1) The study evaluated 55 children treated with Pavlik harnesses for developmental dysplasia of the hip (DDH) to identify early ultrasound predictors of late acetabular dysplasia or avascular necrosis.
2) Three sonographic findings on initial ultrasounds predicted late sequelae: a dynamic coverage index of 22% or less, an alpha angle less than 43 degrees, and abnormal echogenicity of the cartilaginous roof.
3) Abnormal echogenicity of the cartilaginous roof was the most specific single predictor, with a sensitivity of 100% and specificity of 88% for residual dysplasia.
Reverse shoulder arthroplasty using an implant with a lateral center of rotationSatoshi Kajiyama
Reverse shoulder arthroplasty (RSA) using an implant with a lateral center of rotation was studied to evaluate outcomes, complications, and the influence of surgeon experience. At minimum 2-year follow-up of the first 60 RSAs performed by a single surgeon:
- Mean improvements in range of motion and shoulder function scores were significant and comparable to results reported by the implant's design team.
- Experience influenced results, with better outcomes in the later cases compared to the initial 15 cases.
- Complications including revision surgeries were more common in the early cases, indicating a potential learning curve for the procedure.
This document discusses adjacent level disease in the cervical spine. It provides background on a 62-year-old woman who presented with neck and occipital pain and had a history of anterior cervical discectomy and fusion surgeries at C5-C6 and C6-C7 levels in 1990 and 2007. It then reviews literature on adjacent segment degeneration rates of about 3% per year and 25% within 10 years, with risk factors including pre-existing degeneration and fusions at lower cervical levels.
Selective fusion for idiopathic scoliosis review by dr.shashidhar b kDr. Shashidhar B K
SCOLIOISIS SURGEON BANGALORE
SCOLIOSIS SURGEON INDIA
Website: http://spinesurgeonbangalore.com/
My goal is to provide spine care with a patient centeric-holistic approach in Bangalore, encompassing all aspects of non-operative and operative management of spinal disorders with special interest in the management of spinal deformities (scoliosis and kyphosis).
Bangalore Spine Specilaist Clinic. For Appointment contact : Call: 08025442552( 9 am to 9 pm). Whatsapp: +919448311068. Email: drshashidharbk@gmail.com.
This study evaluated the intermediate and long-term results of femoral neck lengthening (Morscher osteotomy) in 18 patients (20 hips) with a median follow-up of 7 years. Postoperatively, the Trendelenburg test was negative in most patients and the median Harris Hip Score improved significantly. Radiographic examination found progression of osteoarthritis in 3 patients, while one operation failed and required total hip replacement after 4 years and two others required it at 10 years. The procedure successfully reduced leg length discrepancy in most patients. The study concluded that Morscher osteotomy can effectively treat patients with short femoral neck and overgrown greater trochanter with a positive Trendelenburg test and mild leg length
1) Arthroscopic stabilization of anterior shoulder instability has advantages over open surgery such as better cosmesis, less morbidity, and possibly less loss of external rotation. However, past studies reporting on arthroscopic stabilization have been limited by small sample sizes and variable surgical techniques and patient characteristics.
2) Several arthroscopic techniques have been developed and studied, including stapling, transglenoid suturing, suture anchors, and biodegradable tacks. Recurrence rates vary significantly between studies and depend on patient factors like age and activity level. Improper patient selection and surgical technique also contribute to failed stabilization.
3) Recent studies directly comparing suture anchor and transglenoid fixation techniques found lower recurrence
This study evaluated the short-term clinical and radiographic outcomes of 64 patients who underwent biological resurfacing of the glenoid with a dermal graft and humeral head resurfacing. At a minimum of 2 years follow-up, patients demonstrated improvements in pain, range of motion, and function based on standardized scores. Radiographically, the procedure improved glenoid version and centering of the humeral head in patients with preoperative subluxation. One patient required revision to a polyethylene glenoid. The authors concluded that biological resurfacing may be a viable alternative to polyethylene resurfacing in young, active patients with glenohumeral osteoarthritis.
Adult Idiopathic Scoliosis is a progressive scoliosis case in a 31-year old female from the Cayman Islands whose curvature progressed after pregnancy and caused thoracic and lower back pain. She presented with a 91 degree curvature from T3 to T12 and in a wheelchair with pulmonary compromise. The surgical strategy involved an anterior release and thoracoplasty, followed by posterior spinal fusion from T3 to L1 using pedicle screws and hooks to correct the curvature. This resulted in a 52% correction of her curvature and resolution of her symptoms.
Reverse shoulder arthroplasty using an implant with a lateral center of rotationSatoshi Kajiyama
Reverse shoulder arthroplasty (RSA) using an implant with a lateral center of rotation was studied to evaluate outcomes, complications, and the influence of surgeon experience. At minimum 2-year follow-up of the first 60 RSAs performed by a single surgeon:
- Mean improvements in range of motion and shoulder function scores were significant and comparable to results reported by the implant's design team.
- Experience influenced results, with better outcomes in the later cases compared to the initial 15 cases.
- Complications including revision surgeries were more common in the early cases, indicating a potential learning curve for the procedure.
