Gap nonunion
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This document discusses the management of tibial diaphysis gap nonunions. Gap nonunions present a major challenge due to associated infection, previous surgeries, and bone loss. The key principles of treatment include managing any infection through debridement and antibiotics, achieving bone union through techniques like cancellous bone grafting or the Masquelet technique, and addressing soft tissue coverage and deformities. Successful treatment may require multiple reconstructive surgeries using methods like the Ilizarov technique to gradually regenerate bone between fragments.
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This document discusses the concept of the center of rotation of angulation (CORA) in orthopedic surgery. The CORA is the point about which a deformed bone may be rotated to achieve correction of an angular deformity without introducing a translational deformity. Proper identification of the CORA allows selection of the optimal correction axis and type of osteotomy, such as opening, closing, or dome osteotomy, to realign the bone. Correction along the bisector line passing through the CORA ensures pure angular correction without residual translation. Identification of multiple CORAs indicates more complex multi-apical or translational deformities requiring different surgical techniques.
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CORA (center of rotation of angulation)
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Limb lengthening with a submuscular locking plate provides an alternative for patients where lengthening over an intramedullary nail would be difficult, such as those with open growth plates or narrow medullary canals. The procedure involves submuscular plating followed by external fixation and corticotomy for lengthening, then locking the distal segment and removing the external fixator. In a study of 10 patients who underwent this procedure, the mean lengthening was 4cm with a healing index of 48.1 days/cm and no major complications. This technique permits earlier removal of the external fixator compared to external fixation alone.More Related Content
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Tips, tricks and pitfalls of proximal femoral nailing (PFN)
1. Proximal femoral nailing (PFN) requires thorough pre-operative planning including imaging and assessment of fracture pattern and patient comorbidities.
2. It is important to reduce the fracture before making the entry point, as the entry point will determine surgical success.
3. Factors such as varus reduction, medializing the shaft, high tip-apex distance, and penetration of the femoral head can lead to poor outcomes like nonunion.
minimally invasive percutaneous plate osteosynthesis
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.
Poller screw
Poller screws, also known as blocking screws, are non-interlocking screws placed outside an intramedullary nail to improve fracture reduction and fixation. They provide a more rigid construct by serving as a surrogate cortex where nail-cortex contact is insufficient. Their placement helps centralize the guidewire in the medullary canal and maintains reduction through a blocking effect. While there is no consensus on their exact placement, they are generally inserted on the concave side of expected deformities to prevent malalignment during nailing.
Principles of locking compression plates
This document discusses the principles of absolute and relative stability in fracture fixation, as well as locking compression plates. It describes how absolute stability aims to reduce strain below a critical level for primary healing without callus formation, while relative stability allows some motion and secondary bone healing through callus formation. Locking compression plates provide angular stability through locking head screws in the plate and bone, maintaining blood supply while providing fixation. They can be used for compression of reduced fractures or for splinting in multifragmentary fractures.
Tumor mega prosthesis
- The document discusses principles of limb salvage surgery for bone tumors. It covers staging of tumors, including radiological and surgical staging. Radiological modalities like CT, MRI, PET scans help determine tumor extent and metastases.
- Principles of biopsy and factors affecting success of limb salvage surgery are outlined. Surgical resection aims to remove the tumor with an adequate margin while reconstructing the limb functionally. Pre-operative staging and adjuvant therapy can aid resectability.
- The goal of limb salvage surgery is a painless, functional reconstructed limb while achieving oncologic control.
Principles of external fixation
External fixation is a method of immobilizing fractures using pins through the skin and bone. It allows realignment, distraction, or compression of fracture elements. External fixation facilitates early mobility and decreased hospitalization times. Common indications include open fractures, limb lengthening, and arthrodesis. External fixators can be unilateral or bilateral, and uniplanar or biplanar. Proper pin placement, diameter, preloading, and frame construction are important for mechanical stability. Fracture healing occurs through indirect bone formation when treated with external fixation. Dynamization applies micromovement at the fracture site to stimulate healing.
