- The study evaluated short term results of using low density implants for correction of adolescent idiopathic scoliosis in 30 patients. Low density implants were defined as less than 1.6 screws per spinal level fused.
- Results found that low density implants achieved a mean Cobb's angle correction from 60.47 pre-op to 19.1 post-op with a mean 5.09% loss of correction at 12 months follow-up. Operative time, blood loss, and costs were reduced compared to higher density constructs.
- Low density implants provided satisfactory correction outcomes with fewer complications than higher density constructs, showing potential as an efficient technique for correcting AIS. Larger, longer-term studies are still
Presentations from Professor Adnan Saithna at the North West Upper Limb Group Meeting January 2018, focusing on current concepts in the diagnosis and management of long head of biceps tendon pathology, with an emphasis on the young, active patient with anterior shoulder pain
The document summarizes a study on arthroscopic remplissage for recurrent anterior shoulder instability. 48 patients underwent remplissage in addition to Bankart repair, with a mean follow-up of 37 months. The failure rate was 6.3%, and 93.7% were satisfied without restrictions. Scores on the ASES, Rowe, and Oxford scales all significantly improved post-operatively without loss of range of motion. The study concludes remplissage enhances Bankart repair for managing instability, with good results and no effect on shoulder movement.
The document discusses leadless pacemakers as an alternative to traditional transvenous pacemakers. It provides a brief history of pacemakers and then describes the key advantages of leadless pacemakers as being less invasive, having a shorter procedure time and recovery period, and eliminating complications related to transvenous leads. It summarizes the results of clinical trials showing the safety and efficacy of implanting leadless pacemakers, with high implant success rates and low complication rates similar to traditional pacemakers.
This document discusses evidence-based medicine (EBM) and summarizes several studies comparing different treatment methods for distal femur fractures. EBM aims to optimize patient care by emphasizing evidence from well-designed research. Several articles compare outcomes of internal fixation with intramedullary nails versus locking plates. In general, nails provide better callus formation, stiffness, and less micromotion at the fracture site, while plates have higher nonunion rates and require more secondary procedures. Retrograde nailing appears to have advantages for distal femur fractures, including improved alignment and reduced complications.
This document summarizes rotator cuff syndrome and arthroscopic subacromial decompression (ASAD). It discusses the anatomy and biomechanics of the rotator cuff. Common causes of rotator cuff pathology include impingement, tendinopathy, and tears. Conservative treatment includes physiotherapy and injections. ASAD is recommended for refractory stage 2 or 3 impingement, involving bursectomy, coracoacromial ligament release, and acromioplasty. Long-term studies show ASAD provides pain relief, improved function, and prevents future rotator cuff tears in the majority of patients. Patient selection, accurate diagnosis, and surgical technique affect outcomes.
Robotic spine surgery is on the cutting edge of medicine, allowing our surgeons to exercise an incredible level of precision, well beyond standard capabilities.
This document discusses classifications and treatments for clavicle fractures. It notes that midshaft fractures make up 80% of clavicle fractures. For midshaft fractures, displaced fractures may be treated surgically or non-surgically. A Cochrane review found no difference in outcomes between surgery and conservative treatment, though some studies found surgery resulted in fewer non-unions but more complications. The document concludes that treatment should be individualized based on the patient and fracture characteristics.
Presentations from Professor Adnan Saithna at the North West Upper Limb Group Meeting January 2018, focusing on current concepts in the diagnosis and management of long head of biceps tendon pathology, with an emphasis on the young, active patient with anterior shoulder pain
The document summarizes a study on arthroscopic remplissage for recurrent anterior shoulder instability. 48 patients underwent remplissage in addition to Bankart repair, with a mean follow-up of 37 months. The failure rate was 6.3%, and 93.7% were satisfied without restrictions. Scores on the ASES, Rowe, and Oxford scales all significantly improved post-operatively without loss of range of motion. The study concludes remplissage enhances Bankart repair for managing instability, with good results and no effect on shoulder movement.
The document discusses leadless pacemakers as an alternative to traditional transvenous pacemakers. It provides a brief history of pacemakers and then describes the key advantages of leadless pacemakers as being less invasive, having a shorter procedure time and recovery period, and eliminating complications related to transvenous leads. It summarizes the results of clinical trials showing the safety and efficacy of implanting leadless pacemakers, with high implant success rates and low complication rates similar to traditional pacemakers.
This document discusses evidence-based medicine (EBM) and summarizes several studies comparing different treatment methods for distal femur fractures. EBM aims to optimize patient care by emphasizing evidence from well-designed research. Several articles compare outcomes of internal fixation with intramedullary nails versus locking plates. In general, nails provide better callus formation, stiffness, and less micromotion at the fracture site, while plates have higher nonunion rates and require more secondary procedures. Retrograde nailing appears to have advantages for distal femur fractures, including improved alignment and reduced complications.
