Flexor tenolysis is the surgical release of non-gliding adhesions along tendons after injury and repair. It involves exploring the tendon sheath and pulley system through windows to fully mobilize the flexor digitorum profundus and superficialis tendons. Care must be taken to avoid dividing pulleys and handle them with hooks or retractors. The tendons are dissected from each other and adhesions are released with traction and a knife or blade. Post-operatively, the hand is immobilized and active exercises begun to prevent re-adhesion. Complications can include tendon rupture, edema, or pulley damage.
This document discusses flexor tenolysis, which is the surgical release of non-gliding adhesions along tendons after injury and repair. It forms adhesions that restrict finger flexion. The document covers indications, timing, techniques, postoperative care, and complications of flexor tenolysis. Extensor tenolysis is also briefly mentioned, which treats tightness of extrinsic extensor tendons that restricts finger extension.
Parálisis Cerebral Infantil: Tratamiento ortopédico de las alteraciones de ca...Teletón Paraguay
This document discusses orthopedic care for cerebral palsy, focusing on treatments for hip issues. It describes stages of muscle contractures and treatments like botulinum toxin, casting, and surgery. Surgical options for hip subluxation/dislocation are discussed, including adductor releases, femoral and pelvic osteotomies. Dega osteotomy and the San Diego procedure are described for acetabular dysplasia. Post-operative management involves splinting and rehabilitation. The authors' experience with over 70 hip surgeries in 4 years is presented, showing low rates of reoperation.
En esta exposición explicaremos anatomía en relación a las fracturas distales de fémur, veremos como algunos de los músculos del muslo y de la pierna pueden influir en en a adecuada reducción de la fractura, así como la importancia de conocer el paquete vascular y nervioso del hueco popitleo, describiremos las clasificación AO trauma de fémur distal, algunos tratamientos brindados por el Dr. Müller y Cols. así como algunos ejemplos de osteosintesis.
Scaphoid fractures account for almost 75% of all carpal bone fractures. They typically occur from a fall on the outstretched hand with the wrist extended and radially deviated. Clinical features include tenderness over the snuffbox and reduced range of motion, though not dramatically. Imaging includes X-rays from multiple angles, though a fracture may not be visible initially and CT or MRI are more sensitive for diagnosis. Treatment depends on the location and displacement of the fracture, ranging from immobilization in a cast to surgical fixation with screws for displaced or proximal pole fractures. Complications can include non-union, avascular necrosis, and osteoarthritis if not properly treated.
This document discusses radial tunnel syndrome and a new surgical approach called the transbrachioradialis approach. Radial tunnel syndrome is an underdiagnosed entrapment neuropathy of the radial nerve. A new provocative test called the supinator fatigue test was proposed to aid in diagnosis. The transbrachioradialis approach provides a simple, quick and reproducible surgical exposure of the radial tunnel. Initial results using this new approach showed excellent or good outcomes in 75% of patients.
This document discusses fractures of the olecranon bone. It begins with the epidemiology, noting these fractures have a bimodal distribution in younger individuals due to high-energy trauma and older individuals due to simple falls. The anatomy section outlines the subcutaneous position of the olecranon making it vulnerable to trauma, as well as its articulation with the elbow joint. Clinical presentation, evaluation, classification systems, treatment objectives, nonoperative and operative treatment options including various surgical techniques are then covered in detail.
The document discusses the blood supply and anatomy of the scaphoid bone in the wrist. It notes that the scaphoid receives most of its blood supply from the dorsal branches of the radial artery, putting it at high risk for osteonecrosis if fractured. It describes different classification systems for scaphoid fractures and presents options for management, including cast immobilization, percutaneous fixation, open surgery and arthroscopy. Complications of fractures like nonunion are also outlined.
This document discusses scaphoid fractures of the wrist. It notes that the scaphoid is a commonly fractured bone located on the anterior aspect of the wrist. Scaphoid fractures often occur when falling on an outstretched hand, as this puts the wrist in dorsiflexion and radial deviation, placing stress on the scaphoid tuberosity. Clinical diagnosis involves tenderness over the anatomical snuff box or pain with axial thumb compression. Treatment depends on whether the fracture is displaced or undisplaced, and may involve casting, closed reduction with a Herbert screw, or open reduction with bone grafting in more severe cases.
This document discusses flexor tenolysis, which is the surgical release of non-gliding adhesions along tendons after injury and repair. It forms adhesions that restrict finger flexion. The document covers indications, timing, techniques, postoperative care, and complications of flexor tenolysis. Extensor tenolysis is also briefly mentioned, which treats tightness of extrinsic extensor tendons that restricts finger extension.
Parálisis Cerebral Infantil: Tratamiento ortopédico de las alteraciones de ca...Teletón Paraguay
This document discusses orthopedic care for cerebral palsy, focusing on treatments for hip issues. It describes stages of muscle contractures and treatments like botulinum toxin, casting, and surgery. Surgical options for hip subluxation/dislocation are discussed, including adductor releases, femoral and pelvic osteotomies. Dega osteotomy and the San Diego procedure are described for acetabular dysplasia. Post-operative management involves splinting and rehabilitation. The authors' experience with over 70 hip surgeries in 4 years is presented, showing low rates of reoperation.
En esta exposición explicaremos anatomía en relación a las fracturas distales de fémur, veremos como algunos de los músculos del muslo y de la pierna pueden influir en en a adecuada reducción de la fractura, así como la importancia de conocer el paquete vascular y nervioso del hueco popitleo, describiremos las clasificación AO trauma de fémur distal, algunos tratamientos brindados por el Dr. Müller y Cols. así como algunos ejemplos de osteosintesis.
Scaphoid fractures account for almost 75% of all carpal bone fractures. They typically occur from a fall on the outstretched hand with the wrist extended and radially deviated. Clinical features include tenderness over the snuffbox and reduced range of motion, though not dramatically. Imaging includes X-rays from multiple angles, though a fracture may not be visible initially and CT or MRI are more sensitive for diagnosis. Treatment depends on the location and displacement of the fracture, ranging from immobilization in a cast to surgical fixation with screws for displaced or proximal pole fractures. Complications can include non-union, avascular necrosis, and osteoarthritis if not properly treated.