Krukenberg surgery
The Krukenberg surgery converts the forearm into a forceps-like structure by separating the radius and ulna into opposing rays that can act against each other like chopsticks. This allows amputees, especially in areas without modern prosthetics, to regain some hand function. The procedure involves longitudinally splitting the flexor and extensor muscles of the forearm into radial and ulnar groups and severing the interosseous membrane to separate the radius and ulna at their tips while maintaining motion at their proximal ends. Reconstructing the forearm in this way provides a more useful alternative to amputees than a mechanical prosthesis.
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The document discusses the history and evolution of bearing surfaces used in total hip arthroplasty. Early designs from the 1910s-1950s used materials like glass, vitallium, and acrylic, which caused issues like fragmentation, tissue reactions, and bone destruction. Modern designs include conventional and cross-linked polyethylene, metal-on-metal, ceramic-on-ceramic, and ceramic-on-metal combinations. Design characteristics like material hardness, lubrication, and wear properties were improved but each bearing surface still carries some risks like wear debris, metal ions, fracture, or noise. Future directions include advanced polyethylenes and larger metal-on-metal designs to reduce wear. No single ideal bearing exists and patient factors help
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Otto Pelvis, also known as primary protrusio acetabuli, was first described by German pathologist Otto in 1824. It is characterized by medial protrusion of the acetabulum. There are two types: primary, which remains a diagnosis of exclusion, and secondary. Clinical features include a marked female predilection and bilateral involvement. Radiographs can identify protrusio using Kohler's line or central edge angle. Management depends on age and degeneration, ranging from valgus osteotomy in younger patients to total hip arthroplasty with grafting in older patients. Surgical techniques aim to restore the hip center through lateralization and reconstruction of bone defects.
Floating Knee
This document discusses floating knee injuries, which involve ipsilateral fractures of the femur and tibia. It describes the classification system for floating knee injuries, which includes true floating knee injuries (extra-articular fractures of both bones) and various types involving articular fractures. These injuries often result from high-energy trauma and are associated with injuries to other body parts. Treatment involves stabilizing the patient, addressing any life-threatening injuries, and providing initial stabilization of the fractures often using external fixation before definitive surgical fixation of the fractures.
High tibial osteotomy
High tibial osteotomy (HTO) is a surgical procedure that involves correcting angular deformities of the tibia. It has been used to treat conditions like osteoarthritis, osteochondritis dissecans, and malalignment. There are several techniques for HTO including lateral closing wedge osteotomy, medial opening wedge osteotomy, and dome osteotomy. HTO can help relieve pain from unicompartmental osteoarthritis and delay the need for knee replacement in young, active patients. Potential complications include fracture, nonunion, nerve palsy, and issues that can make later knee replacement more difficult. Precise surgical planning and fixation are important for achieving good outcomes from HTO.
Management of TendoAchillis rupture
Dr. Ankur Mittal presented on diagnostic tests and imaging for Achilles tendon injuries. [1] Ultrasound is often used to determine tendon thickness and gap size for complete ruptures and is inexpensive and fast. [2] MRI is better for detecting incomplete tears and planning surgery for chronic tears but is more expensive. [3] Imaging is rarely needed for acute cases but can help with chronic cases for diagnosis and surgical planning.
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description and principles of using locking compression plates - done during basic fracture fixation course
Superior Shoulder Suspensory Complex injuries (SSSC)
This document discusses zonal CME conducted at GSLMC on the superior shoulder suspensory complex (SSSC). It defines the SSSC as a bony and soft tissue ring structure that maintains the stable relationship between the scapula and axial skeleton. Injuries to two structures in the SSSC can cause instability known as the "floating shoulder". Treatment depends on the amount of displacement, with conservative management used for displacements under 5mm and no caudal displacement of the glenoid. Surgical stabilization is recommended for larger displacements or malalignment.
Bearing surfaces
This document summarizes the history and evolution of hip replacement surgery. It discusses early attempts at hip replacement in the 1840s using wooden blocks. Modern hip replacement surgery began in the 1920s with mould arthroplasty to reshape damaged bone. A variety of materials were then tested for the joint replacement components, including glass, plastics, alloys. Key developments included the first total hip replacement using stainless steel in 1938, the introduction of polyethylene and metal-on-metal designs in the 1960s, and the first ceramic-on-ceramic design in 1970. The document outlines different bearing material options for modern hip replacements and their advantages and disadvantages.
