Videoscopic assisted thoracoscopic surgery in correction of thoracic scoliosis
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This document discusses thoracoscopic scoliosis correction, a minimally invasive surgical technique. It describes how thoracoscopic spine surgery uses small incisions and an endoscopic camera to correct scoliosis through a single-lung ventilation technique. The advantages over traditional thoracotomy include less invasiveness, earlier return to work, and less postoperative morbidity. The document also presents a case study of an 11-year-old female patient who underwent successful thoracoscopic instrumented correction of her scoliosis.
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This document provides a history of surgery for otosclerosis and stapes surgery from the late 1800s to modern times. It summarizes key developments such as the first stapedectomy performed by John Shea in 1956 using an oval window vein graft and nylon prosthesis. The goals, indications, contraindications, surgical techniques including stapedectomy and stapedotomy are described in detail. Potential problems during surgery like floating footplates, perilymph gushers, and overhanging facial nerves are also outlined along with post-operative care and complications. Long term results tend to show initial hearing improvements are often not maintained over decades with re-operation or hearing aid use often needed.
New advances in spine surgery
This document discusses new advances in spine surgery. It describes minimally invasive techniques that are becoming more common, such as balloon kyphoplasty to treat vertebral fractures, cervical disc replacement instead of fusion, and minimal access lumbar surgery. These new approaches aim to reduce trauma to muscles and soft tissues compared to conventional open surgeries. The document also discusses the importance of selecting the right surgical treatment and technique based on a patient's individual clinical findings and investigational results.
Fractures around hip
Fractures and dislocations around the hip can include femoral neck fractures, intertrochanteric fractures, subtrochanteric fractures, femoral head fractures, acetabular fractures, and hip dislocations. The document discusses the anatomy, mechanisms of injury, classifications, presentations, imaging, and treatment options for each of these conditions. Treatment may involve nonoperative management or operative procedures like open reduction internal fixation or arthroplasty depending on the fracture pattern and degree of displacement. Complications can include avascular necrosis, nonunion, malunion, and post-traumatic arthritis.
Neck of femur fracture & Trochanteric femur fracture
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INJURIES AROUND HIP [Autosaved].pptx
This document discusses various injuries around the hip joint, including dislocation of the hip, fractures of the neck of femur, and intertrochanteric fractures of the femur. It describes the mechanisms, clinical presentations, investigations, treatments, and potential complications of each type of injury. Posterior dislocation of the hip is discussed in most detail, outlining the mechanism of injury, clinical signs, imaging findings, closed and open reduction techniques, and immobilization methods. Fractures of the neck of femur are also covered in depth, including classification systems, risk factors, anatomy, diagnosis, and various treatment options depending on patient factors.
Amputation principles
This document outlines the principles of amputation, including definitions, indications, classifications, pre-operative preparations, operative techniques, post-operative care, complications, rehabilitation, prosthetics, and follow-up. It notes that amputation involves removing a limb or part of a limb by trauma, constriction or surgery. The pre-operative assessment determines the appropriate level of amputation based on factors like blood supply. The surgery involves dividing muscles and bones above the intended level and creating skin flaps for coverage. Post-operative care focuses on rehabilitation, residual limb shaping, and prosthetic fitting to maximize patient function and independence.
Dr mmp miss thorasic infection
This document discusses minimal access and endoscopic approaches to spinal surgery. It notes the advantages of these approaches over conventional open surgeries, including less tissue damage, blood loss, post-operative pain and recovery time. Specific techniques discussed include video-assisted thoracoscopic surgery (VATS) for thoracic procedures and endoscopic retroperitoneal approaches for lumbar surgery. Indications, equipment, positioning and technical considerations for performing VATS and spinal endoscopy are outlined. Case examples of using these techniques for thoracic tuberculosis and discitis are also presented.
Intertrochanteric fracture
1) Intertrochanteric fractures occur in the region between the greater and lesser trochanter of the proximal femur. They are extracapsular fractures that usually unite easily with abundant blood supply.
2) These fractures are common in elderly individuals, often resulting from a sideways fall. Younger patients may incur these fractures from high-energy injuries.