This document discusses radial tunnel syndrome and a new surgical approach called the transbrachioradialis approach. Radial tunnel syndrome is an underdiagnosed entrapment neuropathy of the radial nerve. A new provocative test called the supinator fatigue test was proposed to aid in diagnosis. The transbrachioradialis approach provides a simple, quick and reproducible surgical exposure of the radial tunnel. Initial results using this new approach showed excellent or good outcomes in 75% of patients.
This document discusses fractures of the olecranon bone. It begins with the epidemiology, noting these fractures have a bimodal distribution in younger individuals due to high-energy trauma and older individuals due to simple falls. The anatomy section outlines the subcutaneous position of the olecranon making it vulnerable to trauma, as well as its articulation with the elbow joint. Clinical presentation, evaluation, classification systems, treatment objectives, nonoperative and operative treatment options including various surgical techniques are then covered in detail.
The document discusses the blood supply and anatomy of the scaphoid bone in the wrist. It notes that the scaphoid receives most of its blood supply from the dorsal branches of the radial artery, putting it at high risk for osteonecrosis if fractured. It describes different classification systems for scaphoid fractures and presents options for management, including cast immobilization, percutaneous fixation, open surgery and arthroscopy. Complications of fractures like nonunion are also outlined.
This document discusses scaphoid fractures of the wrist. It notes that the scaphoid is a commonly fractured bone located on the anterior aspect of the wrist. Scaphoid fractures often occur when falling on an outstretched hand, as this puts the wrist in dorsiflexion and radial deviation, placing stress on the scaphoid tuberosity. Clinical diagnosis involves tenderness over the anatomical snuff box or pain with axial thumb compression. Treatment depends on whether the fracture is displaced or undisplaced, and may involve casting, closed reduction with a Herbert screw, or open reduction with bone grafting in more severe cases.
1. Wilhelm Roentgen discovered x-rays in 1895, allowing for better diagnosis and classification of wrist fractures. Scaphoid fractures are the most common carpal bone fractures, accounting for 70% of carpal fractures.
2. Treatment options depend on the specific bone fractured and degree of displacement. Nondisplaced fractures are usually treated conservatively with casting while displaced fractures often require surgical fixation using methods like K-wire fixation.
3. Complications can include nonunion, pain, and arthritis. However, advances in surgical techniques and hardware have reduced morbidity and allowed for faster rehabilitation, important considerations for athlete patients.
The scaphoid bone is located in the wrist and is vulnerable to injury due to its position. It has a tenuous blood supply and reduced healing capacity. Scaphoid fractures are difficult to diagnose on initial imaging and occur most commonly at the waist of the bone. Treatment depends on fracture pattern and stability, with nondisplaced fractures typically treated non-operatively with casting and displaced or unstable fractures often requiring surgical fixation. While casting results in immobilization, surgical treatment allows for earlier rehabilitation and return to activity.
This document provides information on scaphoid fractures, including anatomy, biomechanics, classification, diagnosis, treatment and complications. Scaphoid fractures make up 60-70% of carpal bone fractures and often result from falls on an outstretched hand. Treatment depends on factors like location, displacement and time since injury. Options include cast immobilization for nondisplaced fractures or surgery like open reduction and internal fixation for displaced fractures. Complications can include nonunion, malunion and osteoarthritis if not treated properly.
Η αρθροσκόπηση του Καρπού στα Κατάγματα της Περιφερικής Κερκίδας- Αrthroscop...Nikos Darlis
This document discusses arthroscopically assisted fixation of distal radius fractures. Key points include:
- Arthroscopy can optimize results for distal radius fractures by allowing for more accurate reduction and detection of concomitant ligament or TFCC injuries compared to fluoroscopy alone.
- Common indications are intra-articular fractures, radial styloid fractures, die punch fractures, and fractures with suspected ligament or TFCC injuries.
- Arthroscopy assists in assessing and managing injuries to the TFCC, scapholunate ligament, and other soft tissues that could affect outcomes.
- Studies have found arthroscopically assisted fixation may lead to better mid-term results than open reduction internal fixation or fluor
This patient sustained a right foot Lisfranc fracture dislocation from an MVA. Imaging shows a fracture dislocation of the tarsometatarsal (TMT) joint with lateral displacement of the metatarsals. Immediate treatment includes following ATLS protocols given the risk of vascular injury and compartment syndrome associated with this high-energy injury. Surgical management aims to restore anatomic alignment through open reduction and internal fixation, potentially using screws, K-wires or plating, to allow a painless, plantigrade stable foot.
This document describes the surgical procedure for repairing a Type 2 radial head fracture. It involves making a skin incision over the radial head, exposing the fracture, reducing the fracture anatomically with tools like elevators and k-wires, and fixing it with a Herbert screw placed under the articular surface. Range of motion is checked after fixation to ensure stability before closing.
This document discusses the treatment of Galeazzi fractures, which involve a break in the distal third of the radius bone along with dislocation of the distal radio-ulnar joint. It outlines the evaluation, surgical approaches, techniques for open reduction and internal fixation using plates or pins, post-operative care, and potential complications. The prognosis depends on factors like the timing of surgery and whether the radius fracture and joint dislocation are properly reduced.
The document summarizes an orthopedic case conference discussing a 25-year-old male patient who injured his right wrist when a cabinet fell on it. The patient has a laceration wound on his right wrist with a torn flexor tendon and suspected closed fracture of the scaphoid bone. The conference discusses the epidemiology, anatomy, presentation, imaging, and treatment options for scaphoid fractures. Common treatment approaches include thumb spica casting for stable fractures or open reduction internal fixation surgery for unstable fractures.
Scaphoid fracture and perilunate dislocation Thiyagarajan G
This document provides information on scaphoid fractures and perilunate dislocations of the wrist. It begins with an introduction to scaphoid fractures, including their incidence and location. It then describes the anatomy of the scaphoid bone and its articulations. Mechanisms of injury are explained as hyperextension injuries. Classification systems for scaphoid fractures and perilunate dislocations are outlined. Clinical assessment, investigations including imaging, complications, and types of perilunate dislocations are summarized.
