Bone cement
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Bone cement, also known as polymethyl methacrylate (PMMA), is widely used in orthopedic and trauma surgery to fix implants. It was first used in the late 1800s but its modern use began in the 1950s when Sir John Charnley used it for total hip arthroplasty. Bone cement is a two-component system consisting of PMMA powder and methyl methacrylate liquid that undergo an exothermic polymerization reaction. It has optimal strength in compression and provides a tight bond between implant and bone, but is brittle. Modern antibiotic-loaded bone cement allows targeted delivery of antibiotics to surgical sites.
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This document discusses bone cement, its properties, uses, and risks. Some key points:
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Biomaterials final project (2)
The Ceramax Ceramic Total Hip Replacement is designed to replace damaged hip joints due to conditions like osteoarthritis. It uses a ceramic material called BIOLOX delta that is stronger and tougher than other ceramics. The cementless implant has a porous coating and hydroxyapatite layer to help the bone grow into the implant and stabilize it. The device is intended to last 15 years or more to rehabilitate hips and improve mobility.
Advanced complex casting, bracing and introduction to FRC
This document provides information on various casting materials and techniques. It discusses fibreglass, polyester, conformable polyester, and semi-rigid polyester materials which differ in properties like strength, edges, surfaces, and setting times. It also describes casting techniques like functional fracture bracing, functional rigid casting (FRC), and combicasting. FRC aims to stabilize the fracture site while allowing flexibility and functional movement proximal and distal. It can provide micro-motion and benefits like being removable, lightweight, durable, and cost-effective.
Dental implant materials
Tooth loss from disease has always been a feature of mankind’s existence. For centuries people have attempted to replace missing teeth using implantation.
This presentation includes an introduction to implant osseointegration mechanism, various implant biomaterials, selection critria, and recent advances in the field of implant biomaterials.
Dental Cements
This document provides an overview of various types of dental cements. It begins with definitions and a brief history of dental cements. It then classifies cements based on their ingredients and discusses their ideal requirements. The document goes on to describe specific cement types in detail, including their characteristics, properties, and uses. It covers traditional cements like zinc phosphate, as well as contemporary materials like resin-modified glass ionomers. The document provides a comprehensive reference on the formulation and application of different dental cements.
Localized bone augmentation and implant site development
This document discusses localized bone augmentation techniques for implant site development, including guided bone regeneration using barrier membranes and various bone graft materials. Key techniques covered are autogenous bone grafts, localized ridge augmentation, horizontal bone augmentation using particulate or block grafts, and simultaneous or delayed implant placement. Complications of these procedures are also summarized.
Total elbow arthroplasty
This document discusses total elbow arthroplasty. It provides an overview of the different types of elbow implants, including fully constrained, semi-constrained, and unconstrained designs. Semi-constrained implants are most commonly used. Patient selection criteria and contraindications are outlined. Post-operative care involves restricting motion and weight-bearing initially. Common complications include instability, polyethylene wear, osteolysis, loosening, and infection. Revision surgery may be needed in cases of painful or failed elbow replacements.
provisional restoration in fixed taif.pdf
Provisional restorations are used temporarily between tooth preparation and the final restoration. They must provide pulp protection, maintain periodontal health, and have a good fit with proper contours and smooth surfaces. Materials for provisional restorations include polymethyl methacrylate (PMMA), polyethyl methacrylate, and microfilled composite. Provisionals can be made using custom indirect, direct, or indirect-direct techniques involving impressions, casts, and temporary crowns formed in the mouth or lab. Fiber-reinforced composites can provide longer-term interim restorations.
Modern Cementing Technique: Acetabulum
- Modern cementing techniques for acetabular cups aim to improve the bone-cement interface through techniques like subchondral bone removal, multiple anchorage holes, thorough cleaning, and sustained cement pressurization.
- Studies show these techniques result in a stronger interface and less early radiolucency compared to classical cementing methods.
- The optimal technique involves removing subchondral bone when possible, drilling multiple anchorage holes, thoroughly cleaning the bone bed, applying cement under sustained pressure until cup insertion.
