This document discusses biodegradable implants and their use in orthopedic surgery. It provides details on:
- Common biodegradable materials used like PGA, PLLA, PDLLA which degrade over time in the body from 1-6 months.
- Their applications include fixation of fractures, ligament surgery, and drug/growth factor delivery.
- Advantages are that removal surgery is not needed but disadvantages are they are typically more expensive and weaker than metals.
- The degradation process involves hydrolysis breaking down the implant into fragments which are then absorbed.
Interbody Fusion Cages are available in radiolucent PEEK, and Titanium. Cages are avaliable in numerous footprints. heights and sagittal profiles to provide the flexibility to accommodate
various patient anatomies
Orthopedics is a Reconstructive Surgery. Mangled extremity is an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). A Decision have to be made Amputation + Prosthesis Vs. Limb salvage procedure which includes Irrigation & Debridement, External fixation, Antibiotic bead spacers, Soft tissue coverage and finally Restoring Skeletal Stability by Salvage of Bone Defect
Interbody Fusion Cages are available in radiolucent PEEK, and Titanium. Cages are avaliable in numerous footprints. heights and sagittal profiles to provide the flexibility to accommodate
various patient anatomies
Orthopedics is a Reconstructive Surgery. Mangled extremity is an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). A Decision have to be made Amputation + Prosthesis Vs. Limb salvage procedure which includes Irrigation & Debridement, External fixation, Antibiotic bead spacers, Soft tissue coverage and finally Restoring Skeletal Stability by Salvage of Bone Defect
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Bone Grafts /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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Root resorption is a condition characterized by a partial loss of root cementum and dentin.
Root resorption of the deciduous dentition is a physiological process and it is a necessary precursor to the eruption of permanent teeth.
Permanent teeth root resorption is a pathological inflammatory process and it can be affected by several factors
Apical root resorption can be also related to an orthodontic treatment and it can be present during the treatment or at the end of it.
This root resorption is called orthodontically- induced inflammatory root resorption (OIRR) and it is considered a distinct pathologic process.
Patient-related and treatment-related factors are involved in the onset and progression of this root resorption.1. Cemental or surface resorption with remodeling. In this process, only the outer cemental layers are resorbed, and they are later fully regenerated or remodeled. This process resembles trabecular bone remodeling.
2. Dentinal resorption with repair (deep resorption). In this process, the cementum and the outer layers of the dentin are resorbed and usually repaired with cementum material. The final shape of the root after this resorption and formation process may or may not be identical to the original form.
. Circumferential apical root resorption. In this process, full resorption of the hard tissue components of the root apex occurs, and root shortening is evident.
Orthodontic forces applied to the biologic system act similarly on bone and cementum, which are separated by the periodontal membrane. If there are no differences in the biologic behavior of these two organs, both would resorb equally.
Since cementum is more resistant to resorption compared with the more vulnerable bone, applied forces usually cause bone resorption, which leads to tooth movement. However, resorption of the cementum and dentin may also occur
Several theories explaining the resistance of the dental tissues, especially cemental resistance to resorption, exist.
It is documented that the uncalcified mineral tissues, osteoid, precementum, and predentin are resistant to resorption and may initially prevent loss of root tissue.
These layers might contain noncollagenic materials, eg, the cells themselves, that possess potent anticollagenase propertiesAfter extensive research in this field, mainly with tooth replantation models, Andreasen, relates surface resistance to the innermost cellular layer of the periodontal ligament.
This layer supplies the protective mechanism to the root, as well as the potential for a repair.
The cementoblasts, fibroblasts, osteoblasts, endothelial, and perivascular cells are included in this layer
However, continuous pressure will eventually lead to resorption of these areas
Root resorption occurs when pressure on the cementum exceeds its reparative capacity and dentin is exposed, allowing multinucleated odontoclasts to degrade the root substance.