This document discusses adjacent level disease in the cervical spine. It provides background on a 62-year-old woman who presented with neck and occipital pain and had a history of anterior cervical discectomy and fusion surgeries at C5-C6 and C6-C7 levels in 1990 and 2007. It then reviews literature on adjacent segment degeneration rates of about 3% per year and 25% within 10 years, with risk factors including pre-existing degeneration and fusions at lower cervical levels.
Selective fusion for idiopathic scoliosis review by dr.shashidhar b kDr. Shashidhar B K
SCOLIOISIS SURGEON BANGALORE
SCOLIOSIS SURGEON INDIA
Website: http://spinesurgeonbangalore.com/
My goal is to provide spine care with a patient centeric-holistic approach in Bangalore, encompassing all aspects of non-operative and operative management of spinal disorders with special interest in the management of spinal deformities (scoliosis and kyphosis).
Bangalore Spine Specilaist Clinic. For Appointment contact : Call: 08025442552( 9 am to 9 pm). Whatsapp: +919448311068. Email: drshashidharbk@gmail.com.
This study evaluated the intermediate and long-term results of femoral neck lengthening (Morscher osteotomy) in 18 patients (20 hips) with a median follow-up of 7 years. Postoperatively, the Trendelenburg test was negative in most patients and the median Harris Hip Score improved significantly. Radiographic examination found progression of osteoarthritis in 3 patients, while one operation failed and required total hip replacement after 4 years and two others required it at 10 years. The procedure successfully reduced leg length discrepancy in most patients. The study concluded that Morscher osteotomy can effectively treat patients with short femoral neck and overgrown greater trochanter with a positive Trendelenburg test and mild leg length
1) Arthroscopic stabilization of anterior shoulder instability has advantages over open surgery such as better cosmesis, less morbidity, and possibly less loss of external rotation. However, past studies reporting on arthroscopic stabilization have been limited by small sample sizes and variable surgical techniques and patient characteristics.
2) Several arthroscopic techniques have been developed and studied, including stapling, transglenoid suturing, suture anchors, and biodegradable tacks. Recurrence rates vary significantly between studies and depend on patient factors like age and activity level. Improper patient selection and surgical technique also contribute to failed stabilization.
3) Recent studies directly comparing suture anchor and transglenoid fixation techniques found lower recurrence
This study evaluated the short-term clinical and radiographic outcomes of 64 patients who underwent biological resurfacing of the glenoid with a dermal graft and humeral head resurfacing. At a minimum of 2 years follow-up, patients demonstrated improvements in pain, range of motion, and function based on standardized scores. Radiographically, the procedure improved glenoid version and centering of the humeral head in patients with preoperative subluxation. One patient required revision to a polyethylene glenoid. The authors concluded that biological resurfacing may be a viable alternative to polyethylene resurfacing in young, active patients with glenohumeral osteoarthritis.
Adult Idiopathic Scoliosis is a progressive scoliosis case in a 31-year old female from the Cayman Islands whose curvature progressed after pregnancy and caused thoracic and lower back pain. She presented with a 91 degree curvature from T3 to T12 and in a wheelchair with pulmonary compromise. The surgical strategy involved an anterior release and thoracoplasty, followed by posterior spinal fusion from T3 to L1 using pedicle screws and hooks to correct the curvature. This resulted in a 52% correction of her curvature and resolution of her symptoms.
Correlation between acl injury and involvement of the anterolateral ligament ...Prof. Hesham N. Mustafa
Background:
Clinical testing has demonstrated the role of the anterolateral ligament (ALL) in controlling anterolateral laxity and knee instability at high angles of flexion. Few studies have discussed the association between an anterior cruciate ligament (ACL) injury and ALL injury, specifically after residual internal rotation and a post-ACL reconstruction positive pivot-shift that could be attributed to ALL injury. The goal of this study was to assess the correlation between ALL injury and ALL injury with concomitant ACL injury using MRI.
Material and Methods:
This was a retrospective study of 246 patients with unilateral ACL knee injuries from a database that was reexamined to identify whether ALL injuries occurred in association with ACL injuries. We excluded the postoperative reconstructed cases. The charts were reviewed on the basis of the presence or absence of diagnosed ACL injury with no regard for age or sex.
Results:
Of the 246 patients with ACL injury, there were 165 (67.1%) patients with complete tears, 55 (22.4%) with partial tears, and 26 (10.6%) with sprains. There were 176 (71.5%) patients with ALL and associated ACL injuries, whereas 70 (28.5%) did not have associated ACL injuries. There was a significant statistical relationship between ACL and ALL injuries (P<0.0001).
Conclusions:
There is high incidence of ALL tears associated with ACL injuries. Clinicians should be aware of this injury and consider the possibility of simultaneous ALL and ACL repair to prevent further knee instability.
Level of Evidence:
Level IV.
1. The study evaluated the repeatability of 3D kinematic measurements of gait and simple upper limb tasks in children with hemiplegic cerebral palsy.
2. 3D gait analysis showed high repeatability in sagittal plane measures and moderate repeatability in frontal and transverse planes.
