This diagnostic X-ray (radiograph) illustrates a post-operative status of a transradial amputation in an upper limb. The image captures the distal humerus, elbow joint, and the proximal portions of the radius and ulna. The elbow joint maintains its anatomical alignment. Distally, the radius and ulna are sharply and transversely truncated, demonstrating a clear surgical bone cut consistent with amputation at the mid-to-distal forearm level. A red rectangle highlights this amputation site. The bone density appears normal with visible trabecular patterns in the proximal segments. Surrounding soft tissues are visible as less radiopaque shadows, terminating abruptly at the surgical margin. There is a slight mottled appearance of the soft tissue at the distal end, likely representing post-operative edema, surgical dressing material, or inflammatory changes. This visual serves as a clinical example of post-surgical imaging for limb amputation monitoring and orthopedic evaluation.

This clinical photograph shows a male patient three months post-operatively following bilateral upper limb amputations, a common sequela of severe high-voltage electrical injuries. On the patient's left side, there is an above-elbow (transhumeral) amputation; the residual limb appears well-healed with a rounded distal contour and no visible signs of acute inflammation or infection. On the patient's right side, a below-elbow (transradial) amputation is visible, currently managed with a white gauze dressing and medical tape extending toward the shoulder, suggesting ongoing wound care or protection of the surgical site. The patient is in a supine position, and the surrounding torso skin shows signs of prior trauma or healing. This image serves as a clinical example of post-amputation recovery and surgical management in the context of major limb trauma and burn rehabilitation within the specialties of orthopedic and plastic surgery.

A clinical photograph of an upper extremity following a transradial mid-forearm amputation. The residual limb is shown with a vacuum-assisted closure (VAC) system in place. The distal end of the stump is covered with a black, porous polyurethane foam dressing, which is secured and airtight under a transparent adhesive drape. A circular suction port is positioned on the lateral aspect of the stump, with a translucent tube containing trace amounts of serosanguinous fluid extending from it. The skin proximal to the transparent dressing exhibits a color gradient: there is a zone of erythematous, reddish-pink inflammation immediately adjacent to the dressing, transitioning into a yellowish-tan hue, and finally returning to a standard skin tone near the elbow. This image demonstrates the management of a complex surgical site, specifically for cases of pyoderma gangrenosum where optimized immunosuppression and negative pressure wound therapy are utilized to promote healing and prevent further tissue necrosis.

This comparative X-ray radiography series displays a human left forearm in two distinct clinical states: acute trauma and post-surgical amputation. Image A is an anteroposterior view of the forearm following a blast injury, showing significant soft tissue swelling, loss of normal tissue planes, and traumatic disarticulation at the wrist joint. A radiopaque tourniquet is visible proximally. The distal radius and ulna are present but surrounded by diffuse opacity suggesting edema and hemorrhage. Image B shows the same anatomical region five months later following a transradial amputation. The distal portions of the radius and ulna have been surgically resected, exhibiting smooth, rounded cortical margins at the amputation site. Multiple small, radiopaque metallic vessel clips are visible within the distal soft tissues. The elbow joint remains intact in both views. This comparison illustrates the transition from severe musculoskeletal trauma to the stable post-operative state of a residual limb, relevant for orthopedics and physical medicine and rehabilitation (PM&R).

Clinical photograph of a gross surgical specimen following a below-elbow amputation for recurrent osteosarcoma. The specimen consists of an amputated limb segment, likely the forearm and distal stump, exhibiting a massive, bulbous expansion of the distal end. The skin over the enlarged area is pale, taut, and displays a mottled appearance with reddish and purplish vascular discoloration, suggesting an underlying aggressive tumor. The proximal surgical margin shows a traumatic, hemorrhagic transection site with visible subcutaneous fat, muscle tissue, and potentially bone fragments. The global appearance characterizes a localized recurrence of a high-grade bone malignancy in a limb stump. The specimen is displayed on a green sterile surgical drape, and a small, detached biopsy or tissue fragment is seen adjacent to the main mass. This image serves as a pathology specimen study of musculoskeletal oncology, illustrating the gross morphology of tumor recurrence and its impact on limb architecture.