This document summarizes rotator cuff syndrome and arthroscopic subacromial decompression (ASAD). It discusses the anatomy and biomechanics of the rotator cuff. Common causes of rotator cuff pathology include impingement, tendinopathy, and tears. Conservative treatment includes physiotherapy and injections. ASAD is recommended for refractory stage 2 or 3 impingement, involving bursectomy, coracoacromial ligament release, and acromioplasty. Long-term studies show ASAD provides pain relief, improved function, and prevents future rotator cuff tears in the majority of patients. Patient selection, accurate diagnosis, and surgical technique affect outcomes.
Robotic spine surgery is on the cutting edge of medicine, allowing our surgeons to exercise an incredible level of precision, well beyond standard capabilities.
This document discusses classifications and treatments for clavicle fractures. It notes that midshaft fractures make up 80% of clavicle fractures. For midshaft fractures, displaced fractures may be treated surgically or non-surgically. A Cochrane review found no difference in outcomes between surgery and conservative treatment, though some studies found surgery resulted in fewer non-unions but more complications. The document concludes that treatment should be individualized based on the patient and fracture characteristics.
Studio di follow-up di 10,1 anni sulla cementazione artroplastica totale del ...MerqurioEditore_redazione
1) The study evaluated the long-term clinical and radiographic outcomes of 179 cementless total knee arthroplasties performed in 112 patients with rheumatoid arthritis over an average follow-up period of 10.1 years.
2) At the last follow-up, the mean knee and function scores on the Knee Society clinical rating system improved significantly, and 92.7% and 91.1% of knees respectively showed good or excellent results.
3) Radiographically, there was no evidence of loosening in the femoral or tibial components in the majority of cases. The 15-year survival rate of the prostheses was 96.8%.
1) The study evaluated the long-term clinical and radiographic outcomes of 179 cementless total knee arthroplasty procedures performed in 112 patients with rheumatoid arthritis over an average follow-up period of 10.1 years.
2) At the last follow-up, the mean knee and function scores on the Knee Society clinical rating system improved significantly, and 92.7% and 91.1% of knees respectively showed good or excellent results.
3) Radiographically, components were well-aligned and fixed at the last follow-up. Subsidence occurred in 6.7% of tibial components, and radiolucent lines were observed in 12.8% of femoral components and 24% of tib
1) The study evaluated the long-term clinical and radiographic outcomes of 179 cementless total knee arthroplasties performed in 112 patients with rheumatoid arthritis over an average follow-up period of 10.1 years.
2) At the last follow-up, the mean knee and function scores on the Knee Society clinical rating system improved significantly, and 92.7% and 91.1% of knees respectively showed good or excellent results.
3) Radiographically, components were well-aligned and fixed in position with few radiolucencies observed. The 15-year survival rate of the procedure was 96.8%.
1) The study evaluated the long-term clinical and radiographic outcomes of 179 cementless total knee arthroplasty procedures performed in 112 patients with rheumatoid arthritis over an average follow-up period of 10.1 years.
2) At the last follow-up, the mean knee and function scores on the Knee Society clinical rating system improved significantly, and 92.7% and 91.1% of knees respectively showed good or excellent results.
3) Radiographically, components were well-aligned and fixed at the last follow-up. The 15-year survival rate was 96.8%, with only one revision for loosening, indicating the cementless technique provided satisfactory long-term results for rheumatoid arthritis patients.
Ewing's sarcoma is a rare cancer that affects bones or soft tissue. It is characterized by small, round cancer cells and commonly affects children and young adults. Treatment involves induction chemotherapy, followed by local therapy with surgery or radiation if possible, along with additional maintenance chemotherapy. The multimodal approach has improved survival rates in recent decades, though long-term outcomes remain challenging due to the risk of recurrence or secondary cancers.
Biologic Knee Replacement (BKR) is our approach to treating knee injuries, from trauma to arthritis, and is designed to help people delay, or even avoid, artificial knee replacement. BKR is a scientifically-proven collection of our out-patient surgical techniques and procedures and consists of any combination of meniscus transplantation, articular cartilage paste grafting, ligament replacement as explained in further detail below. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using Biologic Knee Replacement.
A study of core decompression & free fibular strut grafting in the management...Vltech Knr
Core decompression and free fibular strut grafting were studied as a treatment for osteonecrosis of the femoral head. In the study of 28 hips with Ficat-Arlet grade 1-3 osteonecrosis, 67.86% of patients experienced pain relief after the procedure. At the 6-month follow up, 82.61% of patients were considered surgical successes based on Harris Hip Scores and radiographic evidence. However, 8 hips showed further advancement of osteonecrosis despite the procedure. The study concluded that core decompression with fibular grafting can effectively treat early stage osteonecrosis, but patient factors like age, hip flexibility, and adherence to post-op care affected outcomes.