Implant materials in orthopaedics
This document provides an overview of implant materials used in orthopaedics. It defines key terms like stress, strain, modulus of elasticity. Common implant materials discussed include stainless steel, titanium alloys, cobalt chrome alloys, ceramics, polymers. Ideal properties for implants are outlined. Tissue responses to implants and complications are summarized. Recent advances aim to better match implant properties to bone. While no material is perfect, advances in engineering and materials science may help improve orthopaedic implants.
BONE CEMENTS
Bone cements have been used since the late 19th century to anchor orthopedic implants. They are composed of PMMA powder mixed with MMA liquid monomer. The exothermic polymerization reaction produces hardened acrylic cement anchoring implants. Key developments included the use of centrifugation and vacuum mixing to reduce porosity. Antibiotic-loaded cement was introduced in the 1970s. Compressive strength above 70MPa is required. Complications include bone cement implantation syndrome occurring during implantation. Removal requires careful techniques to avoid bone loss.
Introduction to dental implants / online orthodontic courses
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Bone cement.pptx 2 its science and cementing technique and safe surgical use
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Obstetrical Brachial Plexus Palsy(OBPI).pptx
This document discusses obstetrical brachial plexus palsy (OBPP), which occurs due to excessive traction on the brachial plexus during childbirth. There are three patterns of injury - Erb's palsy from injury to the upper roots (C5-C6), Klumpke's palsy from injury to the lower roots (C8-T1), and total plexus injury involving C5-T1. Erb's palsy causes weakness of shoulder abduction and external rotation while Klumpke's palsy results in clawing of the hand. Treatment involves initial observation and physiotherapy with surgery considered if no improvement is seen after 3 months. Surgical options
Supra condylar fracture
This document discusses supracondylar humeral fractures in children. It notes that these are the most common pediatric fractures, usually occurring from falls onto an outstretched hand in children ages 5-7. The fractures are classified into 4 types based on displacement and angulation. Type I are undisplaced while types II-IV are increasingly displaced, with type III being completely displaced. Treatment depends on type, with undisplaced or mildly angulated fractures treated with splinting while more severe fractures require closed or open reduction and percutaneous pinning under imaging guidance.
Fracture of the distal radius
This document discusses fractures of the distal radius, including Colles' fractures (transverse fractures with dorsal displacement), Smith's fractures (volar displacement), and Barton's fractures (dorsal or volar rim avulsions). Treatment depends on the fracture type and degree of displacement/fragmentation. Displaced fractures may be reduced manually or surgically with K-wires, plates, or external fixation. Outcomes depend on restoring length, alignment, and congruity while allowing early motion. Complications include malunion, nonunion, instability, and arthritis.
Monteggia fracture dislocation
Simplifying Monteggia fracture-dislocation. All information have been collected from authentic sources.
Galeazzi fracture dislocation
This document discusses Galeazzi fracture dislocations, which involve a fracture of the distal or middle third of the radius shaft combined with dislocation of the distal radioulnar joint. It describes the typical mechanism of injury, importance of recognizing these injuries, anatomy and functions of the triangular fibrocartilage complex, radiographic evaluation, clinical features, and treatment approaches including closed or open reduction and internal fixation followed by immobilization to stabilize the reduced distal radioulnar joint. Complications are also outlined.
Fracture shaft of tibia
1) The document discusses fracture of the tibia shaft, including classification, clinical features, imaging findings, treatment options, and postoperative management.
2) Treatment depends on factors like soft tissue state, bone injury severity, stability, and contamination. Options include conservative treatment, intramedullary nailing, and plating.
3) Intramedullary nailing is the treatment of choice for most tibia shaft fractures. Plating is best for metaphyseal fractures not suitable for nailing. External fixation is an alternative to avoid exposure.
Ankle fracture
1. Ankle fractures are commonly caused by twisting injuries and can involve the lateral malleolus, medial malleolus, or both. More severe fractures involve the tibial plafond.
2. Fractures are classified using the Lauge-Hansen or Denis-Weber systems to determine the mechanism and pattern of injury.
3. Treatment depends on the fracture type but often involves operative fixation using plates, screws, or external fixation to restore ankle anatomy and stability.
