Management of Heterotopic Ossification of the Elbow in Patients with Elbow and Brain Injury a Retrospective Study by V Psychoyios in Orthopedic Research Online Journal
This document describes a case report of a rare congenital anomaly called ulnar dimelia in a 1.5 year old male patient. Ulnar dimelia is characterized by double ulnae in the forearm, polydactyly, absence of the radius and thumb. The patient presented with restricted elbow and wrist movement and an unacceptable cosmetic appearance. Management would require multiple staged surgeries but the parents neglected further treatment after the initial visit. Ulnar dimelia results from imbalanced signals during embryonic development leading to abnormalities in the forearm, hand and digits. Surgical management aims to improve function and cosmesis but often requires several procedures and long-term follow up.
Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
The document summarizes research on gait analysis of patients with spina bifida. It describes the three main types of spina bifida and their associated neurological impairments and functional classifications. Instrumental gait analysis is discussed as a tool to objectively measure biomechanical variables during walking. Results from gait analysis can inform treatment through assessing quality of ambulation, effects of orthotics, muscle function, and postoperative changes.
In hospital complications after total joint arthroplastyFUAD HAZIME
The study prospectively collected data on systemic and local complications from 15,383 joint arthroplasty procedures performed over 6 years. There were 486 major systemic complications, most commonly pulmonary embolism (152 cases), tachyarrhythmia (92), and acute myocardial infarction (36). There were also 109 major local complications, including 16 vascular injuries and 29 peripheral nerve injuries. The incidence of complications was higher after knee arthroplasty, bilateral procedures, and revision surgery. This study provides baseline data on the range and frequency of potential in-hospital complications following elective joint arthroplasty.
ANESTHETIC MANAGEMENT OF TOTAL HIP REPLACEMENT SURGERYDebashish Mondal
This document discusses hip replacement arthroplasty (HRA). It provides information on the types of HRA, indications for surgery, preoperative evaluation and anesthesia considerations. The key points are:
- HRA involves replacing damaged hip joint surfaces with prosthetics to relieve pain and restore function. It can be total or half (hemi) replacement.
- Candidates typically have severe osteoarthritis or other conditions causing irreversible hip damage and unremitting pain.
- Patients require thorough medical evaluation due to common comorbidities in the elderly population undergoing HRA.
- Regional anesthesia like spinal is preferred over general anesthesia for HRA due to benefits like reduced blood loss and better postoperative pain control.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This case report describes a rare case of recurrent simultaneous bilateral anterior shoulder dislocations in a 31-year-old man following epileptic seizures. The man's shoulders had dislocated simultaneously and anteriorly two years prior during a seizure. Following another seizure, both shoulders dislocated again in the same manner. The shoulders were reduced under general anesthesia and immobilized for 6 weeks. Rehabilitation was initiated and at follow-ups 3 and 9 months later, shoulder function had improved substantially without recurrence. Bilateral anterior shoulder dislocations secondary to seizures are very uncommon and this case adds to the limited reports in the literature of this rare lesional association.
The search for biological adjuncts to enhance flexor tendon healingAlphonsus Chong
The document summarizes research on using biological adjuncts to enhance flexor tendon healing. It discusses how surgical techniques and rehabilitation have improved results but adhesion formation remains a challenge. Various adjuncts are explored including growth factors, platelet rich plasma, stem cells, and gene therapy which show potential to aid faster healing with less adhesions. Ultrasound, magnetic fields, and rhynchophylline have also demonstrated positive impacts on tendon repair in animal studies. Continued research seeks safer and more effective ways to biologically manipulate the healing process at the cellular level.
This document describes a case report of a rare congenital anomaly called ulnar dimelia in a 1.5 year old male patient. Ulnar dimelia is characterized by double ulnae in the forearm, polydactyly, absence of the radius and thumb. The patient presented with restricted elbow and wrist movement and an unacceptable cosmetic appearance. Management would require multiple staged surgeries but the parents neglected further treatment after the initial visit. Ulnar dimelia results from imbalanced signals during embryonic development leading to abnormalities in the forearm, hand and digits. Surgical management aims to improve function and cosmesis but often requires several procedures and long-term follow up.
Study of functional outcome following arthroscopic anatomical ACL reconstruct...Dr.Avinash Rao Gundavarapu
This document summarizes a study examining the functional outcomes of 40 patients who underwent arthroscopic anatomical ACL reconstruction using autologous hamstring grafts. The study found significant improvements in stability scores (measured by IKDC, Lachman, anterior drawer, and pivot shift tests) at 6-month follow-up compared to pre-operation scores. Complications were minor, with 7.5% having superficial infections and 7.5% difficulty regaining full range of motion. The study concludes that anatomical ACL reconstruction is an excellent technique for restoring stability, especially in active patients.
The document summarizes research on gait analysis of patients with spina bifida. It describes the three main types of spina bifida and their associated neurological impairments and functional classifications. Instrumental gait analysis is discussed as a tool to objectively measure biomechanical variables during walking. Results from gait analysis can inform treatment through assessing quality of ambulation, effects of orthotics, muscle function, and postoperative changes.
In hospital complications after total joint arthroplastyFUAD HAZIME
The study prospectively collected data on systemic and local complications from 15,383 joint arthroplasty procedures performed over 6 years. There were 486 major systemic complications, most commonly pulmonary embolism (152 cases), tachyarrhythmia (92), and acute myocardial infarction (36). There were also 109 major local complications, including 16 vascular injuries and 29 peripheral nerve injuries. The incidence of complications was higher after knee arthroplasty, bilateral procedures, and revision surgery. This study provides baseline data on the range and frequency of potential in-hospital complications following elective joint arthroplasty.
ANESTHETIC MANAGEMENT OF TOTAL HIP REPLACEMENT SURGERYDebashish Mondal
This document discusses hip replacement arthroplasty (HRA). It provides information on the types of HRA, indications for surgery, preoperative evaluation and anesthesia considerations. The key points are:
- HRA involves replacing damaged hip joint surfaces with prosthetics to relieve pain and restore function. It can be total or half (hemi) replacement.
- Candidates typically have severe osteoarthritis or other conditions causing irreversible hip damage and unremitting pain.
- Patients require thorough medical evaluation due to common comorbidities in the elderly population undergoing HRA.
- Regional anesthesia like spinal is preferred over general anesthesia for HRA due to benefits like reduced blood loss and better postoperative pain control.
