This is my Original Research done in 1981 and it has been well documented in literature.My Website is:kmohaniyer.com and my Email for any correspondence is:kmiyer28@hotmail.com
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.
The triangular fibrocartilage complex (TFCC) is located in the wrist between the ulnar bone end and the carpals. It is a complex structure and is a major function is stabilizing, cushioning and smooth movement at the radio ulnar joint of the wrist.
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.
The triangular fibrocartilage complex (TFCC) is located in the wrist between the ulnar bone end and the carpals. It is a complex structure and is a major function is stabilizing, cushioning and smooth movement at the radio ulnar joint of the wrist.
Jordan was born with skeletal issues which included low muscle tone, absent clavicles, and congenital kyphosis. He was later diagnosed with cleidocranial dysostosis, a rare hereditary congenital disorder which causes teeth and bones in the upper torso to develop abnormally. At the age of 13, Jordan’s spine had developed multiple hemivertebrae in addition to scoliosis and kyphosis curves.
Jordan underwent a posterior spinal fusion with Ponte osteotomies to help straighten his spine and expand his ribs. He did very well after surgery and was able to return to playing basketball five months after surgery.
http://www.davidsfeldmanmd.com/patient-education/case-studies/jordan-cleidocranial-dysostosis
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
Vincenzo: Arthrogryposis w/ Lower Limb Deformities, Severe Contractures, & Pt...David S. Feldman, MD
Vincenzo is a young man from Bari, Italy who had been diagnosed with arthrogryposis at birth and had been wheelchair bound since the age of six. His family had sought treatment in Altamura and Milano Italy but doctors had not provided any treatment and told the family that nothing could be done to improve his condition. At age 14, he traveled with his family to America to seek treatment.
During our consultation I found that while Vincenzo’s arthrogryposis had caused severe contractures and lower limb deformities, many of these issues could be resolved with surgery and therapy. Over the course of two years, I performed muscles and tendon releases to allow for improved range of motion. By the end of treatment, Vincenzo was able to walk without assistance and had greater control of his arms which allowed him to use his hands in ways he could not before.
http://www.davidsfeldmanmd.com/patient-education/case-studies/vincenzo-arthrogryposis-lower-limb-deformity-contractures-pterygium
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
Ideal Indications Meniscus Repair KNEE INJURY COMMON SPORTS INJURY
HOW TO DEAL SPORTS INJURY
RETURN TO SPORTS AFTER KNEE INJURY
BEST KNEE SURGEON DOCTOR IN JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
Biomechanical Properties of the AnteroLateral Ligament (ALL) of the Knee comp...KHALIFA ELMAJRI
Improvising is an established corner in orthopaedic surgery .But if we start handling healthy body tissues surgically we are actually disturbing nature. The lateral knee region is known by its complex functional anatomy. Injury to the integrity of biceps tendons components in this region or direct injury to the FCL could happen during surgery in this region. As the injuries of FCL augment ALRI of the knee it is worth to study the effect of passing the graft deep to the LCL in lateral extra-articular reconstructions , an injury could arise from fixing distal FCL to its tunnel which prevent FCL normal gliding within this tunnel.
To restore function of a structure in the lateral knee using another structure one should have sound comparable knowledge’s about exact nature of structures to be handled, their clinical anatomy and their material and structural properties is a must before their investment, this to minimise the risk of introducing imbalance to a sensitive ligamentous balance or alter the proprioceptive function or affect the stability of the lateral meniscus .That’s why the more work on the anterolateral knee would be invested, in addition to management of acute knee injury , in the study of graft placement isometry in ACL reconstruction , as well as isometry of lateral extra-articular reconstructions to control (ALRI) with ITT, when indicated .