ILIZAROV EXTERNAL FIXATOR
general discussion about Ilizarov external fixator with its history, principles, indication, application, advantage and disadvantage
Idiopathic chondrolysis of the hip
Idiopathic chondrolysis of the hip is a rare condition characterized by the destruction of articular cartilage in the hip of unknown cause, mainly affecting adolescent females. It presents with insidious hip, thigh, or knee pain and radiographic evidence of joint space narrowing. While the etiology is unknown, theories include abnormal cartilage metabolism triggered by an environmental event, abnormal intra-articular pressure, or mechanical insult to the cartilage. Treatment focuses on NSAIDs, protected weight bearing, range of motion exercises, and in some cases surgery such as distraction arthroplasty or arthroplasty.
External fixator
External fixators are used to immobilize fractures by inserting pins through the skin and bone that are connected by a rigid scaffolding outside the limb. There are two main types - pin fixators and ring fixators. Pin fixators are applied quickly but have limitations in controlling deformities, while ring fixators can achieve complex reconstruction but are heavier. Professor Gavril Ilizarov developed ring fixators in the 1950s which use tensioned wires between rings to stabilize fractures. Ring fixators can be used to treat limb lengthening, deformity correction, non-unions, joint contractures and more complex fractures. They work by gradually distracting the bone between rings.
Proximal fibular osteotomy
This document summarizes a study on using proximal fibular osteotomy (PFO) to treat medial compartment osteoarthritis of the knee. PFO is presented as a simpler, less expensive alternative to procedures like high tibial osteotomy (HTO). The study included one patient who underwent PFO and was followed for 6 months, showing decreased pain scores and improved knee joint space. While PFO provided good short-term outcomes, more research is needed to establish its role compared to procedures like HTO and unicompartmental knee arthroplasty. PFO may be particularly suitable for resource-limited settings due to its low cost and technical simplicity.
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Tips, tricks and pitfalls of proximal femoral nailing (PFN)
Tips, tricks and pitfalls of proximal femoral nailing (PFN)
minimally invasive percutaneous plate osteosynthesis
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Superior Shoulder Suspensory Complex injuries (SSSC)
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Similar to Gap nonunion
Treatment of segmental femoral fracture.pptx
This document discusses treatment options for segmental femoral fractures, specifically the option of modified minimally invasive plate osteosynthesis (MIPO). Segmental femoral fractures require careful treatment due to the severe soft tissue damage and risk of infection. Modified MIPO is proposed as an alternative to intramedullary nailing when it is contraindicated. The key steps of modified MIPO include making small incisions, indirect fracture reduction, stable fixation with locking plates while preserving blood supply, and early return of function through minimal soft tissue disruption. Complications can include malalignment, infection, and non-union if not performed carefully.
Ortho Journal Club 1 by Dr Saumya Agarwal
Ortho Journal Club 1 by Dr Saumya AgarwalCentral Institute of Orthopaedics, Safdarjang Hospital and VMMC, New Delhi
Limb lengthening with a submuscular locking plate provides an alternative for patients where lengthening over an intramedullary nail would be difficult, such as those with open growth plates or narrow medullary canals. The procedure involves submuscular plating followed by external fixation and corticotomy for lengthening, then locking the distal segment and removing the external fixator. In a study of 10 patients who underwent this procedure, the mean lengthening was 4cm with a healing index of 48.1 days/cm and no major complications. This technique permits earlier removal of the external fixator compared to external fixation alone.High tibial osteotomy ppt
High tibial osteotomy (HTO) is a surgical procedure that redirects the mechanical axis of the knee joint to unload the arthritic compartment and redistribute stress. The goals are to correct angular deformity at the knee and reduce pain from conditions like osteoarthritis. While HTO provides relief in the short-term, results deteriorate over time, so it is considered an interim procedure before potential knee replacement. Candidate patients are generally young and active with isolated medial compartment disease. Surgical techniques include lateral closing wedge and medial opening wedge osteotomies, with risks including patella baja, fracture, nerve injury, and non-union. HTO can postpone knee replacement surgery by 7-10 years when performed correctly.