Short Term Analysis of Clinical, Functional Radiological Outcome of Total Kne...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This case report describes a rare case of recurrent simultaneous bilateral anterior shoulder dislocations in a 31-year-old man following epileptic seizures. The man's shoulders had dislocated simultaneously and anteriorly two years prior during a seizure. Following another seizure, both shoulders dislocated again in the same manner. The shoulders were reduced under general anesthesia and immobilized for 6 weeks. Rehabilitation was initiated and at follow-ups 3 and 9 months later, shoulder function had improved substantially without recurrence. Bilateral anterior shoulder dislocations secondary to seizures are very uncommon and this case adds to the limited reports in the literature of this rare lesional association.
The search for biological adjuncts to enhance flexor tendon healingAlphonsus Chong
The document summarizes research on using biological adjuncts to enhance flexor tendon healing. It discusses how surgical techniques and rehabilitation have improved results but adhesion formation remains a challenge. Various adjuncts are explored including growth factors, platelet rich plasma, stem cells, and gene therapy which show potential to aid faster healing with less adhesions. Ultrasound, magnetic fields, and rhynchophylline have also demonstrated positive impacts on tendon repair in animal studies. Continued research seeks safer and more effective ways to biologically manipulate the healing process at the cellular level.
This document discusses anesthesia considerations for total hip replacement (THR) and total knee replacement (TKR) surgeries. It covers preoperative evaluation and optimization of comorbidities. Regional anesthesia techniques like spinal, epidural and peripheral nerve blocks are preferred due to advantages like less blood loss, better pain control and early mobility. General anesthesia is an option as well. Intraoperative monitoring, fluid management and prevention of complications like venous thromboembolism and cement implantation syndrome are discussed. Early mobilization and multimodal analgesia are emphasized for postoperative care.
Quantitative analysis of patellar tendon size and structure in asymptomatic ...Medical_Lab
Risultati dello studio ecografico in relazione all'analisi quantitativa della dimensione e della struttura del tendine rotuleo in un giocatore professionista asintomatico.
This document describes a case report of a 31-year-old man who suffered a hip dislocation and femoral neck fracture in a motor vehicle accident. During surgery, the integrity of the medial femoral circumflex artery and retinacular vessels was assessed to determine whether osteosynthesis or joint replacement should be performed. Observation of the intact artery and vessels allowed for fixation of the fracture with screws. Follow-up angiography and bone scans confirmed adequate blood supply to the femoral head. However, signs of implant failure later emerged, requiring revision surgery. The case report demonstrates the importance of intraoperative assessment of vascular structures in deciding between head-preserving or replacing procedures for this injury pattern.
Retrograde Intramedullary Nail with Femoral Head Allograft for Large Deficit ...skisnfeet
The document summarizes a study that evaluated the outcomes of using a retrograde intramedullary nail with femoral head allograft for large defect tibiotalocalcaneal arthrodesis. Eleven patients were included who had this procedure for conditions such as Charcot neuroarthropathy, avascular necrosis, or revision fusion. While complications occurred in six patients, eight patients were considered successes based on clinical and radiographic criteria, such as stability and union. The technique provides a powerful one-stage method to address large bony deficits but also carries risk, as only partial unions were observed in some cases. Overall, it was deemed a useful technique for this difficult patient population.
1) A study compared the clinical results of using hollow screws versus plates for treating spiral fractures of the lower third of the tibia combined with posterior malleolar fractures.
2) 61 patients were treated with tibia plate fixation and either hollow screw fixation (34 patients) or plate fixation (27 patients) of the posterior malleolar fracture.
3) At 6-36 months follow up, all fractures healed well with no differences in healing time or infection rates between the two groups. Functional outcomes assessed using the Baird-Jackson scoring system also did not significantly differ between groups.
This study evaluated the surgical management of 18 patients with posterior cruciate ligament (PCL) avulsions from the tibia using cannulated screw fixation. The average age was 29 years and most injuries were from road traffic accidents. Patients underwent open reduction and fixation of the avulsed PCL fragment with a cannulated screw. At an average follow up of 31 months, all patients had full range of motion and good knee stability. The average postoperative Lysholm score was 91, indicating excellent outcomes. The authors concluded that open reduction and fixation with a cannulated screw is an effective technique for tibial avulsion injuries of the PCL.
This document discusses spine immobilization and injury. It provides data on the incidence and mechanisms of spine injuries from the Trauma Audit between 2010-2014. It showed the majority of urgent spine surgeries were for the cervical and thoracic regions. The principles of clinical assessment for the cervical and thoracolumbar spine are outlined, including the NEXUS criteria for clearing the cervical spine. Imaging guidelines and classifications systems for cervical (SLIC) and thoracolumbar (TLICS) injuries are summarized. Various immobilization devices for the cervical, thoracic, and lumbar spine like halos, Minerva braces, and TLSO braces are described.
The anterior cruciate ligament (ACL) is a key ligament in the knee that prevents anterior tibial translation and rotational loads. It frequently tears during high-impact sports. The ACL inserts on the femur and tibia and is composed of two bundles that restrain movement differently based on knee flexion angle. While partial ACL tears may be treated nonsurgically, complete tears typically require surgical reconstruction using a graft to replace the torn ligament. Postoperative rehabilitation focuses initially on regaining range of motion and strength before gradually progressing to sport-specific activities.
1. This document evaluates surgical treatment of periprosthetic femoral fractures associated with total hip arthroplasty from 2004-2010.
2. It classifies fractures using the Vancouver classification system based on location and fixation of the stem. Vancouver B2 fractures around a loose stem had the poorest results with many complications.
3. Treatment outcomes are reported for 47 patients with various fracture types. Vancouver B2 fractures treated with long stem revision and cerclage had better outcomes than open reduction and internal fixation. Overall, treatment of periprosthetic fractures remains challenging with high complication rates.
Objectives: 1. Evaluate the result of ankle arthroscopy; 2. Evaluate the surgical indication and
technique of ankle arthroscopy.
Patients and methods: retrospective research 40 patients underwent ankle arthroscopy in Saint Paul
University Hospital and Hanoi Medical University Hospital
This study evaluated the early rehabilitation effects of percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniations. 91 patients underwent PTED and were followed for 6 months. Results showed significantly reduced low back and leg pain based on VAS and ODI scores after surgery compared to before. No significant differences in low back pain scores at 3 days, 3 months, and 6 months post-op were found. PTED resulted in less trauma, fewer complications, and markedly shortened postoperative rehabilitation time, demonstrating it is a safe and effective treatment for lumbar disc herniations.