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
• استشاري جراحة العمود الفقري في الاردن / مرضى العمود الفقري بطرق جراحية وغير جراحية / جراحة العمود الفقري بالتداخل المحدود / عمليات الديسك أو الإنزلاق الغضروفي / علاج الديسك / عمليات الديسك / الم الظهر من الديسك / جراحة الد يسك / علاج الديسك في الاردن / اطباء الديسك / اطباء الديسك في الاردن / اسباب الديسك / الام الديسك / الم العمود الفقري / اسباب الانزلاق الغضروفي / اوجاع الديسك / اعراض الديسك / علاج الديسك / افضل اطباء الديسك في الاردن / اسرع علاج للديسك في الاردن / افضل طبيب لعلاج الانزلاق الغضروفي / افضل طبيب لعلاج الانزلاق الغضروفي في الاردن / كسور الفقرات / قوس العمود الفقري عند الكبار / حقائق عن آلام الظهر والديسك / تحرير عصب اليد / عمليات تحرير العصب / ألم الظهر المزمن علاج ألم الظهر المزمن / الانزلاق الغضروفي / هشاشة العظام / علاج هشاشة العظام / نقص فيتامين د / نقص الكالسيوم في الجسم / فائدة الكالسيوم في الجسم / مشاكل نقص الكالسيوم في الجسم / ترقق العظام / عمليات الفقرات / اعراض الديسك / اعراض هشاشة العظام / اعراض نقص الفيتامين د / اعراض نقص الكالسيوم / عندي آلام شديدة في أسفل / خدران في اليد / خدران او تنميل اليد / خدران الرجل / خدران الساق / خدران الاطراف / تنميل الاطراف / تنميل اليد / رجوع الديسك
Jordan was born with skeletal issues which included low muscle tone, absent clavicles, and congenital kyphosis. He was later diagnosed with cleidocranial dysostosis, a rare hereditary congenital disorder which causes teeth and bones in the upper torso to develop abnormally. At the age of 13, Jordan’s spine had developed multiple hemivertebrae in addition to scoliosis and kyphosis curves.
Jordan underwent a posterior spinal fusion with Ponte osteotomies to help straighten his spine and expand his ribs. He did very well after surgery and was able to return to playing basketball five months after surgery.
http://www.davidsfeldmanmd.com/patient-education/case-studies/jordan-cleidocranial-dysostosis
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
Vincenzo: Arthrogryposis w/ Lower Limb Deformities, Severe Contractures, & Pt...David S. Feldman, MD
Vincenzo is a young man from Bari, Italy who had been diagnosed with arthrogryposis at birth and had been wheelchair bound since the age of six. His family had sought treatment in Altamura and Milano Italy but doctors had not provided any treatment and told the family that nothing could be done to improve his condition. At age 14, he traveled with his family to America to seek treatment.
During our consultation I found that while Vincenzo’s arthrogryposis had caused severe contractures and lower limb deformities, many of these issues could be resolved with surgery and therapy. Over the course of two years, I performed muscles and tendon releases to allow for improved range of motion. By the end of treatment, Vincenzo was able to walk without assistance and had greater control of his arms which allowed him to use his hands in ways he could not before.
http://www.davidsfeldmanmd.com/patient-education/case-studies/vincenzo-arthrogryposis-lower-limb-deformity-contractures-pterygium
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
Ideal Indications Meniscus Repair KNEE INJURY COMMON SPORTS INJURY
HOW TO DEAL SPORTS INJURY
RETURN TO SPORTS AFTER KNEE INJURY
BEST KNEE SURGEON DOCTOR IN JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
Biomechanical Properties of the AnteroLateral Ligament (ALL) of the Knee comp...KHALIFA ELMAJRI
Improvising is an established corner in orthopaedic surgery .But if we start handling healthy body tissues surgically we are actually disturbing nature. The lateral knee region is known by its complex functional anatomy. Injury to the integrity of biceps tendons components in this region or direct injury to the FCL could happen during surgery in this region. As the injuries of FCL augment ALRI of the knee it is worth to study the effect of passing the graft deep to the LCL in lateral extra-articular reconstructions , an injury could arise from fixing distal FCL to its tunnel which prevent FCL normal gliding within this tunnel.
To restore function of a structure in the lateral knee using another structure one should have sound comparable knowledge’s about exact nature of structures to be handled, their clinical anatomy and their material and structural properties is a must before their investment, this to minimise the risk of introducing imbalance to a sensitive ligamentous balance or alter the proprioceptive function or affect the stability of the lateral meniscus .That’s why the more work on the anterolateral knee would be invested, in addition to management of acute knee injury , in the study of graft placement isometry in ACL reconstruction , as well as isometry of lateral extra-articular reconstructions to control (ALRI) with ITT, when indicated .