Αρθροσκόπηση του Καρπού, απο την Κλινική Εξέταση στις Σύνθετες Επεμβάσεις- Wr...Nikos Darlis
Review of the clinical exam, radiologic findings and operative treatment of common wrist conditions treated with wrist arthroscopy
Ομιλία στο Σεμινάριο Χειρουργικής του Χεριού, Ιωάννινα 30 Οκτ- 1 Νοε, 2014. "Ανασκόπηση της Αρθροσκόπησης στο Χέρι".
An olecranon fracture is a break of the proximal end of the ulna bone where it forms part of the elbow joint. It most often occurs from a fall on an outstretched arm. Diagnosis is made through physical exam finding tenderness and a gap at the fracture site as well as x-rays. Treatment depends on the severity of the break, with minor fractures treated by casting and more severe displaced fractures requiring surgical fixation such as screws, plates or wires to stabilize the bone fragments. Complications can include stiffness, non-healing of the fracture and arthritis if not properly treated.
This document discusses the anatomy, classification, and management of fractures of the talus bone. It describes the different types of talar fractures including neck, body, lateral and posterior process, and head fractures. It outlines the mechanisms of injury, investigations, treatment options including casting, open reduction internal fixation, and excision depending on the fracture type and degree of displacement. Complications of the different fracture types such as avascular necrosis, osteoarthritis, and malunion are also summarized.
A 46-year-old male presented with left wrist pain after falling on an outstretched hand on ice two days prior. Examination revealed pain with wrist rotation and a click sound with certain movements. Imaging showed a scapholunate dissociation, a ligament tear between the scaphoid and lunate bones. Without treatment, this injury can lead to carpal instability and arthritis. The patient was referred to orthopedics for surgical repair.
Lateral condyle of humerus fracture in childrenAnilKC5
This document discusses lateral condyle fractures of the distal humerus in children. It notes that these fractures have a higher risk of malunion, nonunion, and avascular necrosis than other elbow fractures in children. Treatment depends on the degree of articular displacement, and may involve closed reduction with percutaneous pinning or open reduction and internal fixation. Complications can include elbow stiffness, cubital deformities, growth disturbances, osteonecrosis, and mal/non-union. Proper imaging including stress views are important to evaluate displacement and stability to guide treatment.
Arthroscopic excision is an effective treatment for dorsal and volar wrist ganglion cysts, with lower recurrence rates compared to open excision or needle aspiration. The procedure involves inserting arthroscopic portals near the cyst and using a shaver to resect the cyst stalk and surrounding capsule. Advantages over open excision include smaller incisions, earlier return to function, and less post-operative pain. Recurrence rates for arthroscopic excision are approximately 9%, compared to 20% for open excision.
elbow and wrist and hand fracture with managementkajalgoel8
describing anatomy of the wrist and hand ..
what is fracture
mechanism of injury of all the fracture
classification of fracture
clinical features
radiologicals exminations
management of the fracture
This document discusses the case of a 39-year-old male weightlifter who experienced a painful pop in his elbow followed by inability to carry things, consistent with a distal biceps tendon rupture. Distal biceps tendon ruptures typically occur in dominant arms of men in their 40s during eccentric loading. Surgical repair is usually recommended for young, active patients to restore function, with fixation techniques like suture buttons providing the strongest repair. Postoperative rehabilitation involves immobilization in flexion and supination.
1. Common complications of hip replacement surgery include dislocation (1-2%), nerve injury (1-2% for primary, 3-4% for revision, 5-6% for developmental dysplasia of the hip), infection (<1%), pulmonary embolism (fatal in 0.1-0.5% without prophylaxis), and heterotopic ossification.
2. Risk factors for complications include component malposition, soft tissue imbalance, central nervous system disorders affecting gait and balance, and peripheral nerve or muscle disorders.
3. Long term complications include aseptic loosening due to osteolysis from histiocytic response to wear debris, pseudotumors from metal-on-metal
This document discusses supracondylar humeral fractures in children. It notes that these are the most common pediatric fractures, usually occurring from falls onto an outstretched hand in children ages 5-7. The fractures are classified into 4 types based on displacement and angulation. Type I are undisplaced while types II-IV are increasingly displaced, with type III being completely displaced. Treatment depends on type, with undisplaced or mildly angulated fractures treated with splinting while more severe fractures require closed or open reduction and percutaneous pinning under imaging guidance.
Arthroscopic treatment of scaphoid fractures & nonunionsAaron Venouziou
This document discusses arthroscopic treatment of scaphoid fractures and nonunions. It notes that scaphoid fractures make up 70% of all carpal fractures, most common in males aged 15-30, and are often sports-related injuries. Nonoperative treatment results in healing within 6-8 weeks for undisplaced fractures, but longer for displaced fractures. Operative treatment is recommended for displaced fractures, fractures over 1mm displaced, fractures over 35 degrees angulated, or fractures with associated soft tissue injuries. Arthroscopically assisted percutaneous fixation allows for direct visualization of fracture reduction and guide wire placement, helping ensure central screw placement which results in better fixation and union rates. This technique is described for both acute
1) Flexor tenolysis is the surgical release of non-gliding adhesions along tendons that form after injury and repair.
2) It involves exploring the tendon sheath and releasing adhesions between the flexor digitorum profundus and superficialis tendons from the tip of the finger to the palm using dissection.
3) Post-operatively, the finger is immobilized in flexion to prevent readhesion while the patient performs active exercises as soon as possible.
Entropion is the in-turning of the eyelid margin. It can be congenital or acquired, with the most common type being involutional/senile entropion caused by laxity of the eyelid tissues and weakness of the retractors. Examination involves assessing lid laxity, snap back test, and tendon laxity. Treatment depends on severity and includes sutures, transverse lid splits with everting sutures, horizontal lid shortening procedures, and lower lid retractor procedures. Ectropion is eyelid eversion away from the globe and can also be congenital or acquired, with involutional being most common. Examination tests for laxity and muscle weakness.
