a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Hip dysplasia describes a condition where the hip becomes partially or fully dislocated and/or the hip’s ball (femoral head) and socket (acetabulum) are misaligned. The condition primarily affects children but is also commonly diagnosed in adulthood. Treatment options range from simple bracing to extensive surgery and should be determined based on the patient’s age and the severity of their condition.
http://www.davidsfeldmanmd.com/specialties/hip-dysplasia
Avascular necrosis (AVN) or Aseptic Necrosis of the hip is caused by a disruption to the hip’s blood supply which results in the deterioration and often collapse of the ball of the thigh bone (femoral head). Early identification and treatment of the condition increases the likelihood that a patient’s hip will recover. Surgery may be required in severe cases to repair or revascularize (restore circulation) the hip or to replace the hip in neglected/end stage cases.
http://www.davidsfeldmanmd.com/specialties/avascular-necrosis-hip
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Hip dysplasia describes a condition where the hip becomes partially or fully dislocated and/or the hip’s ball (femoral head) and socket (acetabulum) are misaligned. The condition primarily affects children but is also commonly diagnosed in adulthood. Treatment options range from simple bracing to extensive surgery and should be determined based on the patient’s age and the severity of their condition.
http://www.davidsfeldmanmd.com/specialties/hip-dysplasia
Avascular necrosis (AVN) or Aseptic Necrosis of the hip is caused by a disruption to the hip’s blood supply which results in the deterioration and often collapse of the ball of the thigh bone (femoral head). Early identification and treatment of the condition increases the likelihood that a patient’s hip will recover. Surgery may be required in severe cases to repair or revascularize (restore circulation) the hip or to replace the hip in neglected/end stage cases.
http://www.davidsfeldmanmd.com/specialties/avascular-necrosis-hip
Idiopathic scoliosis is a condition that causes the spine to curve to the side. While the cause of scoliosis is unknown, it usually runs in families and typically affects girls and young women more often and severely than boys and young men. Mild cases that do not cause pain or discomfort require no treatment. However, cases that are moderate to severe and with or without pain or discomfort require treatment which is determined on a case by case basis.
http://www.davidsfeldmanmd.com/specialties/scoliosis
Problem faced by Adult with Cerebral Palsy & their emediesjitendra jain
As with any other normal individual, function of Cerebral Palsy affected individual also declines significantly as result of aging but proportion of problems can be more. Shorter life span in these group of population not because of cerebral palsy but commonly due to existing co-morbidities so it is better to understand their co-morbidity and try to resolve them .
Holistic concept in treatment of Cerebral Palsy jitendra jain
it is very difficult to manage cerebral palsy because we cant repair brain damage but we can give good quality of independent life by combination good rehabilitation tool which include advance therapeutic technique, botulinum toxin early age child and SEMLOSSS surgical concept in others. Our aim of management is to take these person to their highest capability and decrease their physical limitation as much as possible. This ppt have brief review about latest concept in mx of cerebral aplsy
Adult hip dysplasia describes a condition where the hip’s ball (femoral head) and socket (acetabulum) are misaligned. The condition is common in children but is also found in adolescents and adults who have had no history of problems in childhood. Treatment options include temporizing with medication and/or physical therapy but surgery is often required to fix the problem.
http://www.davidsfeldmanmd.com/specialties/adult-hip-dysplasia
Francesca: Anterior Physeal Arrest with Recurvatum Deformity & Shortening Cas...David S. Feldman, MD
Francesca is a competitive level female gymnast who sustained a proximal tibia fracture at the age of 10. The injury damaged her growth plate (physis) which caused it to close prematurely and led to the development of deformities where her right leg was shorter than her left and her right knee bent backwards 16 degrees more than her left knee. Francesca underwent a proximal tibia fibular osteotomy surgical procedure and had a Taylor Spatial Frame applied to her leg. The combination of this surgical procedure with physical therapy resolved her lower limb issues and allowed her to return to gymnastic.