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
• استشاري جراحة العمود الفقري في الاردن / مرضى العمود الفقري بطرق جراحية وغير جراحية / جراحة العمود الفقري بالتداخل المحدود / عمليات الديسك أو الإنزلاق الغضروفي / علاج الديسك / عمليات الديسك / الم الظهر من الديسك / جراحة الد يسك / علاج الديسك في الاردن / اطباء الديسك / اطباء الديسك في الاردن / اسباب الديسك / الام الديسك / الم العمود الفقري / اسباب الانزلاق الغضروفي / اوجاع الديسك / اعراض الديسك / علاج الديسك / افضل اطباء الديسك في الاردن / اسرع علاج للديسك في الاردن / افضل طبيب لعلاج الانزلاق الغضروفي / افضل طبيب لعلاج الانزلاق الغضروفي في الاردن / كسور الفقرات / قوس العمود الفقري عند الكبار / حقائق عن آلام الظهر والديسك / تحرير عصب اليد / عمليات تحرير العصب / ألم الظهر المزمن علاج ألم الظهر المزمن / الانزلاق الغضروفي / هشاشة العظام / علاج هشاشة العظام / نقص فيتامين د / نقص الكالسيوم في الجسم / فائدة الكالسيوم في الجسم / مشاكل نقص الكالسيوم في الجسم / ترقق العظام / عمليات الفقرات / اعراض الديسك / اعراض هشاشة العظام / اعراض نقص الفيتامين د / اعراض نقص الكالسيوم / عندي آلام شديدة في أسفل / خدران في اليد / خدران او تنميل اليد / خدران الرجل / خدران الساق / خدران الاطراف / تنميل الاطراف / تنميل اليد / رجوع الديسك
Hallux valgus - Practical approach and recent advances Dr Shivam R Shah
More than 140 types of different osteotomies are described for hallux valgus treatment . Here i have tried to present scarf osteotomy with recent advances in the corrective osteotomies for hallux valgus
Τρία κοινά κλινικά σενάρια που οδηγούν σε αρθροσκόπηση του καρπού- Three comm...Nikos Darlis
Three common clinical scenarios leading to wrist arthroscopy
Ομιλία στο 20ο Συνέδριο της Ελληνικής Εταιρείας Χειρουργικής του Χεριού, 4-6 Σεπ, Αλεξανδρούπολη,
3 common clinical scenarios leading to wrist arthroscopy. Alexandropolis 2014Νίκος Δαρλής
Overview of the 3 most common clinical scenarios leading to wrist arthroscopy. Invited lecture at the 20th Congress of the Hellenic Hand Surgery Society Meeting, Sep 4-6 2014.
Ανασκόπηση των 3 κυριοτέρων κλινικών Σεναρίων που οδηγούν σε αρθροσκόπηση του καρπού. Προσκεκλημένη Ομιλία στο 20ο Συνέδριο της Ελληνικής Εταιρείας Χειρουργικής του Χεριού, 4-6 Σεπ, Αλεξανδρούπολη,
The Stone Clinic is a sports medicine clinic in San Francisco, California, offering orthopaedic surgery and medical care, physical therapy and rehabilitation, and radiology imaging services. The Stone Clinic was founded by Kevin R. Stone, M.D., an orthopaedic surgeon, combining himself with a team of nurses, physical therapists, imaging specialists, and patient coordinators, in 1988 to focus on caring for injured athletes and people experiencing arthritis pain.
The Stone Clinic is founded on the goal of rehabilitating all patients to an operating level higher than before they were injured. The Stone Clinic specializes in sports medicine and injury treatment of knee, shoulder, and ankle joints. Stone has lectured and is recognized internationally as an authority on cartilage and meniscal growth, replacement, and repair. Stone and the Stone Clinic are known for the development of the paste grafting surgical technique in 1991, combined with meniscus replacement, which are biologic joint replacement procedures for the regeneration of the knee joint. Surgical procedures were subjected to rigorous outcomes analysis with the results reported in peer reviewed journals. The surgical techniques have been taught to surgeons in the US and worldwide, through lectures and videos.
Nursing students, medical students, residents, fellows, and other physicians from various institutions around the world, rotate through The Stone Clinic and mentor with Stone. The Stone Clinic hosts the annual Meniscus Transplantation Study Group Meeting as well as the annual Professional Women Athlete's Career Conference.
1.The best way for the anterior approach to the hip on a standard operating table using a leg holder with a combined spinal anaesthetic and general anaesthetic, as written by John O’Donnell, Melbourne, Australia, in 2018.
