Complex Fractures and Instability of the Elbow joint: Advances in Mechanism and Pathophysiology, Injury paterns, Treatment principals and Results are discussed in this presentation.
Οι εξελίξεις στην χειρουργική των σύνθετων καταγμάτων του αγκώνα συζητούνται σε αυτή την παρουσίαση
Elbow joint is a complex multiarticular joint. Its stability is provided by multiple factors , however unstable elbow is not uncommon .
"Types of elbow instability, how to suspect , diagnose and how to treat" .
All these will be discussed at the lecture which will be presented by Dr. Ahmed Saleh (assistant Lecturer at Mansoura University Hospitals.
Complex Fractures and Instability of the Elbow joint: Advances in Mechanism and Pathophysiology, Injury paterns, Treatment principals and Results are discussed in this presentation.
Οι εξελίξεις στην χειρουργική των σύνθετων καταγμάτων του αγκώνα συζητούνται σε αυτή την παρουσίαση
Elbow joint is a complex multiarticular joint. Its stability is provided by multiple factors , however unstable elbow is not uncommon .
"Types of elbow instability, how to suspect , diagnose and how to treat" .
All these will be discussed at the lecture which will be presented by Dr. Ahmed Saleh (assistant Lecturer at Mansoura University Hospitals.
Neck of femur and Distal end radius fracture case... evidence based #dr_azankiAbdallah El-Azanki
a 46 years old patient with ipsilateral neck femur and distal end radius fracture, the aim of this lecture is to highlight the deficit of evidence base or literature for such combined cases and to stimulate orthopedic surgeons in reporting how did they manage their cases.
#dr_azanki
In this presentation we will discuss the basic of axial trauma from head to pelvis. We will discuss the important key points that aids in the diagnosis of axial trauma
Neck of femur and Distal end radius fracture case... evidence based #dr_azankiAbdallah El-Azanki
a 46 years old patient with ipsilateral neck femur and distal end radius fracture, the aim of this lecture is to highlight the deficit of evidence base or literature for such combined cases and to stimulate orthopedic surgeons in reporting how did they manage their cases.
#dr_azanki
In this presentation we will discuss the basic of axial trauma from head to pelvis. We will discuss the important key points that aids in the diagnosis of axial trauma
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
Can read freely here
https://sethiortho.blogspot.com/
Challenges and Solutions in
Management of Distal Humerus Fractures
Epidemiology
Anatomy
Classification
Controversies and Recent studies
Approach
Implants selection
Plate configuration
Ulnar nerve transposition
Role of total elbow arthroplasty in DHF
Role of hemiarthroplasty in DHF
Metaphyseal comminution –
Anatomic complexity of the distal humerus
Positioning of the plates
TBW –
Skin closure
Osteoporotic nature of the bone –
Less BMD/Thin metaphysis
Screw Pullout strength is low
DHF account for 2% of all adult fractures
The common pattern of fracture
Intraarticular and involves both columns
Bimodal distribution
Peak incidence in young male and in older female patients
Young male – High-velocity injury
Older female - Osteoporosis
The distal humerus is flattened and expanded bony structure
It is composed of lateral and medial columns with the trochlea situated between these columns.
The location of the trochlea is central rather than medial
Formed by Medial SCR + M/Epicondyle
The distal end has 450 angulation with humeral shaft
M/ Epicondyle gives attachment for MCL & Common Flexor Origin
The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection
Ulnar nerve
Formed by Lateral SCR and L/Epicondyle and Capitulum
Distal end has 200 with humeral shaft
L/ epicondyle gives attachment for LCL & common extensor origin
Its posterior surface is non articular and can be used as a site for a plate fixation
The lateral column curves anteriorly
Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus.
The medial column including the medial epicondyle is in line with the humeral shaft.
It forms the center of the triangle
It has 30 - 80 – external rotation & 250 anterior divergent with the shaft
It forms a 40 - 80 degree valgus direction
X-ray -
Anterior-posterior view
lateral View
Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture.