This clinical photograph demonstrates the use of an upper-limb myoelectric prosthesis during Activities of Daily Living (ADLs). The image shows a patient with a transradial (below-elbow) amputation performing a kitchen-related task. The prosthesis features a white or off-white forearm casing that fits over the residual limb, secured by a black wristband-style interface. The terminal device is an articulated prosthetic hand with anatomical finger modeling, shown here providing a stable platform and grip to hold a bowl. The patient's contralateral intact hand is using a spoon, illustrating the coordinated bimanual function and stabilization that prosthetic rehabilitation aims to achieve. Educational concepts include prosthetic fitting, functional rehabilitation post-amputation, and the integration of assistive devices into daily life. The image is relevant to orthopedic surgery, physical medicine and rehabilitation (PM&R), and occupational therapy.

A clinical photograph of a male patient five weeks post-operative, following bilateral upper limb amputations due to high-voltage electrical injuries. The patient has a left above-elbow amputation (transhumeral) and a right below-elbow amputation (transradial). The distal ends of both stumps show active healing; the right stump exhibits significant areas of red granulation tissue and possible skin grafting sites, while the left stump shows signs of tissue repair with some visible exudate or dressing material. The anterior abdominal wall and torso display extensive depigmented and scarred patches, consistent with healed thermal or electrical flame burns covering approximately 10% of the Total Body Surface Area (TBSA). The photograph illustrates the severe musculoskeletal and dermatological consequences of electrical trauma requiring multidisciplinary surgical management, including debridement and escharectomy. This image serves as an educational resource for orthopedic surgery, plastic surgery, and burn rehabilitation units.

This clinical photograph displays a residual limb following a transradial (below-elbow) amputation. The stump is depicted in a flexed position, showing a healthy, well-healed surgical outcome. The residual limb exhibits a cylindrical shape with slight distal tapering and a smooth, rounded distal end, indicating appropriate soft tissue coverage and successful maturation of the stump. The skin is medium brown with a visible, slightly rough texture and distributed hair follicles. There are sporadic, small hyperpigmented macules across the surface, but no signs of inflammation, ulceration, or dehiscence at the distal end. This image serves as an educational example of a healthy, mature residual limb suitable for prosthetic fitting and weight-bearing preparation in the field of physical medicine and rehabilitation.

This operative photograph demonstrates the surgical 'filleting' of a right hand and forearm for the creation of a pedicled fillet flap. The image shows a transverse incision across the level of the metacarpal heads, with the soft tissue envelope (skin and subcutaneous fat) being dissected away from the underlying skeletal and deep muscular structures. Visible anatomical components include the exposed metacarpal bones, intrinsic hand musculature (interossei), and the distal radius and ulna of the forearm. A large section of the soft tissue remains connected proximally, revealing the underlying bone and deep forearm musculature. The purpose of this technique is to harvest a neurovascularly intact soft tissue flap from a non-salvageable distal extremity to provide coverage for a proximal amputation stump. The procedure highlights principles of orthopaedic oncology and reconstructive plastic surgery, specifically the use of spare parts for wound closure.

This composite educational graphic illustrates a multi-stage orthopedic surgical procedure for forearm bone reconstruction and fixation. Panel (a) shows an intraoperative clinical photograph of the surgical site with muscle retraction and use of surgical instruments to expose the radius and ulna. Panel (b) demonstrates the internal fixation phase, featuring a metallic locking compression plate secured with five screws onto a bone segment, effectively bridging a surgical osteotomy. Panel (c) shows the post-operative skin closure with a long, curvilinear incision along the dorsal-lateral forearm secured by surgical staples. Panel (d) presents postoperative anteroposterior (AP) and lateral radiographic views of the forearm. These X-rays confirm the alignment of the distal radius with the proximal ulna, showing the metallic plate and screw construct in situ. The radiographs also demonstrate the absence of the proximal radius following excision and the presence of a surgical drain. This sequence is representative of a complex reconstruction for conditions such as radial head dislocation or distal ulnar deficiency.

Intraoperative clinical photograph showing a single-bone forearm reconstruction. The image depicts a surgical field with an extensive longitudinal incision on the forearm. A metallic compression plate is positioned across an osteotomy site, fixating the remaining proximal ulna to the distal radius with five visible bicortical screws. The surrounding anatomy shows exposed red muscle tissue and retracted skin edges held by surgical retractors. The hand and digits are visible at the top of the frame, showing some blood staining typical of an active procedure. This visual demonstrates an osteosynthesis technique used for salvage or reconstructive procedures, such as those necessitated by hereditary multiple exostoses. The orientation shows a distal-to-proximal alignment intended to restore forearm stability and axial alignment. Blue surgical drapes and gloved hands are visible, highlighting the sterile operative environment.