1. Wilhelm Roentgen discovered x-rays in 1895, allowing for better diagnosis and classification of wrist fractures. Scaphoid fractures are the most common carpal bone fractures, accounting for 70% of carpal fractures.
2. Treatment options depend on the specific bone fractured and degree of displacement. Nondisplaced fractures are usually treated conservatively with casting while displaced fractures often require surgical fixation using methods like K-wire fixation.
3. Complications can include nonunion, pain, and arthritis. However, advances in surgical techniques and hardware have reduced morbidity and allowed for faster rehabilitation, important considerations for athlete patients.
The scaphoid bone is located in the wrist and is vulnerable to injury due to its position. It has a tenuous blood supply and reduced healing capacity. Scaphoid fractures are difficult to diagnose on initial imaging and occur most commonly at the waist of the bone. Treatment depends on fracture pattern and stability, with nondisplaced fractures typically treated non-operatively with casting and displaced or unstable fractures often requiring surgical fixation. While casting results in immobilization, surgical treatment allows for earlier rehabilitation and return to activity.
This document provides information on scaphoid fractures, including anatomy, biomechanics, classification, diagnosis, treatment and complications. Scaphoid fractures make up 60-70% of carpal bone fractures and often result from falls on an outstretched hand. Treatment depends on factors like location, displacement and time since injury. Options include cast immobilization for nondisplaced fractures or surgery like open reduction and internal fixation for displaced fractures. Complications can include nonunion, malunion and osteoarthritis if not treated properly.
Η αρθροσκόπηση του Καρπού στα Κατάγματα της Περιφερικής Κερκίδας- Αrthroscop...Nikos Darlis
This document discusses arthroscopically assisted fixation of distal radius fractures. Key points include:
- Arthroscopy can optimize results for distal radius fractures by allowing for more accurate reduction and detection of concomitant ligament or TFCC injuries compared to fluoroscopy alone.
- Common indications are intra-articular fractures, radial styloid fractures, die punch fractures, and fractures with suspected ligament or TFCC injuries.
- Arthroscopy assists in assessing and managing injuries to the TFCC, scapholunate ligament, and other soft tissues that could affect outcomes.
- Studies have found arthroscopically assisted fixation may lead to better mid-term results than open reduction internal fixation or fluor
This patient sustained a right foot Lisfranc fracture dislocation from an MVA. Imaging shows a fracture dislocation of the tarsometatarsal (TMT) joint with lateral displacement of the metatarsals. Immediate treatment includes following ATLS protocols given the risk of vascular injury and compartment syndrome associated with this high-energy injury. Surgical management aims to restore anatomic alignment through open reduction and internal fixation, potentially using screws, K-wires or plating, to allow a painless, plantigrade stable foot.
This document describes the surgical procedure for repairing a Type 2 radial head fracture. It involves making a skin incision over the radial head, exposing the fracture, reducing the fracture anatomically with tools like elevators and k-wires, and fixing it with a Herbert screw placed under the articular surface. Range of motion is checked after fixation to ensure stability before closing.
This document discusses the treatment of Galeazzi fractures, which involve a break in the distal third of the radius bone along with dislocation of the distal radio-ulnar joint. It outlines the evaluation, surgical approaches, techniques for open reduction and internal fixation using plates or pins, post-operative care, and potential complications. The prognosis depends on factors like the timing of surgery and whether the radius fracture and joint dislocation are properly reduced.
The document summarizes an orthopedic case conference discussing a 25-year-old male patient who injured his right wrist when a cabinet fell on it. The patient has a laceration wound on his right wrist with a torn flexor tendon and suspected closed fracture of the scaphoid bone. The conference discusses the epidemiology, anatomy, presentation, imaging, and treatment options for scaphoid fractures. Common treatment approaches include thumb spica casting for stable fractures or open reduction internal fixation surgery for unstable fractures.
Scaphoid fracture and perilunate dislocation Thiyagarajan G
This document provides information on scaphoid fractures and perilunate dislocations of the wrist. It begins with an introduction to scaphoid fractures, including their incidence and location. It then describes the anatomy of the scaphoid bone and its articulations. Mechanisms of injury are explained as hyperextension injuries. Classification systems for scaphoid fractures and perilunate dislocations are outlined. Clinical assessment, investigations including imaging, complications, and types of perilunate dislocations are summarized.
Αρθροσκόπηση του Καρπού, απο την Κλινική Εξέταση στις Σύνθετες Επεμβάσεις- Wr...Nikos Darlis
Review of the clinical exam, radiologic findings and operative treatment of common wrist conditions treated with wrist arthroscopy
Ομιλία στο Σεμινάριο Χειρουργικής του Χεριού, Ιωάννινα 30 Οκτ- 1 Νοε, 2014. "Ανασκόπηση της Αρθροσκόπησης στο Χέρι".
An olecranon fracture is a break of the proximal end of the ulna bone where it forms part of the elbow joint. It most often occurs from a fall on an outstretched arm. Diagnosis is made through physical exam finding tenderness and a gap at the fracture site as well as x-rays. Treatment depends on the severity of the break, with minor fractures treated by casting and more severe displaced fractures requiring surgical fixation such as screws, plates or wires to stabilize the bone fragments. Complications can include stiffness, non-healing of the fracture and arthritis if not properly treated.
This document discusses the anatomy, classification, and management of fractures of the talus bone. It describes the different types of talar fractures including neck, body, lateral and posterior process, and head fractures. It outlines the mechanisms of injury, investigations, treatment options including casting, open reduction internal fixation, and excision depending on the fracture type and degree of displacement. Complications of the different fracture types such as avascular necrosis, osteoarthritis, and malunion are also summarized.
A 46-year-old male presented with left wrist pain after falling on an outstretched hand on ice two days prior. Examination revealed pain with wrist rotation and a click sound with certain movements. Imaging showed a scapholunate dissociation, a ligament tear between the scaphoid and lunate bones. Without treatment, this injury can lead to carpal instability and arthritis. The patient was referred to orthopedics for surgical repair.