This research article studied parameters of the lower lumbar intervertebral foramen related to the superior articular process using X-ray imaging. X-rays of the lumbar spine from 104 adults were analyzed. Measurements were taken of the height, width, and other dimensions of the lower lumbar intervertebral foramen. The results found no significant gender differences in foramen parameters. Parameters related to the superior articular process, such as height and distance from bony landmarks, showed significant age-related differences between those aged 40-60 and over 60. This data supplements the intervertebral foramen database and provides a reference for individualized minimally invasive spine surgeries, especially in elderly patients over 60 years old.
This document describes a modified posterior approach technique for the hip joint. The key steps of the technique include making a skin incision from just below the posterior superior iliac spine curving toward the greater trochanter. The greater trochanter is then osteotomized to include the insertions of surrounding muscles. This posterior triangular flap is turned down to expose the hip joint capsule. The advantages of this modified approach include decreased risk of dislocation compared to conventional approaches by preserving bone and soft tissue attachments and providing stable exposure of the hip joint and surrounding structures.
The role of radiation diagnostic methods in pathological changes of the hip j...SubmissionResearchpa
Endoprosthesis replacement-operational treatment of diseases and damages of hip joint. The problem of prevention of complications and their negative effects is extremely actual today. However the role of different beam techniques in identification of adverse effects and complications of endoprosthesis replacement of joints is studied insufficiently. Results of clinic and diagnostic and beam researches of 40 patients with pathology of hip joint are analyzed. The used beam methods of research - roentgenography, multispiral computed tomography. At presurgical stage the main objective was detection of pathology of joint, definition of indications and planning of operative measure. Situation and relationship of components of endoprosthesis, condition of bone tissue, and also bone cement round cup and leg of prosthesis were key parameters of radiological assessment of outcomes of endoprosthesis replacement. Complex use of radiological techniques (roentgenography and spiral computed tomography) allows to specify and add semiotics of changes of bone tissue at the level of acetabular hollow and proximal department of femur after endoprosthesis replacement. by Janibekov J. J 2020. The role of radiation diagnostic methods in pathological changes of the hip joint before and after endoprosthetics. International Journal on Integrated Education. 3, 11 (Dec. 2020), 203-205. DOI:https://doi.org/10.31149/ijie.v3i12.918. https://journals.researchparks.org/index.php/IJIE/article/view/918/866 https://journals.researchparks.org/index.php/IJIE/article/view/918
This case report describes a rare occurrence of an aneurysmal bone cyst arising from an iliopubic chondromyxoid fibroma in a 20-year-old male patient. Imaging showed an osteolytic tumor in the left iliopubic ramus. The tumor was excised surgically and microscopic examination confirmed the diagnosis of chondromyxoid fibroma with areas consistent with an aneurysmal bone cyst. This case represents an unusual location for a chondromyxoid fibroma and confirms the rare association between aneurysmal bone cysts and chondromyxoid fibromas. The patient recovered well after surgery with no recurrence after one year of follow up.
Safe surgical dislocation[ssd] for avascular necrosis hip[ avn]drashraf369
presenting a novel technic to treat avascular necrosis of hip.AVN hip is a challenge for any orthopaedic surgeon especially in precollapse stage. here dr mohamed ashraf and dr jyothis george from govt TD medical college alleppey kerala india demonstrate a novel and effective method to arrest the progression of disease to collapse.instead of performing a conventional core decompression they do multiple micro core decompression through safe surgical dislocation of GANTZ .in addition they are supplementing the procedure with intralesional infiltration of zolidronic acid to prevent structural collapse.
Management of extensor mechanism deficit as a consequence of patellar tendon ...FUAD HAZIME
This article describes a new surgical technique for reconstructing the extensor mechanism in patients who have experienced patellar tendon loss following total knee arthroplasty. The technique involves using an allograft consisting of the patella, patellar tendon, and tibial tubercle. The allograft is secured with the host patella by creating a trough in the host patella and fitting the allograft patella into it, allowing for bone-to-bone healing. The results were promising, with no patients experiencing more than a 10 degree extensor lag at final follow-up. This technique aims to provide a more stable reconstruction compared to previous techniques by promoting direct bone healing rather than relying solely on soft tissue healing.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
The document describes a retrospective case series of 10 patients with post-traumatic radioulnar synostosis who were treated using a triple therapy combination of preoperative radiotherapy, resection of heterotopic ossification and insertion of an anconeus interposition flap, and postoperative indomethacin. All 10 patients reported excellent postoperative Mayo elbow performance scores and significant improvements in range of motion compared to preoperatively. One patient experienced a complication that resolved with follow-up. The triple therapy combination was found to provide good functional outcomes and prevent recurrence of radioulnar synostosis.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
This document discusses anesthesia considerations for total hip replacement (THR) and total knee replacement (TKR) surgeries. It covers preoperative evaluation and optimization of comorbidities. Regional anesthesia techniques like spinal, epidural and peripheral nerve blocks are preferred due to advantages like less blood loss, better pain control and early mobility. General anesthesia is an option as well. Intraoperative monitoring, fluid management and prevention of complications like venous thromboembolism and cement implantation syndrome are discussed. Early mobilization and multimodal analgesia are emphasized for postoperative care.
Quantitative analysis of patellar tendon size and structure in asymptomatic ...Medical_Lab
Risultati dello studio ecografico in relazione all'analisi quantitativa della dimensione e della struttura del tendine rotuleo in un giocatore professionista asintomatico.
This document describes a case report of a 31-year-old man who suffered a hip dislocation and femoral neck fracture in a motor vehicle accident. During surgery, the integrity of the medial femoral circumflex artery and retinacular vessels was assessed to determine whether osteosynthesis or joint replacement should be performed. Observation of the intact artery and vessels allowed for fixation of the fracture with screws. Follow-up angiography and bone scans confirmed adequate blood supply to the femoral head. However, signs of implant failure later emerged, requiring revision surgery. The case report demonstrates the importance of intraoperative assessment of vascular structures in deciding between head-preserving or replacing procedures for this injury pattern.
Retrograde Intramedullary Nail with Femoral Head Allograft for Large Deficit ...skisnfeet
The document summarizes a study that evaluated the outcomes of using a retrograde intramedullary nail with femoral head allograft for large defect tibiotalocalcaneal arthrodesis. Eleven patients were included who had this procedure for conditions such as Charcot neuroarthropathy, avascular necrosis, or revision fusion. While complications occurred in six patients, eight patients were considered successes based on clinical and radiographic criteria, such as stability and union. The technique provides a powerful one-stage method to address large bony deficits but also carries risk, as only partial unions were observed in some cases. Overall, it was deemed a useful technique for this difficult patient population.
1) A study compared the clinical results of using hollow screws versus plates for treating spiral fractures of the lower third of the tibia combined with posterior malleolar fractures.
