explanation about limp salvage

1. LIMP SALVAGE ANAS AL DERBASHI

2. *DEFINE BONE SARCOMA *INDICATION FOR SURGERY. *PHYSICAL EXAMINATION * *TYPE & COMPONENT OF PROSTHESIS *NURSING COMSIDERATION *SURGERY KNEE &HIP PROCEDUREOPARATIVE *TO KNOW SURGIAL INSTURMENT USED IN OBEJECIVE:

3. Its divided into two group: 1.Benign tumors: *Bone cysts, are expanding lesion within bone this present with painful, palpable mass of the long bone (vertebra or flat bone) in children may cause pathological fracture. *Osteochondroma. 2.Malignant tumors: *Sarcoma, its from connective and supportive tissue. *myelomas bone marrow tumor . *(OSTEOSARCOMA)is the most common malignant bone tumors BONE TUMORE

4. BONE TUMORS Ewing’s sarcoma of the distal two-thirds of the femur, Sagittal section of a high-grade osteosarcoma of the distal femur. Biologic behavior of bone and soft-tissue sarcomas

5. Extension of an osteosarcoma of the distal femur to the knee joint along the cruciate ligaments

6. *Rheumatoid arthritis *Osteosarcoma *Trauma *Maintain stability *Relieve pain INDICATION OF SURGERY

7. *Physical examination of orthopedic injuries in the ED is based on a simple four step process *Palpation of the injury for deformity and tenderness *Assess range of motion (both active and passive) of the affected bone, as well as consideration of the joints above and below the injured bone *Inspection (deformity, swelling, discoloration) Neurovascular exam PHYSICAL EXAMINATION

8. Preoperative planning might include physical examination, patient education, radiographic examination, ((((Patients should be educated about what to expect before, during, and after surgery)))), PHYSICAL EXAMINATION

9. Most joint replacement consist metal and high density polyethylene component ,the joint implant may cemented in the prepared bone with polymethy methacrylate (PMMA: a bone bonding agent) which has properties similar to bone which may lead to failure of prosthesis, cementing method of securing prosthetic implant. *Cementless,artificial joint component ,porouse-coated.that allow pt bone to grow accurate fitting and the presence of healthy bone with adequate blood supply are important in using cementless component TYPE &COMPONENT OF PROSTHESIS

10. Distal femoral modular replacement. The most current prosthetic design for replacement

11. Modular prostheses. (A) Proximal femur, and (B) total femur

12. 1.Pain management(medication). 2.Wound care(keep wound clean and dry sign of infection). 3.Mobility(using assistive device, don’t moving in acute flexion put pillow between knee) 4.Potential problems. dislocation of prosthesis,, pain,,encourge pt to accept help with ADLs. NURSING CONSEDRATION

13. T K R

14. KNEE SURGERYLIMP SALVAGE (A) Anatomic location of malignancy. Adequate resection includes 15–20 cm of the distal femur and proximal tibia and portions of the quadriceps. (B) An intra-articular resection is usually performed.

15. SURGICAL PROCEDURE FOR DISTAL FEMUR Surgical approach and incision. The patient is placed supine on the operating table. The entire extremity, including the groin and pelvis, is prepared and Draped The groin should always be included to allow for the rare instance in which exposure of the common femoral vessels is required.

16. (A) Popliteal exploration. Resectability is determined by exploration of the popliteal space and vessels. (B) Superficial femoral artery exploration. The superficial femoral artery is (C) Posterior exploration. The interval between the popliteal vessels and the posterior femur is developed and explored. The popliteal artery is mobilized,

17. Distal femoral resection. Proximal femoral osteotomy

18. Tibial osteotomy and preparation of the femur Preparation of the proximal tibial canal Preparation of distal femur by facing reamer.

19. Trial reduction with templates. The purpose of the trial reduction is to determine the easy of insertion of the femoral and tibial components prior to cementing

21. CLOSURE

23. spacer blocks Resect the distal femur using the chosen resection level. The distal thickness of the Sigma femoral implant is 9 mm (10 mm on size 6). The holes on the block are designated -2, 0 and +2, indicating in millimeters the amount of bone resection each will yield supplemental to that indicated on the calibrated outrigger. Position the oscillating saw blade through the slot or, where applicable, position the blade flush to the top cutting surface of the block. Resect the condyles and check the surface for accuracy.

24. Assemble the upper cutting platform Assemble the upper cutting platform Translate the lower assembly anteroposteriorly to align it parallel to the tibial axis.

25. Lateral alignment is similarly confirmed.

26. Cut an entry slot with a narrow oscillating saw into the intercondyle the attachment of the PCL. Position an osteotome to shield the ligament Fixation of plate cutting in the tibia anterior with alignment reevaluation at trial reduction.

27. FEMORAL SIZER

28. The Femoral Sizing Guide: Anterior Down/Posterior Up The Anterior Reference Femoral Sizing Guide

29. Cutting Block

30. TABIAL PREPRATION STEM PUNCH drill bushing

32. Femoral and proximal tibial cuts are now completed.

33. FINISH CUTTING THE FEMURE AND TIBIA THIN PREPARED FOR TRIAL

34. Trial Reduction

35. permanent tibial insert at any time during the cementing procedure.

36. LIMP SALVAGE TOTAL FEMUR SAVAGE

37. Titanium are strong, have excellent biocompatibility, and are more flexible than Cocr

38. PROXIMAL FEMUR

39. NORMALHIP

40. COMPONANT OF T H R Acetabular Component ,,shell & liner Femoral Component ,stem and head

42. Proximal humeralprostheses

43. PROXIMAL HUMERUS

44. proximal tibial

46. Various proximal tibial prostheses

47. surgery requires a number of instruments to be available to the surgeon. Surgical instruments are needed to expose the joint, retract and protect soft tissue, and cut and shape the bone. Additionally, trays of instruments are provided with implant systems. These instruments allow for appropriate sizing, shaping, and cutting of the bone SURGICAL INSTRUMENT

48. These general instrument trays should include: • standard surgical instruments: a basic tray that varies from hospital to hospital but should include scissors, hemostats, clamps, retractors, forceps, scalpel handles, needle holders, and other standard instruments • retractors: general retractors that are used on many different orthopedic surgical procedures (e.g., Hofmann, Hibbs, and Richardson retractors); and specific retractors that are used for particular TJA applications (e.g., a Charley retractor for THA or a notch retractor for TKA) • osteotomes: surgical chisels that come in various sizes (usually 0.25 to 1 inch) and are either straight or curved SURGICAL INSTRUMENT

49. • curettes: spoon-shaped cutting tools that come in various sizes (2–5 mm) • rongeurs: plier-like tissue resectors that have slightly sharpened jaws used to grab and/or rip tissue • large oscillating and/or reciprocating saw (depending on surgeon preference) for cutting/shaping bone • reamer: a drill-like device with a high torque-to-speed ratio used to prepare the canal of the femur or humerus

50. acetabular reamer: reamer that has a hemispherical head to prepare the acetabulum for cup replacement • pulsatile lavage system: battery-operated irrigating system that delivers pressurized irrigation • medullary canal preparation kit: brush used to scrub the intramedullary canal after reaming/broaching, suction apparatus, cement restrictor, etc; used to mechanically remove any debris from the canal prior to cementing • post-op drain system (if the surgeon prefers a drain;) • cement gun • vacuum cement mixer: cement mixing bowl used under suction; limits formation of air pockets in the cement and limits staff exposure to methylmethacrylate fumes • electrocautery: instrument whose electrified tip is used to cauterize bleeding tissue

52. THANK YOU