3. 3D analysis of shoulder and elbow flexion/extension during hand-to-head and hand-to-mouth tasks was highly repeatable, while rotational measures showed moderate repeatability.
This study analyzed cervical spine motion in 11 patients who underwent anterior cervical fusion surgery between the C5-C6 vertebrae. Motion analysis was performed using bi-planar fluoroscopy and clinical measures including neck disability, pain, and quality of life scores were assessed. During neck rotation, increased rotation between the C3-C4 vertebrae correlated with worse clinical outcomes, while increased rotation between C4-C5 correlated with better outcomes. The findings suggest that increased mobility at the level adjacent to the fusion site is healthier, while increased mobility two levels above may indicate a compensatory unhealthy state and potentially increased risk of adjacent segment disease.
This study evaluated replacing the lateral scapula (LS) projection with a modified trauma axial (MTA) projection in the routine radiographic examination of acute shoulder injuries. A retrospective analysis of 244 shoulder examinations found that an anteroposterior (AP) view paired with an MTA projection identified 33 more traumatic abnormalities than an AP view paired with an LS projection. The MTA projection more clearly showed injuries like Hill-Sachs lesions, glenoid fractures, and fractures of the greater tuberosity. Additionally, the MTA projection had a lower estimated radiation dose than the LS projection. Therefore, the study recommends that the routine acute shoulder examination should include only AP and MTA projections.
This study evaluated the results of 42 patients who underwent arthroscopic repair of full-thickness rotator cuff tears using a side-to-side suturing technique without fixation to bone. At an average follow-up of over 5 years, 98% of patients reported good or excellent results on the UCLA shoulder scale. The mean UCLA score was 33, and the majority of patients reported excellent strength, minimal pain, and full function following the procedure. The study concluded that for select rotator cuff tears, a purely arthroscopic side-to-side repair can provide excellent long-term outcomes without the need for anchoring the repair to bone.
This study aimed to establish normative measurements of cervical spinal canal and spinal cord dimensions based on MRI scans of 140 healthy volunteers. The researchers found that dimensions varied significantly based on sex, spinal level, height, and to a lesser extent age. They defined normal ranges for sagittal diameters and cross-sectional areas of the spinal canal and cord at C1, C3, and C6 levels, accounting for sex, level, age and height. Having defined normal cervical spinal anatomy will aid radiologists in assessing potential spinal stenosis.
1) The document describes an endoscopic technique for gastrocnemius recession to treat ankle equinus contracture as an alternative to open gastrocnemius release.
2) Key steps of the endoscopic procedure include making a small medial incision, using an endoscope to visualize and transect the medial and lateral heads of the gastrocnemius tendon while avoiding surrounding nerves and vessels, and confirming a gain of at least 10-15 degrees of ankle dorsiflexion.
3) Potential advantages over open release include smaller incisions and faster recovery, though the endoscopic technique has a learning curve and risks of poor visualization if surrounding anatomy cannot be safely defined and protected.
Butler's procedure has been used since 1968 to correct congenital varus (overriding) 5th toe deformity. The authors reviewed 48 procedures in 36 patients followed for 1-16 years. Results were good to excellent in 93.75% of patients. Age did not significantly affect results, so the procedure can be used for all age groups. It remains the gold standard technique for correcting this deformity.
1. This study compared general anesthesia (GA) and spinal anesthesia (SA) for 100 patients undergoing lumbar disk surgery through a randomized controlled trial.
2. Intraoperatively, mean blood loss was less with GA but not significantly. Surgeon satisfaction was higher with GA. No major complications occurred with either.
3. Postoperatively, hypertension was more common after GA, and nausea/vomiting were more frequent after SA.
4. Contrary to previous studies, the findings revealed SA had no advantages over GA, and GA may reduce risks and complications.
This document discusses a 48-year-old woman presenting with neck pain and right upper extremity symptoms two years following an anterior cervical discectomy and fusion (ACDF) at C4-C7. Imaging shows a nonunion at C6-C7 with graft collapse and anteriorly migrated screws. The patient's options for revision surgery are discussed, including an anterior-only, posterior-only, or combined anterior-posterior procedure. Risk factors for ACDF nonunion and strategies for bone grafting and fixation are also reviewed.
Ebm of non union of neck of femur fractureAyush Arora
This document summarizes evidence from 4 studies on the treatment of non-union of femoral neck fractures with delayed presentation. The studies found that valgus osteotomy with internal fixation using a dynamic hip screw and plate provides stability and compression, allowing union rates of 80-90%. Iliac bone grafting and muscle pedicle bone grafting from the quadratus femoris further enhance union by addressing bone loss and vascularity. The techniques resulted in satisfactory hip function and union in the majority of patients at medium to long-term follow-up.
The document presents five case reports that required referral from a physical therapist to a physician or specialist due to abnormal screening test results during differential diagnosis of hip versus lumbar spine pathology. Each case resulted in a new diagnosis beyond the scope of physical therapy, such as fracture or osteonecrosis of the hip. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" were useful in differentiating hip from lumbar spine pathology in each patient. The clinical experience suggests these screening tests may effectively identify hip pathology, but further research is needed.
Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability...Peter Millett MD
Stability of the shoulder comes from a complex interaction of various factors. Dynamic and static components are provided by soft tissue and bony structures creating joint stability. Recurrent anterior glenohumeral instability can be a difficult problem because there is a wide variety of possible pathologies. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
The document summarizes several studies on upper extremity injuries in pitchers. Key findings include:
1) UCL tears and SLAP tears can decrease shoulder range of motion and pitching mechanics.
2) Improper trunk rotation and humeral torsion are linked to greater shoulder stress and injuries.
3) Surgical repair and tenodesis can restore pitching ability, though nonsurgical options have similar return-to-play rates.
4) Partial effort throwing programs have been shown to reduce shoulder stress compared to maximum effort programs.
Skeletal maturity can be assessed using hand-wrist radiographs. Several methods exist including Greulich and Pyle (1959), Bjork (1972), and Fishman (1982). Greulich and Pyle use an atlas to compare maturity. Bjork identifies 9 stages of ossification. Fishman's Skeletal Maturation Assessment identifies 11 stages based on ossification events in the fingers, wrist, and radius. Assessment of skeletal maturity is important for orthodontic treatment planning to determine facial growth status and the timing of growth modification interventions.
This document reviews evidence comparing volar locking plate (VLP) fixation versus K-wire fixation for Colles fractures of the distal radius. Several studies found no significant differences in functional outcomes or complications between the two methods at 1-2 years post-operatively. However, VLP was found to provide more stable and accurate fixation, earlier functional recovery, and fewer reoperations for complications compared to K-wiring or fragment-specific plating. Overall, current evidence suggests VLP and K-wiring have similar long-term outcomes, but VLP may have advantages in the early postoperative period and lower reoperation rates.
Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
Relationship between extrinsic factors and the acromio humeral distance (1)The Arm Clinic
This study investigated the relationship between various extrinsic factors and acromio-humeral distance (AHD) in male control and elite athlete shoulders. Measurements were taken of scapular rotation, shoulder range of motion, pectoralis minor length, thoracic curve, and AHD in neutral and 60° abduction. Correlations between the factors and AHD were determined, with some significant but weak relationships found. Multiple linear regression showed that combinations of factors accounted for up to 36% of the variance in AHD. The study supports that extrinsic factors influence AHD in a multi-factorial and population-specific manner.
The value of dynamic MRI in cervical spondylotic myelopathy: About 24 cases.T...Michel Triffaux
Dynamic magnetic resonance imaging (MRI) of the cervical spine is extremely useful in assessing
pathological changes at the spinal cord, vertebrae, discs, ligaments and facet joints. we attempted to
document the radiological changes that the cervical spine undergoes during dynamic maneuvers and the
effects of Dynamic MRI in management of cervical myelopathy, emphasizing on the changes in treatment
protocol effected by the new findings discovered. Our work is based on 24 consecutive patients with
cervical spondylotic myelopathy had cervical MR imaging in neutral position, in flexion and extension of
the cervical spine between January 2021 and December 2021. The result found the mean age was 57.9
years (range 26-85 years). Among these 24 patients, there were 11 males and 13 females. Total number of
levels of compression were 47 and the additional levels of involvement were 17. Additional levels of
compression were noted in 12 patients, among these 17 new levels, 7 were in the posterior and 10 in the
anterior. The most affected level was C5C6 with 16 cases. All additional levels of compression were noted
in extension; Reduction of the cervical canal was observed in 20 patients only in extension. In the bending
sequences we have noticed an increase of the canal diameter in 3 patients. The location of the
compression is in 15 cases anterior, 2 cases posterior and 5 cases are mixed anterior and posterior
Surgery was considered in 17 patients. Anterior procedures were 11 (ACDF/ corpectomy and fusion) and
Posterior surgeries were 6 (laminoplasty/laminectomy), and. The rest of the patients did not require
surgery and was conservatively treated. A change of the signal was found in 3 patients during the
acquisition in extension position a. Most studies have shown a reduction of the root canal with an increase
of the compression level, which was the case in our study. MRI is a useful tool for diagnosis of CM, it does
not give an exact idea as to which is the offending level in a multilevel compression that requires surgery.
Even the approach and procedure cannot be decided on a static examination and hence are subject to
significant interpractitioner the role of extension MRI in determining cervical compression levels. Thus,
dynamic cervical spine MRI should be an important investigation before we decide to write off surgical
treatment in patients with cervical myelopathy and cord signal changes without definitive compression on
static MRI. Flexion and extension MRI is an important tool for decision making and planning appropriate
management in cervical compressive myelopathy.
MRI is increasingly used to evaluate developmental dysplasia of the hip (DDH) as it is a noninvasive imaging modality that provides excellent anatomic detail of both ossified and unossified structures of the hip. While ultrasound and radiography were previously the standard modalities depending on patient age, MRI is now widely used for treatment planning, monitoring, and in the postoperative period. The radiologist should be familiar with the critical MRI findings of DDH and the increasing role of MRI in the evaluation and management of this condition.