L- shaped Corticotomy - osteomyelitis
This document summarizes a surgical technique called L-shaped corticotomy with vascularized bone flap sliding for treating chronic osteomyelitis of the tibia. Some key points:
- Traditional Ilizarov techniques have long treatment times and risks of complications, so this technique aims to shorten treatment.
- It involves radical debridement followed by an L-shaped bone cut preserving blood supply, then sliding the bone flap to increase contact area for healing.
- A study of 34 patients found this technique reduced the external fixation time and index compared to traditional methods, with no major complications.
- By preserving blood supply and increasing contact area, it may promote faster bone formation and healing compared to traditional Il
Limb salvage surgery
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Infective nonunion
1. The document compares the Ilizarov technique and Masquelet technique for treating infected nonunions of the tibia.
2. The Masquelet technique is a two-stage procedure that uses a PMMA spacer to induce the formation of a vascularized membrane, which is then used to support bone grafting.
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CPT.pptx
congenital pseudoarthrosis of tibia or anterolateral bowing of tibia is cause of major morbidity in children with no definitive or curative management.
Amputation
This document summarizes key information about amputation:
1. Amputation may be necessary due to trauma, ischemia, infection, tumors or congenital anomalies. Factors like peripheral neuropathy increase risk of amputation for diabetics.
2. The level of amputation is determined based on factors like skin perfusion and oxygen levels, with the goal of ensuring wound healing and a functional residual limb.
3. The surgical procedure involves dividing muscles below the intended bone cut, handling nerves to prevent neuromas, and shaping the bone for a smooth contour. Rigid dressings aid rehabilitation.
4. Rehabilitation progresses from non-weight bearing to partial weight bearing as healing is documented. Complications can
osteosynthesis associated infection part II
This document discusses treatment strategies for osteosynthesis-associated infection (OAI). It outlines approaches for acute, delayed, and late infections, as well as infections after union. Key points include aggressive debridement and implant retention if stable; external fixation if unstable; and local antibiotic therapy via beads, spacers, or coated rods. A two-stage approach uses antibiotic-laden cement spacers followed by grafting. Challenging scenarios like large defects are addressed after controlling infection. Overall treatment aims to eradicate infection while maintaining stability and function.
infection after fracture osteosynthesis
1) Osteosynthesis-associated infection (OAI) treatment aims to eradicate infection while allowing fracture healing. Key factors are mechanical stability, time since fixation, and presence of union. 2) For acute infections (<2 weeks), antibiotics and drainage may suffice; deeper infections require debridement. Delayed (3-10 weeks) and late (>10 weeks) infections often involve biofilm/osteomyelitis and may require implant removal. 3) Management strategies include debridement, implant retention/removal, external fixation, local antibiotic therapy, and staged reconstruction. Outcomes depend on fracture stability, soft tissue integrity, and infection control.
Mandibular reconstruction
This document discusses various techniques for mandibular reconstruction after resection for tumors or injuries. The goals of reconstruction are to restore mandibular continuity, alveolar bone height, facial contours and function. Options include reconstruction plates, non-vascularized bone grafts for smaller defects, and microvascular free flaps for larger defects or those needing implant placement. The fibula and scapula flaps are commonly used, providing adequate bone stock. Proper classification of defect type and immediate versus delayed reconstruction must be considered to achieve optimal aesthetic and functional outcomes.
Amputations
This document provides information on amputations of the lower limb. It discusses the indications for amputation including peripheral vascular disease, trauma, burns, frostbite, infections, and tumors. It covers the surgical principles of amputation including determination of amputation level, techniques, postoperative care, and complications. It also provides specifics on transtibial (below knee) amputation techniques for both ischemic and nonischemic limbs.