Francesca recently qualified for Nationals and will be competing in the next few days. We wish her the best of luck and we’ll all be rooting for her!
http://www.davidsfeldmanmd.com/patient-education/case-studies/francesca-anterior-physeal-arrest-recurvatum-deformity-shortening
Charlotte has been my patient since she was three years old. Over the years, I’ve collaborated with other medical professionals to treat her for various issues with her right leg. When Charlotte was 13, we began a multifaceted course of treatment to correct a complex lower limb deformity that occurred as a result of her earlier leg issues. These treatments have made it possible for Charlotte to keep her leg while avoiding amputation and prosthetics.
http://www.davidsfeldmanmd.com/patient-education/case-studies/charlotte-complex-lower-limb-deformity
Axel: Arthrogryposis, Clubfeet, & Dislocated Hips and Knees Case StudyDavid S. Feldman, MD
At the time of Axel’s birth, it was apparent to both Axel’s parents and doctors that there was something very wrong with his legs. His pediatrician had never seen a case like his before. I began treating Axel when he was three days old after diagnosing him with bilateral clubfeet, dislocated knees, and subluxated (partially dislocated) hips caused by arthrogryposis.
By the age of one, Axel was doing very well. He was standing and holding on independently and had begun walking with assistance. Axel has had an excellent short term result for a severely involved child with arthrogryposis.
Shaunak was diagnosed at birth with achondroplasia, a bone growth disorder that causes a form of dwarfism. Shortly before his sixth birthday, he visited my office with his family to discuss options for limb lengthening and correction of his bowed legs. Shaunak’s limb deformities were corrected in stages over the course of eight months.
Shortly before his 14th birthday we discussed options for additional lengthening and the correction of a deformity that occurred as he grew. This course of treatment is still in progress and Shaunak’s case study will be updated once treatment is complete.
http://www.davidsfeldmanmd.com/patient-education/case-studies/shaunak-achondroplasia
Anthony was diagnosed with Legg-Calve-Perthes disease at the age of four and was treated by me until the age of 10. His multi-faceted and individualized course of treatment consisted of therapy, non-weight bearing, and surgery. Five years after his last procedure, Anthony’s Legg-Calve-Perthes is completely resolved and he should continue to enjoy normal hip function for many decades to come.
www.davidsfeldmanmd.com/patient-education/case-studies/anthony-legg-calve-perthes-disease
After six years of intermittent groin pain, Nadine sought medical care when her symptoms became worse. An MRI revealed a cartilage tear in her right hip and she was later diagnosed with bilateral hip dysplasia. When Nadine visited me for a second opinion, I found that her right hip was worse than her left and recommended a right hip periacetabular (Ganz) osteotomy.
In the months since her surgery, Nadine’s right hip pain has been resolved and she’s been able to return to her normal activities.
http://www.davidsfeldmanmd.com/patient-education/case-studies/nadine-hip-dysplasia
At the age of 13, Stephanie underwent a posterior spinal fusion to treat her scoliosis which severely affected her lumbar and thoracic vertebrae. Following her surgery, Stephanie was able to recover and return to her activities without any restrictions in a relatively short amount of time.
http://www.davidsfeldmanmd.com/patient-education/case-studies/stephanie-severe-idiopathic-scoliosis
Nathalie was diagnosed with osteogenesis imperfecta (Type IV) as a toddler. Osteogenesis imperfecta is a congenital genetic condition that causes brittle bones which fracture easily from minor impact and in some cases for no reason. As a result, Nathalie experienced multiple fractures throughout her childhood which required several surgical procedures.
Given the nature of osteogenesis imperfecta, these childhood fractures were to be expected. However, Nathalie’s parents’ diligence in immediately seeking care has helped to limit the long-term effects that could have resulted from her injuries. Nathalie is now in her early teens and doing very well overall.
http://www.davidsfeldmanmd.com/patient-education/case-studies/nathalie-osteogenesis-imperfecta
Hip dysplasia in adults, types, radiographs and management!
Useful for Orthopaedic residents and Surgeons.
Include most of the basics from reliable sources, pardon for any mistakes. Contact at singh_prabhjeet@yahoo.com for any corrections.