A side-by-side clinical photograph documenting surgical planning for a major upper limb amputation and the resulting specimen. The left panel shows the patient's distal forearm and hand prior to surgery. A 'fish mouth' incision line is marked in surgical ink at the mid-distal forearm, accompanied by a '12 cm' measurement. Multiple small circular markings and areas of skin mottling/discoloration are visible on the forearm, suggesting compromised vascularity. The left ring finger demonstrates clear dry gangrene with black, necrotic tissue. The right panel displays the amputated distal hand segment positioned on a blue sterile field. The specimen shows the exposed radius and ulna at the proximal resection margin. The palmar surface of the hand reveals non-healing surgical wounds and sutures at the base of the fingers, particularly near the gangrenous ring finger. This visual illustrates surgical level selection and planning in the context of peripheral vascular disease and diabetic limb complications.

A series of three intraoperative clinical photographs (d, e, f) demonstrating various orthopedic surgical instruments arranged on a sterile blue drape to illustrate spatial configurations for medical object recognition systems. Image (d) displays a set of instruments, including bone forceps, tissue forceps, surgical clamps, and a periosteal elevator, arranged in a crossed and overlapping manner. Image (e) illustrates a densely packed but non-overlapping arrangement of tools such as multiple forceps types, surgical scissors, a thyroid retractor, and a scalpel handle. Image (f) shows a sparse, non-overlapping configuration featuring a thyroid retractor, surgical scissors, bone forceps, and a spreader. The collection highlights key morphological features of common surgical tools, emphasizing differences in head shapes, sizes (e.g., vascular forceps), and handle types used in basic orthopedic procedures. These images serve as educational examples for surgical tray organization and the development of automated instrument counting and identification algorithms in a clinical setting.

This intraoperative clinical photograph displays a comprehensive instrumentation set organized on a sterile blue drape, prepared for a thyroidectomy or a similar head and neck surgical procedure. The set combines traditional open surgical tools with specialized endoscopic equipment. Key categories of instruments visible include: (1) Dissection and Cutting: Metzenbaum scissors (short and long), a scalpel handle, and monopolar electrocautery with a long tip extension. (2) Grasping and Clamping: Various forceps including DeBakey atraumatic forceps (short and long), Klemmer tissue forceps, and Johann forceps. (3) Retraction: Farabeuf and Langenbeck wound retractors alongside a specialized modified thyroidectomy retractor (Modena retractor) designed for specific working space maintenance. (4) Minimally Invasive/Endoscopic Tools: A 30° endoscopic camera, multiple trocars, a vessel sealing device for hemostasis, and an endoscopic suction/irrigation assembly with flexible tubing. (5) Miscellaneous: Sterile gauze pads and a basin containing surgical solution. This image serves as an educational reference for perioperative nursing and surgical preparation for combined open and endoscopic neck surgery.

This intraoperative clinical photograph displays a surgical instrument setup on a Mayo stand draped in green sterile fabric, prepared for a thyroid or neck procedure. On the left, a circular basin contains a syringe and needles, while a kidney dish holds gauze and packaged scalpel blades. Below these, long vascular forceps and a three-pronged white self-retaining retractor are visible. The center area contains coiled electrosurgical cords, a blue bovie pen, and suction tubing. The right side features a large, rectangular tray densely packed with specialized surgical tools, including Macindoe scissors, dissection clips, various fine-tipped forceps, and clamps. Additional instruments outside the tray on the upper right include hinged retractors and slender grasping tools. The arrangement illustrates standard operating room protocol for sharp safety, using kidney dishes for transfer and organized trays for instrument management. This visual serves as an educational resource for surgical technology, perioperative nursing, and surgical residency training, emphasizing the organization and nomenclature of head and neck surgical instrumentation.

Clinical photograph of a severe traumatic injury to the index finger of a 69-year-old patient, following a circular saw accident. The image shows an extensive, longitudinal open wound and partial amputation involving the middle (P2) and distal (P3) phalanges. There is significant destruction and loss of skin, subcutaneous tissue, and deeper structures. The wound exhibits irregular, macerated edges with visible exposure of bone fragments and likely tendon or neurovascular damage. Surgical forceps and a retractor are shown manipulating the tissues to assess the extent of the damage during primary soft tissue management. The surrounding skin of the hand appears relatively intact, although localized ecchymosis and active hemorrhage are present within the injury site. This visual illustrates a high-energy hand trauma scenario that necessitates complex surgical intervention, ultimately resulting in proximal interphalangeal (PIP) joint exarticulation and stump formation.