This document discusses the diagnosis and management of avascular necrosis of the femoral head. It begins by describing the early diagnosis through clinical suspicion and radiological evaluation using MRI to detect changes. It then discusses staging systems and using quantification of damage to determine appropriate treatment, with the main options being head preservation procedures like core decompression or osteotomies, or head replacement through surface replacements or total hip arthroplasties. Factors like the stage of necrosis, location of lesions, age and overall health are considered for treatment planning. Case studies demonstrate outcomes of various procedures.
Zoltan Ruzsa presents results from a pilot study evaluating transradial access for femoral artery interventions. The study included 141 patients with symptomatic femoral artery stenosis treated via transradial access using 6F sheathless guiding catheters between 2014-2016. Angiographic and technical success rates were high at 87.2% and 75.9% respectively, with minor access site complications in only 3 patients (2.1%). While long term follow up showed revascularization was needed in 23.4% of patients at 12 months, the results demonstrate transradial access for femoral interventions can be performed safely with acceptable morbidity. Larger comparative studies are still needed to determine long term outcomes compared to traditional femoral access.
The document discusses the management of severe congenital hip dysplasia (CHD) with total hip arthroplasty (THA) plus a shortening osteotomy performed at the same time. It notes that this technique allows for faster bone healing, precise control of femoral derotation, and retention of thigh muscles. The results of 376 Crowe IV hips treated with THA and subtrochanteric shortening osteotomy over 25 years are presented, with a complication rate of around 22-18% reported.
This document discusses arthroscopic rotator cuff repair. It begins with the anatomy of the rotator cuff and classifications of tears. It then discusses techniques for arthroscopic repair including single versus double row repairs and different types of sutures and anchors. It summarizes studies comparing biomechanical properties and retear rates of different repair methods. The document concludes with long term follow up of repairs showing rerupture rates increase with larger tear size and age.
Predictors of Patients’ Functional Outcome after Motor Nerve Transfers in Man...Professor M. A. Imam
To maximize outcome in nerve transfers:
1- The recipient nerve reinnervated close to the target muscle.
2- Direct repair without intervening grafts.
3- Similarly behaving neuromuscular units (agonistic donors and recipients)
MIROS (Minimally Invasive Reduction and Osteosynthesis System®)CHAUDHARY ARPAN
MIROS (Minimally Invasive Reduction and Osteosynthesis System
MIROS consists of four 2.5 mm thick and 50 cm long stainless steel or titanium wires the end
of which is introduced into a metallic clip.
Assumed that the MIROS might provide greater fracture stability and less complications
with respect to traditional percutaneous pinning (TPP).
Anotomic-Biological Reconstruction of Acromio-Clavicular Joint Injuries-Dr. U...TheRightDoctors
This study evaluated 11 patients who underwent an anatomic reconstruction of the acromio-clavicular joint using a semitendinosus graft. At a minimum follow-up of 6 months, 8 patients had excellent outcomes, 2 had good outcomes, and 1 had a satisfactory outcome based on Constant and ASES scores. Complications included minimal loss of reduction in 1 patient and wound edge necrosis in another. The technique aims to anatomically reconstruct the coracoclavicular and acromioclavicular ligaments. The authors concluded the technique provides stable reconstruction with low complication rates. However, they noted limitations including the small sample size and need for longer-term studies.
Purpose: To evaluate the influence of age and severity of keratoconus in the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS).
This document discusses techniques for transradial access and intervention. It begins by outlining three levels of competency for operators and discusses when radial access may not be appropriate. It then provides a step-by-step guide for radial access procedures, covering patient positioning, arterial puncture, navigating vascular anatomy, catheter selection, and hemostasis. Predictors of procedural failure are presented. The document concludes by providing tips for implementing a successful radial program.
This document provides guidelines for clearing the cervical spine in trauma patients. It discusses the Canadian C-Spine Rules and Nexus Low Risk Criteria clinical decision rules that can be used to determine if imaging is needed. It also provides algorithms outlining the imaging and precautions recommended based on factors like the patient's age, clinical exam findings, mechanism of injury, and ability to be assessed. The key points are that clinical decision rules can help determine if imaging is needed, and imaging and precautions depend on the results and presence of injuries or neurological abnormalities found.
This study evaluated the long-term clinical and radiological outcomes of 126 patients with 239 osteoporotic vertebral fractures treated with balloon kyphoplasty compared to a conservatively treated control group. Patients undergoing kyphoplasty had significantly reduced pain scores and improved disability scores that were maintained at the 2-year follow-up, while the control group showed no significant changes. Kyphoplasty also significantly restored vertebral height and alignment, while conservative treatment did not significantly impact radiographic measures. This study demonstrates the long-term benefits of balloon kyphoplasty over conservative care for osteoporotic vertebral fractures.