NCCT – Elbow
Articular surfaces
Position of the fracture fragments
useful for identifying impacted fracture fragments that make reduction challenging
Olecranon Osteotomy Approach – 52-57%
Triceps sparing VS Olecranon osteotomy approach
The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter
Smaller diameter of the humerus, permitting only one or two short screws for fixation.
Interruption of blood supply to the lateral column
blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
Διάγνωση και αντιμετώπιση της οξείας ασταθειας της απω κερκιδωλενικής. Acute distal radioulnar joint Instability, isolated and with concommitan fracture, diagnosis and treatment
Περιφερικές Νευρομεταφορές για βλάβες του Ωλενίου Νεύρου- Distal Nerve transf...Nikos Darlis
The role of distal nerve tranfers from Median to an injured Ulnar nerve, basic principals, surgical technique and reported results
Ο ρόλος των περιφερικών νευρομεταφορών στην αντιμετώπιση υψηλών βλαβών του Ωλενιου νεύρου. Βασικές αρχές, χειρουργική τεχνική και δημοσιευμένα αποτελέσματα
Παθησεις καμπτήρων τενόντων του χεριού στα παιδιά- Hand Flexor tendon lesions...Nikos Darlis
Πρωτοπαθής συρραφή, Δευτεροπαθείς ανακατασκευές καμπτήρων τενόντων με ραβδους σιλικόνης, Εκτινασσώμενος αντιχειρας στα παιδιά
Primary repair , secondary reconstruction of flexor tendons in children and pediatric trigger thumb management
Αρθροσκόπηση του Καρπού, απο την Κλινική Εξέταση στις Σύνθετες Επεμβάσεις- Wr...Nikos Darlis
Review of the clinical exam, radiologic findings and operative treatment of common wrist conditions treated with wrist arthroscopy
Ομιλία στο Σεμινάριο Χειρουργικής του Χεριού, Ιωάννινα 30 Οκτ- 1 Νοε, 2014. "Ανασκόπηση της Αρθροσκόπησης στο Χέρι".
Τρία κοινά κλινικά σενάρια που οδηγούν σε αρθροσκόπηση του καρπού- Three comm...Nikos Darlis
Three common clinical scenarios leading to wrist arthroscopy
Ομιλία στο 20ο Συνέδριο της Ελληνικής Εταιρείας Χειρουργικής του Χεριού, 4-6 Σεπ, Αλεξανδρούπολη,
Aνασκόπηση της Παθολογίας Αγκώνα & Αντιβραχίου Δαρλής 2014Nikos Darlis
Aνασκόπηση της Παθολογίας Αγκώνα & Αντιβραχίου. Από τις Α ρθροπλαστικές ως την Ω λένια νευρίτιδα. Πιεστικές Νευροπάθειες, Παθήσεις Τενόντων, Αρθρίτιδα, Αρθροσκόπηση και Αρθροπλαστικές
Review of the pathology of the elbow and forearm, compressive neuropahies, Tendon pathology, Arthritis Arthroscopy and Arthroplasties
TFCC Repair in 2014: from hammoc to icebergNikos Darlis
State of the art in Triangular FibroCartilage Complex lesion management. Current concepts in anatomy biomechanics and treatment with special focus in arthroscopic techniques. Detailed step by step description of the surgical technique with animations and video. See also https://www.youtube.com/watch?v=rgbemvKbtFk. Visit www.orthoinfo.gr
Συγχρονες τεχνικές αντιμετώπισης των βλαβών του Τρίφωνου Ινοχόνδρινου Συμπλέγματος στον Καρπό
Η Άσηπτη Νέκρωση του Μηνοειδούς: Τι δεν μάθαμε σε 100 χρόνια- Kienbock's dise...Nikos Darlis
State fo the art on Kienbock's disease (avascular necrosis of the lunate). One handred years after its first description, it remains a source for controversies. What is new and what is outdated? Where do we go next?
Η αρθροσκόπηση του Καρπού στα Κατάγματα της Περιφερικής Κερκίδας- Αrthroscop...Nikos Darlis
Indications, technique and limitations in the use of wrist arthroscopy in distal radius fracture fixation.