This clinical photograph shows an intraoperative view of a surgical procedure involving the right sternoclavicular joint (SCJ). The image captures an open anterior clavicle approach with exposed deep tissue and bone. Two Kocher forceps are utilized to mark and grasp the medial clavicle in preparation for resection. Additional surgical instruments, including a metal retractor and a scalpel handle, are visible within the operative field, which exhibits significant hemorrhagic staining and disrupted soft tissue consistent with active debridement for septic arthritis. The surgical team is seen wearing sterile blue gowns and light-colored surgical gloves with visible blood staining. This visual serves as an educational example of orthopedic surgical management for SCJ infection, specifically demonstrating the marking of the resection length on the medial clavicle. The image illustrates the anatomical relationship of the medial clavicle to the surrounding anterior chest wall musculature and the depth of the surgical field required for effective joint irrigation and debridement.

This clinical photograph captures a close-up of an open rhinoplasty procedure focusing on the exposure of the nasal septum. The surgical field demonstrates the elevation of the mucoperichondrial flap from the underlying septal cartilage, creating a sub-mucoperichondrial plane. The septum appears as a central, whitish-pink structure composed of smooth cartilage and more rigid posterior bone. Several surgical instruments are in use: a retractor is positioned superiorly to provide exposure of the osteocartilaginous dorsum, forceps are holding soft tissue edges, and a scalpel is performing a precise incision or dissection along the septal cartilage. A sharp elevator or probe is also visible, assisting in tissue manipulation. Hemorrhagic spots are present throughout the field, typical of active dissection. This image illustrates a critical stage in septal surgery, necessary for correcting deviations or harvesting graft material, such as spreader grafts, to improve the internal nasal valve and airway patency.

This composite image illustrates the surgical use of a Gigli saw for performing an olecranon osteotomy. Panel (a) is a photograph of the instrument itself, showing a flexible, twisted wire cable made of high-tensile stainless steel, attached to two T-shaped handles designed for a two-handed to-and-fro cutting motion. Panel (b) provides an intra-operative clinical photograph showing the surgical field of the elbow. A surgeon’s gloved hands are visible manipulating the Gigli saw, which has been passed through the soft tissue to interface with the bone. The operative area shows exposed muscle and bone with appropriate surgical retraction. Panel (c) is a labeled anatomical diagram depicting the path of the saw in relation to the distal humerus, the head of the radius, and the semilunar notch of the olecranon. The diagram highlights the 'inside-out' technique, where the saw is positioned against the articulating surface of the sigmoid notch (devoid of cartilage) and moved vertically to the surface of the olecranon to create a clean, linear osteotomy for joint exposure during distal humerus fracture fixation.

Clinical photograph in two panels (A and B) demonstrating a bilateral transtibial (below-knee) amputation procedure in a surgical setting. Panel A shows an intraoperative view of the right lower extremity during the amputation process. Visible features include exposed muscle, bone, and vascular tissues at the distal stump, with blood-stained surgical drapes and a gloved surgeon's hand stabilizing the limb. Panel B illustrates the postoperative result for both the left and right legs. Both stumps are now surgically closed and encased in clean, white pressure dressings. A green pneumatic tourniquet or Esmarch bandage is visible on the upper thigh of one limb to maintain hemostasis. Both images show the patient positioned on a green sterile surgical drape. The content illustrates the progression from an active surgical resection to the final stabilized postoperative state of bilateral residual limbs, relevant for surgical education, anesthesia management (CFSNBs), and perioperative care training.

This clinical photograph captures an intraoperative view of a mandibular osteotomy procedure, a critical step in maxillofacial reconstruction or tumor resection (e.g., for ameloblastoma). The surgical field shows the exposed mandible with distinct purple ink markings on the cortical bone surface, indicating the planned osteotomy line derived from a preoperative rapid prototyping (RP) template. A surgical Gigli saw is visible on the left, positioned to initiate the bone cut along the marked path. An orange-tipped surgical instrument is also seen being applied to the inferior border of the mandible to assist in stabilization or guidance. The surrounding soft tissue is retracted, showing the submandibular surgical approach and the blood-stained operative site. This image demonstrates the clinical application of computer-aided surgical planning and template-guided osteotomy to ensure high precision in mandibular resection, facilitating accurate subsequent reconstruction with bone grafts.