This document provides an overview of hip anatomy, approaches to the hip joint, and the treatment of avascular necrosis (AVN) of the hip. It discusses various surgical approaches to the hip including anterior, anterolateral, lateral, posterior, and medial. It also describes the classification systems for AVN and reviews nonsurgical and surgical treatment options such as core decompression, bone grafting, osteotomies, and hip replacement. The goal of hip preserving surgeries is to redistribute weight bearing while total hip arthroplasty is recommended for late-stage AVN.
Osteoporosis is a progressive bone disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fractures. It occurs when bone resorption by osteoclasts exceeds bone formation by osteoblasts. Risk factors include age, gender, genetics, smoking, alcohol, obesity, low vitamin D, and medications like corticosteroids. It is diagnosed using DEXA scans and managed through lifestyle changes, calcium/vitamin D supplementation, and pharmacological therapies like bisphosphonates, strontium, raloxifene, teriparatide, calcitonin, and denosumab. Emerging therapies target mechanisms like cathepsin K, sclerost
This document discusses principles and techniques of internal fracture fixation. It defines common fracture terms like union, delayed union, and nonunion. It describes high versus low energy fractures and different fracture patterns. Key principles of fixation discussed include stability, compression, and healing mechanisms like primary versus secondary bone healing. Various fixation techniques are covered such as lag screws, plates, intramedullary nails, and external fixation. Reduction techniques both direct and indirect are also reviewed.
More Related Content
Similar to Evaluation of short term results of low density.pptx
Studio di follow-up di 10,1 anni sulla cementazione artroplastica totale del ...MerqurioEditore_redazione
1) The study evaluated the long-term clinical and radiographic outcomes of 179 cementless total knee arthroplasties performed in 112 patients with rheumatoid arthritis over an average follow-up period of 10.1 years.
2) At the last follow-up, the mean knee and function scores on the Knee Society clinical rating system improved significantly, and 92.7% and 91.1% of knees respectively showed good or excellent results.
3) Radiographically, there was no evidence of loosening in the femoral or tibial components in the majority of cases. The 15-year survival rate of the prostheses was 96.8%.
1) The study evaluated the long-term clinical and radiographic outcomes of 179 cementless total knee arthroplasty procedures performed in 112 patients with rheumatoid arthritis over an average follow-up period of 10.1 years.
2) At the last follow-up, the mean knee and function scores on the Knee Society clinical rating system improved significantly, and 92.7% and 91.1% of knees respectively showed good or excellent results.
3) Radiographically, components were well-aligned and fixed at the last follow-up. Subsidence occurred in 6.7% of tibial components, and radiolucent lines were observed in 12.8% of femoral components and 24% of tib
1) The study evaluated the long-term clinical and radiographic outcomes of 179 cementless total knee arthroplasties performed in 112 patients with rheumatoid arthritis over an average follow-up period of 10.1 years.
2) At the last follow-up, the mean knee and function scores on the Knee Society clinical rating system improved significantly, and 92.7% and 91.1% of knees respectively showed good or excellent results.
3) Radiographically, components were well-aligned and fixed in position with few radiolucencies observed. The 15-year survival rate of the procedure was 96.8%.
1) The study evaluated the long-term clinical and radiographic outcomes of 179 cementless total knee arthroplasty procedures performed in 112 patients with rheumatoid arthritis over an average follow-up period of 10.1 years.
2) At the last follow-up, the mean knee and function scores on the Knee Society clinical rating system improved significantly, and 92.7% and 91.1% of knees respectively showed good or excellent results.
3) Radiographically, components were well-aligned and fixed at the last follow-up. The 15-year survival rate was 96.8%, with only one revision for loosening, indicating the cementless technique provided satisfactory long-term results for rheumatoid arthritis patients.
Ewing's sarcoma is a rare cancer that affects bones or soft tissue. It is characterized by small, round cancer cells and commonly affects children and young adults. Treatment involves induction chemotherapy, followed by local therapy with surgery or radiation if possible, along with additional maintenance chemotherapy. The multimodal approach has improved survival rates in recent decades, though long-term outcomes remain challenging due to the risk of recurrence or secondary cancers.
Biologic Knee Replacement (BKR) is our approach to treating knee injuries, from trauma to arthritis, and is designed to help people delay, or even avoid, artificial knee replacement. BKR is a scientifically-proven collection of our out-patient surgical techniques and procedures and consists of any combination of meniscus transplantation, articular cartilage paste grafting, ligament replacement as explained in further detail below. Being "bone on bone" does not always mean that the joint needs to be artificially replaced, often the "bone on bone" is isolated to a portion of the knee joint and this can be repaired using Biologic Knee Replacement.
