Man doesn’t heal fractures, Nature does, What happens to animals with fractures??
When was the first metal put in the human body?
Why occasionally fractures don’t heal despite multiple surgeries?
Is there any absolute indication for internal fixation??
I have tried to answer these and other questions in this paper
Fractures occur when a bone breaks due to excess pressure. There are several types of fractures including compound fractures where the bone pierces the skin, oblique fractures where the break is at an angle to the bone's axis caused by twisting forces, and impacted fractures where the broken bone fragments are compressed together often from attempting to break a fall with outstretched arms. Diagnosis involves x-rays or other imaging tools, and treatment depends on the location and severity of the fracture.
13 years in prison, ORTHOPAEDICS AND A LITTLE MORE by Dr L.Prakash M.S. orth ...L Prakash
Accused of grave charges and convicted of offences that I would never even imagine committing, I was sentenced to numerous terms of imprisonment including life imprisonment.
I spent 13 years as a prisoner, eight as an under trial and seven as a life convict, under difficult, desperate and depressing circumstances.This is my experience of practicing orthopaedics in those times, with limited or no facilities, treating desperate patients who had nowhere else to go.
Accused of grave charges and convicted of offences that I would never even imagine committing, I was sentenced to numerous terms of imprisonment including life imprisonment.
I spent 13 years as a prisoner, eight as an under trial and seven as a life convict, under difficult, desperate and depressing circumstances.This is my experience of practicing orthopaedics in those times, with limited or no facilities, treating desperate patients who had nowhere else to go.
- Untreated fractures in animals heal on their own through immobilization and gradual return to function, showing nature can heal fractures without medical intervention.
- The earliest known case of a metal implant in the human body dates back to an Egyptian mummy from around 2600 years ago.
- Fractures heal through the biological process of hematoma resolution, callus formation, calcification, consolidation, and remodeling. Rigid immobilization or plating can disrupt this process by damaging blood supply and delaying healing compared to conservative treatment.
This talk will focus on; Biomechanics of bone healing, Logic behind original Ilizarov principles, Prakash bangles for paediatric use, Recent experiments in material research and Do’s and dont’s of this system
The document summarizes a lecture on the Ilizarov external fixator. It discusses the history of its invention by Professor Gavril Ilizarov in Russia in the 1950s. It outlines the principles of distraction osteogenesis and details the components, application procedure, post-operative care, rehabilitation and removal of the Ilizarov fixator. Key indications for its use include limb lengthening, deformity correction, infected non-unions, and congenital pseudarthrosis. The document concludes with experiences using the Ilizarov technique at EMCH, including cases of infected non-unions and complex fractures.
Orthopedics is a Reconstructive Surgery. Mangled extremity is an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). A Decision have to be made Amputation + Prosthesis Vs. Limb salvage procedure which includes Irrigation & Debridement, External fixation, Antibiotic bead spacers, Soft tissue coverage and finally Restoring Skeletal Stability by Salvage of Bone Defect
A fracture is a broken bone that can occur in different ways and types. The document discusses four types of fractures: oblique fractures which occur at an angle to the bone, compound fractures where the bone breaks through the skin, spiral fractures where the bone is twisted apart, and comminuted fractures where the bone is broken into multiple pieces. Treatment depends on the severity but may include casts, surgery to realign bones, or internal fixation with pins and rods.
Fractures occur when a bone breaks due to excess pressure. There are several types of fractures including compound fractures where the bone pierces the skin, oblique fractures where the break is at an angle to the bone's axis caused by twisting forces, and impacted fractures where the broken bone fragments are compressed together often from attempting to break a fall with outstretched arms. Diagnosis involves x-rays or other imaging tools, and treatment depends on the location and severity of the fracture.
13 years in prison, ORTHOPAEDICS AND A LITTLE MORE by Dr L.Prakash M.S. orth ...L Prakash
Accused of grave charges and convicted of offences that I would never even imagine committing, I was sentenced to numerous terms of imprisonment including life imprisonment.
I spent 13 years as a prisoner, eight as an under trial and seven as a life convict, under difficult, desperate and depressing circumstances.This is my experience of practicing orthopaedics in those times, with limited or no facilities, treating desperate patients who had nowhere else to go.
Accused of grave charges and convicted of offences that I would never even imagine committing, I was sentenced to numerous terms of imprisonment including life imprisonment.
I spent 13 years as a prisoner, eight as an under trial and seven as a life convict, under difficult, desperate and depressing circumstances.This is my experience of practicing orthopaedics in those times, with limited or no facilities, treating desperate patients who had nowhere else to go.
- Untreated fractures in animals heal on their own through immobilization and gradual return to function, showing nature can heal fractures without medical intervention.
- The earliest known case of a metal implant in the human body dates back to an Egyptian mummy from around 2600 years ago.
- Fractures heal through the biological process of hematoma resolution, callus formation, calcification, consolidation, and remodeling. Rigid immobilization or plating can disrupt this process by damaging blood supply and delaying healing compared to conservative treatment.
This talk will focus on; Biomechanics of bone healing, Logic behind original Ilizarov principles, Prakash bangles for paediatric use, Recent experiments in material research and Do’s and dont’s of this system
The document summarizes a lecture on the Ilizarov external fixator. It discusses the history of its invention by Professor Gavril Ilizarov in Russia in the 1950s. It outlines the principles of distraction osteogenesis and details the components, application procedure, post-operative care, rehabilitation and removal of the Ilizarov fixator. Key indications for its use include limb lengthening, deformity correction, infected non-unions, and congenital pseudarthrosis. The document concludes with experiences using the Ilizarov technique at EMCH, including cases of infected non-unions and complex fractures.