3) Treatment involves restoring the normal femoral neck shaft angle to allow early mobilization. Conservative treatment uses traction methods while surgery employs internal fixation devices like dynamic hip screws or intramedullary nails.
neglected proximal humerus fractures-a surgical challenge, dr mohamed ashraf...
neglected proximal humerus fractures are a nightmare for trauma surgeons due to its poor outcome.dr mohamed ashraf enumerate and demonstrate the surgical challeneges and tips and tricks of surgical management of these fractures
Fracture neck of femur
This document discusses the anatomy, blood supply, classification, clinical features, treatment, and complications of fractures of the neck of the femur. It notes that these fractures most commonly occur in elderly women due to low-energy falls. The goals of treatment are to minimize discomfort, restore hip function, achieve early stable fixation or prosthetic replacement, and allow rapid mobilization. Surgical options include internal fixation with screws or plates for younger patients or total hip replacement or hemiarthroplasty for elderly patients. Complications can include non-union, osteonecrosis, fixation failure, and issues associated with prolonged immobilization.
Amputation Topic Orthopaedics Presentation
This document provides information about amputation indications, surgical principles, and post-operative care. It discusses various types of amputations for both lower and upper limbs. The main indications for amputation include peripheral vascular disease, trauma, malignancy, infection, burns, and frostbite. The surgical principles focus on choosing an amputation level for optimal function, creating adequate skin and muscle flaps, and hemostasis. Post-operative care involves pain management, rigid dressings, physiotherapy, and prosthetic training to prevent complications like infection, contractures, and phantom limb pain.
Shoulder and ankle instability
This document discusses shoulder and ankle injuries. Regarding shoulders, it describes the anatomy and stabilizers of the shoulder joint. It discusses classifications for shoulder instability and common associated lesions like Bankart and Hill-Sachs lesions. For ankles, it outlines the prevalence and classifications of ankle sprains and fractures. It provides guidance on clinical examination, imaging and management considerations for various ankle injuries.
anesthetic considerations in spine surgery
This document discusses anesthetic considerations for spine surgery. It covers various types of spine surgeries and their associated risks. Prone positioning presents challenges like difficult airway and eye injuries that can be prevented with proper positioning and monitoring of vital parameters. Blood loss is a major concern, especially in complex procedures, so measures like hypotensive anesthesia and antifibrinolytic therapy are used. Neurological monitoring techniques like SSEP and MEP are employed to detect injuries. Recent advances in navigation, endoscopy and robotics have made surgeries less invasive with benefits like lower blood loss and faster recovery. Regional anesthesia and specialized equipment allow addressing anesthesia needs for complex cases and new techniques.
Thoracic Outlet Syndrome
This document describes a case of thoracic outlet syndrome caused by a cervical rib in a 22-year old male patient who presented with numbness, pain, discoloration, and swelling in his right arm. Imaging revealed a cervical rib compressing the brachial plexus. The patient underwent surgery to remove the cervical rib, which relieved his symptoms. The document then provides an overview of thoracic outlet syndrome, including its causes, types, symptoms, diagnostic techniques like physical exams and imaging, and treatment options like physical therapy, medications, and surgical decompression.
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Developmental coxa vara is a rare developmental abnormality characterized by decreased femoral neck-shaft angle, short femoral neck, and relative overgrowth of the greater trochanter. It presents after walking age with limping. Radiographs show decreased neck-shaft angle and triangular bone fragment in medial femoral neck. Treatment involves surgical correction of deformity.
A summary of fractures of acetabulum
The document provides an overview of acetabular fractures, including anatomy, mechanisms of injury, clinical evaluation, classification, and treatment. It describes the two-column construct of the acetabulum and classifies fractures according to the Judet-Letournel system as elementary or associated. Treatment involves restoring congruity through nonoperative or operative means, with the goal of anatomic reduction to prevent post-traumatic arthritis. Surgical approaches aim to address instability, congruity, and osseous fragments through open reduction and internal fixation.
Terrible triad of the Elbow
1) The document discusses the anatomy, definition, classification, treatment, and prognosis of the "terrible triad of the elbow" injury, which involves concurrent fractures of the radial head and coronoid process along with elbow dislocation.
2) The terrible triad injury commonly results from high-energy trauma and causes damage to multiple ligaments and bone structures in the elbow. Proper management focuses on repairing the coronoid process, radial head, and lateral collateral ligaments.
3) With recent advances, outcomes of treated terrible triad injuries have significantly improved, with most patients regaining over 100 degrees of flexion. However, the authors argue that the term "terrible triad" is no longer accurate
The foot in CP part 2 of 3
The document discusses various foot deformities that can occur in cerebral palsy, including varus, valgus, equinovarus, and equinovalgus deformities. It describes how these deformities can be addressed through both soft tissue procedures like tendon lengthenings and transfers, as well as bone procedures like osteotomies of the calcaneus when deformities are rigid. Specific procedures discussed in detail include posterior tibial tendon lengthening and transfers, anterior tibial tendon splits, and Dwyer's calcaneal osteotomy.