Brief discussion regarding management of physiotherapy, pharmacotherapy, orthosis, principles of orthopedic surgical managements, addressing problems at hip, knee and ankle, soft tissue release procedures, osteotomies, timing of surgery, complications, prognosis, hip at risk signs, birthday syndrome, role of botulinum toxin, upper extremity involvement, contracture release.
Knee replacement in a recurvatum deformity is one of the most challenging scenarios. This uncommon surgery is based on a few simple principles which are explained in this ppt. Hyperextension can be a part of neurological disorder, primary ligament laxity, mal-alignment around the joint, post traumatic conditions etc. a careful dissection and minimal bone cuts are essential points in this surgery. Contrary to regular principle we end up stuffing the joint to balance the posterior capsular hammock.
Hope this ppt helps you with your surgery planning.
Post Polio Residual Palsy: Pathophysiology & Principles of RxAnisuddin Bhatti
Prof. Anisuddin Bhatti, Paeds Orthop Surgeon delivered lecture on Post Polio paralysis and deformities Part 1 on Pathophysio and principles of treatment, through Dr. Ziauddin University Hospital Clifton Karachi webinar on googel.meet, on 3rd April 2021. Acknowledge for material taken from Research papers, slideshare and books as referred in reference list.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
The Hip Joint in Cerebral Palsy | David S. Feldman, MD
1. HOSPITAL FOR JOINT DISEASES
THE HIP JOINT IN CEREBRAL PALSY
David S. Feldman, MD
Professor of Orthopedic Surgery and Pediatrics
Chief, Pediatric Orthopedic Surgery
NYU/Hospital for Joint Diseases
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
2. Define the
Problem
(This review is meant to aid in knowledge but
is no way is intended to be a thorough and
comprehensive analysis of each topic)
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
3. Why The Hip??
•Hip is particularly sensitive to
muscle imbalance.
•Large number of large muscles
crossing the joint.
•Psoas
•Adductors
•Rectus
•Hamstrings
•ITB
•G max/med/min
•Short Ext Rotators
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
4. Cerebral Palsy
•Children with CP develop hip subluxation
•80% of Patients with Spastic Quadraplegia develop hip
subluxation
•Spastic Diplegia and hemiplegia is associated with
Acetabular Dysplasia
•Excessive Femoral Antetversion is common. This often
causes the ambulating child to walk with his or her turned
in excessively.
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
5. Progressive Hip Subluxation
•Often Painful
•Leads to assymetry and pelvic obliquity
•Dislocated hips become contracted
•Wind Swept Deformity
•Sitting imbalance
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
7. Evaluation
•Contracture versus spasticity (R1 and R2)?
•Is there antagonist spasticity?
•Is there a dystonic or an athetoid component?
•Age of the patient and growth potential.
•Is there dynamic tone?
•Is there a contracture/spasticity a joint above or below the
joint you are dealing with?
•Is the joint subluxated, dislocated or at risk?
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
8. Evaluation
•Is there pain?
•When, where and with which
activities?
• Groin, thigh and buttock pain and
prolonged sitting or standing.
•Is there a limp?
• Trendelenburg
•Is the problem femoral,
acetabular, both or neither?
• I.e. Anteversion or Retroversion
•Is there joint congruency?
• If loss of congruity then type of surgery
will change.
•Does the Joint Reduce on the
abduction-internal rotation view
(Van Rosen)?
• Reducible hip is needed for Osteotomy
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
9. Evaluation
•PE – How much Flexion/
Extension of the hip?
Abduction/adduction? Pain
with IR? Gait
abnormalities? ROM?
LLD?