Femoral head fracture
Femoral head fractures occur in 5-15% of hip dislocations and often go undiagnosed. The Pipkins classification categorizes femoral head fractures into four types based on location and severity, with implications for surgical management and prognosis. Type I fractures involve the non-weight bearing portion, Type II the weight bearing portion, Type III include an associated neck fracture, and Type IV include an acetabular fracture. Diagnosis is typically via x-ray or CT scan. Treatment depends on fracture type, with smaller Type I fragments sometimes treated non-operatively, Type II fractures requiring open reduction and internal fixation, and arthroplasty considered for more complex or elderly fractures. Complications can include avascular necrosis, arthritis
Fracture of the femoral shaft
The document discusses fracture of the femoral shaft, including classifications of femoral shaft fractures and the significance of the third fragment. It also discusses the anatomical and mechanical axes of the femur, approaches to the femoral shaft, advantages and disadvantages of different surgical techniques like closed antegrade nailing, and key steps in the surgical procedure like patient positioning, preparation of the femur, and reaming.
Distal femoral fracture
This document discusses the treatment of distal femoral fractures. It describes the major muscle groups in the thigh, including the adductors, quadriceps, and hamstrings. It outlines four operative treatment options for distal femoral fractures: DCS/ORIF, DFLP, DFN, and external fixation. It provides details on the swashbuckler surgical approach for distal femoral fractures, including patient positioning, incision details, exposure of the distal femur, and closure. It also describes the technique for retrograde intramedullary nailing with DFN, including patient positioning, entry point location, and final nail position.
Fracture shaft of humerus
Fractures of the humeral shaft are commonly caused by falls onto the hand or elbow. While most can be treated non-operatively, operative treatment may be necessary to restore alignment and stability through plate osteosynthesis, intramedullary nailing, or external fixation. Nerve injuries, particularly to the radial nerve, are a common complication and usually recover spontaneously, though exploration may be needed if function does not return within 12 weeks. Conservative treatment involves immobilization in a hanging cast with early range of motion exercises to prevent stiffness.
Fractures of scapula
Fractures of the scapula are often caused by high-energy trauma such as blunt trauma, crushing injuries, falls, or seizures. Treatment depends on the specific location and severity of the fracture. Isolated fractures of the body are usually treated non-operatively with sling immobilization and early range of motion exercises. Intra-articular fractures of the glenoid surface may require surgical fixation if displaced more than 5 mm or involve over 25% of the surface to prevent shoulder instability. Combined fractures involving the clavicle or acromioclavicular ligament disruption can cause significant displacement, making diagnosis difficult and often requiring operative treatment of at least one injury.
Radial neck fracture
Radial neck fractures most commonly occur in children ages 4-14 years old due to incomplete ossification of the radial head. Undisplaced fractures in adults can be treated non-operatively, while displaced fractures may require open reduction and internal fixation with a locking plate. In children, treatment depends on the degree of angulation, with non-operative immobilization used for less than 30 degrees, closed manipulation for 30-60 degrees, and possible surgical intervention for over 60 degrees. Clinical features include pain over the radial head and neck with forearm rotation.
Radial head fracture
Radial head fractures are common elbow injuries that can range from undisplaced partial fractures to comminuted fractures. They are often caused by falls onto the elbow or outstretched hand. Treatment depends on the Mason classification and may involve closed reduction, open reduction with screws or plates, or fragment removal. The goal is a pain-free range of motion. Postoperative care involves splinting followed by gradual exercises over 3-4 weeks.
Fracture proximal humerus
Fractures of the proximal humerus are common injuries, usually occurring in older osteoporotic patients after falls. The Neer classification system divides fractures into 1, 2, 3, or 4-part patterns based on the number of displaced bone fragments. Treatment depends on the fracture type and patient factors. Minimally displaced fractures are treated non-operatively with rest and rehabilitation. More displaced fractures may require operative fixation using techniques like percutaneous pins, plates, or nails to stabilize the fragments. Complications can include avascular necrosis, nerve injuries, stiffness, and malunion.
Olecrenon fracture
1. Olecrenon fractures can be classified as simple transverse fractures caused by a fall on an outstretched hand or comminuted fractures caused by a direct blow.
2. Displaced or undisplaced fractures as well as involvement of the ulno-humeral joint are important factors in treatment and prognosis.