A study of core decompression & free fibular strut grafting in the management...Vltech Knr
Core decompression and free fibular strut grafting were studied as a treatment for osteonecrosis of the femoral head. In the study of 28 hips with Ficat-Arlet grade 1-3 osteonecrosis, 67.86% of patients experienced pain relief after the procedure. At the 6-month follow up, 82.61% of patients were considered surgical successes based on Harris Hip Scores and radiographic evidence. However, 8 hips showed further advancement of osteonecrosis despite the procedure. The study concluded that core decompression with fibular grafting can effectively treat early stage osteonecrosis, but patient factors like age, hip flexibility, and adherence to post-op care affected outcomes.
This document discusses the diagnosis and management of avascular necrosis of the femoral head. It begins by describing the early diagnosis through clinical suspicion and radiological evaluation using MRI to detect changes. It then discusses staging systems and using quantification of damage to determine appropriate treatment, with the main options being head preservation procedures like core decompression or osteotomies, or head replacement through surface replacements or total hip arthroplasties. Factors like the stage of necrosis, location of lesions, age and overall health are considered for treatment planning. Case studies demonstrate outcomes of various procedures.
Zoltan Ruzsa presents results from a pilot study evaluating transradial access for femoral artery interventions. The study included 141 patients with symptomatic femoral artery stenosis treated via transradial access using 6F sheathless guiding catheters between 2014-2016. Angiographic and technical success rates were high at 87.2% and 75.9% respectively, with minor access site complications in only 3 patients (2.1%). While long term follow up showed revascularization was needed in 23.4% of patients at 12 months, the results demonstrate transradial access for femoral interventions can be performed safely with acceptable morbidity. Larger comparative studies are still needed to determine long term outcomes compared to traditional femoral access.
The document discusses the management of severe congenital hip dysplasia (CHD) with total hip arthroplasty (THA) plus a shortening osteotomy performed at the same time. It notes that this technique allows for faster bone healing, precise control of femoral derotation, and retention of thigh muscles. The results of 376 Crowe IV hips treated with THA and subtrochanteric shortening osteotomy over 25 years are presented, with a complication rate of around 22-18% reported.
This document discusses arthroscopic rotator cuff repair. It begins with the anatomy of the rotator cuff and classifications of tears. It then discusses techniques for arthroscopic repair including single versus double row repairs and different types of sutures and anchors. It summarizes studies comparing biomechanical properties and retear rates of different repair methods. The document concludes with long term follow up of repairs showing rerupture rates increase with larger tear size and age.
Predictors of Patients’ Functional Outcome after Motor Nerve Transfers in Man...Professor M. A. Imam
To maximize outcome in nerve transfers:
1- The recipient nerve reinnervated close to the target muscle.
2- Direct repair without intervening grafts.
3- Similarly behaving neuromuscular units (agonistic donors and recipients)
MIROS (Minimally Invasive Reduction and Osteosynthesis System®)CHAUDHARY ARPAN
MIROS (Minimally Invasive Reduction and Osteosynthesis System
MIROS consists of four 2.5 mm thick and 50 cm long stainless steel or titanium wires the end
of which is introduced into a metallic clip.
Assumed that the MIROS might provide greater fracture stability and less complications
with respect to traditional percutaneous pinning (TPP).
Anotomic-Biological Reconstruction of Acromio-Clavicular Joint Injuries-Dr. U...TheRightDoctors
This study evaluated 11 patients who underwent an anatomic reconstruction of the acromio-clavicular joint using a semitendinosus graft. At a minimum follow-up of 6 months, 8 patients had excellent outcomes, 2 had good outcomes, and 1 had a satisfactory outcome based on Constant and ASES scores. Complications included minimal loss of reduction in 1 patient and wound edge necrosis in another. The technique aims to anatomically reconstruct the coracoclavicular and acromioclavicular ligaments. The authors concluded the technique provides stable reconstruction with low complication rates. However, they noted limitations including the small sample size and need for longer-term studies.
Purpose: To evaluate the influence of age and severity of keratoconus in the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS).
This document discusses techniques for transradial access and intervention. It begins by outlining three levels of competency for operators and discusses when radial access may not be appropriate. It then provides a step-by-step guide for radial access procedures, covering patient positioning, arterial puncture, navigating vascular anatomy, catheter selection, and hemostasis. Predictors of procedural failure are presented. The document concludes by providing tips for implementing a successful radial program.
This document provides guidelines for clearing the cervical spine in trauma patients. It discusses the Canadian C-Spine Rules and Nexus Low Risk Criteria clinical decision rules that can be used to determine if imaging is needed. It also provides algorithms outlining the imaging and precautions recommended based on factors like the patient's age, clinical exam findings, mechanism of injury, and ability to be assessed. The key points are that clinical decision rules can help determine if imaging is needed, and imaging and precautions depend on the results and presence of injuries or neurological abnormalities found.