Orthopedics is a Reconstructive Surgery. Mangled extremity is an injury to at least three out of four systems (soft tissue, bone, nerves, and vessels). A Decision have to be made Amputation + Prosthesis Vs. Limb salvage procedure which includes Irrigation & Debridement, External fixation, Antibiotic bead spacers, Soft tissue coverage and finally Restoring Skeletal Stability by Salvage of Bone Defect
A fracture is a broken bone that can occur in different ways and types. The document discusses four types of fractures: oblique fractures which occur at an angle to the bone, compound fractures where the bone breaks through the skin, spiral fractures where the bone is twisted apart, and comminuted fractures where the bone is broken into multiple pieces. Treatment depends on the severity but may include casts, surgery to realign bones, or internal fixation with pins and rods.
Bone loss is rare in Clinical practice. To treat them is to prevent amputation and putting them back to their routine, It requires lot of dedication and car from both the patient and the treating surgeon. This is a ppt presentation in last week symposium, SRMC & RI, Chennai.
The document discusses delayed union and nonunion of fractures. It defines nonunion as a fracture that shows no signs of healing after 9 months. It classifies nonunions based on bone loss and callus formation. The causes, clinical features, investigations, and management of nonunions are described. Management options include open reduction, rigid fixation, bone grafting, electrical stimulation, and the Ilizarov technique. Types of bone grafts like cancellous, cortical, and Phemister grafts are also outlined.
This study compared outcomes of patients treated for posttraumatic tibial defects using either the classic Ilizarov method with external fixation only or an integrated technique combining external fixation with internal plate or nail fixation. The integrated technique resulted in less time spent in the external fixator (7 months vs 11 months). Both techniques had similar rates of complications. At final follow-up, union rates were 100% and functional outcomes were good to excellent in both groups, indicating the integrated technique can provide comparable results with less time in an external fixator.
This document provides information on fractures of the tibia. It begins with definitions of fractures and their various classifications. The causes of tibial fractures include direct forces, indirect forces, twisting, bending, and pathological fractures. Fracture patterns include transverse, oblique, spiral, impacted, comminuted, and compression fractures. Treatment options for tibial fractures depend on the fracture type and include casting, intramedullary nailing, plating, and external fixation. Complications can include nonunion, malunion, infection, and hardware failure. Open fractures require urgent debridement and antibiotics to prevent infection.
This document discusses various limb lengthening methods, including external fixation methods that use external frames, internal fixation methods that use intramedullary nails, and combined methods. External methods involve bone fixation with rods connected to an external frame, while internal methods use intramedullary nails for distraction and fixation without an external frame. Some common internal methods discussed are the Bliskunov-Dragan nail, Albizzia telescopic nail, Guichet nail system, and ISKD intramedullary rod. Combined methods first use an external fixator for lengthening before replacing it with an internal rod.
This document provides an overview of the management of open fractures. It defines an open fracture as a soft tissue injury complicated by a broken bone with communication to the external environment. The history of open fracture treatment is discussed, from ancient practices like debridement to modern advances with antibiotics and fixation methods. Classification systems for open fractures are presented, including the Gustilo-Anderson classification which correlates the degree of soft tissue injury with infection risk. Key steps in managing open fractures are described, including thorough debridement and irrigation, antibiotic administration, fracture stabilization options like external or internal fixation depending on the injury, and wound management. Overall infection rates and healing times are correlated with the classification of the soft tissue injury.
This document discusses nonunion fractures, including definitions, causes, classification, evaluation, and management. Some key points:
- Nonunion occurs when a fracture fails to heal in the expected time and is unlikely to heal without further intervention. Delayed union is when healing is delayed but still possible with treatment.
- Causes of nonunion include poor vascularity, instability, infection, and patient factors like smoking or diabetes. Types of nonunion include hypertrophic, atrophic, necrotic, and defect.
- Evaluation involves standard radiographs and stress views. Treatment includes non-operative options like bracing or stimulation, or operative options like plating, nailing, bone grafting, and correction
This document provides an overview of musculoskeletal injuries, focusing on fractures. It discusses the healing process for bones, classifications of fractures, and typical timescales for fracture healing. The functions and composition of bone tissue are explained. The stages of fracture healing are outlined, from initial inflammation and hematoma formation to remodeling. Principles of fracture management include reduction, immobilization, and rehabilitation. Complications of fractures like infection, malunion, and nonunion are also reviewed.
This document discusses outcomes of treating distal tibia fractures using minimally invasive plate osteosynthesis (MIPO) technique. It provides an overview of the MIPO surgical procedure and reviews several studies comparing MIPO to traditional open reduction and internal fixation. The studies found MIPO resulted in high union rates, shorter healing times, and fewer complications like infection compared to open reduction. MIPO preserves the fracture site's blood supply and limits soft tissue damage, allowing for better callus formation and healing.
Fracture healing is a complex process that begins immediately after a bone is broken and continues for many years as the bone remodels. It involves the formation of a soft callus that is later replaced by hard bony callus as new bone bridges the fracture gap. The type and amount of new bone formed depends on factors like fracture type, stability, and biological environment. Fracture healing progresses through inflammatory, callus formation, consolidation, and remodeling stages. Complications can include malunion, delayed union, and nonunion, which are influenced by injury, patient, tissue, and treatment factors and require specific management approaches.