Surgical treatment of CTEV
Surgical treatment of clubfoot aims to achieve a plantigrade foot through complete release of all contracted structures. The timing of surgery is typically between 9-12 months of age. Various surgical techniques fully release the hindfoot, midfoot, and forefoot joints. Postoperative casting is crucial to maintain correction, while complications like under- or over-correction, infection, and loss of correction require additional treatment. Residual or resistant clubfoot in older children presents unique challenges requiring customized surgical and non-surgical approaches.
Fibular strut
This document describes a technique using an autologous fibular strut graft as a "biological intramedullary nail" to treat complex nonunions of long bones. 22 patients with nonunions of the humerus, femur or tibia were treated with this technique, with a mean time to union of 17 weeks. Complications included 3 cases of nerve palsy and 3 superficial infections, all of which resolved. The technique provides biological fixation and osteogenesis without the need for reaming or additional hardware. It is presented as a simple option for difficult nonunions, especially in osteoporotic bone.
Autologous chondrocyte implantation
This document discusses autologous chondrocyte transplantation (ACT), a treatment for cartilage defects. It covers the stages of ACT healing, indications, prerequisites, investigations, the implantation procedure, and rehabilitation goals. The proliferative, transition, and remodeling stages of healing are described. Advantages include producing hyaline-like cartilage to fill defects of any size. Disadvantages include being more invasive and expensive with a longer recovery than other options.
Fracture shaft of femur by dr ashutosh
This document discusses fractures of the femoral shaft. It begins by describing the anatomy of the femur bone. It then defines femoral shaft fractures and describes their typical mechanisms. Clinically, patients experience thigh pain and tenderness. Imaging includes x-rays of the hip, femur and knee. Treatment options include traction, intramedullary nailing, plating or external fixation depending on the fracture pattern and patient factors. Early mobilization and rehabilitation are important. Complications can include shock, fat embolism, infection and malunion.
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The radial nerve innervates the extensor muscles of the forearm and hand. Damage to the radial nerve causes wrist drop where the patient is unable to extend the wrist and fingers, impairing grasping. Symptoms include pain, numbness, weakness of hand grip and drooping of the wrist and fingers. Diagnosis involves assessing range of motion, imaging tests and electrodiagnostic tests. Treatment depends on the underlying cause but may include medications, injections, bracing and physical therapy.
Tourniquets
Tourniquets are devices used to control blood flow to an extremity during surgery. Various types of tourniquets have been developed throughout history including the Esmarch bandage and modern pneumatic tourniquets. Proper tourniquet placement and pressure are important to minimize complications like nerve injury, muscle injury, and bleeding. Tourniquet time should be limited to 1.5-2 hours to avoid local and systemic effects. Complications can be further reduced by following precautions during tourniquet application and use.
Torticollis
Torticollis is a twisting of the neck that can have several causes. In newborns, it is often due to injuries during birth or fetal positioning, while in older children it may result from neck injuries, infections, or other conditions. The document discusses the main types and causes of torticollis, including congenital muscular torticollis in newborns, self-limiting torticollis, trauma, infections, tumors, and certain drugs. Ultrasound is often used to diagnose congenital cases in newborns, while CT and MRI are used to diagnose other causes like trauma, infections, or tumors in older children. Treatment depends on the underlying cause but may include stretching, physical therapy
Thoracic outlet syndrome
Thoracic outlet syndrome occurs when the blood vessels or nerves in the thoracic outlet - the space between the lower neck and upper chest - become compressed. This can cause pain and numbness in the shoulders and neck as well as reduced pulse. It is commonly caused by anatomical variations like cervical ribs or muscle abnormalities that reduce the space available to the neurovascular structures passing through. Diagnosis involves clinical tests like Adson's maneuver and imaging like MRI. Treatment ranges from physiotherapy and analgesics for mild cases to surgical removal of the first rib and scalene muscles for more severe or progressive cases.
Tennis elbow
Tennis elbow, also known as lateral epicondylitis, is a tendinopathy of the common extensor tendon near the lateral epicondyle of the elbow. It results from repetitive microtears in the tendon due to overuse from activities involving forceful wrist extension. Clinically, it presents as lateral elbow pain that worsens with activities like handshaking or turning a doorknob. Physical examination reveals tenderness over the lateral epicondyle. While most cases resolve with conservative treatment like rest, NSAIDs, bracing, and physical therapy within 6-12 months, surgical debridement may be considered for persistent or recurrent cases.