Acc to Rudolph ,Resorption typically attacks the root tip and
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
2. Biodegradable implants are derived by transforming
compounds that are present in nature to structural
plastics.
Organic molecules are polymerized to form strong
fibers and solid compounds.
When these polymers are implanted in patients,
they degrade and are eliminated from the body in a
period of time.
3. history
The first biodegradable material was made from
animal intestines and used as a suture material by
Galen in 175 BC.
The first usage of these materials in
orthopaedic surgery was in 1984 by Rokkanen for the
treatment of internal fixation of ankle fractures .
4. materials
Widely used biodegradable materials include
polyglycolic acid (PGA),
poly-L- lactic acid (PLLA),
poly-DL-lactic acid (PDLLA), PGA/trimethylene
carbonate compolymers (PGA/TMC),
poly-p-dioxanone (PDS) and
poly-beta-hydroxybutyric acid (PBHBA).
5. Biodegradable materials need to be hydrolytically
labile and sturdy, at least for a period of time.
To meet these requirements, they are produced by the
“self-reinforcing” (SR)technique .
The biodegradation process takes from one to 6
months starting around 6 onth post op.
This period depends on contact with body
fluids,temperature, motion, molecular weight, crystal
form and geometry of material, and the tissue that is
implanted.
6. biodegradation
begins with the polymer chains being broken into
smaller fragments by hydrolysis--- molecular weight
of the implant decreases --- the mechanical strength
decreases allowing subsequent mechanical
fragmentation and absorption of the implant to begin.
Actual mass loss of the implant occurs through the
release of soluble degradation products,
--phagocytosis by macrophages and histiocytes,
intracellular degradation and finally, metabolic
elimination through the citric acid (Krebs) cycle to
carbon dioxide and water, which are expelled from
the body via respiration and urine.
7. Clinical applications
The mechanical properties of the materials permit
them to be used with metaphyseal and peri-articular
fractures where the loading is relatively low.
For treating small-bone fractures such as ankle
fractures .
Not suitable for comminuted and unstable fractures.
8. Clinical applications
Another suitable anatomic area for application is the
elbow joint, for fixing fractures of the radial head,
olecranon, capitellum and distal humerus.
Comminuted fractures --- not good candidates .
Also #s of the distal radial styloid, patella, glenoid
fossa and acetabulum; osteochondral fractures in the
knee, tibial plateau, phalanx, calcaneus and talus; and
also hallux valgus surgery.
Screws or rods may also be used for epiphyseal #s.
9. Clinical applications
Other uses--- as interference screws in knee ligament
surgery;
for the promotion of osteogenesis in bone defects;
for the slow release of antibiotics and
growth factors; as an antiadhesive
membrane for preventing adhesions in flexor tendon
surgery;
as a matrix for cells in cartilage, bone or connective
tissue engineering.
10. Maintenance of alignment and fixation of bone fractures,
osteotomies, arthrodeses or bone grafts (OTPSTM Pin)
• Maintenance of reduction and fixation of cancellous bone
fractures, osteotomies or arthrodesis of the upper extremity,
ankle and foot (OTPSTM Ankle)
• Bone graft & fragment containment, cement restriction in
total joint arthroplaties, protective barrier for bone graft harvest
sites (OTPSTM Mesh)
• Fixation of non-comminuted diaphyseal fractures of the
metacarpal, proximal phalangeal middle phalangeal and
osteotomies (OTPSTM Hand/Mini)
11. advantages
main advantage of biodegradable implants---
secondary operation for removal not necessary, in
contrast to metallic implants, which need to removed
because of osteopenia, corrosion and irritation of
adjacent tissues.
As biodegradable implants degrade, they lose
strength and this puts loading of bone--- prevent
bone resorption.
Will not interfere wth radiological imaging.