Fracture healing involves several stages: initial tissue destruction and hematoma formation, inflammation and cellular proliferation, callus formation, consolidation into hard callus, and remodeling. Complications can include malunion (improper healing), delayed union (slow healing), and nonunion (failure to heal). Malunion is caused by inaccurate reduction or immobilization and can impair function. Delayed union involves healing taking longer than average, while nonunion is defined as no healing after 9 months. Systemic and local factors like nutrition, smoking, infection, and unstable fixation can contribute to complications. Treatment depends on the complication and may include electrical stimulation, surgery with bone grafting and fixation.
This document discusses aseptic loosening of total hip arthroplasty (THA) components. It notes that while success rates for THA are high, osteolysis and loosening continue to plague surgeons, with failure rates as high as 20% due to these complications. The document then discusses the biological process of osteolysis, sources and rates of particulate debris from different bearing surfaces, modes of wear, and radiographic signs of loosening for cemented and cementless femoral and acetabular components. Treatment options including revision surgery and indications for surgery are also summarized.
Prof. Muhammad Shahiduzzaman discusses fractures in pediatric patients. He notes that 60% of the population in Bangladesh is under 20 years old, and fractures account for 15% of injuries in children. Fracture patterns differ from adults due to children having stronger ligaments, more cartilage, and growth plates that allow for remodeling. Common fractures include buckle fractures, greenstick fractures, and Salter-Harris fractures of the physis. Treatment depends on the fracture type but often involves closed reduction and casting, with surgery reserved for more complex cases. Children generally heal faster than adults from fractures.
This document discusses paediatric fractures, including physeal injuries, supracondylar fractures of the humerus, and paediatric abuse. Key points include:
- Children's bones have a physis/growth plate not present in adults, making physeal injuries common fracture patterns like buckle fractures and greenstick fractures.
- Supracondylar fractures frequently occur in the distal humerus and can be posteriorly or anteriorly displaced. Nerve injuries and compartment syndrome are complications.
- Paediatric abuse is difficult to diagnose but risk factors include inconsistent history, delay in care, and fractures in non-mobile children. A skeletal survey aids investigation.
Delayed fracture healing can refer to slow union or delayed union. Slow union means healing is taking longer than usual but is progressing normally, while delayed union means healing has not advanced at the average rate after 3 months. Causes of delayed union include poor blood flow, severe tissue damage, and periosteal stripping. Treatment may involve encouraging exercise and weight bearing or surgical options like internal fixation or bone grafting. Non-union occurs if there is no healing after 9 months. Types include hypertrophic, atrophic, and avascular non-unions. Management involves open reduction, bone grafting, fixation, or the Ilizarov technique. Delayed union differs from non-union in that delayed union still shows some
This document discusses bone and fracture healing. It covers the key stages and processes of both endochondral and intramembranous ossification. Endochondral healing involves the formation of a cartilage callus that is later replaced with bone, while intramembranous healing forms bone directly without a cartilage intermediate. Both involve cells, scaffolding, blood supply, and signaling molecules. Complications like malunion, delayed union, and nonunion can occur if healing is disrupted by factors like instability, open fractures, or patient health issues.
The document discusses fracture healing, malunion, and nonunion. It describes the typical stages of fracture healing including hematoma formation, fibrocartilaginous callus formation, bony callus formation, and bone remodeling. It identifies factors that can influence and interfere with normal fracture healing such as open fractures, severity of injury, blood supply damage, nutrition, and smoking. Treatment for nonunion and malunion is also covered including bone grafting, electrical stimulation, and corrective osteotomy.
Delayed union and nonunion occur when a fracture fails to heal properly or stops healing. The presentation defines these conditions and reviews the fracture healing process. Key causes of disturbed healing are poor vascularity, instability, and infection. Treatment principles involve stabilization of the fracture, enhancing biological healing factors like bone grafting, and eradicating any infection. Prevention requires adequate initial stabilization and monitoring for signs of delayed healing.
Non-union is defined as a fracture that shows no signs of healing after 9 months or no progressive healing over 3 months. It occurs when fractures heal through secondary bone healing which relies on relative stability, or when there are mechanical or biological factors interfering with healing. Mechanical causes include issues with reduction, position, alignment, stabilization or implants, while biological causes include local issues like soft tissue damage or infection, or systemic issues such as diabetes, smoking or malnutrition. The most common sites for non-union are the neck of the femur, scaphoid, lower third tibia, lower third ulna and lateral humerus condyle.
Design criteria for a Total Knee prosthesis for the Indian populationL Prakash
Life expectancy is increasing, Patients are becoming more obese, increasing the demands on the implants, Replacements done 20 years or earlier are all coming back for revision and We have too many choices for implants and thus often make wrong choices. Indian knees are anatomically different from Caucasean counterparts. As squatters, our hips are often spared the ordeal of primary OA, which we well compensate by the high incidence of OA knees. The demands and expectations of our patients differ considerably from their western counterparts
This paper is an attempt to address these problems
The document discusses the advantages and disadvantages of posterior stabilized (PS) and posterior cruciate retaining (PCR) total knee arthroplasty designs. PS designs offer better range of motion and are easier for deformity cases but require tight gaps and alignment. They may have increased wear from the spine/cam articulation. PCR designs have less exaggerated knee motions and translation but less range of motion. Mobile bearing designs and patient factors should be considered when choosing between PS and PCR.
Bone loss is rare in Clinical practice. To treat them is to prevent amputation and putting them back to their routine, It requires lot of dedication and car from both the patient and the treating surgeon. This is a ppt presentation in last week symposium, SRMC & RI, Chennai.