Lateral condyle of humerus fracture in childrenAnilKC5
This document discusses lateral condyle fractures of the distal humerus in children. It notes that these fractures have a higher risk of malunion, nonunion, and avascular necrosis than other elbow fractures in children. Treatment depends on the degree of articular displacement, and may involve closed reduction with percutaneous pinning or open reduction and internal fixation. Complications can include elbow stiffness, cubital deformities, growth disturbances, osteonecrosis, and mal/non-union. Proper imaging including stress views are important to evaluate displacement and stability to guide treatment.
Arthroscopic excision is an effective treatment for dorsal and volar wrist ganglion cysts, with lower recurrence rates compared to open excision or needle aspiration. The procedure involves inserting arthroscopic portals near the cyst and using a shaver to resect the cyst stalk and surrounding capsule. Advantages over open excision include smaller incisions, earlier return to function, and less post-operative pain. Recurrence rates for arthroscopic excision are approximately 9%, compared to 20% for open excision.
elbow and wrist and hand fracture with managementkajalgoel8
describing anatomy of the wrist and hand ..
what is fracture
mechanism of injury of all the fracture
classification of fracture
clinical features
radiologicals exminations
management of the fracture
This document discusses the case of a 39-year-old male weightlifter who experienced a painful pop in his elbow followed by inability to carry things, consistent with a distal biceps tendon rupture. Distal biceps tendon ruptures typically occur in dominant arms of men in their 40s during eccentric loading. Surgical repair is usually recommended for young, active patients to restore function, with fixation techniques like suture buttons providing the strongest repair. Postoperative rehabilitation involves immobilization in flexion and supination.
1. Common complications of hip replacement surgery include dislocation (1-2%), nerve injury (1-2% for primary, 3-4% for revision, 5-6% for developmental dysplasia of the hip), infection (<1%), pulmonary embolism (fatal in 0.1-0.5% without prophylaxis), and heterotopic ossification.
2. Risk factors for complications include component malposition, soft tissue imbalance, central nervous system disorders affecting gait and balance, and peripheral nerve or muscle disorders.
3. Long term complications include aseptic loosening due to osteolysis from histiocytic response to wear debris, pseudotumors from metal-on-metal
This document discusses supracondylar humeral fractures in children. It notes that these are the most common pediatric fractures, usually occurring from falls onto an outstretched hand in children ages 5-7. The fractures are classified into 4 types based on displacement and angulation. Type I are undisplaced while types II-IV are increasingly displaced, with type III being completely displaced. Treatment depends on type, with undisplaced or mildly angulated fractures treated with splinting while more severe fractures require closed or open reduction and percutaneous pinning under imaging guidance.
Arthroscopic treatment of scaphoid fractures & nonunionsAaron Venouziou
This document discusses arthroscopic treatment of scaphoid fractures and nonunions. It notes that scaphoid fractures make up 70% of all carpal fractures, most common in males aged 15-30, and are often sports-related injuries. Nonoperative treatment results in healing within 6-8 weeks for undisplaced fractures, but longer for displaced fractures. Operative treatment is recommended for displaced fractures, fractures over 1mm displaced, fractures over 35 degrees angulated, or fractures with associated soft tissue injuries. Arthroscopically assisted percutaneous fixation allows for direct visualization of fracture reduction and guide wire placement, helping ensure central screw placement which results in better fixation and union rates. This technique is described for both acute
1) Flexor tenolysis is the surgical release of non-gliding adhesions along tendons that form after injury and repair.
2) It involves exploring the tendon sheath and releasing adhesions between the flexor digitorum profundus and superficialis tendons from the tip of the finger to the palm using dissection.
3) Post-operatively, the finger is immobilized in flexion to prevent readhesion while the patient performs active exercises as soon as possible.
Entropion is the in-turning of the eyelid margin. It can be congenital or acquired, with the most common type being involutional/senile entropion caused by laxity of the eyelid tissues and weakness of the retractors. Examination involves assessing lid laxity, snap back test, and tendon laxity. Treatment depends on severity and includes sutures, transverse lid splits with everting sutures, horizontal lid shortening procedures, and lower lid retractor procedures. Ectropion is eyelid eversion away from the globe and can also be congenital or acquired, with involutional being most common. Examination tests for laxity and muscle weakness.
Dr. Madhu Karna Consultant Pediatric OphthalmologistMadhu Karna
This document discusses factors affecting outcomes in resurgery for strabismus. Key factors include careful preoperative measurements, findings at initial surgery, risk of overcorrection based on patient characteristics, and unmasking of other ocular issues. The success rate for resurgery of congenital esotropia is 80-85%. Planning for resurgery involves reviewing previous records to identify virgin versus re-operated muscles. Expectations are for stable alignment, full eye movement, and good cosmesis. Resurgery is typically performed at least 2 months after initial surgery, except for specific cases. Reoperation is expected in 5-10% of strabismus surgeries and each reoperation increases the risk
This document discusses clavicular fractures. It begins with relevant anatomy of the clavicle and mechanisms of injury. It then describes classifications of fractures, with midshaft fractures being most common. Clinical history, imaging, and treatment options are outlined for different fracture types. Conservative treatment is generally recommended for medial fractures while immobilization or closed/open reduction may be used for midshaft fractures. Lateral fractures are also discussed along with complications. The conclusion emphasizes counseling for most fractures but certain types like displaced midshaft fractures may require operative intervention.
The document discusses the management of peri-articular fractures through a span-scan-plan approach. It emphasizes using spanning external fixation initially to stabilize the fracture and joint, allowing time for soft tissue healing and improved radiographic evaluation through CT scanning. This helps formulate an optimal surgical plan to address the fracture based on its characteristics, available techniques, implants, and patient factors. Proper planning is important for achieving desired objectives like anatomical reduction while preserving soft tissues.
This document provides guidance on appropriate use of the ColonRing device for colorectal anastomoses. It discusses checking patient and surgical factors before use, such as bowel prep, comorbidities that may impact healing. It also addresses potential issues that may be encountered like mucous plugs, foreshortened bowel, or thick fibrotic tissue. The document provides accommodations for different situations like diverting ostomies or modifying the anastomosis technique. It aims to help users safely and properly apply the ColonRing device for colorectal anastomoses.