2) 61 patients were treated with tibia plate fixation and either hollow screw fixation (34 patients) or plate fixation (27 patients) of the posterior malleolar fracture.
3) At 6-36 months follow up, all fractures healed well with no differences in healing time or infection rates between the two groups. Functional outcomes assessed using the Baird-Jackson scoring system also did not significantly differ between groups.
This study evaluated the surgical management of 18 patients with posterior cruciate ligament (PCL) avulsions from the tibia using cannulated screw fixation. The average age was 29 years and most injuries were from road traffic accidents. Patients underwent open reduction and fixation of the avulsed PCL fragment with a cannulated screw. At an average follow up of 31 months, all patients had full range of motion and good knee stability. The average postoperative Lysholm score was 91, indicating excellent outcomes. The authors concluded that open reduction and fixation with a cannulated screw is an effective technique for tibial avulsion injuries of the PCL.
This document discusses spine immobilization and injury. It provides data on the incidence and mechanisms of spine injuries from the Trauma Audit between 2010-2014. It showed the majority of urgent spine surgeries were for the cervical and thoracic regions. The principles of clinical assessment for the cervical and thoracolumbar spine are outlined, including the NEXUS criteria for clearing the cervical spine. Imaging guidelines and classifications systems for cervical (SLIC) and thoracolumbar (TLICS) injuries are summarized. Various immobilization devices for the cervical, thoracic, and lumbar spine like halos, Minerva braces, and TLSO braces are described.
The anterior cruciate ligament (ACL) is a key ligament in the knee that prevents anterior tibial translation and rotational loads. It frequently tears during high-impact sports. The ACL inserts on the femur and tibia and is composed of two bundles that restrain movement differently based on knee flexion angle. While partial ACL tears may be treated nonsurgically, complete tears typically require surgical reconstruction using a graft to replace the torn ligament. Postoperative rehabilitation focuses initially on regaining range of motion and strength before gradually progressing to sport-specific activities.
1. This document evaluates surgical treatment of periprosthetic femoral fractures associated with total hip arthroplasty from 2004-2010.
2. It classifies fractures using the Vancouver classification system based on location and fixation of the stem. Vancouver B2 fractures around a loose stem had the poorest results with many complications.
3. Treatment outcomes are reported for 47 patients with various fracture types. Vancouver B2 fractures treated with long stem revision and cerclage had better outcomes than open reduction and internal fixation. Overall, treatment of periprosthetic fractures remains challenging with high complication rates.
Objectives: 1. Evaluate the result of ankle arthroscopy; 2. Evaluate the surgical indication and
technique of ankle arthroscopy.
Patients and methods: retrospective research 40 patients underwent ankle arthroscopy in Saint Paul
University Hospital and Hanoi Medical University Hospital
This study evaluated the early rehabilitation effects of percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniations. 91 patients underwent PTED and were followed for 6 months. Results showed significantly reduced low back and leg pain based on VAS and ODI scores after surgery compared to before. No significant differences in low back pain scores at 3 days, 3 months, and 6 months post-op were found. PTED resulted in less trauma, fewer complications, and markedly shortened postoperative rehabilitation time, demonstrating it is a safe and effective treatment for lumbar disc herniations.
This research article studied parameters of the lower lumbar intervertebral foramen related to the superior articular process using X-ray imaging. X-rays of the lumbar spine from 104 adults were analyzed. Measurements were taken of the height, width, and other dimensions of the lower lumbar intervertebral foramen. The results found no significant gender differences in foramen parameters. Parameters related to the superior articular process, such as height and distance from bony landmarks, showed significant age-related differences between those aged 40-60 and over 60. This data supplements the intervertebral foramen database and provides a reference for individualized minimally invasive spine surgeries, especially in elderly patients over 60 years old.
This document describes a modified posterior approach technique for the hip joint. The key steps of the technique include making a skin incision from just below the posterior superior iliac spine curving toward the greater trochanter. The greater trochanter is then osteotomized to include the insertions of surrounding muscles. This posterior triangular flap is turned down to expose the hip joint capsule. The advantages of this modified approach include decreased risk of dislocation compared to conventional approaches by preserving bone and soft tissue attachments and providing stable exposure of the hip joint and surrounding structures.
The role of radiation diagnostic methods in pathological changes of the hip j...SubmissionResearchpa
Endoprosthesis replacement-operational treatment of diseases and damages of hip joint. The problem of prevention of complications and their negative effects is extremely actual today. However the role of different beam techniques in identification of adverse effects and complications of endoprosthesis replacement of joints is studied insufficiently. Results of clinic and diagnostic and beam researches of 40 patients with pathology of hip joint are analyzed. The used beam methods of research - roentgenography, multispiral computed tomography. At presurgical stage the main objective was detection of pathology of joint, definition of indications and planning of operative measure. Situation and relationship of components of endoprosthesis, condition of bone tissue, and also bone cement round cup and leg of prosthesis were key parameters of radiological assessment of outcomes of endoprosthesis replacement. Complex use of radiological techniques (roentgenography and spiral computed tomography) allows to specify and add semiotics of changes of bone tissue at the level of acetabular hollow and proximal department of femur after endoprosthesis replacement. by Janibekov J. J 2020. The role of radiation diagnostic methods in pathological changes of the hip joint before and after endoprosthetics. International Journal on Integrated Education. 3, 11 (Dec. 2020), 203-205. DOI:https://doi.org/10.31149/ijie.v3i12.918. https://journals.researchparks.org/index.php/IJIE/article/view/918/866 https://journals.researchparks.org/index.php/IJIE/article/view/918
This case report describes a rare occurrence of an aneurysmal bone cyst arising from an iliopubic chondromyxoid fibroma in a 20-year-old male patient. Imaging showed an osteolytic tumor in the left iliopubic ramus. The tumor was excised surgically and microscopic examination confirmed the diagnosis of chondromyxoid fibroma with areas consistent with an aneurysmal bone cyst. This case represents an unusual location for a chondromyxoid fibroma and confirms the rare association between aneurysmal bone cysts and chondromyxoid fibromas. The patient recovered well after surgery with no recurrence after one year of follow up.
Safe surgical dislocation[ssd] for avascular necrosis hip[ avn]drashraf369
presenting a novel technic to treat avascular necrosis of hip.AVN hip is a challenge for any orthopaedic surgeon especially in precollapse stage. here dr mohamed ashraf and dr jyothis george from govt TD medical college alleppey kerala india demonstrate a novel and effective method to arrest the progression of disease to collapse.instead of performing a conventional core decompression they do multiple micro core decompression through safe surgical dislocation of GANTZ .in addition they are supplementing the procedure with intralesional infiltration of zolidronic acid to prevent structural collapse.
