Presentation contain etiology, blood supply of femoral head & neck,pathogenesis ,classification system ,clinical features,diagnosis,managment, pelvic & femoral osteotomies in detail
Madelung deformity is an abnormality of the palmar ulnar part of the distal radial physis in which progressive ulnar and volar tilt develops at the distal radial articular surface, with dorsal subluxation of the distal ulna.
OSTEOLYSIS AND LOOSENING OF total hip arthroplasty IMPLANTS.pptx by dr vasu ...Vasu Srivastava
Aseptic Loosening of implants is caused by osteolysis. It is most significant factor limiting longevity of THA. Revision for loosening is 4x higher than next leading cause (dislocation at 13.6%), and its particularly problematic in younger patients [2].
Osteolysis is bone resorption caused by the body’s response to particulate debris generated as the THA implant wears out. Motion between any two components of the prosthesis (ie the femoral head and the acetabuluar liner, the head-neck junction of the femoral stem, or the liner and shell of the acetabulum) generates debris that floats around the joint. This debris stimulates a host response. Particles of metal, poly, or cement can all cause osteolysis, albeit different types of reaction. Osteolysis is important because it leads to implant loosening and/or periprosthetic fractures.
While osteolysis is the primary cause of loosening, infection must be part of the differential diagnosis.
Historical Perspective: Osteolysis was first described by Harris in 1976 and it was attributed to “cement disease” [3], because it was observed around the femoral component, and this was what started the drive for cementless implants. Yet after significant R&D, and development of cementless implants, osteolysis was still seen around the implants [4], and the histology was similar between cemented [5] and cementless implants [6]. Surgeons then looked for another cause of osteolysis and recognized that it was produced by wear particles.
STAGES OF OSTEOLYSIS
1) Debris production (ie poly wear) is the initial stage (we talk about metal debris in a separate section because it behaves totally differently, see section). Particulate debris in THA is produced by Abrasive and Adhesive wear (whereas the TKA produces delaminating wear: small fissures form within the poly).
▪ Adhesive wear is two surfaces bonding together causing the softer material to “peel” off as a thin film onto the harder surface during motion.
Volumetric wear is a specific type of adhesive wear, and it occurs as the femoral head articulates with the cup liner, and the amount of wear is proportional to the femoral head radius squared (therefore larger femoral head = more wear..this is why the initial Charnley implants, which used conventional poly, used a size 22 femoral head). Linear wear is caused by focused stress on a isolated part of the poly due to abnormal loading.
▪ Abrasive wear occurs when a harder surface (which is never completely smooth) cuts or ploughs through a softer surface, like a cheese grater. Both cause particle formation. Most wear occurs superiorly in the cup (or at the rim in cases of impingement).
The conventional PE wear from articulating with a Cobalt-chrome head is 0.10 mm/year. The ultramolecular weight poly (UMWPE, also known as highly-crosslinked poly) wear is about 0.02 mm/year. What is the difference between conventional and UMWPE?
Assessent and radiology of distal end radius fractureSusanta85
distal end radius is a common fracture in elderly groups and also in young by high velocity trauma its assessment and radiology should know for its management
Presentation contain etiology, blood supply of femoral head & neck,pathogenesis ,classification system ,clinical features,diagnosis,managment, pelvic & femoral osteotomies in detail
Madelung deformity is an abnormality of the palmar ulnar part of the distal radial physis in which progressive ulnar and volar tilt develops at the distal radial articular surface, with dorsal subluxation of the distal ulna.
OSTEOLYSIS AND LOOSENING OF total hip arthroplasty IMPLANTS.pptx by dr vasu ...Vasu Srivastava
Aseptic Loosening of implants is caused by osteolysis. It is most significant factor limiting longevity of THA. Revision for loosening is 4x higher than next leading cause (dislocation at 13.6%), and its particularly problematic in younger patients [2].
Osteolysis is bone resorption caused by the body’s response to particulate debris generated as the THA implant wears out. Motion between any two components of the prosthesis (ie the femoral head and the acetabuluar liner, the head-neck junction of the femoral stem, or the liner and shell of the acetabulum) generates debris that floats around the joint. This debris stimulates a host response. Particles of metal, poly, or cement can all cause osteolysis, albeit different types of reaction. Osteolysis is important because it leads to implant loosening and/or periprosthetic fractures.
While osteolysis is the primary cause of loosening, infection must be part of the differential diagnosis.
Historical Perspective: Osteolysis was first described by Harris in 1976 and it was attributed to “cement disease” [3], because it was observed around the femoral component, and this was what started the drive for cementless implants. Yet after significant R&D, and development of cementless implants, osteolysis was still seen around the implants [4], and the histology was similar between cemented [5] and cementless implants [6]. Surgeons then looked for another cause of osteolysis and recognized that it was produced by wear particles.
STAGES OF OSTEOLYSIS
1) Debris production (ie poly wear) is the initial stage (we talk about metal debris in a separate section because it behaves totally differently, see section). Particulate debris in THA is produced by Abrasive and Adhesive wear (whereas the TKA produces delaminating wear: small fissures form within the poly).