2.The chapter on total hip replacement as a day case, which is an evolution in total hip replacement, has been written by authors from Frankfurt, Germany, mentioning their schedule in detail in 2018.
3.The principles of anterior approach for total hip arthroplasty have been discussed in detail by authors from Italy in 2018. Their technique involves choice of patients; superficial and deep dissection, exhibiting each step through excellent figures; and dedicated surgical instruments along with the use of intra-operative imaging.
4. Chapter from formerly Hip Preservation Fellow, Research Fellow at Warwick Medical School, UK now based in Sri Lanka discussing how the Direct Anterior approach to the Hip in 2018 can be done on the plain table with supporting explaining figures which is useful in countries in Asia like India without the use of special operating tables and dedicated surgical instruments for the same.
5.An additional chapter on DAA ,written by Dr Kirubakaran Pattabiraman, assistant professor, Department of Orthopedics, JIPMER, Puducherry, India, has been added in the book because his contribution is the most unique as it provides extensive details on DAA.
6.The main aim of this book is for the upcoming postgraduates in orthopedics anywhere in the world to be well versed in the direst anterior approach (DAA) to the hip joint.
K.MohanIyer[15/8/2023]
Piriformis Syndrome:
Table of contents
1.Introduction.
2.Epidemiology of Piriformis Syndrome.
3.Predisposing Factors.
4.Aetiology of Piriformis Syndrome.
5.Specific tests for the Piriformis Syndrome.
6.Pathophysiology
7.Differential Diagnosis
8.Imaging
9.Electro-diagnostic studies
10.Intrapelvic Causes of Sciatica in Piriformis Syndrome
11.Pyomyositis of the Piriformis Muscle
12.Bipartitite Piriformis giving rise to sciatic nerve entrapment
13.Hydrodissection of Piriformis Syndrome
14.Composite Anatomical Variations between the Sciatic
Nerve and the Piriformis Muscle
15.Epidemiology.Clinical Diagnosis of Piriformis Syndrome
16. Peroneal Neuropathy in Piriformis Syndrome
17. Physiotherapy for Piriformis syndrome
18.Treatment of Piriformis Syndrome
19.Complications with Prognosis.
The foreword has been given by Mr Dipen K Menon,MS(Orth), FRCS (Eng Et Glasg), MCh(Orth), FRCS(Tr Et Orth) Consultant Orthopaedic Surgeon, Kettering General Hospital,NHS Foundation Trust (Affiliated to University of Leicester), United Kingdom.
"Piriformis Syndrome" is currently planned to be published by 29.10.2023.
K.Mohan Iyer[1/8/2023]
Modified Posterior Approach to the Hip Joint.pdfnew.pdfKrishnamohan Iyer
Modified Posterior Approach to the Hip Joint[2nd edition]
Table of contents
This is more complex as the entire manuscript is based on my original research that I had done in 1981,which I have been following since then till today with my references.
Chapter no.1: Introduction Posterior Approach(PA) by
Ahmed Zaghloul, Assistant Lecturer,
Orthopaedic department, Faculty of
Medicine, Mansoura University, Egypt.
Chapter no.2: Additional version of PA by Kemal Şibar and
Alper Öztürk,Ankara,Turkey.
Chapter no.3: Direct Anterior Approach to the Hip by Prof.
John O'Donnell,Melbourne,Australia.
Chapter no.4:Principles of Direct Anterior Approach to the
Hip by Alessandro Geraci,Orthopaedic
Department, CaFoncello Hospital,Treviso, Italy
Chapter no.5:Anterior Minimally Invasive Surgery (AMIS) by
Hiran Amarasekera,Consultant Orthopaedic
Surgeon, Neville Fernando Teaching Hospital,
Malabe, Sri Lanka
Chapter no.6: DAA by Kirubakaran Pattabiraman,
Department of Orthopedics,JIPMER,
Puducherry,INDIA and Prof Thomas
Mullner,Austria.
Chapter no.7:DAA[Direct Anterior Approach to the Hip Joint]
by Calllum McBryde et al [Consultant Young
Adult Hip Surgeon, Department of Trauma &
Orthopaedics, Royal Orthopaedic Hospital NHS
Trust, Birmingham, UK]
Chapter no.8:Direct Anterior Approach for Total Hip
Arthroplasty by Rajesh Malhotra and Deepak
Gautam
"Modified Posterior Approach to the Hip Joint 2nd ed." is tentatively planned to be published by 24.09.2023.
