable angle locking plate, achieving stable fixation and restoration of the articular surface.



Dr. Ravi Teja Boddapalli
Consultant Orthopaedic Surgeon

🔺 CASE 120: FIX THE FRACTRUE - PRESERVE THE HIP 🔺 An 80 year old gentleman sustained a left intertrochanteric fracture ...
16/08/2026

🔺 CASE 120: FIX THE FRACTRUE - PRESERVE THE HIP

🔺 An 80 year old gentleman sustained a left intertrochanteric fracture following a fall.

🔺The question that often comes up with elderly patients is:
“Why not replace the hip and allow immediate weight bearing?”

🔺Because not every intertrochanteric fracture needs a replacement.
This was an extra-articular fracture with a reconstructable proximal femur. In an appropriately selected patient, a proximal femoral nail (PFN) provides a minimally invasive, load-sharing fixation while preserving the patient’s native hip joint.

🔺The advantages of fixation include:
• Smaller surgical exposure and less soft-tissue disruption
• Lower intraoperative blood loss
• Shorter operative time
• Preservation of the native femoral head and hip joint
• No prosthetic joint, dislocation or periprosthetic fracture risk
• A biomechanically favourable intramedullary construct, particularly when there is subtrochanteric extension
• Early mobilization and weight bearing can still be considered when the reduction and fixation are stable and the patient’s overall condition permits

🔺Importantly, hemiarthroplasty is not wrong. It has an important role in carefully selected elderly patients, particularly when fixation is unlikely to provide a stable construct.

🔺The goal isn’t to choose “replacement versus fixation” based on age alone. The goal is to choose the least morbid operation that provides a stable construct and allows the patient to return to function safely.

Dr. Ravi Teja Boddapalli
Consultant Trauma, Joint Replacement and Arthroscopy Surgeon
Apollo Hospitals, Visakhapatnam

🔺 CASE 120: FIX THE FRACTRUE - PRESERVE THE HIP 🔺 An 80 year old gentleman sustained a left intertrochanteric fracture...
15/08/2026

🔺 CASE 120: FIX THE FRACTRUE - PRESERVE THE HIP

🔺 An 80 year old gentleman sustained a left intertrochanteric fracture following a fall.

🔺The question that often comes up with elderly patients is:
“Why not replace the hip and allow immediate weight bearing?”

🔺Because not every intertrochanteric fracture needs a replacement.
This was an extra-articular fracture with a reconstructable proximal femur. In an appropriately selected patient, a proximal femoral nail (PFN) provides a minimally invasive, load-sharing fixation while preserving the patient’s native hip joint.

🔺The advantages of fixation include:
• Smaller surgical exposure and less soft-tissue disruption
• Lower intraoperative blood loss
• Shorter operative time
• Preservation of the native femoral head and hip joint
• No prosthetic joint, dislocation or periprosthetic fracture risk
• A biomechanically favourable intramedullary construct, particularly when there is subtrochanteric extension
• Early mobilization and weight bearing can still be considered when the reduction and fixation are stable and the patient’s overall condition permits

🔺Importantly, hemiarthroplasty is not wrong. It has an important role in carefully selected elderly patients, particularly when fixation is unlikely to provide a stable construct.

🔺The goal isn’t to choose “replacement versus fixation” based on age alone. The goal is to choose the least morbid operation that provides a stable construct and allows the patient to return to function safely.

Dr. Ravi Teja Boddapalli
Consultant Trauma, Joint Replacement and Arthroscopy Surgeon
Apollo Hospitals, Visakhapatnam

🔺CASE 118: 105/F - COMMINUTED DISTAL FEMUR FRACTRUE WITH A DHS IN-SITU What would be your plan? My plan was not to re...
04/08/2026

🔺CASE 118: 105/F - COMMINUTED DISTAL FEMUR FRACTRUE WITH A DHS IN-SITU

What would be your plan?

My plan was not to remove the DHS.