The foot in cp part 1 of 3
The document provides an overview of surgical techniques for correcting equinus deformity in patients with cerebral palsy. It discusses the causes of equinus deformity and indications for surgery. Several open and percutaneous surgical techniques are described for lengthening the Achilles tendon or gastrocnemius-soleus muscle complex, including the White modification, Z-plasty lengthening, Moreau and Lake percutaneous lengthening, and Strayer gastrocnemius-soleus lengthening. Postoperative care involves casting the leg in dorsiflexion followed by bracing to maintain correction. Surgical treatment aims to improve ambulation but may require additional procedures to address unmasked toe deformities.
The knee in cerebral palsy
This document provides an overview of knee deformities in cerebral palsy and treatments for flexion deformity. It discusses how the hip and knee are related through connecting muscles. Flexion deformity is the most common knee issue and can be caused by tight hamstrings, weak quads, or other factors. Evaluation involves assessing various muscles for spasticity and strength. Common surgical techniques discussed include fractional lengthening of the hamstring tendons and combined hamstring lengthening with posterior capsule release. Distal femoral extension osteotomy with patellar tendon advancement is also summarized.
The hip in cerebral palsy part 1 of 2
This document provides an overview of common hip deformities and surgical procedures used to treat hip issues in cerebral palsy patients. It discusses flexion, adduction, and subluxation/dislocation deformities and treatments like adductor tenotomy, iliopsoas recession/release, and varus derotational osteotomy. Flexion deformities are addressed with procedures like psoas lengthening while adduction issues are treated with soft tissue releases like adductor tenotomy. More severe cases may require bony procedures such as varus derotational osteotomy. Post-operative care focuses on physical therapy and positioning to improve hip range of motion.
The hip in cerebral palsy part 2 of 2
This document provides an overview of hip deformities in cerebral palsy and various surgical procedures used to treat them. It discusses hip subluxation and dislocation, risk factors, and treatments like adductor releases and varus derotational osteotomies. It then describes the details of the combined one-stage correction procedure known as the "San Diego procedure", which involves a lateral femoral osteotomy and anterior pericapsular pelvic osteotomy to realign the hip. Diagrams illustrate the surgical steps of each approach. The goal of these interventions is to prevent progressive hip deformity and dislocation in cerebral palsy patients.
Fat embolism
This document provides background information on fat embolism syndrome (FES). It discusses that FES has a high incidence in patients with major trauma and causes multi-organ inflammation if not diagnosed and treated swiftly. While the exact mechanisms are not fully understood, FES is thought to be triggered by the release of fat emboli from bone fractures that occlude blood vessels and cause pulmonary and systemic inflammation. The diagnosis is mainly clinical based on respiratory, skin and neurological symptoms following trauma. Supportive care is the primary treatment approach through oxygenation, ventilation and symptom management while efforts focus on prevention, early diagnosis and surgical stabilization of fractures.
Ortho club sept2015
This document presents a case study of an unusual outcome in an untreated femoral neck fracture. A 55-year-old woman fell and sustained an intra-capsular fracture of the left femoral neck but refused surgical treatment. Ten years later, imaging showed that her fracture had developed a pelvi-femoral bony bridge with pseudarthrosis and nonunion of the fracture site. This outcome of pelvi-femoral bony bridge formation in an untreated femoral neck fracture has not been previously reported. The patient was asymptomatic and no further treatment was needed.
Acute isolated medial midtarsal dislocation
The document describes two case reports of acute isolated midtarsal dislocations. Case 1 involved a 23-year-old male who sustained a medial talonavicular dislocation playing volleyball, which was treated with closed manipulation and casting. Case 2 involved a 35-year-old woman who fell from a height onto a plantarflexed foot, causing dorsal dislocation of the talonavicular and calcaneocuboid joints, requiring open reduction and K-wire fixation. The discussion covers classification of midtarsal injuries, mechanisms of various dislocation patterns, and the rarity of isolated dorsal midtarsal dislocations. Early anatomical reduction and stable fixation were concluded to improve outcomes for these midfoot dislocation injuries.