K.Mohan Iyer[1/8/2023]
Revised final table of contents:
1.Introduction.
2.Epidemiology of Piriformis Syndrome.
3.Predisposing Factors.
4.Aetiology of Piriformis Syndrome.
5.Specific tests for the PS
6.Pathophysiology
7.Differential Diagnosis
8.Imaging
9.Electro-diagnostic studies
10.Intrapelvic Causes of Sciatica in Piriformis Syndrome
11.Pyomyositis of the Piriformis Muscle
12.Bipartitite Piriformis giving rise to
sciatic nerve entrapment
13.Hydrodissection of Piriformis Syndrome
14.Composite Anatomical Variations between the Sciatic
Nerve and the Piriformis Muscle
15.Epidemiology.Clinical Diagnosis of Piriformis Syndrome
16. Peroneal Neuropathy in Piriformis Syndrome
17. Physiotherapy for Piriformis syndrome
18.Treatment of Piriformis Syndrome
19.Complications with Prognosis.
20. References
21.References for further reading[9 chapters]
K.Mohan Iyer[6/7/2023]
Modified Posterior Approach to the Hip Joint,2nd Edition,
The Surgery for the Hip Joint has evolved considerably in different parts of the world.This evolution dates back to as early as 1883 and is still occuring in many parts of the world.Dr,K.Mohan Iyer started with his research in 1981 and is seen in many textbooks of repute.It has reached a new dimension to include
1. Posterior Approach to Hip Joint.
2. Southern Posterior Approach of the Hip
3. Direct Anterior Approach to the Hip Joint
4. Principles of the Anterior Approach for Total Hip
Arthroplasty
5. Anterior Minimally Invasive Surgery
6. The Direct Anterior Approach
7. Direct Anterior Approach to the Hip Joint
8. Direct Anterior Approach for Total Hip Arthroplasty.
The best part of his research is its feasibility in third world countries when it can be done in an indegenious way as shown in detail in chapter 8 of this book.
This book is being published by Springer Nature[Switzerland] and should be released in 2023.
K.Mohan Iyer[10/6/2023]
My ebook titled Posterior Approaches to the Hip Joint should be available by ...Krishnamohan Iyer
Citations in textbooks of repute
Original Research work done: A New Posterior Approach to the Hip Joint – K. Mohan Iyer, Injury, 13, 76-80, 1981.
1 Campbell’s Textbook of Operative Orthopaedics,12th Edition,by S.Terry Canale and James H.Beaty,Page No.331.
2. The Year Book of Orthopaedics 1982-Mark B.Coventry, Pages:371-373.
3.The Hip: ISBN 10:0812113020/ISBN 13:9780812113020
My original work has been quoted on page no.90.
4. Surgery of the Hip, Elsevier, Mosby/Saunders, Volume 2, by Daniel J.Berry and Jay R.Lieberman, Page No.269.
5. The Adult Hip by John J Callaghan MD, Aaron G Rosenberg MD, Harry E Rubash. Volume 1, Callaghan, Rosenberg and Rubash, ISBN:078175092X, Pages:700-701,718.
6. Surgery of the Hip Edited by Raymond G. Tronzo; Ref.no.187:(Page no.333):Fractures of the Hip in Adults: My original research on the Hip Joint has been quoted.
7. Minially Invasive Total Joint Arthroplasty by William J Hozak,Martin Kirsmer,Michael Hogler,Peter M Bonutti,Franz Rachbauer,Jonathan L Scaffer,William J Donnelly(Editors).
My original work(1981) is also referred to in this book Total
Hip Arthroplasty Arch Orthop Trauma Surg 102:225-229 at reference no.24[pages 115 -229]
This is my book review that came out on 24th Sunday 2017 in the EJOST(European Journal of Orthopaedic Surgery and Traumatology),which I have sent as an attachment.
K.Mohan Iyer(25/9/2017)
This is my next book after which I will be publishing my book “Hip Joint in Adults: Advances and Developments” following my book THE HIP JOINT.by PanStanford,Singapore.(17/7/2017)
Detailed programme of the Global Ortho Congress at Philadelphia,USA where my presentation is on 8/11/2016 at 3.15 to 3.35 pm as seen in this attachment.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
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.