Flaps are units of tissue transferred from one site to another while maintaining their own blood supply. There are several types of flaps classified by blood supply, proximity to defect, transfer method, and tissue contained. Key advantages include replacing tissue with like tissue and obtaining bulk. Careful patient evaluation and flap design are needed to choose the best option. Monitoring after surgery is also important to detect any vascular issues promptly.
This document discusses retinal detachment, specifically rhegmatogenous retinal detachment. It defines retinal detachment as the separation of the neural retina from the pigment epithelium of the retina. Rhegmatogenous retinal detachment results from a retinal break held open by vitreous traction, allowing liquefied vitreous to accumulate under the retina and separate it from the RPE. The document covers the epidemiology, risk factors, examination techniques including indirect ophthalmoscopy and ultrasound, and characteristics of rhegmatogenous retinal detachment.
Lateral condyle fractures of the elbow are common in children between ages 6-10 years. They occur when a varus force is applied to an extended elbow. These fractures are prone to displacement and nonunion due to pull from forearm extensors and being bathed in synovial fluid. Treatment depends on the amount of displacement, with undisplaced fractures often treated non-operatively and displaced fractures requiring closed or open reduction and internal fixation. Complications can include ulnar nerve palsy, osteonecrosis, nonunion, and cubitus deformities.
This document discusses common knee injuries, including acute injuries like ACL tears, meniscal tears, and patellar dislocations, as well as overuse injuries. It provides details on mechanisms of injury, symptoms, physical exam findings, imaging, treatment including RICE protocol and possible surgery, and prognosis. Knee injuries are common due to the knee's role in weight bearing and lack of bony and muscular support, making it prone to ligament tears and cartilage damage from sudden movements or repetitive stress.
This document discusses humeral fractures in animals. It describes the causes, types, and treatment of humeral fractures. Most humeral fractures are caused by minor trauma from falls or playing. Distal humeral fractures, which involve the elbow joint, account for about half of all humeral fractures. The lateral humeral condyle is most commonly fractured due to the force from the radial head during weight bearing. Fixation methods for lateral condylar fractures include lag screws or self-compressing orthofix pins. A study found that while both methods provided adequate stability, lag screws generated greater compression over a larger area of the fracture site compared to pins.
This document discusses various surgical interventions for bilateral vocal fold paralysis (BVFP). It classifies interventions into extra-laryngeal and intra-laryngeal approaches. Extra-laryngeal approaches include different types of arytenoidectomy procedures developed over time, while intra-laryngeal approaches utilize newer endoscopic techniques with lasers. The document outlines different procedures like laser cordotomy, medial arytenoidectomy, and endoscopic suture lateralization. It also discusses the indications, contraindications, and history of treatments for BVFP, from early tracheostomies to modern laser and endoscopic methods.
Flexor tendon injury final edit with picturesGautam Kalra
This document discusses flexor tendon injuries and their management. It covers the anatomy of flexor tendons and pulley system, zones of injury, tendon healing process, and approaches to repairing different types of injuries. For zone I injuries of the finger, which involve a single tendon in the osteofacial tunnel, the document recommends end-to-end repair if sufficient length is available, or transosseous techniques if the stump is too short. Avulsion injuries are classified and recommendations are given for repair timing based on the classification and presence of the vincular system.
This document discusses injuries to the shoulder girdle and humerus, including acromioclavicular injuries, dislocations, and fractures of the clavicle. It describes the mechanisms of various injuries, methods of diagnosis including physical exam findings and x-rays, and approaches to treatment including closed reduction techniques and immobilization methods. Reduction methods like Kocher's are outlined step-by-step for anterior shoulder dislocations. Greenstick fractures are noted as common in children. Immobilization with a sling or ring method is generally recommended for clavicle fractures and injuries requiring support.
1. Flexor tendon injuries can occur in any of the 5 zones defined by Kleinert and Verdan and require different surgical approaches depending on the location and severity of the injury.
2. Primary repair within 12-24 hours of injury provides the best functional outcomes while delayed or secondary repairs have higher risks of adhesion formation.
3. Flexor tendon repair techniques aim to accurately approximate the tendon ends with core sutures while minimizing handling and restoring the normal gliding relationship between tendons. Postoperative rehabilitation is crucial.
4. Flexor tendon grafting is indicated for injuries with segment
The document summarizes anatomy and common injuries around the humerus and elbow joint. It discusses fractures of the humeral shaft, supracondylar fractures of the distal humerus in children, radial head and elbow dislocations. Management of these injuries includes closed reduction, splinting, casting or surgical fixation depending on the type and displacement of the fracture. Nerve injuries are common complications and must be monitored during treatment.
This document discusses eyelid ectropion, including its definition, classification, causes, clinical presentation, evaluation, and surgical treatment options. Eyelid ectropion refers to eversion of the eyelid away from the eye. It is classified as involutional, cicatricial, paralytic, or mechanical. Surgical treatment depends on the type and severity of ectropion, and may include procedures like conjunctival cautery, wedge resections, horizontal lid tightening, and sling or grafting techniques. Potential complications of ectropion surgery include under or overcorrection, recurrence, and eyelid notching or punctal injury. A thorough evaluation is important to plan the appropriate surgical approach for correcting the
CHAPTER 26 r Endocrine and Nervous SystemsPRACTICALUsi.docxTawnaDelatorrejs
CHAPTER 26 r Endocrine and Nervous Systems
PRACTICAL
Using the CPT manual, code the following:
2l.Incisionanddrainageofaninfectedthyroglossalductcyst.
& cpr code(s):
lr. *"^ovar of a complete cerebrospinal fluid shunt system; without
replacement.
& cpr code(s):
23. Suture of the posterior tibial nerve'
& cpr code(s):
T. w^bar sympathetic block (left)'
CPT Code:
25. Mioodissection, microrepair ulnar digital nerve teft middle
frnger'
CPT Codes:
4u. n ur"*ent of a dorsal column stimulator with implanted generator,
with stereotactic stimulation of spinal cord'
27. Epidual iniection of a steroid, caudal'
ur/g. aruniotomy for drainage of an intracranial abscess;
infratentorial.