The document discusses delayed union and nonunion of fractures. It defines nonunion as a fracture that shows no signs of healing after 9 months. It classifies nonunions based on bone loss and callus formation. The causes, clinical features, investigations, and management of nonunions are described. Management options include open reduction, rigid fixation, bone grafting, electrical stimulation, and the Ilizarov technique. Types of bone grafts like cancellous, cortical, and Phemister grafts are also outlined.
This study compared outcomes of patients treated for posttraumatic tibial defects using either the classic Ilizarov method with external fixation only or an integrated technique combining external fixation with internal plate or nail fixation. The integrated technique resulted in less time spent in the external fixator (7 months vs 11 months). Both techniques had similar rates of complications. At final follow-up, union rates were 100% and functional outcomes were good to excellent in both groups, indicating the integrated technique can provide comparable results with less time in an external fixator.
This document provides information on fractures of the tibia. It begins with definitions of fractures and their various classifications. The causes of tibial fractures include direct forces, indirect forces, twisting, bending, and pathological fractures. Fracture patterns include transverse, oblique, spiral, impacted, comminuted, and compression fractures. Treatment options for tibial fractures depend on the fracture type and include casting, intramedullary nailing, plating, and external fixation. Complications can include nonunion, malunion, infection, and hardware failure. Open fractures require urgent debridement and antibiotics to prevent infection.
This document discusses various limb lengthening methods, including external fixation methods that use external frames, internal fixation methods that use intramedullary nails, and combined methods. External methods involve bone fixation with rods connected to an external frame, while internal methods use intramedullary nails for distraction and fixation without an external frame. Some common internal methods discussed are the Bliskunov-Dragan nail, Albizzia telescopic nail, Guichet nail system, and ISKD intramedullary rod. Combined methods first use an external fixator for lengthening before replacing it with an internal rod.
This document provides an overview of the management of open fractures. It defines an open fracture as a soft tissue injury complicated by a broken bone with communication to the external environment. The history of open fracture treatment is discussed, from ancient practices like debridement to modern advances with antibiotics and fixation methods. Classification systems for open fractures are presented, including the Gustilo-Anderson classification which correlates the degree of soft tissue injury with infection risk. Key steps in managing open fractures are described, including thorough debridement and irrigation, antibiotic administration, fracture stabilization options like external or internal fixation depending on the injury, and wound management. Overall infection rates and healing times are correlated with the classification of the soft tissue injury.
This document discusses nonunion fractures, including definitions, causes, classification, evaluation, and management. Some key points:
- Nonunion occurs when a fracture fails to heal in the expected time and is unlikely to heal without further intervention. Delayed union is when healing is delayed but still possible with treatment.
- Causes of nonunion include poor vascularity, instability, infection, and patient factors like smoking or diabetes. Types of nonunion include hypertrophic, atrophic, necrotic, and defect.
- Evaluation involves standard radiographs and stress views. Treatment includes non-operative options like bracing or stimulation, or operative options like plating, nailing, bone grafting, and correction
This document provides an overview of musculoskeletal injuries, focusing on fractures. It discusses the healing process for bones, classifications of fractures, and typical timescales for fracture healing. The functions and composition of bone tissue are explained. The stages of fracture healing are outlined, from initial inflammation and hematoma formation to remodeling. Principles of fracture management include reduction, immobilization, and rehabilitation. Complications of fractures like infection, malunion, and nonunion are also reviewed.
This document discusses outcomes of treating distal tibia fractures using minimally invasive plate osteosynthesis (MIPO) technique. It provides an overview of the MIPO surgical procedure and reviews several studies comparing MIPO to traditional open reduction and internal fixation. The studies found MIPO resulted in high union rates, shorter healing times, and fewer complications like infection compared to open reduction. MIPO preserves the fracture site's blood supply and limits soft tissue damage, allowing for better callus formation and healing.
Fracture healing is a complex process that begins immediately after a bone is broken and continues for many years as the bone remodels. It involves the formation of a soft callus that is later replaced by hard bony callus as new bone bridges the fracture gap. The type and amount of new bone formed depends on factors like fracture type, stability, and biological environment. Fracture healing progresses through inflammatory, callus formation, consolidation, and remodeling stages. Complications can include malunion, delayed union, and nonunion, which are influenced by injury, patient, tissue, and treatment factors and require specific management approaches.
Fracture healing involves several stages: initial tissue destruction and hematoma formation, inflammation and cellular proliferation, callus formation, consolidation into hard callus, and remodeling. Complications can include malunion (improper healing), delayed union (slow healing), and nonunion (failure to heal). Malunion is caused by inaccurate reduction or immobilization and can impair function. Delayed union involves healing taking longer than average, while nonunion is defined as no healing after 9 months. Systemic and local factors like nutrition, smoking, infection, and unstable fixation can contribute to complications. Treatment depends on the complication and may include electrical stimulation, surgery with bone grafting and fixation.
This document discusses aseptic loosening of total hip arthroplasty (THA) components. It notes that while success rates for THA are high, osteolysis and loosening continue to plague surgeons, with failure rates as high as 20% due to these complications. The document then discusses the biological process of osteolysis, sources and rates of particulate debris from different bearing surfaces, modes of wear, and radiographic signs of loosening for cemented and cementless femoral and acetabular components. Treatment options including revision surgery and indications for surgery are also summarized.
Prof. Muhammad Shahiduzzaman discusses fractures in pediatric patients. He notes that 60% of the population in Bangladesh is under 20 years old, and fractures account for 15% of injuries in children. Fracture patterns differ from adults due to children having stronger ligaments, more cartilage, and growth plates that allow for remodeling. Common fractures include buckle fractures, greenstick fractures, and Salter-Harris fractures of the physis. Treatment depends on the fracture type but often involves closed reduction and casting, with surgery reserved for more complex cases. Children generally heal faster than adults from fractures.