Comparison of ceiling effects
The study found that the patient-rated outcome scores DASH and PRWE exhibited substantial ceiling effects when used to assess the outcome of surgical treatment for distal radial fractures one year post-operatively, with over 20% of patients achieving the maximum score on both scales. In contrast, the physician-rated MMWS score did not demonstrate a ceiling effect, with only 10.4% of patients achieving the maximum score. Due to the ceiling effects, the patient-rated scales were limited in their ability to distinguish between patients with high levels of function, whereas the physician-rated scale could better discriminate outcomes at the upper end of the scale.
Tissue engineering in orthopaedics
The document summarizes recent applications of tissue engineering principles in orthopaedics. It discusses how scaffolds, signals, and cells have been combined in various tissue engineering strategies to treat fracture nonunions, osteonecrosis, and chondral/osteochondral defects. For fracture nonunions, delivering mesenchymal stem cells on an atelocollagen scaffold improved healing rates. Treating osteonecrosis with autologous mesenchymal stem cells seeded on bone grafts showed prevention of disease progression in some cases. Cell doses and scaffold properties were found to influence outcomes. Tissue engineering approaches for cartilage defects, including cell injections and composite scaffolds, demonstrated symptom improvement over baseline.
Robo hand
1) Advances in 3D printing are increasing access to customized and affordable upper extremity prostheses for children.
2) Open-source 3D printed prosthesis designs can be downloaded and printed for a fraction of the cost of traditional prostheses.
3) The process involves downloading a design, scaling and customizing the parts, 3D printing the components, assembling them, fitting the prosthesis, and providing training.
Hiv and orthopaedics
1) Modern antiretroviral treatment has increased life expectancy for HIV-positive patients, resulting in more presenting for elective and emergency orthopaedic surgery.
2) HIV-positive patients can experience various musculoskeletal manifestations including bone disorders, joint diseases, myopathies, and neoplasms. Common conditions include osteomyelitis, osteonecrosis, septic arthritis, and Kaposi sarcoma.
3) Outcomes for procedures like joint replacements and fracture treatments in HIV-positive patients have been found to be comparable to HIV-negative patients when considering infection and complication rates, with some increased risk for certain patient subgroups or procedures. Overall management requires consideration of individual factors like CD4 count and viral load
Technique of percutaneous iliosacral screw fixation of sacroiliac disruptions...
This document describes a technique for percutaneous iliosacral screw fixation of a sacroiliac disruption using the patient in a supine position. A 39-year-old female presented with lower back pain and inability to move her right hip following a traffic accident. Imaging revealed a right sacroiliac joint disruption and pubic ramus fracture. The technique involves using fluoroscopy to mark the entry point in the safe zone of the sacral ala and advancing a guide wire and cannulated screw under imaging guidance. Intraoperative and postoperative imaging confirmed satisfactory screw placement, and at 35 days post-op the patient had significant pain relief and early healing was seen on x-rays.
What's new in hand surgery- 2015
This document summarizes topics presented at recent hand surgery conferences and articles published in hand surgery journals. It discusses declines in finger replantation rates, factors associated with loss of reduction in distal radius fractures involving the volar ulnar corner, higher complication rates but similar outcomes for surgical versus nonsurgical treatment of distal radius fractures in older patients, the need for caution in hand transplantation, ongoing debates around flexor tendon rehabilitation protocols, advances in extensor tendon rehabilitation using relative motion splinting, and a study showing the efficacy and safety of treating two joints rather than one with collagenase injections for Dupuytren contracture.
Cerebral palsy- Etiology and Classification
This document provides an overview of cerebral palsy, including:
1) The history of cerebral palsy, first identified by William Little in 1843.
2) The etiology and risk factors, which can include prenatal, perinatal, and postnatal brain insults between conception and age 2.
3) The classification of cerebral palsy by anatomical region affected (monoplegia, hemiplegia, diplegia, etc.) and physiological type (spastic, athetoid, ataxic, etc.). Spastic is the most common type, affecting the corticospinal tracts.
Histology of Small Round Blue Cell Tumor (SRBCT)
The document discusses small round blue cell tumors (SRBCT), describing their histological features including islands of cells with blue nuclei giving a bluish hue separated by collagen fibers. The tumor cells have monomorphic, closely packed nuclei and form pseudorosettes. Other features indicating rapid tumor growth include the tumor cells infiltrating collagen fibers and muscle fibers, as well as areas of necrosis. Immunohistochemistry is needed to confirm identification of SRBCT.