1. Removed the screws while retaining the DHS plate.
2. Corrected the deformity using K-wires in both the coronal and sagittal planes.
3. Inserted a distal femoral nail, with the entry point directed toward the deformity to achieve the best possible alignment as the reamers entered the diaphysis.
4. Inserted the proximal locking screws through the DHS plate.
5. Deliberately did not lock the nail distally at this stage.
6. Applied a distal femoral locking compression plate (DF-LCP) using the MIPPO technique, with distal screws passing through both the plate and the nail.
7. Proximally, inserted one screw engaging the plate, DHS, and nail (“plate–DHS–nail”), along with one additional unicortical screw for supplemental fixation.
8. The medial fragment was not exposed or addressed due to operative time constraints.

Dr. Ravi Teja Boddapalli
Consultant Orthopaedic Surgeon
Apollo Hospitals, Visakhapatnam

🔺CASE 119: SPLIT DEPRESSION FRACTURE OF THE LATERAL TIBAIL PLATEAU46/ Female 🔺This case involved a split-depression fr...
24/07/2026

🔺CASE 119: SPLIT DEPRESSION FRACTURE OF THE LATERAL TIBAIL PLATEAU
46/ Female

🔺This case involved a split-depression fracture of the lateral tibial plateau, with the split being incomplete.

🔺A cortical window was created to gain access to the posterolateral depressed articular fragment. A submeniscal arthrotomy was performed to allow direct visualization of the joint surface and ensure an anatomical reduction.

🔺Following elevation of the depressed articular fragment, the metaphyseal void was filled with autologous cancellous bone graft harvested from the iliac crest. Definitive fixation was achieved using a 3.5 mm lateral proximal tibial rafting plate, providing stable subchondral support and restoration of the articular surface.

🔺CASE 118: 105/F - COMMINUTED DISTAL FEMUR FRACTRUE WITH A DHS IN-SITU What would be your plan?
19/07/2026

🔺CASE 118: 105/F - COMMINUTED DISTAL FEMUR FRACTRUE WITH A DHS IN-SITU

What would be your plan?

🔺 CASE 113: DISTAL FEMUR FRACTURE WITH A PFN IN SITU 🔺An 80-year-old female presented to the ER following a fall at hom...
19/07/2026

🔺 CASE 113: DISTAL FEMUR FRACTURE WITH A PFN IN SITU

🔺An 80-year-old female presented to the ER following a fall at home.

🔺Radiographs revealed a spiral fracture of the distal third of the left femur, with a subtle fracture line extending distally, but without definite intra-articular extension.

🔺The challenge was the presence of a short proximal femoral nail (PFN), inserted 10 years ago at another center.

🔺This is one of those fractures where multiple surgical strategies can be justified.

What were my options?

1. Retain the nail and perform distal femur plating (the plate cannot end short of the nail for obvious reasons; it should overlap the nail).
2. Remove the nail and insert a long PFN.
3. Remove the nail, insert a long PFN, and add a distal femur augmentation plate.
4. Remove the nail and perform distal femur plating.

What I did:

I removed the distal locking bolts from the nail, clamped the fracture, and provisionally fixed it with K-wires. I then positioned the plate and confirmed that the screws could pass through both the plate and the nail to achieve bicortical fixation. I also ensured that one locking screw passed through the nail. And there you have it.

ONE FRACTURE. MANY SOLUTIONS. THE MANY WAYS OF A TRAUMA SURGEON.

🔺CASE 117: COMMINUTED INTER-TROCHANTERIC FRACTURE 82 year old. Fixed with Synthes TFNA. I’ll give the surgical steps a...
18/07/2026

🔺CASE 117: COMMINUTED INTER-TROCHANTERIC FRACTURE
82 year old.
Fixed with Synthes TFNA.

I’ll give the surgical steps and details in my next post on this fractrue. You can share your queries here and I’ll make sure I cover them in the next post.

Address

Apollo Hospitals, Arilova
Visakhapatnam
530040

Telephone

+919121005061

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