Tendo achilles
The Achilles tendon connects the calf muscles to the heel bone and is active during walking, running, and jumping. It is vulnerable to rupture, which commonly occurs in the watershed area 2-6cm above the heel in males ages 25-50 during sports. Diagnosis involves physical exam findings like inability to raise the toes and a gap or defect being felt. Treatment options include immobilization in a cast or surgical repair, with the goal of restoring proper tension and length. Post-operative care focuses on protecting the repair during healing over 6 months using casts, braces, and physical therapy.
Surgical site infections
Surgical site infections occur when bacteria enter through an incision made during surgery. They are classified as superficial, deep, or organ/space infections. Common causative agents include Staphylococcus aureus and Streptococcus pneumoniae. Factors that increase risk include patient health issues like malnutrition or diabetes as well as surgical factors like poor technique, inadequate prophylactic antibiotics, or an unclean operating environment. Diagnosis involves clinical signs plus lab and imaging tests. Treatment consists of antibiotics, wound debridement, and drainage. Prevention strategies focus on proper patient preparation, strict sterile techniques in the operating room, and careful post-operative wound care.
Spinal cord tractography
Diffusion tensor imaging (DTI) and fiber tractography are MRI techniques that can be used together to non-invasively visualize spinal cord tracts. DTI measures the anisotropic diffusion of water in tissue to infer the orientation of white matter tracts. Fiber tractography then generates 3D reconstructions of the tracts. This technique provides information about spinal cord injuries or other pathologies. However, it faces challenges from motion artifacts and has limitations when tracts converge or cross or are non-homogeneous. Despite this, DTI tractography can be used to prognosticate outcomes from spinal cord deformities, injuries, tumors, or myelopathies. Two case studies are described, one with a C6 burst fracture
Spina ventosa
Spina ventosa is a form of tuberculous dactylitis that affects the short tubular bones of the hands and feet in children. It occurs secondary to tuberculosis infection and presents as swelling and tenderness of the affected bone. Investigations may show leukocytosis and elevated inflammatory markers. Chest x-rays and bone x-rays can identify periosteal reaction, lytic lesions, or sclerosis. Biopsy is needed to confirm the diagnosis. A case report described a 13-year-old girl with left index finger pain, weight loss, and loss of appetite who was found to have spina ventosa on biopsy along with a tuberculoma seen on brain MRI. She was started on antitub
Snapping hip syndrome
There are three main types of snapping hip: external, internal, and intra-articular. External snapping hip is caused by increased tension in the iliotibial band over the greater trochanter with repeated flexion and extension. Internal snapping hip involves snapping of the iliopsoas tendon over the femoral head. Intra-articular snapping hip is caused by labral tears or loose bodies in the hip joint. Conservative treatments include rest, stretching, strengthening, and therapies like cold compression, while operative options involve procedures like Z-plasty of the iliotibial band or arthroscopic surgery to address intra-articular issues.
Scurvy
- Scurvy is a disease caused by vitamin C deficiency that results from a lack of vitamin C in the diet for several weeks. It impairs collagen formation and causes hemorrhaging in tissues.
- Symptoms include bleeding gums, loose teeth, bruising of the skin, and bone fractures. In infants, scurvy can cause pseudoparalysis and swelling over bones from subperiosteal hemorrhaging.
- Diagnosis is based on low vitamin C blood levels and x-ray findings of bone changes like the white line of Fraenkel. Treatment involves vitamin C supplementation in doses of at least 200mg daily until recovery is complete.
Screws in orthopedics
This document provides an overview of screws in orthopedic surgery. It discusses the history of screw development from ancient times through modern innovations in materials. The anatomy of a screw is described in detail, including the head, shaft, thread, tip, and special features like pitch, diameter, and cannulation. Different types of screws are compared based on their properties and intended uses in cortical versus cancellous bone. Special screw designs like Herbert screws, lag screws, and dynamic hip screws are also briefly mentioned.