3. Treatment depends on whether the fracture is displaced or undisplaced - undisplaced fractures are treated non-operatively while displaced or unstable fractures typically require operative treatment using plates and screws.
Distal humeral fracture
This document discusses distal humeral fractures, providing details on:
- The challenges of these fractures, which often involve articular comminution and occur in older patients
- The posterior Campbell surgical approach for exposure and fixation using plates
- Post-operative management including immediate active mobilization and complications such as stiffness
Fracture coronoid process of ulna
Simplifying fracture of the coronoid process of ulna. All information have been taken from authentic sources.
Fracture clavicle
Fractures of the clavicle are common injuries, accounting for 2.6-4% of all fractures. In adults, clavicle fractures can be more problematic than in children. Displaced mid-shaft fractures, lateral-third fractures with coracoclavicular ligament disruption, and medial-third fractures threatening mediastinal structures often require surgical fixation, while minimally displaced fractures are usually treated non-operatively with slings or immobilization. Surgical techniques include plating, intramedullary fixation, coracoclavicular screws/plates, and hook plates. Complications can include non/malunion, shoulder stiffness, and for medial fractures, mediastinal injuries from implant migration
Fracture of the capitellum
This document discusses fracture of the capitellum bone in the elbow. It begins by noting that this is a rare fracture that can be more extensive than it initially appears, sometimes involving other bones like the trochlea or posterior humerus. Clinically, patients present with tenderness on the lateral elbow held in 70 degrees of flexion. Imaging like x-rays can show displacement of the capitellum bone from the radial head or a "double arc sign" indicating extension into the trochlea. CT scans may help clarify the injury. Fractures are classified by Bryan and Morrey into three types. Treatment depends on displacement, with undisplaced fractures treated nonsurgically and displaced fractures requiring open reduction
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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ABDOMINAL TRAUMA in pediatrics part one.
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
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Non-respiratory Functions of the Lungs.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The Best Ayurvedic Antacid Tablets in India
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Role of Mukta Pishti in the Management of Hyperthyroidism
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
The Electrocardiogram - Physiologic Principles
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Physiology of Chemical Sensation of smell.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Top 10 Best Ayurvedic Kidney Stone Syrups in India
we have mentioned the best 10 ayurvedic Kidney Stone Syrups. You can check all these products and choose the best one for yourself.
Top-Vitamin-Supplement-Brands-in-India List
Swisschem Dermacare provides the Top 10 Vitamin Supplement Brands in India. To know more about us give us call at our official number
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Novas diretrizes da OMS para os cuidados perinatais de mais qualidadeProf. Marcus Renato de Carvalho
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
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Bone cement
- 1. Prepared by Dr. Md. Ashiq Rahman Resident Bone Cement
- 2. Introduction •Chemical name is Polymethyl methacrylate (PMMA). •Another name is acrylic bone cement. •Widely used for implant fixation in various Orthopedic and trauma surgery
- 3. History •Themistokles Gluck (1870),A German Physician and Surgeon fixed a total knee prosthesis made of ivory using cement made of plaster and colophony Themistokles Gluck (1853–1942) Colophony Plaster powder
- 4. The pioneer on PMMA technology is widely credited to German chemist Dr. Otto Röhm. He patented the PMMA product Plexiglas in 1933. Dr. Otto Röhm (1876 – 1939)
- 5. •First PMMA as bone cement use in Orthopaedics is widely credited to the English surgeon, John Charnley, who in 1958, used it for total hip arthroplasty. Sir John Charnley FRS (1911 – 1982)
- 6. Composition •Powdered Polymer • Polymer: Polymethyl methacrylate/co-polymer (PMMA) • Initiator: Benzoyl peroxide (BPO) • Radio-opacifier: Barium sulphate (BaSO4)/ Zirconia (ZrO2) •Liquid Monomer • Monomer: Methyl methacrylate (MMA) • Accelerator: N, N- Dimethyl para- toluidine(DMPT)/diMet hyl para-toluidine (DMpt) • Stabilizer: Hydroquinone
- 7. Polymerization •When 2 component mixed together, a viscous dough is formed. •Initiator & accelerator react together to produce free radicals that cause the polymerization of the monomer molecules. •When two polymer molecules meet, they combine to form an unreactive molecule.