Management of extensor mechanism deficit as a consequence of patellar tendon ...FUAD HAZIME
This article describes a new surgical technique for reconstructing the extensor mechanism in patients who have experienced patellar tendon loss following total knee arthroplasty. The technique involves using an allograft consisting of the patella, patellar tendon, and tibial tubercle. The allograft is secured with the host patella by creating a trough in the host patella and fitting the allograft patella into it, allowing for bone-to-bone healing. The results were promising, with no patients experiencing more than a 10 degree extensor lag at final follow-up. This technique aims to provide a more stable reconstruction compared to previous techniques by promoting direct bone healing rather than relying solely on soft tissue healing.
Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
The document describes a retrospective case series of 10 patients with post-traumatic radioulnar synostosis who were treated using a triple therapy combination of preoperative radiotherapy, resection of heterotopic ossification and insertion of an anconeus interposition flap, and postoperative indomethacin. All 10 patients reported excellent postoperative Mayo elbow performance scores and significant improvements in range of motion compared to preoperatively. One patient experienced a complication that resolved with follow-up. The triple therapy combination was found to provide good functional outcomes and prevent recurrence of radioulnar synostosis.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
1) Multiple infection prevention measures were used in 54 patients undergoing ACL reconstruction surgery, including preoperative skin washing and bathing, intraoperative use of sterile drapes and instruments soaked in vancomycin solution, and postoperative rehabilitation.
2) No postoperative infections occurred in any patients over 6-18 months of follow-up. Knee function scores improved significantly from pre-operation levels.
3) The study suggests that using multiple prevention measures can successfully prevent infections after ACL reconstruction surgery and allow for good postoperative recovery of knee function.
The presentation discusses evidence based medicine in the stream of Orthopaedics. Here I have discussed a case of Ipsilateral Intertronchanteric and Femoral shaft Fracture and its various treatment modalities. The presentation was done at J.N. Medical College Belagavi, India. Lets share, discuss and keep learning.
Management of OA knee by osteotomies around the knee.docxSanthosh Raj
1. Dr. Santhosh Raj BK is conducting a study to evaluate the functional outcomes and cartilage regeneration for patients with medial compartment osteoarthritis of the knee joint following osteotomies.
2. The study will assess patients' functionality before and after distal femoral osteotomy or high tibial osteotomy using various scales. MRI and arthroscopy will also be used to examine cartilage status and regeneration.
3. During surgery, patients will receive platelet-rich plasma injections into damaged cartilage areas in addition to osteotomies and other procedures like ACL reconstruction or meniscal repair. Post-operative rehabilitation protocols will be followed.
Shoulder dislocations are the most common joint dislocations, and only 2% of these are seen as posterior shoulder dislocations. The floating elbow was first described in children, after that shown in adults. Floating elbow cases are very rare, and usually seen with high-energy trauma. Classical definition is the coexistence of the humeral diaphyseal and forearm fracture, but there are other definitions as well.
Stemcell Research Paper on avascular necrosis-AVN-by Dr.Pradeep MahajanDr Pradeep Mahajan
This case report describes the treatment of a 35-year-old male patient with avascular necrosis of the left femoral head using a cell-based therapy. The patient had a 10-year history of left hip pain and was diagnosed with stage II avascular necrosis. He underwent a treatment involving harvesting bone marrow concentrate, stromal vascular fraction from adipose tissue, and platelet-rich plasma, which were injected into the affected area. Follow-up over one year showed improved hip range of motion and pain, and radiological evidence of reduced necrosis and improved joint space. The report concludes the cell-based treatment halted progression of avascular necrosis in this patient.
Comparative study of functional outcome of lateral locking plate fixation an...Om Patil
This document presents a comparative study of functional outcomes between lateral locking plate fixation and dual plating for closed fractures of Schatzker's Grade V tibial condyles in adults. 40 patients with this injury were randomly assigned to either lateral locking plate fixation or dual plating. Patients were followed up to 6 months and evaluated based on range of motion, time to union, and functional scoring scales. Results found that dual plating provided greater stability but was associated with more soft tissue complications and longer surgery time compared to lateral locking plate fixation. Both approaches achieved high rates of fracture union and functional recovery of the knee.
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Syno...CrimsonPublishersOPROJ
Benefits of Mechanical Manipulation of the Sacroiliac Joint: A Transient Synovitis Case Study by Brady Hauser* in Crimson Publishers: Orthopedic Research and Reviews Journal
1) The document provides a surgical technique for an anatomic posterolateral knee reconstruction.
2) It describes making an incision centered over the posterior iliotibial band and performing a common peroneal nerve neurolysis to decompress the nerve.
3) The technique involves identifying the attachment sites of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament on the fibular head in order to drill reconstruction tunnels for graft placement and restore the anatomic structures.
Introduction: Spontaneous Osteonecrosis of the Knee (SONK) is a devastating and debilitating disease that mainly affl icts the
elderly. A conservative approach may forgo the need for surgical intervention. This case report describes an orthopaedic patient diagnosed with SONK. After fi ve months of conservative treatment, the patient was able to walk without pain and remained clinically stable for seven years.
Case Presentation: A 49-year-old male patient diagnosed with SONK of the left knee elected to undergo conservative management in lieu of surgical intervention. Seven years later the patient’s symptoms and MRI demonstrate a dramatic improvement.
This study evaluated the intermediate and long-term results of femoral neck lengthening (Morscher osteotomy) in 18 patients (20 hips) with a median follow-up of 7 years. Postoperatively, the Trendelenburg test was negative in most patients and the median Harris Hip Score improved significantly. Radiographic examination found progression of osteoarthritis in 3 patients, while one operation failed and required total hip replacement after 4 years and two others required it at 10 years. The procedure successfully reduced leg length discrepancy in most patients. The study concluded that Morscher osteotomy can effectively treat patients with short femoral neck and overgrown greater trochanter with a positive Trendelenburg test and mild leg length
This study compared muscle activation and knee mechanics during gait in patients with non-traumatic knee osteoarthritis (OA), post-traumatic knee OA caused by an anterior cruciate ligament injury, and healthy adults. The post-traumatic OA group had lower gastrocnemius muscle activation compared to healthy adults. The non-traumatic OA group had higher activation of the quadriceps and hamstring muscles compared to the post-traumatic OA group. The non-traumatic OA group also had lower knee extension and medial rotation moments during gait compared to the post-traumatic and healthy groups. The results indicate differences in muscle function and knee biomechanics between non-traumatic and
Damage control orthopaedics By Dr Navin Kr singh;AIIMS New DelhiDcoNavin Singh
This document summarizes a presentation on damage control orthopedics (DCO) for polytrauma patients. It defines polytrauma and trauma scoring systems like AIS and ISS. It describes the historical evolution from early total care to DCO, including the recognition that early definitive fixation increased complications. DCO focuses on temporary stabilization through external fixation to minimize surgical insult until the patient is stabilized. The goals are to stop ongoing injury, facilitate care, and later restore function. Studies found DCO with early external fixation and later internal fixation had low mortality and infection rates comparable to primary internal fixation.