NVBDCP.pptx Nation vector borne disease control program
Excision of the trapezium presentation
1. Excision of the Trapezium
K.MOHAN IYER
M.Ch.Orth(Liverpool, U.K.),M.S.Orth(BOM)
F.C.P.S.Orth(BOM),D’Orth(BOM),
M.B.,B.S.(BOM).
2. Original Work
1.The Results of Excision of the Trapezium-
K.Mohan Iyer(Oct.1981) The Hand,Vol.
13,No.3:246-250.
2.Arthrography of the Metacarpo-Scaphoid
Joint following Excision of the Trapezium
-K.Mohan Iyer & G.H.Whitehouse(Oct.
1981) The Hand,Vol.13,No.3:251-256.
3. Work quoted in Literature
(From 1985 till 2002)
1.Osteoarthritis of the Carpometacarpal Joint
of the Thumb-L.Kvarnes & O.Reikeras(Feb.1985)
J.of Hand Surgery,Vol.10-B,No.1,117-120.
2.Rheumatoid Arthritis at the base of the Thumb
treated by Trapezium Resection or Implant
Arthroplasty-L.Kvarnes & O.Reikeras(June 1985)
J.of Hand Surgery,Vol.10-B,No.2,195-196.
3.Interposition Arthroplasty of the
Trapeziometacarpal Joint for Osteoarthritis-Paul
C.Dell & Ruth B.Muniz(July 1987) Clinical
Orthopaedics & Related Research,No.220,27-34.
4. Work quoted in Literature
(From 1985 till 2002)
4.Replacement of the Trapezium with a
Silicone Elastomer Universal Small Joint
Spacer-B.Helal & I.McPherson(Nov.1989)
J.of Hand Surgery,Vol.14B,No.4:456-459.
5.Revision Procedures for complications of
Surgery for OA of the CMC Jt.of the
Thumb-W.B.Conolly & S.Rath(Aug.1993)
J.of Hand Surgery,Vol.18B,No.4:533-539.
5. Work quoted in Literature
(From 1985 till 2002)
6.Excision of the Trapezium for OA at the
base of the Thumb-Varley G.W,Calvey
J,HunterJ.B,BartonN.J,DavisT.R.C(Nov.19
94)JBJS(Br),76-B,Vol.6,964-968.
7.Simple Trapezectomy for Treatment of TM
OA of the Thumb-Vandenbrouche J,De
Schrijver F,De Smet L,Fabry G(1997)
Clin.Rheumatology;16,239-242.
6. Work quoted in Literature
(From 1985 till 2002)
8.A comparison of Trapeziectomy with or without
ligament reconstruction & Tendon interposition-
HJCR Belcher & JE Nicholl (Aug.2000) J.ofHand
Surgery,Vol.25B,No.4:350-356.
9.Early versus late mobilisation after simple excision
of the Trapezium-N.Horlock&HJCR Belcher(Nov.
2002) JBJS(Br),Vol.84-B,No.8:1111-1115.
7. The Trapezium
Surfaces
1.Palmar Surface-Groove and a Tubercle.
2.Dorsal Surface-Related to Radial Artery.
3.Lateral Surface-Lateral collateral ligament
of the wrist joint & capsular ligament of
the carpometacarpal joint.
4.Medial Surface-Facet for the Trapezoid.
5.Proximal Surface-Facet for the Scaphoid.
6.Distal Surface-Saddle shaped for the base of the
first metacarpal.
8. Normal Wrist Joint
Compartments
1.Radiocarpal Joint.
2.Inferior Radioulnar Joint.
3.Midcarpal Joint.
4.Isolated Carpometacarpal Joint of the
Thumb.
9.
10. Intercarpal Joints
1.Joints between bones of the proximal row.
2.Joints between bones of the distal row.
3.Midcarpal Joint
- Between these two rows of bones.
- S shaped cavity lined by synovial
membrane.
- Has 2 projections proximally and
3 projections distally.
18. Pathology
Stage IV:
Subluxated metacarpal fixed by fibrosis &
contracture
Marked hyperextension deformity of the MCP joint
Flexion deformity of the IP joint
Pain minimal or nil
Fixed adducted thumb
19.