•X-ray- AP Pelvis, Judet
(false profile view), Van
Rosen
•CT scan for femoral
anteversion and acetabular
anatomy
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
10. What is femoral anteversion?
Internal rotation of the femur
•Children are born with 2530 degrees of femoral
anteversion
•Resolves to 10-15 degrees
by age 8
•CP –Increasing or nonresolved femoral
anteversion
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
11. 1 yo female - Left dislocated
hip, Right subluxated hip
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
12. After open reduction - 3 yo
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
19. Age 43 s/p THR
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
20. Goals
•SYMMETRY
• Agonist and antagonist complimentary function
• Protect joint
• Minimal or no immobilization
• NO SPICA CASTS ON CHILDREN WITH CP
• The spasticity does not tolerate casting
• Early return to standing and ambulation
• Minimize strength loss
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
21. GOALS
•Stable Reduced Joint
•Reduced Joint Contact
Pressures
•Painless Joint
•Functional Range of Motion
•Decrease incidence of
advanced OA
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
22. Working Together for Ambulation and
Function
•Physical/Occupational Therapist
•Geneticist
•Pediatrician
•Developmental Pediatrician
•Pediatric Neurologist
•Pediatric Physiatrist
•Pediatric Neurosurgeon
•Pediatric Urologist
•Pediatric Orthopedic Surgeon
•Pediatric Social Worker
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
23. Still More
•Pediatric Psychologist
•Nurse
•Orthotist
•Special Education Teacher
•Pediatric Speech Therapist
•Pediatric Nurse Specialist
•Parent or Caregiver
“SPARE THE PATIENT FROM TAKING PART IN
INTERPROFESSIONAL GAMES”
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
28. Surgical Options
•Percutaneous tendon releases (lengthening)
•Open tendon lengthening
•Muscle Recession
•Tendon Transfer Complete vs. Split
•Rhizotomy
•Baclofen pump
•Osteotomy
•Hip Reduction
•Bone/joint Resection
•Scoliosis Surgery
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
29. Which Procedure for Whom?
•Rhizotomy- Less than age 6, SPASTIC
DIPLEGIA. Good trunk control. NO DYSTONIA.
Orthopedic Surgery afterwards if there is
contracture.
•Baclofen Pump – When Spasticity is the main
issue. Can treat dystonic component with high
dosage. Will impair trunk stability if patient has
truncal hypotonia. May increase scoliosis. May
improve speec. May increase drooling.
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
30. Types of Releases/Transfers
•Percutaneous tenotomies- PERCS
•Percutaneous lengthenings -PERCS
•Open lengthening
•Open intramuscular recession
•Complete Transfer in Phase
•Complete Transfer out of Phase
•Split Transfer
•Muscle Slide
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
31. Hip Soft Tissue Contractures
•Hip Flexion - Psoas, Rectus and sartorius
•Hip Extension – Gluteus Maximus
•Adduction – Adductors and Medial Hamstring
•Abduction - ITB and Gluteus Medius
•Internal Rotation – Gluteus Medius and Medial
Hamstring
•External Rotation – Short External
Rotators, and Gluteus Maximus
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
32. Hip Contracture Solutions
•Hip Flexion – Psoas (Psoas Recession)
•Hip Extension – Gluteus Maximus (Osteotomy)
•Adduction – Adductors (Percutaneous
tenotomy)
•Abduction - ITB (Percutaneous tenotomy)
•Internal Rotation – Gluteus Medius (Anterior
Trochanteric Transfer)
•External Rotation – Short External Rotators
(Osteotomy)
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
33. Knee Contractures
•Flexion – Medial and Lateral Hamstrings
•Extension – Rectus Femoris and Vastus
lateralis
•Hadley et al. JPO 1992
•Abel et al JPO 1999
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
34. Knee Contracture Solutions
• Flexion – Medial and Lateral Hamstrings (Pecutaneous/Open Hamstring
lengthening, tenotomies and possible osteotomy)
• Extension – Rectus Femoris (Rectus transfer or possible proximal release)
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
35. SYMMETRY
•Range of motion
•Neck Shaft Angle
•Limb length
•Femoral Anteversion
•Tibial rotation
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
37. Pelvic Osteotomies
•Salter Ostetomy - Below age 8, 15-20
degrees of Antero-lateral coverage
•Pemberton/Dega- Used for a voluminous
acetabulum, The tri-radiate cartilage must be
open
•Tonnis/Steel/Sutherland Osteotomy- Triple
Ostetomies with varying degrees of
freedom, ages 6 to adulthood.