Dr. Ahmed M. Adawy, Professor Emeritus, Dep. Oral & Maxillofacial Surgery. Former Dean, Faculty of Dental Medicine, Al-Azhar University. Condylar fractures represent one of the most controversial issues in maxillofacial traumatology regarding classification, diagnoses and therapeutic management. Classification systems of condylar fracture is discussed. Diagnosis is usually based on history clinical examination and radiographic finding. Treatment ranges from observation, jaw exercises to closed or opened interventions. For years closed reduction was thought to be essentially complication-free. Several serious complications however have been reported including temporomandibular joint ankyloses, malocclusion, mandibular deviation and the generative joint pathology. The absolute and relative indications for open reduction is given. The debate between supporters of open or closed reduction is still continuing and the issue has not been resolved. However, the final choice treatment modality should takes into account the location of the fracture, age of the patient, presence or absence of other associated injuries, cosmetic impact of the surgery and presence of other systemic medical conditions.
This case report describes a rare case of recurrent simultaneous bilateral anterior shoulder dislocations in a 31-year-old man following epileptic seizures. The man's shoulders had dislocated simultaneously and anteriorly two years prior during a seizure. Following another seizure, both shoulders dislocated again in the same manner. The shoulders were reduced under general anesthesia and immobilized for 6 weeks. Rehabilitation was initiated and at follow-ups 3 and 9 months later, shoulder function had improved substantially without recurrence. Bilateral anterior shoulder dislocations secondary to seizures are very uncommon and this case adds to the limited reports in the literature of this rare lesional association.
A comparative study on the clinical and functional outcome of limb salvage su...NAAR Journal
The aim of this study was to analyze the survival, recurrence, complications as well as the quality of life (QOL) in tibial osteosarcoma (OSA) patients managed by limb salvage surgery (LSS), either by a prosthesis, resection or graft or by amputation. 106 tibial osteosarcoma patients were enrolled where 39 had custom-designed endoprosthetic arthroplasty (LSS1), 36 underwent resection and bone graft (LSS2) while only 31 underwent amputation. A Comparison was done based on post-operative survival rates, postoperative recurrence, and complications. The impact of the patient’s QOL was also evaluated.
Similar to Crimson Publishers-Management of Heterotopic Ossification of the Elbow in Patients with Elbow and Brain Injury a Retrospective Study (20)
Rankl Inhibitor Enhances Bone Modeling after Surgical Fixation for Atypical F...CrimsonPublishersOPROJ
Rankl Inhibitor Enhances Bone Modeling after Surgical Fixation for Atypical Femoral Fracture: A Case Report and Review of Management Options by Ong Art Phruetthiphat* in Crimson Publishers: Orthopedic Research and Reviews Journal
Avascular Necrosis of Humeral Head after Thalidomide Use: A Report of Two Cas...CrimsonPublishersOPROJ
Avascular Necrosis of Humeral Head after Thalidomide Use: A Report of Two Cases by Ahmad Rezaeian* in Crimson Publishers: Orthopedic Research and Reviews Journal
Rheumatoid Arthritis Research in India: A Scientometric Assessment of Publica...CrimsonPublishersOPROJ
Rheumatoid Arthritis Research in India: A Scientometric Assessment of Publications during 2007-2016 by Ritu Gupta* in Crimson Publishers: Orthopedic Research and Reviews Journal
Computer Navigated Medial Opening Wedge High Tibial Osteotomy- Review of Lite...CrimsonPublishersOPROJ
Computer Navigated Medial Opening Wedge High Tibial Osteotomy- Review of Literature by Kunal Dhurve* in Crimson Publishers: Orthopedic Research and Reviews Journal
Complications Following Endobutton for Anterior Cruciate Ligament Reconstruct...CrimsonPublishersOPROJ
Complications Following Endobutton for Anterior Cruciate Ligament Reconstruction by Rafik Yassa* in Crimson Publishers: Orthopedic Research and Reviews Journal
Dilution of Open Fracture Grade IIIA of the Lower Leg Using Normal Saline 0.9...CrimsonPublishersOPROJ
Dilution of Open Fracture Grade IIIA of the Lower Leg Using Normal Saline 0.9% Mixed with Honey Compared with Normal Saline 0.9% to the Bacterial Growth by Romy Deviandri* in Crimson Publishers: Orthopedic Research and Reviews Journal
Does the Minimally Invasive Quadriceps Sparing Approach Provide Better Short ...CrimsonPublishersOPROJ
Does the Minimally Invasive Quadriceps Sparing Approach Provide Better Short Term Recovery Than The Medial Parapatellar Approach In Primary Total Knee Arthroplasty? by Rachel Taute* in Crimson Publishers: Orthopedic Research and Reviews Journal
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma-Cri...CrimsonPublishersOPROJ
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma by Pedro Manuel Serrano* in Crimson Publishers: Orthopedic Research and Reviews Journal
Calcaneal Lengthening Using Bone Substitute Graft for Neurological Flatfoot T...CrimsonPublishersOPROJ
Calcaneal Lengthening Using Bone Substitute Graft for Neurological Flatfoot Treatment by Mario Lampropulos* in Crimson Publishers: Orthopedic Research and Reviews Journal
Effect of Suture Tubularization on Quadruple Stranded Hamstring ACL Grafts wi...CrimsonPublishersOPROJ
Effect of Suture Tubularization on Quadruple Stranded Hamstring ACL Grafts with Femoral Suspensory Fixation: A Biomechanical Study by Matthew Richard Moralle* in Crimson Publishers: Orthopedic Research and Reviews Journal
Physical Therapy Modalities and Alternative Methods in Treatment of Soft Tiss...CrimsonPublishersOPROJ
Physical Therapy Modalities and Alternative Methods in Treatment of Soft Tissue Lesions by Elizabeta Popova Ramova* in Crimson Publishers: Orthopedic Research and Reviews Journal
Early Outcome of Discectomy with Interspinous Process Distraction Device a Re...CrimsonPublishersOPROJ
Early Outcome of Discectomy with Interspinous Process Distraction Device a Retrospective Cross-Sectional Study by Gunaseelan Ponnusamy* in Crimson Publishers: Orthopedic Research and Reviews Journal
The Role of Lateral External Fixation in Paediatric Humeral Supracondylar Fra...CrimsonPublishersOPROJ
The Role of Lateral External Fixation in Paediatric Humeral Supracondylar Fracture by Ren Yi Kow* in Crimson Publishers: Orthopedic Research and Reviews Journal
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
2. How to cite this article: D Skouteris, P Tsiasiotis, G Tsikouris, V Psychoyios .Management of Heterotopic Ossification of the Elbow in Patients with Elbow and
Brain Injury a Retrospective Study. Ortho Res Online J. 1(1). OPROJ.000505. 2017. DOI: 10.31031/OPROJ.2017.01.000505
Orthopedic Research Online Journal
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Figure 1: Typical case of elbow HO after olecranon fracture
and brain injury. This patient sustained a subarachnoid
hemorrhage and admitted to ICU for 20 days.