▪ Adhesive wear is two surfaces bonding together causing the softer material to “peel” off as a thin film onto the harder surface during motion.
Volumetric wear is a specific type of adhesive wear, and it occurs as the femoral head articulates with the cup liner, and the amount of wear is proportional to the femoral head radius squared (therefore larger femoral head = more wear..this is why the initial Charnley implants, which used conventional poly, used a size 22 femoral head). Linear wear is caused by focused stress on a isolated part of the poly due to abnormal loading.
▪ Abrasive wear occurs when a harder surface (which is never completely smooth) cuts or ploughs through a softer surface, like a cheese grater. Both cause particle formation. Most wear occurs superiorly in the cup (or at the rim in cases of impingement).
The conventional PE wear from articulating with a Cobalt-chrome head is 0.10 mm/year. The ultramolecular weight poly (UMWPE, also known as highly-crosslinked poly) wear is about 0.02 mm/year. What is the difference between conventional and UMWPE?
Assessent and radiology of distal end radius fractureSusanta85
distal end radius is a common fracture in elderly groups and also in young by high velocity trauma its assessment and radiology should know for its management
A fractured neck of femur (NOF) is a serious injury, especially in older people. It is likely to be life changing and for some people life threatening.
Neck of femur fractures (NOF) are common injuries sustained by older patients who are both more likely to have unsteadiness of gait and reduced bone mineral density, predisposing to fracture. Elderly osteoporotic women are at greatest risk.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Classification & management of legg calve perthes disease
1.
2. RADIOGRAPHY
MAGNETIC RESONANCE IMAGING
BONE SCINTIGRAPHY
ULTRASONOGRAPHY
ARTHOGRAPHY
COMPUTEDTOMOGRAPHY
3. Plain X ray of PELVISWITH BOTH HIP JTS
AP view
Lowenstein’s frog-leg lateral view
Abduction – Adduction views
Knee joints – AP / Lat
Wrist joints – AP / Lat
7. Radio-dense
femoral head
Cyst & leucency in
metaphysis
END OF STAGE:
appearance of
lucencies in
nucleus
6m( up to14m)
8. Lucent areas appear in the ossific nucleus of
femoral head
Demarcation of femoral segments (pillars) –
often central dense
9. Milder form – only ant segement seen on frog-
leg lateral
More severe – no demarcation of pillars
10. END OF STAGE – appearance of new bone in
subchondral area
8m(2 – 35m)
11. STARTSWITH - appearance of new bone in
subchondral area
first in center of head – then expands medially
and laterally
Anterior segment – last to reossify
Process- lucent/necrotic areas of fragmentation
stage replaced by WOVEN BONE which then
ossifies , remodels in to TRABECULAR BONE
12. mild gradual flatenning – children < 5 yrs whose
femoral head is totally involved
most improve
51m(2-122m)
13. femoral head is fully reossified
head remodels so does the acetabulum
Head – normal / extremely flat / aspherical
Physis is inlvolved – overgrowth of greater
trochanter
15. Ponseti – cystic
changes in neck
Prognostic value –
poor outcome
16. Sagging rope sign
radiodense line in prox
femoral metaphysis
Metaphyseal response to
physeal damage
17. Premature physeal closure
With central arrests:
Round head
Short neck
Troch overgrowth
With lateral arrest:
Femoral head tilted Laterally
Elongation of medial neck
Overgrowth of troch
18. Morphological changes in acetabulum in perthes
described by BENJAMIN JOSEPH (JBJS 1989)
Osteoporosis of acetabular roof
Irregularity of contour
Premature fusion of triradiate cartilage
( bicomparmentalisation)
Hypertrophy of articular cartilage & changes in
dimension
19.
20.
21. BICOMPARTMENTALIZATION –
When femoral head protrudes from acetabulum -
medial wall may form
And look like a second compartment for the head
Bicompartmental acetabulum in perthes disease
(JBJS 87-B aug 2005)
22. On plain xray -
bicompartmental
acetabulum appears to be
composed of 2 arc partly
overlapping each other –
interpreted as the
subluxated femoral head
articulating only with the
lateral half of the
acetabulum moulding it
into 2 compartments
23. Used for early diagnosis of LCP disease
Detects –
Configuration of femoral head & acetabulum
Congruity of articular surface
Femoral head containment
Joint effusion
25. helps in
diagnosis of early stages
visualization of early
reperfusion
Transphyseal reperfusion, occurring by
neovascularization through the physis, is
known to be a strong predictor of growth
deformity.
26. Effective tool for diagnosis of pre-radiological
early stages
Revascularization patterns
27. Findings of
Configuration of head
Widening of joint space due to thickend cartilage
Lateral shifting of head
Containment of head within acetabulum
Major Advantage – assessment of congruity of
joint in different range of movement
32. LEGG – two types of head
A “cap” & a “mushroom”(more severe)
WALDENSTROM – classified head 3 categories
Type 1 & 2 with good results
Type 3 – altered shape leading to restriction of ROM
to only flexion & extension (conical)
GOFF – 3 types of head
Spherical, cap, irregular
33. Extent of subchondral # in both AP &
lowenstein frog leg lateral xrays
reliable indicator in the group with
fractures
34. extent of the fracture (line) is less than
50% of the superior dome of the
femoral head
› good results can be expected.