CPT Code:
due to leak of CSF29. Re-opetation, skull base surgery, repair of dura matel
of miOdte cranial fossa; myocutaneous flap graft'
.,a/0. ,.rr.r,ion of a cerebrospinal fluid ventriculoperitoneal
shunt for
hydrocephalus.
CPT Code:
31. Hemilaminectomy, posterior approach, with decomqr-elsion
of two
"-
;.-re;ooi, u"O #ittr excision bi herniated disc atLl-LZ and
foraminotomy at L2-L3'
CPT Codes:
B ur." to decide number of codes necessary to correctly arrswer the question.
odd-numberedanswersarelocatedinAppendixB,whilethefullanswerkeylsonlyavailableintheTEACll
Instructor Resources on Evolve'
iopyright @ 2015 by Saunders, an impdnt of Elsevier Inc' A11 rights reserved'
CHAPTER 26 r Endocrine and Nervous Systems
REPORTS
In Appendix A of this workbook you will find a section titled Repotts, which
contains original reports. Read the rcports indicated below and supply the
ilppropriate CPT and ICD-10-CM/ICD-9-CM codes on the following lines:
J32. Report 4t
CPT Codes: (arthrodesis with discectomy),
(arthrodesis with discectomy),
(instrumentation), (allograft),
(evoked potential)
ICD-10-CM Code:
(ICD-9-CM Code:
33. Report 43
& code(s):
& tco-ro-cM code(s):
(& ICD-o-cM code(s):
& U".. to declde number of codes necessary to correctly answer the questlon.
Odd-numbered answers are located ln Appendlx B, while the full answer key is only available il the TEACH
Instructor Resources on Evolve.
Copydght @ 2015 by Saunders, an impdnt of Elsevier Inc. All rights reserved.
APPENDIX A r RePorts
stapleL We imbricated the staple line with two Ethibond sutures, placed a
wad of fat over the last to adhere the fat neal oul staple line. We tested the
anastomosis with air with the bowel clamped, and there was no evidence of
a leak. We then placed Hemaseel ovel this anastomosis, and then once
again mobilized the mesentery. We then closed the mesenteric defect where
the small bowel had gone in retrogastric fashion with the Ethicon Endo-
suture. We once again placed Hemaseel on our small anastomosis. We
placed L0 flat Jackson-Pratt drains near our GJ anastomosis, which came on
out the Ieft side. We removed the trocal polts under direct vision. We then
extended our umbilical incision and reduced the umbilical hernia. We
closed the fascial defect with .
1. Dr. Souvik Paul discussed flexor tendon injuries and repairs, including the anatomy of the flexor tendons and pulley system, classification of tendon injuries, and surgical techniques for primary and secondary repairs.
2. Flexor tendon injuries are evaluated based on history, exam, and special tests to determine the extent and timing of repair. Various graft options can be used for repairs involving tendon loss.
3. Postoperative rehabilitation protocols emphasize protected early motion to regain function while avoiding adhesion formation. Implant-assisted repairs and staged reconstruction procedures are options for more complex injuries.
This document discusses fractures of the distal radius, including Colles' fractures (transverse fractures with dorsal displacement), Smith's fractures (volar displacement), and Barton's fractures (dorsal or volar rim avulsions). Treatment depends on the fracture type and degree of displacement/fragmentation. Displaced fractures may be reduced manually or surgically with K-wires, plates, or external fixation. Outcomes depend on restoring length, alignment, and congruity while allowing early motion. Complications include malunion, nonunion, instability, and arthritis.
1. 12:24 PM12:24 PM 12:24 PM12:24 PM 11
Flexor TENO LYSISFlexor TENO LYSIS
Surgical releasing ofSurgical releasing of
Non gliding adhesions formNon gliding adhesions form
Along the surface ofAlong the surface of
TENDONTENDON
After injury &After injury &
repairrepair
6. 12:24 PM
12:24 PM 6
f. tenolysis, INDICATIONf. tenolysis, INDICATION
Plateau progress through exercise &Plateau progress through exercise &
splinting. Age? Occupation? Motivation?splinting. Age? Occupation? Motivation?
OA hand? 50% ROM is enough?!OA hand? 50% ROM is enough?!
Active ROMActive ROM << passive ROMpassive ROM
Intact flexor tendon??Intact flexor tendon??
Not irreparable involved jointsNot irreparable involved joints
Finger sensory condition OKFinger sensory condition OK
Circulation condition OKCirculation condition OK
8. 12:24 PM
12:24 PM 8
f. tenolysis,INDICATION.contf. tenolysis,INDICATION.cont
Difficult technique,should not be takeDifficult technique,should not be take
lightlylightly..
It is a surgical onslaught.It is a surgical onslaught.
Unsuccessful tl begets worse.Unsuccessful tl begets worse.
Best candidate? Repaired ten.w/Best candidate? Repaired ten.w/
Localized adhesion.Localized adhesion.
but: more freq. long segment involvementbut: more freq. long segment involvement
wh/ req.extensive exposure.w/ jointwh/ req.extensive exposure.w/ joint
problem is your caseproblem is your case
9. 12:24 PM
12:24 PM 9
f. tenolysis,TIMINGf. tenolysis,TIMING
Exact timing of tenolysis??Exact timing of tenolysis??
Reasonable period of time should beReasonable period of time should be
allowed,for:allowed,for:
softening of wound,softening of wound,
Remodeling of adhesions,Remodeling of adhesions,
Scar tissues maturation,Scar tissues maturation,
Ex th. hand th. tendon mobilization.Ex th. hand th. tendon mobilization.
22 wks. 12wks………………9 mon.22 wks. 12wks………………9 mon.
Judgment of surgeon is prime importance.Judgment of surgeon is prime importance.