This document discusses paediatric fractures, including physeal injuries, supracondylar fractures of the humerus, and paediatric abuse. Key points include:
- Children's bones have a physis/growth plate not present in adults, making physeal injuries common fracture patterns like buckle fractures and greenstick fractures.
- Supracondylar fractures frequently occur in the distal humerus and can be posteriorly or anteriorly displaced. Nerve injuries and compartment syndrome are complications.
- Paediatric abuse is difficult to diagnose but risk factors include inconsistent history, delay in care, and fractures in non-mobile children. A skeletal survey aids investigation.
Delayed fracture healing can refer to slow union or delayed union. Slow union means healing is taking longer than usual but is progressing normally, while delayed union means healing has not advanced at the average rate after 3 months. Causes of delayed union include poor blood flow, severe tissue damage, and periosteal stripping. Treatment may involve encouraging exercise and weight bearing or surgical options like internal fixation or bone grafting. Non-union occurs if there is no healing after 9 months. Types include hypertrophic, atrophic, and avascular non-unions. Management involves open reduction, bone grafting, fixation, or the Ilizarov technique. Delayed union differs from non-union in that delayed union still shows some
This document discusses bone and fracture healing. It covers the key stages and processes of both endochondral and intramembranous ossification. Endochondral healing involves the formation of a cartilage callus that is later replaced with bone, while intramembranous healing forms bone directly without a cartilage intermediate. Both involve cells, scaffolding, blood supply, and signaling molecules. Complications like malunion, delayed union, and nonunion can occur if healing is disrupted by factors like instability, open fractures, or patient health issues.
The document discusses fracture healing, malunion, and nonunion. It describes the typical stages of fracture healing including hematoma formation, fibrocartilaginous callus formation, bony callus formation, and bone remodeling. It identifies factors that can influence and interfere with normal fracture healing such as open fractures, severity of injury, blood supply damage, nutrition, and smoking. Treatment for nonunion and malunion is also covered including bone grafting, electrical stimulation, and corrective osteotomy.
Delayed union and nonunion occur when a fracture fails to heal properly or stops healing. The presentation defines these conditions and reviews the fracture healing process. Key causes of disturbed healing are poor vascularity, instability, and infection. Treatment principles involve stabilization of the fracture, enhancing biological healing factors like bone grafting, and eradicating any infection. Prevention requires adequate initial stabilization and monitoring for signs of delayed healing.
Non-union is defined as a fracture that shows no signs of healing after 9 months or no progressive healing over 3 months. It occurs when fractures heal through secondary bone healing which relies on relative stability, or when there are mechanical or biological factors interfering with healing. Mechanical causes include issues with reduction, position, alignment, stabilization or implants, while biological causes include local issues like soft tissue damage or infection, or systemic issues such as diabetes, smoking or malnutrition. The most common sites for non-union are the neck of the femur, scaphoid, lower third tibia, lower third ulna and lateral humerus condyle.
Design criteria for a Total Knee prosthesis for the Indian populationL Prakash
Life expectancy is increasing, Patients are becoming more obese, increasing the demands on the implants, Replacements done 20 years or earlier are all coming back for revision and We have too many choices for implants and thus often make wrong choices. Indian knees are anatomically different from Caucasean counterparts. As squatters, our hips are often spared the ordeal of primary OA, which we well compensate by the high incidence of OA knees. The demands and expectations of our patients differ considerably from their western counterparts
This paper is an attempt to address these problems
The document discusses the advantages and disadvantages of posterior stabilized (PS) and posterior cruciate retaining (PCR) total knee arthroplasty designs. PS designs offer better range of motion and are easier for deformity cases but require tight gaps and alignment. They may have increased wear from the spine/cam articulation. PCR designs have less exaggerated knee motions and translation but less range of motion. Mobile bearing designs and patient factors should be considered when choosing between PS and PCR.
Varus knees in Indian population. Knee replacement in grossly varus knees. right choice of implants. Correct surgical technique of TKR. design of an Indian TKR.
Poller or blocking screws are used to stabilize fractures treated with small diameter intramedullary nails. They guide the nail like "poller" traffic devices guide vehicles. Blocking screws increase stability of distal and proximal metaphyseal fractures after nailing and can help manage malunited fractures. They work by narrowing the canal to guide the nail anteriorly and prevent sagittal plane deformity. Blocking screws are typically placed medially and laterally as close to the fracture as possible for optimal stabilization. Their placement on the concave side of deformities helps improve reduction by deflecting the nail.
Correcting Varus Deformity of the Knee in Total Knee ReplacementVaibhav Bagaria
This document discusses the varus knee, including:
1. Classification of varus knee deformities into intraarticular, metaphyseal, extraarticular, and PAGODA deformity.
2. The sequential approach to correction involves assessing and classifying the deformity, performing a medial release through multiple structures, osteophyte removal, and bone realignment through techniques like shift and resect or pie crusting if needed.
3. Key steps are creating a medial sleeve through layered release of the MCL and other medial structures, complete removal of osteophytes that can impede correction, and balancing flexion and extension gaps.
This document discusses several types of benign aggressive bone tumors, including giant cell tumor, chondroblastoma, and osteoblastoma. It provides details on the incidence, location, clinical presentation, radiological features, biopsy results, histopathology, grading, management options such as curettage and bone grafting, and complications like recurrence for each tumor type. Giant cell tumor is the most common, usually affecting long bones around the knee, and can be graded based on radiological features and staging systems to determine treatment approach and prognosis.