Correlation between acl injury and involvement of the anterolateral ligament ...Prof. Hesham N. Mustafa
Background:
Clinical testing has demonstrated the role of the anterolateral ligament (ALL) in controlling anterolateral laxity and knee instability at high angles of flexion. Few studies have discussed the association between an anterior cruciate ligament (ACL) injury and ALL injury, specifically after residual internal rotation and a post-ACL reconstruction positive pivot-shift that could be attributed to ALL injury. The goal of this study was to assess the correlation between ALL injury and ALL injury with concomitant ACL injury using MRI.
Material and Methods:
This was a retrospective study of 246 patients with unilateral ACL knee injuries from a database that was reexamined to identify whether ALL injuries occurred in association with ACL injuries. We excluded the postoperative reconstructed cases. The charts were reviewed on the basis of the presence or absence of diagnosed ACL injury with no regard for age or sex.
Results:
Of the 246 patients with ACL injury, there were 165 (67.1%) patients with complete tears, 55 (22.4%) with partial tears, and 26 (10.6%) with sprains. There were 176 (71.5%) patients with ALL and associated ACL injuries, whereas 70 (28.5%) did not have associated ACL injuries. There was a significant statistical relationship between ACL and ALL injuries (P<0.0001).
Conclusions:
There is high incidence of ALL tears associated with ACL injuries. Clinicians should be aware of this injury and consider the possibility of simultaneous ALL and ACL repair to prevent further knee instability.
Level of Evidence:
Level IV.
1. The study evaluated the repeatability of 3D kinematic measurements of gait and simple upper limb tasks in children with hemiplegic cerebral palsy.
2. 3D gait analysis showed high repeatability in sagittal plane measures and moderate repeatability in frontal and transverse planes.
3. 3D analysis of shoulder and elbow flexion/extension during hand-to-head and hand-to-mouth tasks was highly repeatable, while rotational measures showed moderate repeatability.
This study analyzed cervical spine motion in 11 patients who underwent anterior cervical fusion surgery between the C5-C6 vertebrae. Motion analysis was performed using bi-planar fluoroscopy and clinical measures including neck disability, pain, and quality of life scores were assessed. During neck rotation, increased rotation between the C3-C4 vertebrae correlated with worse clinical outcomes, while increased rotation between C4-C5 correlated with better outcomes. The findings suggest that increased mobility at the level adjacent to the fusion site is healthier, while increased mobility two levels above may indicate a compensatory unhealthy state and potentially increased risk of adjacent segment disease.
This study evaluated replacing the lateral scapula (LS) projection with a modified trauma axial (MTA) projection in the routine radiographic examination of acute shoulder injuries. A retrospective analysis of 244 shoulder examinations found that an anteroposterior (AP) view paired with an MTA projection identified 33 more traumatic abnormalities than an AP view paired with an LS projection. The MTA projection more clearly showed injuries like Hill-Sachs lesions, glenoid fractures, and fractures of the greater tuberosity. Additionally, the MTA projection had a lower estimated radiation dose than the LS projection. Therefore, the study recommends that the routine acute shoulder examination should include only AP and MTA projections.
This study evaluated the results of 42 patients who underwent arthroscopic repair of full-thickness rotator cuff tears using a side-to-side suturing technique without fixation to bone. At an average follow-up of over 5 years, 98% of patients reported good or excellent results on the UCLA shoulder scale. The mean UCLA score was 33, and the majority of patients reported excellent strength, minimal pain, and full function following the procedure. The study concluded that for select rotator cuff tears, a purely arthroscopic side-to-side repair can provide excellent long-term outcomes without the need for anchoring the repair to bone.
This study aimed to establish normative measurements of cervical spinal canal and spinal cord dimensions based on MRI scans of 140 healthy volunteers. The researchers found that dimensions varied significantly based on sex, spinal level, height, and to a lesser extent age. They defined normal ranges for sagittal diameters and cross-sectional areas of the spinal canal and cord at C1, C3, and C6 levels, accounting for sex, level, age and height. Having defined normal cervical spinal anatomy will aid radiologists in assessing potential spinal stenosis.
1) The document describes an endoscopic technique for gastrocnemius recession to treat ankle equinus contracture as an alternative to open gastrocnemius release.
2) Key steps of the endoscopic procedure include making a small medial incision, using an endoscope to visualize and transect the medial and lateral heads of the gastrocnemius tendon while avoiding surrounding nerves and vessels, and confirming a gain of at least 10-15 degrees of ankle dorsiflexion.
3) Potential advantages over open release include smaller incisions and faster recovery, though the endoscopic technique has a learning curve and risks of poor visualization if surrounding anatomy cannot be safely defined and protected.
Butler's procedure has been used since 1968 to correct congenital varus (overriding) 5th toe deformity. The authors reviewed 48 procedures in 36 patients followed for 1-16 years. Results were good to excellent in 93.75% of patients. Age did not significantly affect results, so the procedure can be used for all age groups. It remains the gold standard technique for correcting this deformity.
1. This study compared general anesthesia (GA) and spinal anesthesia (SA) for 100 patients undergoing lumbar disk surgery through a randomized controlled trial.