We were able to contact and re-examine 24 patients. There
were 16 men and 8 women with a mean age of 37 years (range 18-
67). In seventeen patients the dominant arm was involved. Two
patients had been lost from the follow up but their medical records
from the last outpatient clinic visit were available. One patient died
of unrelated reason and one patient refused to be re-examined. We
included in this retrospective study 24 patients that we were able
to re-examine clinically and radiographically. The mean follow-up
was 93.2 months (range, 44-201 months).
Regarding the head injury eight patients sustained a subdural
hematoma, five an epidural hematoma, four a subarachnoid
hemorrhage, and seven a diffuse cerebral edema (Table 1). Six
patients underwent a neurosurgical procedure on average of
approximately five hours after admission to the hospital. The elbow
trauma consisted of distal humerus fracture in five patients, an
olecranon fracture in three, in complex fracture dislocation of the
elbow in nine, radial head fracture in three, an elbow dislocation in
two, an MCL rupture in one and an open elbow dislocation in one
patient (Table 2) (Figure 2). Twenty patients underwent operative
fixation of their lesions. The average duration to ICU was 29 days
(range 17-86 days).
Figure 2: a) Open elbow dislocation in 27 yrs old patient who suffered from traumatic epidural hematoma.
b) Almost complete elbow ankylosis after 22 months of the original injury.
Table 1: Head injury lesions.
Subdural hematoma 8
Epidural hematoma 5
Subarachnoid hemorrhage 4
Cerebral edema 7
Table 2: Elbow injuries.
Distal humerus fracture 5
Olecranon fracture 3
Radial head fracture 3
Complex elbow fracture dislocation 9 Total
Terrible triad 3
Posterior Monteggia lesion 4
Transolecranon fracture dilocation 2
MCL rupture 1
Open elbow dislocation 1
Close elbow dislocation 2
3. How to cite this article: D Skouteris, P Tsiasiotis, G Tsikouris, V Psychoyios .Management of Heterotopic Ossification of the Elbow in Patients with Elbow and
Brain Injury a Retrospective Study. Ortho Res Online J. 1(1). OPROJ.000505. 2017. DOI: 10.31031/OPROJ.2017.01.000505
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Ortho Res Online JOrthopedic Research Online Journal
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Surgical management
Excision of the heterotopic bone (formed) as well as elbow soft
tissue contracture release was performed utilizing well-described
surgical techniques in the literature [8,12-14]. Persistent loss of
elbow motion causing disability, limitation of daily activities, pain
anddurationofthesymptomsforatleastninemonthswithnosignof
improvement despite physical therapy were the clinical indications
for surgical intervention. A negative bone scan and normal levels
of alkaline phosphatase were the main laboratory indicators of
heterotopic bone maturity until 2004. Since then we abandoned
their use, as according to our limited experience and the literature
in matter, ALP is not considered a reliable screening method for
early HO detection [15,16]. Furthermore, bone scintigraphy has
limited value for evaluating the maturity of ossification and is little
used in clinical practice [8]. Our main criteria for excision after
2004 were the clinical status, as described above, and a stabilized
lesion radiographically.
Approach was determined by previous skin incisions, presence
of ulnar neuropathy, location of the heterotopic bone and status
of the radial head. A long posterior midline incision was used in
18 patients, a combination of medial and lateral incision in two, a
lateral in two, amedial in one and an anterior in one (Figure 3).
Figure 3: Various approaches utilized for the HO excision from elbow joint
a) A long posterior incision gives access posteriorly, anteriorly medially and laterally to the elbow joint.
b) Medial and lateral approach utilized separately to excise HO from the medial lateral and lateral aspect of the elbow joint.
c) An anterior approach to the elbow joint. Utilized very rarely and in specific cases of HO location at the anterior elbow surface.
d) A medial approach to elbow joint. In this particular case after excision of the HO through the flexor-pronator mass.
Figure 4: Large medial and lateral fasciocutaneous flaps.
Identification and protection of the ulnar nerve (yellow
arrow).
In a posterior approach a large medial and lateral full thickness
fasciocutaneous flaps were created and the ulnar nerve was
identified and released up to the proximal aspect of the flexor carpi
ulnaris (FCU) muscle and protected (Figure 4). After dissection of
the triceps muscle from the posterior humerus, a complete excision
of the posterior capsule was performed as well as excision of
heterotopic bone from the posterior aspect of the joint, especially
around the olecranon and the olecranon fossa. If necessary, the
posterior band of the MCL was released, until gaining flexion up
to 130 degrees or more. When forearm motion was limited the
Kocher interval was developed and an anterior capsulectomy
was performed in combination with excision of heterotopic bone
whenever it was present. In five cases a radial head excision
was undertaken due to enormous enlargement from chondral
metaplasia, after radial head fracture (Figure 5). In six cases a
medial approach through the flexor-pronator mass was developed,
one primarily and the rest as a part of another approach, in order
to completely excise the anterior capsule and achieve full extension
of the joint.
Figure 5: Elbow HO after brain injury and Radial head
fracture.
a)HO in the lateral and medial side.
b)Radial head chondral metaplasia
Hardware for fracture fixation was removed in all patients. In
one patient a supracondylar fracture was created attempting to
gain full extension, and treated with k-wires (Figure 6). In three
4. How to cite this article: D Skouteris, P Tsiasiotis, G Tsikouris, V Psychoyios .Management of Heterotopic Ossification of the Elbow in Patients with Elbow and
Brain Injury a Retrospective Study. Ortho Res Online J. 1(1). OPROJ.000505. 2017. DOI: 10.31031/OPROJ.2017.01.000505
Orthopedic Research Online Journal
4/6
Ortho Res Online J
Volume 1 - Issue - 1
patients a pie crust triceps lengthening/release was performed to gain additional flexion.