12. disadvantages
Disadvantage ---expensive, having less strength than
metals, tissue reactions, causing osteolysis around the
implant and sterile draining sinuses.
most cases, the symptoms of the tissue reaction are
subclinical and pass unnoticed, but in some patients a
clinically manifest inflammatory foreign-body
reaction ensues.
synovitis when implant is put intra articularly
13. Danger of adverse tissue reaction more if the rate of
implant degradation produces more debris particles
than the tissue is able to tolerate. greatest risk when
the gross geometry of the implant is rapidly lost.
(Böstman and Pihlajamäki 2000, Middleton and
Tipton 2000)
typically manifest in the latter stages of implant
degradation i.e. 6-12 months post operatively. In
children, the tissue reactions appear to be quite rare
(2.1 % of cases with polyglycolide implants) and
always mild in character (Rokkanen et al.
14. rate of bacterial infections not related to the implant
material, same after implantation of metal and
biodegradable materials. (Sinisaari 2004)
In studies concerned with polylactide implants, the
adverse tissue reaction rate has usually been lower
than with polyglycolide
All implants cause tissue response but this varies
radically
15. Phases of Degradation
Phases of Degradation of Amorphous Biodegradable
Implants and Tissue Reactions According to Pistner et
al.47
1. healing phase: Unchanged implant, development
of a fibrous capsule with a high amount of fibroblasts
2. Latency phase : Unchanged implant, fibrous
capsule gets thinner with less cells and more fibers or
direct implant contact to bone
16. 3. Protracted resorptive phase :Mainly central
degradation of the implant, development of cracks,
mild to moderate cellular response with invasion of
macrophages and foreign-body giant cells
4. Progressive resorptive phase : Progressive
disintegration of the implant with a severe tissue
response (macrophages, foreign-body giant cells)
5. Recovery phase :No polymer remnants detectable,
development of scar tissue or osseous replacement of
the former implant site
17. Table 2. Classification of Osteolysis (O)
According to Hoffmann et al. and Weiler et
al.46,69
Osteolysis Radiological Findings
O-0 None
O-1 Mild
O - 2 Moderate
O-3 Severe
O-4 Disturbed healing
No osteolytic changes visible
Mild Osteolytic changes at the
implant site (osteolysis 1 mm or
larger than implant diameter)
Moderate Cystic-like extended
osteolysis (osteolysis 3 mm or
larger than implant diameter
Severe Confluence of osteolysis
into a resorption cavity (if more
than 1 implant is used)
Disturbed healing Fracture
displacement, fragment
sequestration, or healing failure
of soft tissue due to osteolysis .
18. Osseous replacement
During or following implant degradation, osseous replacement
may follow 3 different patterns:
1. There is osseous ingrowth while the implant is degrading .
This phenomenon is most desirable but has rarely been found.
it has only been reported to occur during the degradation of
PLLA-co-PDLLA (70:30) or self-reinforced PLLA/PDLLA
composite rods.50,51
2. There is osseous ingrowth in the center of the former implant
site after the implant is degraded .46
3. There is an osseous scaring of the former implant site with a
slow marginal ingrowth of new bone.This kind of replacement
has been found in cases after an osteolytic lesion has occurred
and may progress over several months or years.46
19. Classification and Treatment of Extra-articular Soft-
Tissue Reactions (EA) According to Hoffmann et al.69
Extra-articular Soft-Tissue
Reactions
Symptoms/Findings/Treatment
EA-0 None
EA-1 Mild
EA-2 Moderate
EA-3 Severe
EA-4 Bacterial
superinfection
No or subclinical reaction
Local, mild soft-tissue induration; no
treatment
Fluctuant swelling, fluid
accumulation (ultrasound), local
warmth, reddening, swelling, pain;
single or repetitive puncture
necessary
Spontaneous discharge of sinus,
primary sterile, secondary possible
bacterial contamination; debridement
and open wound treatment.
Deep soft-tissue/bone infection
following EA-2 or EA-3; extensive and
repetitive debridement
29. A prosthesis is an artificial limb, which is fitted to an
individual who has lost a limb.