2. Intraoperatively, mean blood loss was less with GA but not significantly. Surgeon satisfaction was higher with GA. No major complications occurred with either.
3. Postoperatively, hypertension was more common after GA, and nausea/vomiting were more frequent after SA.
4. Contrary to previous studies, the findings revealed SA had no advantages over GA, and GA may reduce risks and complications.
This document discusses a 48-year-old woman presenting with neck pain and right upper extremity symptoms two years following an anterior cervical discectomy and fusion (ACDF) at C4-C7. Imaging shows a nonunion at C6-C7 with graft collapse and anteriorly migrated screws. The patient's options for revision surgery are discussed, including an anterior-only, posterior-only, or combined anterior-posterior procedure. Risk factors for ACDF nonunion and strategies for bone grafting and fixation are also reviewed.
Ebm of non union of neck of femur fractureAyush Arora
This document summarizes evidence from 4 studies on the treatment of non-union of femoral neck fractures with delayed presentation. The studies found that valgus osteotomy with internal fixation using a dynamic hip screw and plate provides stability and compression, allowing union rates of 80-90%. Iliac bone grafting and muscle pedicle bone grafting from the quadratus femoris further enhance union by addressing bone loss and vascularity. The techniques resulted in satisfactory hip function and union in the majority of patients at medium to long-term follow-up.
The document presents five case reports that required referral from a physical therapist to a physician or specialist due to abnormal screening test results during differential diagnosis of hip versus lumbar spine pathology. Each case resulted in a new diagnosis beyond the scope of physical therapy, such as fracture or osteonecrosis of the hip. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" were useful in differentiating hip from lumbar spine pathology in each patient. The clinical experience suggests these screening tests may effectively identify hip pathology, but further research is needed.
Open Anterior Capsular Reconstruction of the Shoulder for Chronic Instability...Peter Millett MD
Stability of the shoulder comes from a complex interaction of various factors. Dynamic and static components are provided by soft tissue and bony structures creating joint stability. Recurrent anterior glenohumeral instability can be a difficult problem because there is a wide variety of possible pathologies. For more shoulder surgery and shoulder instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
The document summarizes several studies on upper extremity injuries in pitchers. Key findings include:
1) UCL tears and SLAP tears can decrease shoulder range of motion and pitching mechanics.
2) Improper trunk rotation and humeral torsion are linked to greater shoulder stress and injuries.
3) Surgical repair and tenodesis can restore pitching ability, though nonsurgical options have similar return-to-play rates.
4) Partial effort throwing programs have been shown to reduce shoulder stress compared to maximum effort programs.
Skeletal maturity can be assessed using hand-wrist radiographs. Several methods exist including Greulich and Pyle (1959), Bjork (1972), and Fishman (1982). Greulich and Pyle use an atlas to compare maturity. Bjork identifies 9 stages of ossification. Fishman's Skeletal Maturation Assessment identifies 11 stages based on ossification events in the fingers, wrist, and radius. Assessment of skeletal maturity is important for orthodontic treatment planning to determine facial growth status and the timing of growth modification interventions.
This document reviews evidence comparing volar locking plate (VLP) fixation versus K-wire fixation for Colles fractures of the distal radius. Several studies found no significant differences in functional outcomes or complications between the two methods at 1-2 years post-operatively. However, VLP was found to provide more stable and accurate fixation, earlier functional recovery, and fewer reoperations for complications compared to K-wiring or fragment-specific plating. Overall, current evidence suggests VLP and K-wiring have similar long-term outcomes, but VLP may have advantages in the early postoperative period and lower reoperation rates.
Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
Relationship between extrinsic factors and the acromio humeral distance (1)The Arm Clinic
This study investigated the relationship between various extrinsic factors and acromio-humeral distance (AHD) in male control and elite athlete shoulders. Measurements were taken of scapular rotation, shoulder range of motion, pectoralis minor length, thoracic curve, and AHD in neutral and 60° abduction. Correlations between the factors and AHD were determined, with some significant but weak relationships found. Multiple linear regression showed that combinations of factors accounted for up to 36% of the variance in AHD. The study supports that extrinsic factors influence AHD in a multi-factorial and population-specific manner.
The value of dynamic MRI in cervical spondylotic myelopathy: About 24 cases.T...Michel Triffaux
Dynamic magnetic resonance imaging (MRI) of the cervical spine is extremely useful in assessing
pathological changes at the spinal cord, vertebrae, discs, ligaments and facet joints. we attempted to
document the radiological changes that the cervical spine undergoes during dynamic maneuvers and the
effects of Dynamic MRI in management of cervical myelopathy, emphasizing on the changes in treatment
protocol effected by the new findings discovered. Our work is based on 24 consecutive patients with
cervical spondylotic myelopathy had cervical MR imaging in neutral position, in flexion and extension of
the cervical spine between January 2021 and December 2021. The result found the mean age was 57.9
years (range 26-85 years). Among these 24 patients, there were 11 males and 13 females. Total number of
levels of compression were 47 and the additional levels of involvement were 17. Additional levels of
compression were noted in 12 patients, among these 17 new levels, 7 were in the posterior and 10 in the
anterior. The most affected level was C5C6 with 16 cases. All additional levels of compression were noted
in extension; Reduction of the cervical canal was observed in 20 patients only in extension. In the bending
sequences we have noticed an increase of the canal diameter in 3 patients. The location of the
compression is in 15 cases anterior, 2 cases posterior and 5 cases are mixed anterior and posterior
Surgery was considered in 17 patients. Anterior procedures were 11 (ACDF/ corpectomy and fusion) and
Posterior surgeries were 6 (laminoplasty/laminectomy), and. The rest of the patients did not require
surgery and was conservatively treated. A change of the signal was found in 3 patients during the
acquisition in extension position a. Most studies have shown a reduction of the root canal with an increase
of the compression level, which was the case in our study. MRI is a useful tool for diagnosis of CM, it does
not give an exact idea as to which is the offending level in a multilevel compression that requires surgery.