Ενδείξεις, τεχνική και περιορισμοί στην χρήση της αρθροσκόπησης του καρπού στα κατάγματα περιφερικής κερκίδας. Ομιλία στο 32ο Ετήσιο Συνέδριο της Ορθοπαιδικής και Τραυματολογικής Εταιρείας Μακεδονίας και Θράκης 9 -11 Μαϊου 2013
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
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.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
10. Pathoanatomy
• All 16 acute elbow dislocations had MCL injury
• Complete tears at the medial side were more common than
the lateral
Schreiber JJ et al., JHS(A), 2014
48. Radial Head
2
• Excision not recommended in complex
elbow instability
– radial head is essential if MCL is injured
• ORIF
• Prosthetic replacement
49. Radial Head: ORIF
• If fracture amenable to
internal fixation
• Safe zone of hardware
placement
• Radial neck fracture
fixation challenging
50.
51. Radial Head: Prosthesis
– Comminuted fractures associated
with elbow dislocations may be
better treated by prosthetic
replacement
– Side-table re-assembly and ORIF
not favored
Ring et al. JBJS-Am 2002
52. Radial Head: Prosthesis
– Remove radial head
fragments
– Perform neck
osteotomy
– Measure head
diameter
– Coronoid first then
RH implant
57. Coronoid
• Suture fixation
through anterior
capsule ?
• Fixation of small
avulsion
fractures???
58. Lateral collateral ligament
4
• Usually avulsed
from its origin from
lateral epicondyle
• Repair with suture
anchors to lateral
epicondyle
59. Lateral collateral ligament
• Repair with suture
anchors to lateral
epicondyle
• With extensor
origin sleeve
60.
61.
62. Intraoperative assessment of
stability
• Clinical
• Radiological (C-arm)
– Forearm in pronation
– Note stable range of motion
– If stable to aprx 500 of
flexion immobilize in
pronation and start early
ROM in hinged brace within
the range of stability
63.
64. Intraoperative assessment of stability
• If stable in narrow ROM or unstable after
the above consider:
–Hinged elbow external fixation
–MCL repair
• Consider especially if dislocation occurs with
forearm in pronation
65. Hinged external fixator
5
• Allows early joint
motion
• Maintains concentric
reduction
• Protects any
repair/fixation
74. aaddddrreessss tthhee ssppeecciiffiicc ccoommppoonneennttss
ooff tthhee iinnjjuurryy
• Bone
– Radial head (repair or replacement)
– Coronoid (repair or bone block)
– Proximal ulna (anatomic repair)
• Ligaments
– LUCL/ extensor origin reattachment
– MCL
75. PPoooorr pprrooggnnoossiiss iinn oollddeerr sseerriieess wwiitthh
nnoo ccoonnssiisstteenntt ttrreeaattmmeenntt pprroottooccooll
– all 4 redislocations out of 23 elbow fracture-dislocations
occurred in terrible triad cases
– severe arthrosis in 12 of 19 elbows @3 to 34 years.
Josefsson et al. CORR 1989
– 7 of 11 patients unsatisfactory result
– arthrosis in 9 of 10 patients @7 years
Ring et al. JBJS-Am, 2002
http://www.flickr.com/photos/doug88888/4627497417/
76. MMooddeerrnn TTrreeaattmmeenntt PPrroottooccooll
SSttuuddiieess ((aafftteerr 22000044)) eennccoouurraaggiinngg……
Flexion arc 1100,
Rotation 1300,
Mayo score 85
…bbuutt lloonngg tteerrmm
DDJJDD uunnkknnoowwnn
No redislocations
Mild arthritis
@ 2,5years
Pugh et al., JBJS (A) 2004, Egol et al, Bull NYU Hosp Jt Dis.2007, Forthman et al.,
JHS(A) 2008, Lindenhovius et al, JHS(A) 2008, Zeiders et al., JBJS 2008
77. THANK YOU
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