35. Extent of the fracture is
more than 50% of the
dome,
› fair or poor results can
be expected
36. In 1971
used radiological findings of epiphyseal
involvement to identify 4 groups
37. anterior femoral
head involvement
no evidence of
sequestrum,
subchondral fracture
line, or metaphyseal
abnormalities
38. anterolateral
involvement
Central sequestrum
Well demarcated
metaphyseal lesions
Subchondral fracture
line – Ant ½
lateral column is intact.
39. large sequestrum - 3/4th
of head.
Junction is sclerotic.
Diffuse Metaphyseal
lesions , anterolaterally
Subchondral fracture
line - post 1/2
The lateral column is
involved.
40. Entire head
Diffuse or central
metaphyseal
lesions
posterior
remodeling of the
epiphysis
41. 1. Gage sign : Described by COURTNEY
GAGE(1933) small osteoporotic segment which
forms a radiolucentV-shaped defect on lateral
epiphysis & adjacent metaphysis on AP xray .
42. 2. Speckled calcification lateral to epiphysis
3. Lateral subluxation of femoral head
4. Horizontally oriented physis
5. Diffuse metaphyseal reaction (metaphyseal
cysts)
43. Based on radiographic changes in lateral portion
of femoral head during fragmentation stage on
AP view
LATERAL PILLAR - lateral 15-30% of epiphysis
on AP xray
44. Group A – no involvement
Group B – at least 50 % of height maintained
Group C – less than 50% of height
maintained
45. Advantage
Easy application in active disease
High correlation bet lat pillar height and amount of
head flattening at skeletal maturity
46. Based on fitting of contour
of healed femoral head to
template of concentric
circles in both AP & Frog
leg lateral views
Good - < 1 mm
Fair - < 2 mm
Poor - > 2 mm
47. described in 1981
Alike MOSE classification, its also
classification of THE END RESULTS
Used to predict the onset of degenerative
joint disease following LCPD
48. I – Shape is normal
II – loss of head height
< 2 mm deviation of concentric circles
Group I & II – “Spherical Congruency”
49. III – Elliptical head
> 2 mm deviation
Contour matches (“Incongrous/Aspherical
congruency”)
50. IV – Flattened
head, >1 cm of
flattening
Contour matches
(“Incongrous/Asph
erical congruency”)
Resemblence with
Cow’s hip
51. V – Collapsed head,
Contour mismatch (“Incongrous/Aspherical
Incongruency”)
52. AIMS:
Prevention of femoral head deformity
Prevention of secondary degenerative
osteoarthritis.
Psychological & Physical development.
53. Elimination of hip irritability.
Containment of the head.
Restoration good ROM
Prevention subluxation.
Attainment of spherical head at end of disease
54. For < 2 to 3 yrs – Observation
For >3 yrs –
Parents counseling
Intermittent symptomatic treatment
Home traction & physical therapy
Hospitalization – loss of ROM
Bed Rest
SkinTraction – slings & springs
NSAIDs
62. Advantages:
Anterolateral coverage
Lengthening of shortened limb
No second operation
Disadvantages:
Improper coverage in older child
Limb length inequality
AVN due to raised pressure in joint
63. Indications:
Failed conservative for containment
8 – 10 yrs
Uncovered head on MRI / Arthrogram
Excessive femoral anteversion
64.
65.
66. Adv:
Maximal coverage in old
Excessive femoral anteversion
Disadv:
Excessive varus angulation
Shortening
Gluteal lurch
Non / delayed union
2nd
sx reqd. for implant removal
Trochanteric overgrowth
67. INDICATION:
Lateral
subluxation
Insufficient
coverage
Hinged abduction
COMPLICATION:
Loss of hip flexion
lateral femoral
cutaneous nerve
68. Rationale:
Widening
Unloads the joint space
Reduces pressure over head
Articular cartilage repair
Maintain congruency
Allows 50 degree flexion
69. Indications & Choice of surgery:
1. Hinged abduction – Valgus subtrochanteric
osteotomy
2. Malformed head in catterall gr 3 – Garceau
cheilectomy
3. Coxa magna – shelf augmentation
4. Large malformed head with subluxation – VDRO +
Pelvic osteotomy
5. Capital physeal arrest & troch overgrowth –
70. Failure of lateral end of
epiphysis to slide under
the edge of acetabulum on
an internally rotated &
abducted AP X rays is s/o
HINGED ABDUCTION.
71. Combination of
VALGUS FLEXION INTERNAL ROTATION
OSTEOTOMY
Coxa vara & hinged abduction - valgus
Changes articular relations – valgus & flexion
External rotation of limb – internal rotation
Improve anterolateral head coverage