This study evaluated the long-term clinical and radiological outcomes of 126 patients with 239 osteoporotic vertebral fractures treated with balloon kyphoplasty compared to a conservatively treated control group. Patients undergoing kyphoplasty had significantly reduced pain scores and improved disability scores that were maintained at the 2-year follow-up, while the control group showed no significant changes. Kyphoplasty also significantly restored vertebral height and alignment, while conservative treatment did not significantly impact radiographic measures. This study demonstrates the long-term benefits of balloon kyphoplasty over conservative care for osteoporotic vertebral fractures.
This document provides an overview of hip anatomy, approaches to the hip joint, and the treatment of avascular necrosis (AVN) of the hip. It discusses various surgical approaches to the hip including anterior, anterolateral, lateral, posterior, and medial. It also describes the classification systems for AVN and reviews nonsurgical and surgical treatment options such as core decompression, bone grafting, osteotomies, and hip replacement. The goal of hip preserving surgeries is to redistribute weight bearing while total hip arthroplasty is recommended for late-stage AVN.
Similar to Evaluation of short term results of low density.pptx (20)
Osteoporosis is a progressive bone disease characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and risk of fractures. It occurs when bone resorption by osteoclasts exceeds bone formation by osteoblasts. Risk factors include age, gender, genetics, smoking, alcohol, obesity, low vitamin D, and medications like corticosteroids. It is diagnosed using DEXA scans and managed through lifestyle changes, calcium/vitamin D supplementation, and pharmacological therapies like bisphosphonates, strontium, raloxifene, teriparatide, calcitonin, and denosumab. Emerging therapies target mechanisms like cathepsin K, sclerost
This document discusses principles and techniques of internal fracture fixation. It defines common fracture terms like union, delayed union, and nonunion. It describes high versus low energy fractures and different fracture patterns. Key principles of fixation discussed include stability, compression, and healing mechanisms like primary versus secondary bone healing. Various fixation techniques are covered such as lag screws, plates, intramedullary nails, and external fixation. Reduction techniques both direct and indirect are also reviewed.
This document discusses various methods for internal immobilization of fractures including intramedullary pinning, rush pins, cross pinning, wires, screws, transfixation, hanging pin casts, and plate fixation. It provides details on how each method is performed, advantages and disadvantages, and examples of fractures they can be used to treat. Complications are also discussed.
This document summarizes several common orthopedic emergencies including open fractures, acute compartment syndrome, dislocations, septic joints, neurovascular injuries, and cauda equina syndrome. Open fractures are classified using the Gustilo-Anderson system and require urgent debridement, antibiotics, and stabilization. Acute compartment syndrome causes increased pressure within fascial compartments and requires timely fasciotomy to prevent muscle and nerve damage. Dislocations of major joints like the shoulder and hip can damage surrounding nerves and blood vessels and need prompt reduction. Septic joints usually involve a single joint and result from bacterial spread, requiring joint washout and prolonged antibiotics. Neurovascular injuries are a risk with fractures and dislocations near major arteries or nerves
This document discusses various techniques for lumbar interbody fusion. It begins by providing background on spinal fusion and its goals of eliminating segmental motion and symptoms through bone bridging. It then reviews the history and indications for fusion, including degenerative conditions. The document focuses on the techniques of interbody fusion, including anterior approaches like anterior lumbar interbody fusion (ALIF) and lateral approaches. It discusses the advantages of ALIF like restoring lordosis and large graft surface area. It also covers posterior lumbar interbody fusion (PLIF) and complications of different approaches.
1) Lumbar interbody fusion involves placing a bone graft or interbody device between vertebral bodies to eliminate motion and promote fusion. It can be performed through anterior, posterior, or lateral approaches.
2) The anterior lumbar interbody fusion (ALIF) approach involves an abdominal incision and carries risks of abdominal organ or vascular injury but allows for larger graft placement and indirect decompression.
3) Lateral approaches like transpsoas lumbar interbody fusion (DLIF/XLIF) and oblique lumbar interbody fusion (OLIF) avoid back muscles but some levels are inaccessible and it carries risks of nerve injury.
The document provides guidance for conducting an orthopedic examination of the knee, outlining aspects to evaluate under history (5 points), general examination (5 points), and local examination (5 points), with the local examination covering inspection, palpation, range of motion testing, neurovascular assessment, and special tests for ligaments, meniscus, and other structures. Examination points are provided for looking at the skin, swelling, symmetry, and other details; palpating the joint line, patella, and effusion; and performing range of motion, stability, and specialized diagnostic tests.
The document discusses the anatomy and common injuries of the spine. It begins by describing the bones that make up the spinal column, including 33 vertebrae separated into 7 cervical, 12 thoracic, 5 lumbar, and 5 sacral segments. The spine provides stability, protects the spinal cord and nerves, and allows movement. Common injuries include strains from sudden movements, sprains from more violent motions, fractures from axial impacts, disc herniations from repetitive flexion, and nerve injuries like cervical nerve stretch syndrome. Prevention focuses on flexibility, proper technique, and core strength while treatment depends on the specific injury but often involves rest, ice, bracing, and monitoring for complications.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
Evaluation of short term results of low density.pptx
1.