Sacral chordoma
Sacral chordoma is a rare, slowly growing malignant tumor that arises from remnants of the notochord, usually occurring in the sacrum. It accounts for 1-4% of all malignancies and is the most common primary malignancy of the sacrum. Patients typically experience lower back pain worsening with sitting in their 5th-7th decade. Imaging shows a destructive lytic lesion in the sacrum. Complete surgical resection is the primary treatment, but recurrence is common due to the locally aggressive nature, leading to poor long-term survival rates.
Robotics in orthopedics
This document discusses the use of robots in orthopaedic surgery. It describes how robotic systems can improve accuracy of bone cuts and component placement compared to manual surgery. Both autonomous and haptic robotic systems are presented. Applications discussed include unicondylar knee replacement using the Mako robotic arm and spinal pedicle screw placement using the Renaissance system. While robotic surgery may provide benefits like increased accuracy, it also has drawbacks such as high costs and long-term outcomes have not proven superiority over manual techniques.
Reverse shoulder arthroplasty
Reverse shoulder arthroplasty involves replacing the humeral head and glenoid fossa with prosthetics to alter the center of rotation and increase deltoid tension and function. It is indicated for rotator cuff tear arthropathy, proximal humeral fractures in the elderly, failed shoulder replacements, and other conditions. The procedure involves an deltopectoral approach to expose the joint, removal of the humeral head and shaping of the glenoid, then implantation of the glenosphere and humeral cup components. Outcomes are best for osteoarthritis and worse for trauma or revision cases. Complications can include infection, nerve injury, implant loosening or breakage.
Prolapsed intervertebral disc
The intervertebral disc consists of three main components: the cartilage end plates, the nucleus pulposus, and the annulus fibrosus. Degeneration of the intervertebral disc is a natural aging process but can be exacerbated by factors like poor nutrition, trauma from sports or injuries, and biomechanical factors related to posture and repetitive microtrauma. The degenerative process typically begins with softening of the nucleus pulposus and weakening of the annulus fibrosus, which can lead to protrusion or extrusion of the nucleus through tears in the annulus. Eventually fibrosis and calcification may occur as the body attempts to repair the degenerated disc.
Pre operative care
The document outlines the steps involved in pre-operative care, which includes conducting a pre-anaesthetic checkup of the patient's medical history and current health status. A series of blood investigations, imaging tests like ECG, ultrasound, and radiological tests are performed. The patient's medication needs and consent for the procedure are also addressed. The pre-operative preparation involves both physical and psychological preparation of the patient by explaining the procedure and potential complications to calm them before surgery.
Plantar fascitis
Plantar fasciitis is a painful condition caused by inflammation of the plantar fascia, a thick ligament connecting the heel to the toes. The pain is usually felt on the bottom of the foot near the heel and is worst upon waking or after long periods of sitting. Repeated microtears in the fascia from overuse can cause degeneration and inflammation. Risk factors include obesity, excessive running or prolonged standing, especially with inadequate foot support. Treatment focuses on reducing inflammation and strain through stretching, orthotics, night splints, and physical therapy exercises.
Pigmented villonodular synovitis
Pigmented villonodular synovitis is an idiopathic overgrowth and pigmentation of the synovial membrane that most commonly affects the knee joint. It presents with pain, swelling, stiffness, and recurrent atraumatic hemorrhaging in the joint. Diagnosis is made through arthroscopic biopsy showing characteristic chocolate-colored lesions. Treatment involves surgical synovectomy or radiation therapy, with recurrence being a potential complication.
Pes cavus
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
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Gap nonunion
- 1. MANAGEMENT OF TIBIAL DIAPHYSIS GAP NON UNION DR PRATIK DHABALIA RESIDENT IN ORTHOPEDICS Dr DY Patil Hospital, Navi Mumbai
- 3. GAP NON UNION • Gap nonunion presents a major challenge to the orthopedic surgeon, especially when associated with infection, old or active osteomyelitis, and multiple previous surgeries. • Management of the gap nonunion is technically difficult, time- consuming, physically and psychologically demanding for the patient. • The problem involves bridging or regenerating areas of bone loss while maintaining limb length and alignment. • Open fractures with bone loss are most common in the tibia due to its subcutaneous anatomical site, and a number of patients have secondary bone loss after surgical debridement of the necrotic bone or osteomyelitis.