- 8. Exothermic reaction • Maximum in vivo temperature of 40° to 47°C • Thermal energy is dissipated into the circulating blood, the prosthesis and the surrounding tissue as the cement cures. • Volume is shrinked to 7% after solidification.
- 9. Factors affecting curing process •Temperature: Increases in room temperature shorten both the dough and setting times by 5% / degree centigrade •Humidity: increased humidity causes delayed setting time.
- 10. Curing process Divided into 4 stages : •Mixing: lasts up to 1 minute as the powder and liquid are homogenized. •Waiting: last several minutes as cement reaches a non-sticky state. •Working: lasts 2 to 4 minutes as cement is applied, viscosity must be enough to withstand bleeding pressure otherwise cement strength will be reduced, prosthesis must be implanted before end of this phase. •Hardening: polymerization stops and cement becomes hard in consistency.
- 11. Properties • Strongest in compression. • Brittle. • Careful stirring and mixing very important, and blood inclusion should be avoided as this decreased the bending strength significantly.
- 12. Properties(cont..) Viscosity: •Type of bone cement according to viscosity •Low viscosity: long mixing phase, short working phase – requires strict adherence to application times. •Medium viscosity: Average mixing and working phase. •High viscosity: short mixing phase, longer working phase, giving the surgeon more time for application. •High viscosity cements result in better prosthetic fixation, as compared to low viscosity cements.
- 13. Use •Arthroplasty •Spinal Compression Fractures •Chronic Osteomyelitis •Tumors – for limb salvage surgery. Bone cement used in distal radius after curettage Antibiotic Cement beads used in Chr. OsteomyelitisBone cement used in THR Vertebroplasty & Kyphoplasty
- 14. Antibiotic loaded bone cement (ALBC) •A modern drug delivery system that delivers the required drugs directly to the surgical site •Various antibiotics – Gentamycin, Tobramycin, Erythromycin, Cefuroxime, Vancomycin, Colistin etc.
- 15. Advantage: • Deliver high concentrations of the drug locally • Can reach to avascular areas • Effective against organisms that are resistant to drug concentrations achieved by systemic antibiotics • Low serum antibiotic concentrations → less toxicity than with systemic administration
- 16. Contra-indication • Presence of active or incompletely treated infection, at the site where the bone cement is to be applied. • Pregnant or nursing; • Allergic to any components of PMMA; • Have metabolic disorders which may impair bone formation; • Hypotensive; • Have renal impairment; and • Have congestive heart failure.
- 17. Adverse effect •Hypotension •Cardiac arrest •Pulmonary embolisms •Elevated serum gamma-glutamyl- transpeptidase (GGTP) upto 10 days post- operation. •Thrombophlebitis. •Loosening or displacement of the prosthesis.
- 18. Adverse effect (Contd.) •Superficial or deep wound infection. •Trochanteric bursitis. •Short-term cardiac conduction irregularities. •Heterotopic new bone formation. •Trochanteric separation.
- 19. Recent Development •PMMA cements cannot induce new bone formation •Recently developed cement consists of bioactive glass beads with PMMA, which resulted in new bone formation around the beads and a significant increase in bending strength compared with PMMA cement without the beads http://www.ajnr.org/content/25/7/1286.full
- 20. (Contd.) •Calcium phosphate cement that converts to hydroxyapatite, is a versatile material used to reconstruct many types of bony surgical defects. •Use: Bone replacement ( instead of bone grafts) e. g. osteoporotic bone, bone loss due to trauma or tumor surgery, kyphoplasty.
- 21. Take Home Message •Bone cement allows secure fixation of implant to bone. •It’s not glue; acts as – a space-filler, to create a tight space for the implants to be held against the irregular bone surface. •All the surgical team members should be aware before application of bone cement.
- 22. References: 1. CAMPBELL’S OPERATIVE ORTHOPAEDICS-13TH EDITION 2. APLEY & SOLOMON’S SYSTEM OF ORTHOPAEDICS AND TRAUMA- 10TH EDITION 3. INTERNET
- 23. Thank You