Spontaneous OsteoNecrosis of Knee (SONK)Avik Sarkar
1) Spontaneous osteonecrosis of the knee (SONK), also known as Ahlback's disease, is a condition where there is necrosis and destruction of bone in the medial femoral condyle of the knee due to reduced blood supply.
2) It most commonly affects elderly women over age 55 and can be caused by corticosteroid use, lupus, alcoholism or other conditions.
3) MRI is the best imaging method to diagnose SONK, showing a discrete area of low signal intensity in the bone replaced by edema. Early stages are treated non-surgically but later stages may require surgical interventions like osteotomy, core decompression or knee replacement.
Cervical Hybrid Arthroplasty by Pablo Pazmino MDPablo Pazmino
This video explains Cervical Arthroplasty in combination with a fusion. When people have more than one cervical disc which has degenerated or which has sustained a traumatic rupture they may need a procedure to address both levels. These herniations may begin to affect the surrounding nerves and/or spinal cord. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Cervical Herniations/ Radiculopathy at multiple levels feel free to look us up online www.beverlyspine.com or call toll free 1-8SPINECAL-1
Bone healing, or fracture healing, is the body's natural process of repairing broken bones. It involves several phases: reactive, reparative, and remodeling. In the reactive phase, a blood clot forms and granulation tissue develops at the fracture site. In the reparative phase, cartilage and bone tissue grow to bridge the fracture. Finally, in the remodeling phase, the bone is reshaped to its original form and strength over 3-5 years. Complications can include delayed healing, non-union, or a fibrous union if immobilization is improper. Modern techniques like electrical stimulation, ultrasound, and bone grafts can accelerate the natural bone healing process.
A bone fracture occurs when a force exceeds a bone's strength, causing it to break. The most common fracture sites are the wrist, ankle, and hip. Children, the elderly, and women with osteoporosis are at highest risk. There are several types of fractures, including greenstick (incomplete break on one side), oblique (at an angle), spiral (twisted break), and impacted (many small fragments driven into each other). Bone fractures heal through stages including hematoma formation, fibrocartilaginous callus growth, bony callus formation, and remodeling over several months.
There are different types of fractures classified by the angle of the bone break, how it occurred, and size of the break. A fracture is a broken bone caused by abnormal force on the bone from accidents, falls, or direct blows. Symptoms include pain, swelling, bruising, deformity, and inability to use the limb. Complications can be blood loss, internal organ injuries, or growth problems in children. The body repairs fractures over months through blood clotting, cartilage formation, and replacement with new bone, but immobilization and physical therapy may be needed. First aid involves splinting, immobilizing the area, and seeking immediate medical help.
Fracture regarding information and also useful in nursing in that types of fracture included and also include treatment regarding fracture , nursing care plan...commonly fracture is more so its very useful for study.....
This video explains the principles behind Lumbar and Cervical Fusions. This video highlights the biology, histology, and what happens on the microscopic level during a fusion. If you or someone you know needs to be seen in regards to Cervical or Lumbar fusion feel free to look us up online www.beverlyspine.com or call toll free 1-8SPINECAL-1
This document discusses different types of bone fractures. A fracture is a break in the bone that is usually caused by abnormal force or impact. Fractures are classified based on the angle of the break, how it occurred, and size of the break. Common symptoms include pain, swelling, bruising, and inability to use the injured limb. Complications can include blood loss, organ injuries, and growth problems in children. The body's natural healing process involves blood clotting, cartilage formation, and replacement with real bone over several months of immobilization and rehabilitation. First aid for fractures focuses on immobilization, bleeding control, splinting, and seeking immediate medical help.
The document discusses the hierarchical structure and mechanical properties of bone. At the macrostructural level, bone is divided into cortical and cancellous bone based on their density. Cortical bone forms the hard outer shell, while cancellous bone is found at the interior and has an irregular structure. Cancellous bone remodels more frequently than cortical bone. Mechanical properties vary between cortical and cancellous bone as well as between different bones and regions within the same bone.
Orthopedic surgery 2nd general principles in fracturesRamiAboali
The document discusses bone formation and fracture classification. There are three types of bone formation: enchondral, where bone replaces cartilage; intramembranous, where bone develops directly from mesenchymal cells; and appositional, where new bone forms on top of existing bone. Fractures can be classified in several ways, including by shape (transverse, oblique, comminuted), location (proximal, distal), stability (stable, unstable), and degree of displacement. Fracture healing occurs either through direct union if the fracture is absolutely stable, or through callus formation involving inflammation, soft callus development, hard callus formation, and remodeling if there is movement at the fracture site.
Spinal fracture also called a vertebral fracture or a broken back is a fracture affecting the vertebrae of the spinal column. Spinal fractures are different than a broken arm or leg. A fracture or dislocation of a vertebra can cause bone fragments to pinch and damage the spinal nerves or spinal cord.
03 Cartilage And Bone Connective TissueKevin Young
This document provides an overview of bones and bone structure. It discusses how bones support vital organs, provide muscle attachments, and allow for body movement. It covers different bone cell types like osteoblasts and osteoclasts, bone growth and development, bone fractures and healing, and age-related bone conditions like osteoporosis. A variety of bone structures, features, and development processes are examined, from long bone anatomy to skull development.
03 Cartilage And Bone Connective Tissueguest334add
Bones support and protect vital organs, provide muscle attachments, and allow movement. Their study is called osteology. Bones are made of tissues including vascular, nervous, connectile, muscular, cartilage and osseous tissue. They store minerals and allow hematopoiesis. Cartilage helps support structures and provides gliding surfaces at joints. Long bones have a diaphysis and epiphyses and develop through endochondral ossification.