- 4. • The nonunion may persist despite a series of reconstructive procedures, with external fixation, internal fixation (plate or intramedullary rods), bone grafting, and Ilizarov frame application. • The patient may require multiple surgeries and sometimes the surgeon is left with no option, but secondary amputation or disarticulation
- 5. PRINCIPLES OF TREATMENT OF GAP NON UNION 1. MANAGEMENT OF INFECTION 2. ACHIEVE UNION AT THE SITE 3. SOFT TISSUE COVERAGE, DEFORMITY CORRECTION AND POST OPERATIVE JOINT STIFFNESS
- 6. INFECTION • Debridement: -removal of all dead and necrotic soft tissues -removing the sinus tracts -sequestrum removal
- 7. • Antibiotic therapy: -given intravenously for 4–6 weeks -then orally for 3–6 weeks. -After the culture and sensitivity, appropriate antibiotics should be started intravenously - Wounds that have been left open for a long time usually have super infection and mixed infection and generally require Aminoglyocsides
- 8. • Patient factors: -control sugar levels -cessation of smoking -optimizing nutrition -treating any chronic liver or renal diseases • Beads -management of open contaminated fractures and infected nonunions -beads are left in place for 2–3 weeks and then removed
- 9. ACHIEVING UNION TECHNIQUES: 1. Papineau type of cancellous bone grafting 2. Autogenous Bone Grafting Using the Masquelet Technique 3. Vascularized fibula graft 4. Huntington's procedure 5. Ilizarov technique
- 10. Papineau Technique • In patients with bone gap less than 4 cm • Cancellous bone grafting • Adequate drainage is provided • Adequate immobilization is provided • Antibiotics are used for prolonged period
- 12. Masquelet technique • Primary shortening followed by lengthening is favoured • Area of segmental loss is filled with a PMMA cement • At 4 to 6 weeks, when an osteogenic membrane has been formed around the cement, the membrane is surgically reopened, the cement is removed, and generous cancellous grafting is carried out • Healing generally occurs slowly but usually by 3 to 6 months. • This, of course, is done in conjunction with internal stabilization. • The membrane itself serves to contain the graft, prevent fibrous ingrowth, and provide growth factors (BMP)
- 16. Vascularised fibular graft • Vascularized bone grafts, by virtue of their inherent vascularity, unite more rapidly with the host bone and are more resistant to infection. • Protected weight bearing post grafting • Weight bearing causes remodelling and hypertrophy of graft
- 18. Huntingtons procedure • Transposition of the ipsilateral fibula to the tibia • Provides mechanical strength. • the fibula is transferred to the tibia as a pedicle graft. • Due to retained blood supply to one end of the transplant, the graft easily takes up and hypertrophies upon weightbearing over a period of time
- 20. Ilizarov method • Law of tension stress and distraction osteogenesis • Corticotomy is done in the fracture fragments and both the fragments are distracted. • When the desired length is achieved, distraction is stopped and consolidation of the new bone formed occurs • Gold standard in infective gap non union • Fibular osteotomy
- 21. • Removal of fixator: Atleast three cortices should be ossified in AP and Lat view xrays Protected weight bearing • Advantages: no skin incision is made, minimally invasive (wires and pins) Very little soft tissue handling Can correct length and deformities in three dimensions Patient can weight bear early after application
- 22. • Disadvantages: Pin tract infective Cumbersome for patient Requires sufficient physiotherapy post operatively Soft tissue contracture Kinking and stretching of neurovascular structures
- 30. ADJUNCTS TO OPERATIVE REPAIR • Autogenous Bone Graft • Reamer–Irrigator–Aspirator • Vascularised grafts • BG substitutes like BMPs, DBM, BM aspirate, PRP • Allografts
- 31. Management of Soft Tissue Compromise Associated with Nonunion • Vac application • SSG • Myocutaneous flaps