Two intra-operative clinical photographs demonstrating a surgical exposure of the distal humerus via an olecranon osteotomy using a Gigli saw. Panel (a) shows the immediate post-osteotomy state where the proximal olecranon fragment and the triceps extensor mechanism have been retracted to reveal the whitish-yellow articular surface of the distal humerus. The surgical field displays exposed reddish muscular tissue and yellow subcutaneous adipose tissue. Panel (b) illustrates the active manipulation and further dissection of the humerus for fracture visualization. Gloved hands are seen retracting the soft tissues and mobilizing the bone fragments. The images highlight a posterior approach to the elbow joint, a common technique for managing complex intra-articular distal humerus fractures to achieve anatomical reduction of the articular surface. The surgical field is moist and contains moderate blood typical of orthopedic procedures involving significant bone and soft tissue exposure.

This composite clinical photograph displays two sequential stages of an osteo-periosteal suture procedure during orthopedic surgery, specifically focusing on the medial clavicle. The top panel illustrates fracture reduction using Jayle's forceps to manipulate and realign the bone fragments within an open surgical field. Retractors are positioned to provide visualization of the red, vascularized periosteal tissue and underlying bone. The bottom panel demonstrates the next stage: bone perforation using a drill bit held in a Jacobs chuck. This step facilitates the passage of non-resorbable sutures for final fixation. Multiple surgical retractors, stay sutures, and sterile adhesive drapes are visible throughout the intraoperative site. The image serves as a teaching tool for surgical techniques in managing sternoclavicular joint injuries or clavicular epiphysiolysis, highlighting the transition from anatomical reduction to mechanical preparation for internal fixation.

This clinical photograph captures an intraoperative view of a redo median sternotomy in a patient with previous sternal reconstruction. The surgical field demonstrates the use of an oscillating saw to perform a midline osteotomy through the sternal bone. A key feature of this procedure is the management of pre-existing horizontal titanium fixation plates. These plates, which were used for prior sternal wound reconstruction, have been cut at the midline; surgical forceps are being used to pull the plate edges upward and outward. This maneuver facilitates safer re-entry by increasing visualization and space between the oscillating saw and the underlying mediastinal structures. The surrounding surgical site is prepped with iodine-based solution and framed by sterile blue drapes. Visible instrumentation includes the oscillating saw, multiple surgical clamps/forceps for retraction, and suction tubing for fluid management. This image illustrates advanced cardiothoracic surgical techniques for managing complex sternal re-operations in the context of prior deep sternal wound infection (DSWI) and hardware fixation.

Clinical photograph illustrating an intraoperative stage of a proximal tibial bone graft harvest. The image shows a small, rectangular surgical incision on the medial aspect of the proximal tibia, approximately 2 cm below the tibial tuberosity. Within the open wound, the cortical bone window and cancellous bone are visible, with minor localized bleeding at the wound edges. A right-angled pituitary forceps is inserted into the osteotomy site to retrieve cancellous bone fragments. A periosteal elevator is positioned at the superior margin of the incision to maintain exposure. A sterile stainless steel bowl is held adjacent to the site by a gloved assistant to receive the harvested graft material. The procedure is performed under sterile conditions, indicated by green surgical drapes and latex-free surgical gloves. This visual demonstrates the medial approach for harvesting autologous bone graft from the tibia, highlighting relevant surgical instruments and anatomical landmarks for orthopedic surgery education.

This intraoperative clinical photograph captures a Doppler-guided hemorrhoidal artery ligation (DGHAL) procedure. The primary focus is a specialized circular, silver-colored anoscope head held by a gloved hand. The device is labeled with 'A.M.I.' in blue, alongside functional markings such as 'WINDOW' in red, 'END', and 'LIG'. These indicators assist the surgeon in orienting the side window for precise arterial targeting. Through the central aperture, surgical forceps are visible manipulating a blue absorbable suture needle into the rectal mucosa. This illustrates the ligation phase of treating symptomatic hemorrhoids, where Doppler ultrasound transducers within the anoscope wall first identify arterial signals, allowing for targeted devascularization and mucopexy. The image serves as a high-fidelity educational tool for colorectal surgeons and residents, demonstrating the use of specialized proctological equipment in minimally invasive surgical interventions.