Bones break in a variety of ways, from hairline fractures to complete breaks. The most common types of fractures include oblique, comminuted, spiral, compound, greenstick, transverse, and simple fractures. Compound fractures are open fractures where the bone pierces the skin, increasing risk of infection. Greenstick fractures seen in children involve incomplete breaks due to their more flexible bones. Proper nutrition including calcium, vitamin D, and other vitamins supports healing of broken bones.
Bones break in a variety of ways, from hairline fractures to complete breaks. The most common types of fractures include oblique, comminuted, spiral, compound, greenstick, transverse, and simple fractures. Compound fractures are open fractures where the bone pierces the skin, increasing risk of infection. Greenstick fractures seen in children involve incomplete breaks due to their more flexible bones. Proper nutrition including calcium, vitamin D, and other vitamins supports healing of broken bones.
Bones break in a variety of ways, from hairline fractures to complete breaks. The most common types of fractures include oblique, comminuted, spiral, compound, greenstick, transverse, and simple fractures. Compound fractures are open fractures where the bone pierces the skin, posing a risk of infection. Greenstick fractures occur more often in children due to their flexible bones. Proper nutrition including calcium, vitamin D, and other vitamins supports healing of broken bones.
Dr Susmit Naskar has completed his Bachelor degree (MBBS) from Calcutta Medical College, the oldest and one of the most renowned medical colleges in India. After completion of his MBBS, he went to Mumbai to earn his Masters degree in Orthopaedics. He completed his masters from Sion’s Lokmanya Tilak Hospital - the Trauma Centre of western India. The Orthopedics unit of Sion Hospital is one of the busiest and diverse Departments in India
A Colles' fracture is a fracture of the distal radius bone in the forearm, just above the wrist. It is caused by falling onto an outstretched hand and results in dorsal displacement of the wrist. Abraham Colles first described this type of fracture in 1814. Treatment depends on severity but may include casting, closed reduction, or open reduction and internal fixation. Complications can include malunion, complex regional pain syndrome, and arthritis.
This document discusses bone healing principles and fracture fixation techniques. It provides information on Jarrad Stevens, an orthopaedic surgeon, and covers topics like primary and secondary bone healing, the four principles of fracture fixation established by AO, and examples of fixation techniques for fractures in the upper limb, lower limb, and pelvis. Examples discussed include plating techniques for fractures of the clavicle, humerus, radius, tibia, and ankle. Rehabilitation approaches are also briefly outlined for some procedures.
This document discusses fractures, including:
1. It defines fractures, dislocations, and subluxations and classifies fracture types such as transverse, oblique, spiral, and comminuted fractures.
2. It describes the signs and symptoms of fractures as well as the general causes including falls, car accidents, blows, and repetitive forces.
3. It explains the management of fractures which involves reduction, immobilization, and healing as well as complications that can occur such as infection, malunion, and delayed healing.
Similar to Fracture healing and reasons for non union (20)
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
2. Man doesn’t heal fractures
Nature does
What happens if you don’t treat fractures??
What happens to animals with fractures??
When was the first metal put in the human
body?
Why occasionaly fractures don’t heal despite
multiple surgeries?
Is there any absolute indication for internal
fixation??
These and other Questions often plague us
orthopaedic surgeons
3. Questions Questions Questions
Wild animals in the jungles don’t go to a bone setter or
an orthopaedic surgeon. Yet their fractures heal most
often.
Animals with fractures know that the broken limb is to
be kept immobile until pain subsides.
They then gradually return to function after the
fracture heals.
11. When was the first metal implanted into the
human bone????
12. An Egyptian mummy with a screw like device transfixing the knee,
is the oldest known case of a metal implant in the bone.
13. The mummy story
In 1971, the Rosicrucian Museum in California acquired a
sealed ancient Egyptian coffin containing the well-
preserved mummy of a high status Egyptian male. More
than two decades later, a team of scientists made a
shocking discovery – the mummy displayed evidence of an
advanced surgical procedure carried out nearly 2,600 years
ago.
Inside the mummy’s left knee was a 9-inch metal
orthopaedic pin that had been inserted with such advanced
biomechanical principles, that initially scientists could not
distinguish it from a modern-day procedure
14. So man has been trying to play god for over two
thousand years!!
15. And now he thinks that he is probably
better than GOD
16. But the worst by nature can certainly not
compete with the worst by man
17. But the worst by nature can certainly not
compete with the worst by man
18. But the worst by nature can certainly not
compete with the worst by man
19. But the worst by nature can certainly not
compete with the worst by man
20. But the worst by nature can certainly not
compete with the worst by man
21. To treat fractures properly, we need to
understand
Biology of normal fracture healing
Blood supply to the bone
Role of immobilisation
Role of micromotion
Role of mobilisation
The difference between ANATOMICAL and
FUNCTIONAL reduction of a fracture.
22. Blood supply to the bone
Is either medullary or cortical
Nutrient artery perfuses the medulla
Periosteal vessels supply cortical bone.
23. When a fracture occurs:
Periosteum is torn
Medullary integrity is disturbed.
A fracture haematoma collects and stops when the
internal pressure equals systolic BP
24. Now starts the fracture healing
Haematoma resolution
Deposition of soft callus
Maturation of the callus
Calcification or hard callus
Consolidation
Remodelling
26. All fractures more or less follows the rule of
three.
No fracture heals before three weeks
Adults take twice the time as adolescents
Children take half the time as adolescents
Lower limb fractures take twice the time as upper limb
fractures
Open fractures take twice or more time as closed
fractures.