2.
3.
4. AIS
-Adolescent idiopathic scoliosis (AIS) is the most common form
of pediatric scoliosis. It occurs between the ages of 10 to 18.
-Surgical treatment is indicated to halt curve progression and
improve cosmetic appearance.
-The main goal of surgery is to achieve correction of deformity
including rotation, a fusion of the structural deformity of the
spine, which will prevent further progression.
5. Implant density is defined as number of implants per
spinal level fused. The ideal metal density in AIS is
unknown but would be the lowest metal density to achieve
satisfactory patient outcomes without increased
complications.
Implant Density
6. - Bilateral placement of pedicle screws at
every level has commonly been used.
- This method provides maximal rigidity to the scoliosis
construct.
-Disadvantages: Increased operative time
,risk of screw malposition and increased cost and blood
loss
All Screws Technique:
7.
8. Aim Of The Work:
The aim of this study is to evaluate short term results of Low density
implants in correction of adolescent idiopathic scoliosis
11. Family counseling
-AIS is primarily a cosmetic deformity
-Treatment was based on the desire to
change the shape of the back .
12. Preoperative Evaluation
-History taking :
-Personal history:.
-Evidence of maturation: included signs of puberty, onset of menarche.
-Presenting complaint
-History of present condition: the Age of onset, course and duration of
symptoms & evidence of maturation.
-Neurological symptoms
-Exclusion of non-idiopathic scoliosis criteria :
13. Physical Examination
-Assessment of shoulder balance
-Assessment of waist crease/pelvic obliquity
-Presence of any cutaneous abnormalities
-Indicators of maturity
-Gait
-Sensory and motor examination
-Reflex examination
-Forward Bending Test
21. Operative Details
-Anesthesia
-Bleeding Management
-Preoperative antibiotics
-Patient Positioning
-Neuromonitoring
-Surgical Technique:
All patients were treated by Correction derotation of curves by
low density implants construct less than 1.6 screw per level
22. Wide sub periosteal exposure of the
spine out to the tips of the transverse
processes
25. Confirmation of the location of the bilateral
vertebral pedicles, screws were placed in an
anatomic position
26. Selection of Fused Levels
The upper instrumented vertebra was
T4 if high right shoulder (with MT curve ) .
T3 if balanced shoulders .
T2 if the high left shoulder .
In Lenke 5 with lumbar curve, fusion stopped at T10 or T9.
The lower instrumented vertebra was the end vertebra if it was
touched by the CSVL and end+1 or end+2 if the end vertebra was not
touched by CSVL .
.
27. Release
-Removal of the interspinous ligaments and midline
ligamentum flavum of the apical regions of the
deformity.
-Costotransversectomy was done to increase spinal
flexibility and facilitates correction technique.
- Costoplasty was done for cases had huge rib hump.
31. Insertion of sub cutaneous
suction drain then wound
closure in layers.
32. Postoperative Management
-Day 0 : ICU & pain management
-Day1 : Patients were moved to the ward ,clinical
assessment and radiological imaging was done.
-Mobilization: Early mobilization out of bed was preferably
started the day after surgery.
-We used a postoperative dorsolumbar brace for 3 months
-Hospital discharge: Patients were discharged on 5th or 6th
day postoperatively.
33. Regular visits post-operative
-14th days: Stitches removal
-One month -3 months-6 months -1 year: Patients will be assessed
Functionally (SRS – 30 questionnaire) and Radiologically
-Radiological outcomes:
Cobbs angle (pre , post 3,6,12 m)
Correction degree
screw density
Loss of correction
34. Case presentation 1
Female patient 16 years old
with AIS Lenke type 3.
Pre Cobb's angle of major
curve was (75⁰),
Pre-operative SRS score was
65
35. She underwent posterior fusion and correction from
T4 to L3 with low density implants (1.58 screw /
level)
36. Final Follow Up at 12 months
-Initial post: 20⁰
-After 3m: 21⁰
-After 6m:23⁰
-After 12 m: 23⁰
-(SRS score = 127)
-Loss of correction : 3⁰ -5,45%.
37.
38. Case presentation 2
Male patient 15 years old
with AIS Lenke type 5.
Pre Cobb's angle of major
curve was (74⁰),
Pre-operative SRS score was
76
39. He underwent posterior fusion and correction
from T5 to L5 with low density implants (1.46)
40. Final Follow Up at 12 months
-Initial post: 28⁰
-After 3m: 29⁰
-After 6m:29⁰
-After 12 m: 30⁰
-(SRS score = 120)
-Loss of correction : 2⁰ -4.34%.