Even the approach and procedure cannot be decided on a static examination and hence are subject to
significant interpractitioner the role of extension MRI in determining cervical compression levels. Thus,
dynamic cervical spine MRI should be an important investigation before we decide to write off surgical
treatment in patients with cervical myelopathy and cord signal changes without definitive compression on
static MRI. Flexion and extension MRI is an important tool for decision making and planning appropriate
management in cervical compressive myelopathy.
MRI is increasingly used to evaluate developmental dysplasia of the hip (DDH) as it is a noninvasive imaging modality that provides excellent anatomic detail of both ossified and unossified structures of the hip. While ultrasound and radiography were previously the standard modalities depending on patient age, MRI is now widely used for treatment planning, monitoring, and in the postoperative period. The radiologist should be familiar with the critical MRI findings of DDH and the increasing role of MRI in the evaluation and management of this condition.
Perthes disease is a childhood condition that affects the blood supply to the femoral head, causing bone death (avascular necrosis). It most commonly affects boys between ages 4-8. While the disease process is self-limiting, it can have permanent effects on the femoral head shape and hip function. Treatment aims to contain the femoral head within the acetabulum during healing to promote proper reshaping, through nonsurgical means like bracing or surgical options like osteotomies if needed. The long-term outcomes are evaluated using classifications like Stulberg or Mose, with the goal of achieving a spherical femoral head congruent with the acetabulum. Management approaches vary between centers based on each child's severity and prognosis
This study compared outcomes of 103 patients who received the Bryan artificial cervical disc replacement to 158 patients who received cervical fusion with the Affinity cervical cage system. Patients were examined at 24 months post-operation. The study found higher rates of new osteophyte formation, disc narrowing, and symptomatic adjacent segment disease in patients who received cervical fusion compared to those who received the artificial disc. Specifically, cervical fusion was associated with a 34.6% rate of new radiographic changes compared to 17.5% for artificial discs. The study concludes that preserving motion with an artificial disc may delay or prevent symptomatic adjacent segment disease compared to fusion.
The document discusses a study of 11 patients with surgically confirmed degenerative dorsal disc herniation. Clinical exams and tests found higher rates of vascular risk factors and increased blood viscosity in these patients compared to controls. MRI and CT myelography showed partially or heavily calcified disc herniations in the lower dorsal spine. The clinical presentation was characterized by a mainly motor myelopathy with remissions and exacerbations. The findings help explain the pathogenesis and clinical presentation of myelopathy from degenerative dorsal disc disease.
Developmental dysplasia of the hip is a condition where the hip joint fails to form properly. It ranges from mild dysplasia to frank dislocation. The best outcomes are seen when treated before 6 months of age using a Pavlik harness. Between 6-18 months, closed or open reduction with spica casting is used. For older children, closed or open reduction with or without pelvic osteotomy is required. Complications include avascular necrosis, redislocation, and residual dysplasia if left untreated. Early diagnosis and treatment leads to the best long-term outcomes.
The document discusses developmental dysplasia of the hip (DDH), previously known as congenital hip dislocation. It covers normal hip development, causes of DDH, diagnosis, treatment including the Pavlik harness, and prognosis. DDH can be detected in newborns through clinical exams and worsens over time without treatment. Early reduction and stabilization of the hip is important for recovery and prevention of long-term issues.
Developmental dysplasia of the hip (DDH) is a condition where the hip joint is not properly formed or does not properly develop during fetal life or infancy. It ranges from shallow hip sockets to partial or complete dislocation of the hip joint. The goals of treatment are to reduce the femoral head into the acetabulum and maintain a concentric reduction to allow for normal hip development. Treatment depends on the age of presentation and severity, and may include use of a Pavlik harness, hip spica cast, closed or open surgical reduction, and osteotomies. Early diagnosis and treatment generally lead to better outcomes.
Developmental dysplasia of the hip (DDH) is a condition where the hip joint is not properly formed or does not properly develop during fetal life or infancy. It ranges from shallow hip sockets to partial or complete dislocation of the hip joint. The goals of treatment are to reduce the femoral head into the acetabulum and maintain a concentric reduction to allow for normal hip development. Treatment depends on the age of presentation and severity, and may include use of a Pavlik harness, hip spica cast, closed or open surgical reduction, and osteotomies. Early diagnosis and treatment generally lead to better outcomes.
