Myanmar Orthopaedic Society

05/06/2026

Milch technique for anterior glenohumeral dislocation :

The patient is usually placed supine.

The affected arm is slowly abducted overhead in the coronal plane while maintaining gentle external rotation.

As the arm approaches 90–150° of abduction, the operator applies gentle pressure with the thumb over the humeral head in the axilla to guide it back into the glenoid.

Continued gradual abduction and external rotation allow the humeral head to slip into place with minimal force.

Adequate analgesia and muscle relaxation improve success.

After reduction, neurovascular status is reassessed, radiographs are obtained to confirm reduction and exclude fractures, and the shoulder is immobilized in a sling.

Advantages: atraumatic, relatively painless, minimal traction required, and low risk of iatrogenic injury when performed correctly.

Indication: uncomplicated anterior shoulder dislocation without associated fractures requiring operative management.

05/06/2026

Each year there are 70,000 new hip fractures in the UK, with an ongoing annual cost to health and social care services of £4.3 billion.



https://ow.ly/wppM50Z6HXl

05/06/2026

Dorsoulnar flap( Brunelli flap)

Before you consult plastics or jump to a complex free flap for a thumb defect, you need to understand the anatomy and utility of the dorsoulnar flap.
This diagram perfectly captures the essence of this workhorse flap. Let's break down exactly when and how you should be using this in your practice.

Indications:
Volar Thumb Defects: Ideal for medium-sized soft tissue defects on the volar aspect or tip of the thumb.
Exposed Vital Structures: When bone, joint, or tendon is exposed and a simple skin graft won’t survive.
Failed Local Advancement: When a Moberg flap won't give you enough reach for a distal injury.

The Procedure:
1 The Design: The flap is designed over the dorsoulnar aspect of the thumb, centered over the MCP joint.

2 The Harvest: You elevate the skin paddle and pedicle, working proximal to distal. Look at the text at the bottom bipolar electrocoagulation is your best friend here to maintain meticulous hemostasis.

3 The Pivot Point: This is the most critical part of image. See the dotted line labeled "Distal limit of dissection" set 1 cm proximal to the crease? Respect that line. Going further risks transecting your perforators.

4 The Rotation: The text notes you can get an 8 cm pedicle. This allows for excellent rotation to the volar thumb, but ensure there is zero tension or kinking of the pedicle.

The Pros:
"Like-with-Like" Tissue: Replaces thumb skin with local, durable skin.
Single-Stage: Gets the patient out of the OR and healing without needing a second division surgery (unlike a cross-finger flap).
Reliable Blood Supply: Based on a robust, constant axial vessel.

The Cons:
Donor Site Morbidity: You will almost always need a full-thickness skin graft to close the donor site on the dorsum of the thumb.
Venous Congestion: The primary reason these fail in junior hands is tight tunneling. (Pro tip: Just open the skin bridge!).
Bulkiness: It can be slightly bulky at the recipient site, occasionally requiring debulking later down the road.
Save image to your phones. Review it before your next thumb trauma case!

05/06/2026

Happy World Clubfoot Day. Today we honor the great Ignacio Ponseti for his clubfoot treatment to ensure that every child born with clubfoot can lead a normal life. We also thank all the Ponseti providers around the world who are working to carry on his legacy..with special thanks to Dr. Jose Morcuende who has spent decades training doctors, and treating patients. We honor you everyday, but today does have special meaning since it is the birthdate of Dr. Ponseti.

05/06/2026

05/06/2026

The 2025 Annual Report is now available online, detailing a year of noteworthy progress in our mission to improve care of the injured in 37 countries in Africa and Asia. The report features success stories about patients treated by our faculty of active surgeons in Burkina Faso, Cambodia, Cameroon, and Malawi. In 2025 alone, the AO Alliance trained over 8,000 healthcare workers during 336 educational events. This brings our cumulative total since 2015 to over 59,000 healthcare workers trained in fracture management through 2,000+ educational events. These educational initiatives are critical to building local capacity and ensuring sustainable improvements in care of the injured.

Read it here: https://ow.ly/kNxq50Z040h

05/06/2026

Wilfred Labi Addo’s illustrious career has been closely linked to his work with the AO Alliance. He joined the AO SEC in 2008 and later served as Chair of the AO Alliance Steering Committee for English-speaking Africa from 2015 to 2023.

“I was privileged to work alongside all the pioneers who laid the foundation for the establishment of the AO Alliance,” Addo said.

The AO Alliance formally began its work in Ghana in 2015, followed by the launch of the Ghana Country Initiative in 2017. Since then, trauma and orthopedic training capacity in Ghana has grown considerably. Residency intake increased from two trainees in 2017 to 97 in May 2026 under a structured six-year training program overseen by a faculty board at the Ghana College of Physicians and Surgeons. The number of training centers expanded from two to seven nationwide.

Addo identifies his proudest achievement as: “Providing unique opportunities for the training and development of surgeons, operating room personnel, and technicians across Africa, who are now national leaders in their respective fields and champions of AO principles.”