47. Cases
(n = 30)
Loss of correction
Range. 0 – 3
Mean ± SD. 1.97 ± 0.81
Loss of correction %
Range. 0 – 10%
Mean ± SD. 5.09 ±2.4
Correction degree
Range. 26 – 56
Mean ± SD. 41.37 ± 10.42
Correction rate (%)
Range. 50.8 – 83.6
Mean ± SD. 68.49 ± 9.1
Radiological outcomes.
48. There were non-statistically significant correlations
between Screw density and post-operative radiological
assessment, (p-values >0.05).
Screw density
r p-value
Loss of correction 0.164 0.387
Loss of correction %
0.035 0.856
Correction degree 0.164 0.387
Correction rate (%) -0.030 0.875
49. Screw density
r P
Operative time 0.504 0.005*
Blood loss 0.779 <0.001*
SRS change -0.259 0.176
Correction degree -0.084 0.150
190
210
230
250
270
290
310
330
0.7 0.9 1.1 1.3 1.5 1.7
Operative
time
Screw density
190
390
590
790
990
1190
1390
1590
0.7 0.9 1.1 1.3 1.5 1.7
Blood
loss
Screw density
52. The goals of surgical treatment
for AIS
-Arrest progression by achieving a solid fusion
-Correction of the deformity
-Improvement of the cosmetic appearance
-Improvement of the functional outcomes, physical and
psychosocial health
- Diminishing the development of low back pain, functional
impairment and cardiopulmonary compromise in adulthood
53. -In This prospective study 30 Patients diagnosed with AIS
treated by low density implants (less than 1.6 screw/level).
-They were evaluated by Whole spine Xrays AP standing ,
lateral & bending views .
-Measurement of cobb s angles in AP standing film pre
operative and postoperatively at 1,3,6,12 monthes.
54. -We found that the mean pre-operative Cobb's angle was 60.47,
the mean post-operative Cobb's was 19.1, the mean loss of
correction was 1.97 and the mean correction degree was 41.37
by using low density implants 1.23
-These correction rates compare equally well with other low
density correction studies cited in the literature.
55. -Advocates of pedicle screw constructs report that the advantages
for all pedicle screw constructs in AIS include improved coronal,
sagittal, and rotational correction, lower pseudarthrosis rates,
lower implant failures and fewer postoperative bracing
requirements.
-On the other hand studies of lower-density fixation, such as
skipped pedicle screw placement constructs, report this to be an
efficient and safe method in management of AIS
56. -All pedicle screws constructs have potential neurological,
vascular, and visceral complications which can result from
screw misplacement.
-Operative time , blood loss , risk and cost are decreased
with the use of low screw density constructs.
57. -Some surgeons were concerned regarding the potential
risks of LD constructs including implant failure, non-union
and increased revision rates.
-The lower safe limit of anchor density to maintain long-
term adequate correction remains undetermined.
58. Demographic data
Curve
types
Screws
density
Pre cobb
Post cobb
Blood loss Op. time
Immd.
Final.
(loss of correction)
Elmalky et
al., 2016 148
106 pts
14 y
All lenke
types
1,18 62,7 21,5 22.8(3.2%) 532 269.2
Ritzman et
al., 2016. 149
52pts
14,7 y
Lenke 1 1.1 54.3 19.3 22.1(8.5%) 856 309
Ozkunt et al.,
2018 147
59 pts
17,3 y
Lenke 5 1,5 42,8 15.37 15,31(0) 676.3 342.2
Tannous et
al., 2018 127
45 pts
14,9 y
All lenke
types
1,19 52,6 15,1 17,5(6.4%) 536.5 271.5
Li et al.,2018
117
63 pts
14.9 y
Lenke 1
Two groups
HD and LD
47.9 15.8 18.1 (3%) 1648 480
Yeh et al.,
2019126
172 pts
14.4 y
All lenke
types
1,3 57,4 20,8 21.7(2.7%) 721.4 302
Kilinc et al.,
2019 139
82pts
14,4 y
Lenke 1 1,1 59,1 28.2 29.9(3.1%) 496 251
Our study
30 pts
13,3 y
All lenke
types
1.23 60.47 17.83 19.1(5.09%) 837 258
59. Conclusion
-Implant density was not significantly related to coronal or axial
curve corrections.
-Low implant density with longer fusion level achieves
excellent curve correction and stability
-Operative time, blood loss, risk and cost are decreased with the
use of low screw density implants.
61. -Pre-operative planning by identification the type of curves is
the corner stone to obtain best correction.
-The use of low density implants achieves satisfactory correction
with less operative time, blood loss and complications.
-The use of monoaxial screws at periapical vertebrae and the use
of rod derotation technique are very useful to obtain good
correction by low density implants.
62. -Intraoperative neuromonitoring is essential to maintain
neurological integrity of the patients
-Intraoperative imaging at the end of surgery to assess
coronal and sagittal balance is very important.
-Further studies should include larger number of cases and
longer follow up period to detect more accurate results.