27. Thus all fractures will unite if you give it
sufficient time.
The only question is whether it will unite in an
anatomical position or not.
28. It is essential to know the
difference
Union in anatomical position versus healing in
functional position.
29. Anatomical position:
No overriding
No rotation
No angulation
Accurate repositioning of the fractured ends.
31. Fracture haematoma is like colostrum for a
new born.
Periostal integrity is essential for microvascular
transport of callus and other factors stimulating bone
healing
We surgeons open the fracture converting a simple one
to COMPOUND.
We then suck away all the valuable haematoma.
33. We then cut the periosteum,
thereby disturbing the blood
supply. We dill holes right across
disturbing the medullary supply
Else we ream the medulla totally
removing the valuable marrow
39. In surgically fixing a fracture we DELAY nature’s
attempts at fracture healing
We deliberately convert a simple (closed) fracture to
compound (open) fracture
All internally fixed fractures will certainly heal
SLOWER than the one left alone
40. An infected non union for a surgeon is just a
statistic
But for the patient it is:
A lost job
A missed examination
A ruined career
A groom or boy being denied marriage
The whole household in debts for years
Misery misery misery
For him it is 100% disaster, multiple surgeries,
prolonged morbidity, and Hell of a life
41. A fractured limb can be encased in a rigid
plaster but the bone inside cannot.
42. A fractured limb can be encased in a rigid
plaster but the bone inside cannot.
43. Micromotion at the fracture site
has a very important role in bone
healing.
Minute movements of the fracture
ends causes callus to be thrown at
the site
44. A cyclically loaded rotatory micro-motion will cause
lot of callus but the ends don’t get a chance to unite.
This causes the elephant foot non union.
45. An angular micromotion produces atrophic
of horse hoof non union
47. A nail providing this situation clearly
throws up a lot of healthy callus
48. Lanyon and Rubin ( 1984) demonstrated that
cyclic axial loading increases callus formation and
maintained good bone mass.
Woolf and Wright (1981) and Goodship &
Kenwright (1985) demonstrated shortened
fracture healing times in animals, with
intermittent cyclic axial dynamization.
49. So it can be logically concluded that fractures can
be treated by :
Rigid immobilisation with compression or locking
plates.
Semi rigid immobilization with nails, made more rigid
by locking.
Non rigid immobilisation by plasters or splints
Rigid immobilisation by external fixators
Dynamic immobilisation by traction or Flexible
external fixators.
50. Rigid versus Non rigid
immobilisation
The Synthes group led by Muller, Algover, and
Willeneggar, advocated compression plating and
described PRIMARY BONE HEALING
51. Primary bone healing
No external callus is visible
Patient returns to function immediately
52. Primary bone healing
X-rays look Fantastic
But: There is no way to tell when the fracture has
united.
53. Primary bone healing
In many cases the fracture has fallen apart when the
plate was removed after eight to nine months.
This prompted the Synthes group to issued a guideline
that the plate should not be removed before 18 to 24
months or never at all
54. What actually happens with
COMPRESSION PLATING?
The plate assumes the function of the bone, bypassing
the forces, which now travel through it.
Surgical trauma, periosteal stripping and medullary
drilling compromises the vascularity.
All plated fractures heal considerably slower than
conservative
55. What actually happens with
COMPRESSION PLATING?
There is a constant race between bone healing and
implant stresses.
If the bone heals first, as it happens in majority of
cases, all is well!!
Else the plate will break!!
56. What actually happens with Intramedullary
unlocked nails??
Advantage of Good vertical compression without
locking.
Gives good resistance in lateral shifts and angular
stresses
BUT BUT BUT….
Reaming of the medulla screws up the blood supply
Gives poor resistance to rotatory stresses.
57. What actually happens with Intramedullary
locked nails??
Good compression and rigid fixation possible
Distinct disadvantage is that compressive
micromotion is lost.
May need dynamisation at a later stage by removal of
some locking screws.
58. What happens with rigid external fixators,
both static and dynamic??
Uniaxial fixators have a very high shear stiffness in the
plane of pins but low in 90 degree shift.
Biaxial fixators have high shear stiffness in both lateral
bending and torsion.
During linear compression of these fixators, plastic
deformation of the pins is usually observed.
59. The magic of original Ilizarov
Original
Original
Original
60. This is not an Ilizarov assembly
See the Shanz pins sticking out!!!
71. The third magic of Llizarov
Controlled Distraction, both for bone transport and
elongation.
Fortunately, this is something everyone knows and
follows.
72. If we do not respect the original
concepts of the designer, the
results will decidedly be inferior!!
73. So what can we conclude from this
talk?
Have I advocated a complete ban on internal fixations
in fractures??
Do I recommend conservative management in all
cases??
Do I recommend Ilizarov in most trauma cases?
75. Internal fixations do have a role, but it is
limited
Ilizarov fixations too should be handled
similarly and the correct patient and
fracture is to be chosen. But please avoid
stiff Shanz pins in the Ilizarov system.
76. In intraarticular fractures with or
without dislocation Ilizarov gives
distinctly better results. A
ligamentotaxis usually restores the
joint.
A good percentage of fractures can well
be treated conservatively.
78. We must not forget skeletal
traction, Fisk traction, gravity
methods, plaster
applications, and splints!!
These too have an important
role in selected cases.
79. And in conclusion:
Hippocrates has said it .. “Do no harm”
Don’t fight nature, assist natural processes.
Think very carefully before converting any simple
fracture into a compound fracture