Figure 6: Iatrogenic fracture after excision of the Elbow HO in attempting to gain full ROM.
a) Elbow HO affecting all the elbow surfaces after elbow dislocation.
b) Supracondylar elbow fracture after HO excision, treated with k-wires.
c) Profile view from the same elbow xray.
The lateral collateral ligament was accidentally detached from
its humeral insertion in one patient and repaired with transosseous
sutures. The ulnar nerve was transposed subcutaneously in twenty-
one patients either as a preventive or as a therapeutic procedure.
Bone wax was applied onto all bony surfaces from which bone was
excised.
A long arm splint with the elbow in full extension was applied
onto the anterior aspect of the joint (Figure 7). Active assisted and
passive flexion-extension exercise begun the first postoperative
day. Indomethacin 75mg was administered twice daily for six
weeks in order to prevent a new ectopic bone formation. An
intensive physiotherapy program was followed and a turnbuckle
splint was applied after edema subsidence, usually after the third
postoperative week. The mean duration of physical therapy was
5 months and the mean duration of the turnbuckle splint usage
was 11 months. No adjuvant radiation therapy was used, although
its true value in HO management is still debated. According to
Cipriano et al. [17] local radiation was not effective in patients with
neurogenic HO. On the other hand, studies on patients with HO
after spinal cord injuries treated with adjuvant radiation therapy
indicate significant improvement in ROM [18,19].
Figure 7: A long arm anterior splint applied with elbow
joint in full extension.
Results
The average arc of elbow motion improved from 40° (range 0°-
80°) pre operatively to 110° (range 0°-140°), with an improvement
of 70° at the final follow-up evaluation. The mean Mayo Elbow
Performance Index MEPI score was 89.9 (range, 60-100). Results
were good to excellent in 18 patients, fair in 5 patients, and poorin
one (Table 3). Among the 24 study patients, 19 (79.1%) obtained a
total ROM of 100oat the final evaluation, and 3 underwent repeated
surgical release due to recurrence of contracture. In two of them a
recurrence of HO was present 9 months on average postoperatively.
Patients who required repeated surgical release had an average arc
of flexion-extension of 70° at the time of their second surgery and
an average of 90° after their second elbow release at final evaluation
for the needs of the present paper.
Table 3: Preop and Postop ROM and the Mayo Elbow Performance
Index.
Preop Postop
Av E/F 45( 35- 85) 110(0-140)
Av S/P 100(45-55) 165(75-85)
MEPI score 45 89.1
Five patients did not gain an arc of >100, and in two of them
recurrence of HO was regarded as the major reason of failure. In
the rest three patients a severe osteoarthritis was developed and
considered as the main reason of the failure.
There was one iatrogenic injury to the lateral ligamentous
complex and one iatrogenic fracture of the distal humerus, treated
accordingly. Three patients developed a mildly valgus deformed
elbow without clinical consequences. Three patients underwent
a second procedure, a transmuscular ulnar nerve transposition
together with internal neurolysis, due to tardy ulnar nerve palsy
75 months on average of 100 months after the index procedure.
Recurrent HO was observed in two patients postoperatively, one of
them denied any further treatment.
5. How to cite this article: D Skouteris, P Tsiasiotis, G Tsikouris, V Psychoyios .Management of Heterotopic Ossification of the Elbow in Patients with Elbow and
Brain Injury a Retrospective Study. Ortho Res Online J. 1(1). OPROJ.000505. 2017. DOI: 10.31031/OPROJ.2017.01.000505
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Discussion
The goal of our study was to assess the outcome in improvement
of the range of motion of the elbow and of the daily activities after
surgical release of elbow stiffness caused by HO after elbow trauma
and concomitant brain injury.
Thus we can state that a very reasonable outcome can be
expected regardless of preoperative ROM or the type of brain injury,
provided that upper limb does not a have any neurological deficit.=
In the past HO has been considered as a poor prognostic factor
after elbow trauma [10,20,21]. Due to the extensive loss in ROM,
the high recurrence rates of HO and complications after surgical
treatment, the decision making for operative intervention was a
less attractive option.
Nowadays, although surgical treatment of HO is technically
demanding and accompanied by high complication rates, there are
studies which report good results after surgical treatment of elbow
stiffness due to HO [4,22-24]. Accordingly, there are studies that
demonstrate better results for the HO group in comparison with
the capsular contracture group after surgical treatment 7. However,
the are no studies evaluating the outcome of surgical release in
patients with elbow trauma and brain injury, admitted for a period
of time to ICU.
We attempted to evaluate the results especially in this
subcategory of patients and to extract conclusions, although
retrospectively, regarding the feasibility of the procedure, the
outcome regarding ROM and ability to perform daily activities.
Furthermoreduetocomplexityofthoseproceduresweencountered
the potentials risks and tried to find ways to avoid or fix them.
Excision of heterotopic bone as well as release of contracture
or ankylosis about the elbow requires a very sound knowledge of
anatomy in this particular area. A posterior skin incision offers a
global approach to elbow surfaces and deep structures. Substantial
improvement in elbow and forearm range of motion can be
anticipated following the procedure described although a high
complication rate early or delayed can interrelate these procedures.
Every patient should be treated with an aggressive rehabilitation
protocol that includes prolonged physical therapy as well as use of
turnbuckle splint14. Adjuvant treatment with indomethacin should
be utilized in every patient as various studies seem to support the
efficacy of NSAIDs and indomethacin in particular [4,25]. While
somelossofmotionfromwhatsignificantlygainedintra-operatively
can be expected, a majority of patients who actively participate in
their physical therapy program will achieve an optimal outcome by
preserving a functional arc of motion.
Conflict of Interest
All the authors certify that they have NO affiliations with
or involvement in any organization or entity with any financial
interest (such as honoraria; educational grants; participation in
speakers’ bureaus; membership, employment, consultancies, stock
ownership, or other equity interest; and expert testimony or patent-
licensing arrangements), or non-financial interest (such as personal
or professional relationships, affiliations, knowledge or beliefs) in
the subject matter or materials discussed in this manuscript.
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6. How to cite this article: D Skouteris, P Tsiasiotis, G Tsikouris, V Psychoyios .Management of Heterotopic Ossification of the Elbow in Patients with Elbow and
Brain Injury a Retrospective Study. Ortho Res Online J. 1(1). OPROJ.000505. 2017. DOI: 10.31031/OPROJ.2017.01.000505
Orthopedic Research Online Journal
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