20. Carpometacarpal Arthritis of
the Thumb
Age:60 Years
Sex:Women(Post Menopausal)
Side:Right side;Both sides frequent
Predisposing Factors:
1.Trauma(30%)
2.Developmental Anomalies
3.Occupational
4.Anatomical
21. Carpometacarpal Arthritis of
the Thumb
Symptoms:
1.Severe pain-Base of the thumb
-Aggravated by movements
2.Swelling over the base of the thumb
3.Stiffness of the Thumb
4.Weak Grip
22. Carpometacarpal Arthritis of
the Thumb-Treatment
(A)Conservative Treatment:
1.Physiotherapy
2.Radiotherapy
3.Splint
4.Intra-articular Steroids
23. Carpometacarpal Arthritis of
the Thumb
(B)Surgical Treatment:-
1.Forage
2.Intra-articular Tenodesis
3.Excision of the Trapezium
4.Arthrodesis
5.Silicone rubber interpositional
arthroplasty
6.Prosthetic Replacement
24. Carpometacarpal Arthritis of
the Thumb
Charcot and Leri(1926)
Robert(1936)
Forestier(1937)
Lasserre,Pauzat and Derennes(1949)
25.
26. Excision of the Trapezium
Gervis(1949) 18 wrists with 16 good results.
(1973) 12 wrists followed up for 6 to 22 years.
Goldner & Clippinger(1955) Excison of the
Trapezium piece-meal.
Murley(1960) 39 wrists with 36 good results.
Marmor & Peter(1969) 7 wrists with 5 good
results.
Sims & Bentley(1970) 27 Trapeziectomies with
excellent results in 15,Good in 6,Fair in 5 & Poor
in one.Incidence of 54% of patients with
associated Trapezio-Scaphoid Arthritis.
47. Results
Functioning tendons of Flexor carpi radialis
and Flexor pollicis longus =26/26 wrists.
Decreased sensations over the dorsum of
the base of the thumb =3/26 wrists.
Keloid formation = 5/26 wrists.
Palpable Neuroma = None.
48. Results
Opposition Grip:
Normal Power = 6 wrists
Decreased power = 20 wrists
Pinch Grip:
Normal Power = 7 wrists
Decreased Power = 19 wrists
49.
50.
51.
52.
53.
54.
55. Radiographic Assessment
1.Level of first metacarpal base.
2.Accessory Ossicles.
3.Radiologic gap.
4.Telescoping.
5.Stress views.
6.Degenerative changes:
-Base of first metacarpal
-Distal Scaphoid
-Elsewhere in the carpus
56. Radiographic Features
1.Telescoping =14 wrists(55%)
2.Accessory Ossicles = 9 wrists(40%)
3.Radiological Gap = 1mm to 6mm
4.Degenerative changes:
-Base of first metacarpal =14 wrists
-Distal Scaphoid = 8 wrists
-No changes =11 wrists
57.
58. Radiographic Features
5.Residual Cartilage:
Base of first MC – Nil in 3 wrists
- Present in 22 wrists
Distal Scaphoid - Nil in 2 wrists
- Present in 23 wrists
6.Lateral subluxation of 1st MC on Abduction
Marked subluxation in 3 wrists
Moderate subluxation in 22 wrists
59.
60. Radiographic Features
7.Maintenance of joint space despite subluxation of
the 1st MC on the Scaphoid on radial deviation of
the wrist.
8.Stress views of the wrist:
No changes = 9 wrists
Widening of the Sc-Trap.Jt =12 wrists
Widening of the Sc-Cap.Jt = 6 wrists
Widening of gap between
the bases of 1st & 2nd MC’s = 6 wrists
67. Arthrographic Assessment
1.Amount of dye injected.
2.Ease of location of the joint & injection.
3.Residual articular cartilage over:-
-Base of the first metacarpal.
-Distal Scaphoid.
76. Conclusion
1.Excision of the Trapezium gives good
results with respect to relief of pain.
2.Good hand function despite some reduction
in the power of Opposition grip and Pinch
grip.
3.Carpal Instability or Laxity may account for
decreased Opposition grip & Pinch grip.
77. Conclusion
4.Arthrographic Features:
-Distinct joint space
-Small & Irregular within 6 months of
Surgery
-Large & Regular thereafter
-Marked subluxation indicates weak grip
5.Late deterioration of pseudoarthrosis in one
patient