14. 12:24 PM
12:24 PM 14
Imaging Studies:Imaging Studies:
Radiographs of the digit are critical inRadiographs of the digit are critical in
assessing the status of the joints and theassessing the status of the joints and the
osseous elements.osseous elements.
High-frequency ultrasound investigation can beHigh-frequency ultrasound investigation can be
used to evaluate the tendons, with an accuracyused to evaluate the tendons, with an accuracy
rate in the range of 84-90% and a false-positiverate in the range of 84-90% and a false-positive
rate of 10%rate of 10%
MRI depicts isolated peritendinous adhesionsMRI depicts isolated peritendinous adhesions
(sensitivity, 91%; specificity, 100%).(sensitivity, 91%; specificity, 100%).
Additionally, frank rupture (sensitivity, 100%;Additionally, frank rupture (sensitivity, 100%;
specificity, 100%) or elongated callusspecificity, 100%) or elongated callus
(sensitivity, 100%; specificity, 94%) is seen.(sensitivity, 100%; specificity, 94%) is seen.
16. 12:24 PM
12:24 PM 16
f.tenolysis,TECHNIQUE. opf.tenolysis,TECHNIQUE. op
Tenolysis=exploration!!??Tenolysis=exploration!!??
Anesthesia: Local?,regional?,general?Anesthesia: Local?,regional?,general?
Active motion? Passive gliding? In op field.Active motion? Passive gliding? In op field.
Tip to palm,zigzag incision.Tip to palm,zigzag incision.
Sheath,pulley system, saving w/ working throughSheath,pulley system, saving w/ working through
retinacular windows.retinacular windows.
First, 2 tendons should be mobilized fully at theFirst, 2 tendons should be mobilized fully at the
pip window. Despite of difficulties.pip window. Despite of difficulties.
FDP should be released distally as sole tendon.FDP should be released distally as sole tendon.
Then 2 tendons should be dissected as farThen 2 tendons should be dissected as far
proximally as they are distinct structures.as N.Lyproximally as they are distinct structures.as N.Ly
17. 12:24 PM
12:24 PM 17
f.tenolysis,TECHNIQUE. Opf.tenolysis,TECHNIQUE. Op contcont..22
Pulleys never be divided.Pulleys never be divided.
Pulleys should be handled by hook or right-Pulleys should be handled by hook or right-
angled retractor.angled retractor.
Dissection of plane should be fallowedDissection of plane should be fallowed
beneath pulleys, by creation of windowbeneath pulleys, by creation of window(s).(s).
Result should be checked by: 1- active flexionResult should be checked by: 1- active flexion
or complete by it. 2- passive traction of tendonor complete by it. 2- passive traction of tendon
at palm or above the wrist.at palm or above the wrist.
19. 12:24 PM
12:24 PM 19
f.tenolysis,TECHNIQUE. Opf.tenolysis,TECHNIQUE. Op contcont..
Then FDP&FDS should be dissected one fromThen FDP&FDS should be dissected one from
the other, in the palm, out as far as A1 pulley.the other, in the palm, out as far as A1 pulley.
Then tenolysis proceeds from both directionsThen tenolysis proceeds from both directions
toward the fusion & adhesion area.toward the fusion & adhesion area.
Traction on the tendons away from the bed &Traction on the tendons away from the bed &
from each other reveals correct plane.from each other reveals correct plane.
Use standard knife or Beaver blade.Use standard knife or Beaver blade.
Never use forceps for traction. Use rubber bandNever use forceps for traction. Use rubber band
22. 12:24 PM
12:24 PM 22
f.tenolysis,POST. Op.f.tenolysis,POST. Op.
Why full motion is not achieved?.Why full motion is not achieved?.
Tenolysis my not be complete. Strong tractionTenolysis my not be complete. Strong traction
by pt. may complete it.by pt. may complete it.
Tourniquet time more than 20-30min.Tourniquet time more than 20-30min.
Tourniquet should be released, maneuverTourniquet should be released, maneuver
should be repeated.should be repeated.
Scar segment may be too long, causing theScar segment may be too long, causing the
tendon to be incompetent for either or both oftendon to be incompetent for either or both of
two reasons:1-quadriga.2-lumrical plus.two reasons:1-quadriga.2-lumrical plus.
23. 12:24 PM
12:24 PM 23
f.tenolysisf.tenolysis ,POST OP.cont.,POST OP.cont.
Complete hemostasis should be achieved.Complete hemostasis should be achieved.
Wound should be closed by a little closer suture & firmWound should be closed by a little closer suture & firm
knots.knots.
Wrist should be immobilized in extension, andWrist should be immobilized in extension, and
tenolized digit in flexion.tenolized digit in flexion.
In order to give maximum power to flexor& clotIn order to give maximum power to flexor& clot
adhesion breakage by passive digit extension.adhesion breakage by passive digit extension.
Rubber band traction is applied in very rare conditionRubber band traction is applied in very rare condition
wn/ tenuous tendon is accepted. so w/ wrist in flexion.wn/ tenuous tendon is accepted. so w/ wrist in flexion.
Unresisted active ex. Throughout the day as soon asUnresisted active ex. Throughout the day as soon as
possible.possible.
On no account should the operated hand be used toOn no account should the operated hand be used to
lift or grasp.lift or grasp.
28. 12:24 PM
12:24 PM 28
EXTENSOR TENOLYSISEXTENSOR TENOLYSIS
Extrinsic extensor tendon tightness.Extrinsic extensor tendon tightness.
Dorsal tenodesis.Dorsal tenodesis.
Principles and techniques are the same as flxPrinciples and techniques are the same as flx
tenolysis, except without critical pulley systemtenolysis, except without critical pulley system
,but sagittal band (shroud fibers) should be,but sagittal band (shroud fibers) should be
protected.protected.
Extrinsic extensor tendon release = separationExtrinsic extensor tendon release = separation
of dual extrinsic-intrinsic extensor control of PIPof dual extrinsic-intrinsic extensor control of PIP
joint.joint.
So, careful ph. exame is important for diagnosisSo, careful ph. exame is important for diagnosis
of intrin-extrin cause of PIP extension deformity.of intrin-extrin cause of PIP extension deformity.