Pemberton's Osteotomy for Acetabular Dysplasia
This is a slideshow based on the journal- JBJS- ESSENTIAL SURGICAL TECHNIQUES, INDIAN EDITION, OCTOBER 2015, VOL.4, NO. 3, SPECIAL EDITION by Shier- Chieg, Huang, MD, PhD, Ting- Ming Wang, MD, PhD, Kuan- Wen Wu, MD, Ken N. Kuo, MD
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Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
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Videoscopic assisted thoracoscopic surgery in correction of thoracic scoliosis
- 1. THORACOSCOPIC SCOLIOSIS CORRECTION Dr. Libin Thomas Manathara Dr. Scott Chacko John AMALA SPINE & JOINT CENTRE AMALA INSTITUTE OF MEDICAL SCIENCES
- 3. MISS IS REALLY MINIMALLY INVASIVE SPINE SURGERY Not only the incision, but also techniques of spine surgery have been changed
- 5. THORACOSCOPIC SPINE SURGERY • SCOLIOSIS • TUMOURS • FRACTURES
- 9. THORACOSCOPIC SPINE SURGERY • ADVANTAGE THORACOSCOPIC THORACOTOMY LESS INVASIVE INVASIVE EARLY RETURN TO WORK LONG POST OPERATIVE STAY LESS MORBIDITY MORE MORBIDITY RIBS ARE INTACT RIBS ARE FRACTURED/CUT
- 10. PORTS • WORKING PORT 15-30mm • THORACO SCOPIC PORT 11mm • FAN RETRACTOR 11mm • SUCTION IRRIGATION 5mm
- 14. Special instruments required • 30 degree thoracoscope • Sharp narrow osteotome • 11mm trochar • 5mm trochar • Fan retractor • Long Cobbs elevator, Rongers • Good camera with twin monitor • Light source –LED • HARMONIC SCALPEL
- 32. 62 44 15 18
- 33. THORACOSCOPIC SCOLIOSIS CORRECTION WITHOUT SCAR ON THE BACK • 14yr old female • Right thoracic curve of 59o T4- L1 • Thoracoscopic instrumented correction • Post OP- 15o
- 34. Delta Baby, 11yrs, female, OP. NO. 2553530 Date of surgery- 10 May 2016
- 35. Presentation • Low back ache for 2 weeks duration • Cough for 2 weeks with associated posttussive emesis • No associated fever • A K/C/O Kyphoscoliosis now progressive • K/C/O ventricular septal defect for which she underwent no surgery • All developmenatl milestones attained to age • No other significant family history
- 36. Clinical Examination • Vitals stable • Systems Normal • Spine, Inspection- Visible thoracic scoliosis with convexity to right • Palpation- Kyphoscolios with thoracic scoliosis with right convexity and compensatory lumbar scoliosis with left convexity • Normal neurological examination
- 37. Pre surgical work up • Pre anaesthetic, cardiology and pulmonology work up was done, no contraindication to surgery • History of congenital heart disease- small sub aortic VSD was noted • PFT done- moderate restriction noted (FVC 52%), No BDR (Bronchodilator responsiveness)
- 38. Surgical Procedure • Video – Assisted Thoracoscopic Spine Surgery (VATS) for Scoliosis • Anteriorly approached via 5 ports under C- arm control • Adequate reduction was obtained
- 39. Right thoracic convexity of 90 degrees and left lumbar convexity of 37 degrees- pre op
- 40. Post op xray
- 41. Discussion • The word “scoliosis” is derived from the Greek word meaning “crooked” • Scoliosis is defined as a lateral deviation of the normal vertical line of the spine • The lateral curvature of the spine also is associated with rotation of the vertebrae • This produces a three-dimensional deformity of the spine that occurs in the sagittal, frontal, and coronal planes
- 42. Discussion • Surgery for scoliosis has seen dramatic progress in the methods of treatment • The surgical incision is most commonly performed posteriorly, on the back of the spine, but there are specific circumstances when an incision is needed to approach the front of the spine (anterior approach)
- 43. Discussion • Historically, anterior surgery was performed through an open thoracotomy • This required a large incision through the chest wall and chest cavity • Technological advances have allowed spine surgeons to perform these same procedures through small incisions in the chest wall using endoscopic instruments
- 45. THORACOSCOPIC SPINE SURGERY DISADVANTAGE STEEP LEARNING CURVE
- 47. AMALA SPINE & JOINT CENTRE