A pylon is the member which provides the
connection between the residual limb (leg stump) and
the prosthetic foot.
A method of immediate post op temporary rigid
dressing.
30. Postoperative management of below-knee
amputation varies widely.
Early rehabilitation oriented immediate post op
management.
Pressure bandages do not always remain secure, tend
to apply uneven pressure and may increase stump
edema by a tourniquet effect.
Burgess and Romano (1968) recommended the use of
rigid plaster dressings immediately after operation.
31. Pylon prosthesis
Definite advantages, but there are concerns that it is
technically demanding.
Impractical in hospitals lacking an experienced
orthotist.
Air-splints, Unna paste dressings and removable rigid
dressings recommended, but
most of these also require skilled application, and are
expensive;
some do not allow either full weight-bearing or early
ambulation.
32. Removable rigid dressings (Wu et al 1979 ; Mueller
1982) shorten rehabilitation while allowing frequent
wound inspection
but they do not permit early weight bearing.
inflatable splints (Sher 1974) ---- this airbag apparatus
holds no advantage over conventional dressings.
The plaster-pylon technique --- advantages of rigid
dressings and early weight bearing.
33. Plaster technique.
At the completion of the operation,
gauze dressing is covered with a single layer of cotton
roll and a stockinette bandage.
The stump of the limb is lifted from the table using
the free end of the stockinette sleeve.
34.
35. This is a simple but important step ----prevents
tension, shear stress and any direct pressure over the
transected tibia.
A rigid plaster dressing is then applied, extending to
upper mid thigh.
After operation the patient is allowed up in a chair,
walker or with crutches depending on physical
capability.
36. If no complications the original plaster is removed
one week later for wound inspection.
change of dressing done,
A new well-moulded cast is then applied and a
copper-tube pylon is added.
37. patient is then allowed to
take partial or full weight as is
tolerated, and is encouraged
to continue to walk
throughout his hospital stay.
38. The pylon was applied on
average seven days after
operation (range 4 to 42).
The cast-pylon was changed
weekly until the stump was
ready for fitting with a
temporary prosthesis.
39. estimation of healing time ---- definition of Wu et a!
(1979) who recorded the interval between amputation
and the ordering of a temporary prosthesis.
Rehabilitation time is then defined as that between
amputation and final discharge, walking with a
temporary prosthesis.
For the pylon group, average time for healing was
40.4 days and for rehabilitation was 108.4 days.
For the soft bandage group, average healing time was
98.4 days and average rehabilitation time 200. 1 days.
40. Removable rigid dressings (Wu et al 1979 ; Mueller
1982) are reported to shorten rehabilitation while
allowing frequent wound inspection, but they do not
permit early ambulation.
inflatable splints (Sher 1974) ---- airbag apparatus
holds no advantage over conventional dressings.
41. advantages
Decreases post op edema
Promotes maturation of scar and stump.
Help to produce a non tender stump
Decreases phantom limb sensation
Early adaptation of amputation
The full length of the cast prevents knee flexion
contracture.
Stump healing and rehabilitation time decreas
42. advantages
The plaster-pylon technique advantages of an
immediate fit prosthesis, an inflatable splint device or
a removable rigid dressing,
added benefit that it does not require the services of
a prosthetist for application.
Early postoperative ambulation with full weight-
bearing is possible in most cases at one week.
In addition, the fitting of a pylon, even if the patient
cannot yet stand--- important in maintaining morale
and encouraging efforts to walk
43. advantages
The pylon allows easier transfer of patients from bed
to chair .
Facilitates nursing care, particularly of older patients.
Amputees can learn to balance and begin to walk long
before an artificial leg is available.
Early out-patient management frees expensive
hospital beds.
The materials used for plaster-pylon application are
cheap, readily available in any hospital, and can be
used by paramedical staff without specialised
training.