•Ganz/Dial Osteotomy- Marked ability to
move acetabulum, Triradiate closure to
adulthood
•Chiari/Shelf- Incongruous hip
coverage, Salvage, metaplasia
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
38. 14 yo with Spastic Diplegia
•Subluxated Left hip
•Dysplastic Acetabulum
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
42. DO NOT IMMOBILIZE THE HIP AND KNEE
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
43. Periacetabular Osteotomy (PAO)
•Bern Periacetabular
Osteotomy
•Described in CORR in 1988 by
Reinhold Ganz
•Periacetabular Osteotomy
that leaves the posterior
column intact
•Allows for medialization of
the hip----Biomechanically
Advantageous
•Allows for immediate weight
bearing
•Need a Congruous and
Reducible Hip
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
55. What Age Does One Go form Botox or Soft
Tissue Peocedures to Osteotomies?
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
56. ANSWER
•Historically age 6-8
•If there are boney changes, i.e flattening or
misshapen femoral head then age is
irrelevant.
•Often early Botox and/or Percs may
prevent the need for boney surgery
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
57. HIP DISLOCATION
SHOULD WE PREVENT? YES
SHOULD WE REDUCE/ Resect? IF PAINFUL
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
58. 5 yo Spastic Quadraplegia
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
63. Etiology (CAUSE) of Internal Rotation Gait??
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
64. Internal Rotation Gait
•Medial Hamstring
•Adductors
•Gluteus Medius Spasticity
•Femoral Anteversion
•? Capsular tightness/hip
anatomy
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
65. IS SURGERY ALWAYS BILATERAL??
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
66. Answer
Always achieve Symmetry. Different
sides may require different
procedures
.
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
67. 9 yo boy with Spastic Diplegia
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
68. May a Child with Hip Subluxation: Bear Weight?
Be in a Stander?
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
69. YES
There are no special precautions
needed for these children aside from
avoiding painful positioning
Hospital for Joint Diseases ● Department of Orthopaedic Surgery
70. DYSTONIA and the Subluxed Hip??
Hospital for Joint Diseases Department of Orthopaedic Surgery
●
76. •Lever arm disease is the adolescent with
calcaneus feet, knee flexion contractures, hip
flexion contractures and lumbar lordosis.
•Should we stop doing heel cord lengthenings in
diplegics and use extensive serial casting?
•Definitely DO NOT OVER LENGTHEN THE
HEEL CORD!!!!!!!!
•Treat before patella alta occurs.
Hospital for Joint Diseases Department of Orthopaedic Surgery
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77. Lever Arm Disease
•Most likely Osteotomies unless caught very
early is the only solution.
•Hip and knee extension osteotomies.
•Patella tendon imbrication.
Hospital for Joint Diseases Department of Orthopaedic Surgery
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78. SCOLIOSIS and the HIP
Hospital for Joint Diseases Department of Orthopaedic Surgery
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79. SCOLIOSIS IN CEREBRAL PALSY
SURGICAL
INDICATIONS:
Progressive deformity
Sitting imbalance
Pelvic obliquity
Hospital for Joint Diseases Department of Orthopaedic Surgery
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81. SCOLIOSIS IN CEREBRAL PALSY
•SURGICAL
MANAGEMENT
ASF/PSF vs.
PSF
•only
Segmental
fixation
•Fuse to the
pelvis
(Galveston)
Hospital for Joint Diseases Department of Orthopaedic Surgery
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85. ROM of the HIP
•Particularly important if the the Spine is
being fused to the pelvis
•Be especially cognizant of lack of true
flexion of the hip
Hospital for Joint Diseases Department of Orthopaedic Surgery
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86. DO NOT!!!!!!
•Lengthen a muscle without addressing the
antagonist
•Miss the dynamic, dystonic or athetoid
component
•Miss a joint subluxation or dislocation
•Miss the opportunity to correct a problem before
secondary changes occur.
•Over lengthen heel cords or hamstrings
•Create assymetry
•Immobilze the knee and hip of a child with CP for
a prolonged period
Hospital for Joint Diseases Department of Orthopaedic Surgery
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