This study aimed to establish comprehensive reference ranges for fetal biometry measurements during 11-14 weeks of gestation using transabdominal ultrasound. Measurements of various fetal anatomical structures were taken from 660 viable singleton pregnancies. Reference ranges including the 5th, 50th, and 95th percentiles were calculated for each biometric parameter and plotted against gestation. The results show that all parameters increase with gestation. Ratios involving ventricle sizes and femur length decrease over time, while head circumference to abdominal circumference remains constant. The reference ranges established can help in diagnosing early growth issues and interpreting measurements in chromosomally abnormal fetuses.
This study analyzed 393 displaced distal radial fractures in children treated with various methods including closed reduction and immobilization, cast immobilization alone, and Kirschner wire fixation. The results showed that closed reduction and immobilization can be considered the first choice of treatment, with 96.4% of fractures initially treated this way healing within normal remodeling limits and only 10% requiring secondary intervention. However, fractures that required repeated reduction maneuvers or had residual displacement after closed reduction showed a higher risk of redisplacement, indicating those cases may be better treated initially with Kirschner wire fixation to prevent loss of reduction. In conclusion, closed reduction and immobilization is generally sufficient but primary Kirschner wiring is recommended for fractures with difficult initial
Chaoui 2016 csp 22q11 giãn khoang vách trong suốtVõ Tá Sơn
This study examined fetuses with microdeletion 22q11 (del 22q11), the most common genetic deletion. The study found:
1) 65% of fetuses with del 22q11 had an enlarged cavum septi pellucidi (CSP), compared to the reference range.
2) The CSP was even more likely to be enlarged (89%) in fetuses with del 22q11 after 22 weeks gestation.
3) An enlarged CSP may be an important additional sonographic marker for del 22q11 when detected along with cardiac defects and thymic hypoplasia.
This study evaluated the long-term outcomes of 11 hips treated with in situ fixation for slipped capital femoral epiphysis, with an average follow up of 26 years. The results showed good functional outcomes for patients with mild (less than 30 degree) slippage, but poorer outcomes for those with moderate or severe (over 30 degree) slippage, including a higher rate of hip impingement and osteoarthritis. The study suggests in situ fixation is best for mild slips, but osteotomy may be preferable for moderate or severe slips to reduce long-term complications.
Idiopathic Scoliosis is a genetic disease (complex trait)Nelson Tang
Idiopathic Scoliosis (AIS) is caused by genetic factors in a complex trait model. It predicted the success of GWAS for AIS. On the other hand, genetic markers do not predict the progression of the curve for the majority of AIS patients.
This study retrospectively evaluated the 4- to 10-year results of 105 arthroscopic rotator cuff repairs performed by a single surgeon between 1990-1996. At average follow-up of 75 months, 94% of the 95 patients available had good to excellent results according to the modified UCLA shoulder scoring system. The study demonstrates that arthroscopic rotator cuff repair can provide excellent long-term clinical outcomes for repair of full-thickness rotator cuff tears.
Developmental Dysplasia of Hip final.pptxsudarshan731
This document provides information on Developmental Dysplasia of the Hip (DDH), including its definition, risk factors, diagnosis, and management approaches. DDH is a spectrum of abnormalities where the hip joint does not properly form during development before or after birth. Risk factors include breech positioning and female sex. Diagnosis involves clinical examination and imaging like ultrasound and x-rays. Management is based on age and severity, ranging from harness treatment in infants, to closed or open reduction and casting in older children, and osteotomies or salvage procedures in older children and adults. The goal is early diagnosis and treatment to reduce dislocation and prevent complications like avascular necrosis.
Developmental dysplasia of the hip (DDH) is a condition where the femoral head has an abnormal relationship with the acetabulum. The document discusses the normal development of the hip joint, pathoanatomy and clinical presentation of DDH, as well as methods of diagnosis including imaging and treatment options depending on the age of presentation. Treatment in infants less than 6 months involves the Pavlik harness to obtain and maintain reduction of the hip to allow for normal development.
A study of core decompression & free fibular strut grafting in the management...Vltech Knr
Core decompression and free fibular strut grafting were studied as a treatment for osteonecrosis of the femoral head. In the study of 28 hips with Ficat-Arlet grade 1-3 osteonecrosis, 67.86% of patients experienced pain relief after the procedure. At the 6-month follow up, 82.61% of patients were considered surgical successes based on Harris Hip Scores and radiographic evidence. However, 8 hips showed further advancement of osteonecrosis despite the procedure. The study concluded that core decompression with fibular grafting can effectively treat early stage osteonecrosis, but patient factors like age, hip flexibility, and adherence to post-op care affected outcomes.
This document discusses developmental dysplasia of the hip (DDH). It describes the signs and symptoms, risk factors, diagnosis, and treatment approaches for different age groups. For newborns under 6 months, treatment focuses on stabilization or reduction of the hip using the Pavlik harness. For infants 6-18 months, closed or open reduction is often needed if the hip is dislocated due to soft tissue contractures. Preliminary traction may help reduce risks of osteonecrosis during reduction in this age group.
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