Total Hip replacement for Ankylosing Spondylitis: Planning & Execution Vaibhav Bagaria
Performing Total Hip replacement in Ankylosing Spondylitis requires a well thought of strategy. Preoperative planning, Inventory ordering, positioning, cup and stem orientation all play a role.
Total Hip replacement for Ankylosing Spondylitis: Planning & Execution Vaibhav Bagaria
Performing Total Hip replacement in Ankylosing Spondylitis requires a well thought of strategy. Preoperative planning, Inventory ordering, positioning, cup and stem orientation all play a role.
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
Medial patellofemoral ligament.
stabilizer of patella during initial 30 degree of flexion.
More than 18 techniques of reconstruction described.
Runs in layer 2 on medial aspect of the knee.
Origin- 1.9mm anterior/3.8 mm distal to adductor tubercle.(Laparade JBJS- Am.07)
Insertion – proximal 2/3 of patella
Along Distal edge of VMO
Broad insertion over 28.2+_ 5.6 mm over proximal 2/3 patella.
Average length 59.8mm +_ 4.8mm.
Passive- Trochlear constraints
Depth ,length(Height)
Patellar engagement
Capsular ligamentous tethers, especially MPFL
(Hautamaa, Fithian et al. 1998)
Dynamic elements
Simulated muscle tension has little effect on patellar mobility. Regardless of flexion angle
(Scnavongers, Farahmand et al 2003
Can read freely here
https://sethiortho.blogspot.com/
DISTAL FEMUR FRACTURES
OVERVIEW
• INTRODUCTION
• EPIDEMIOLOGY
• ANATOMY AND IT’S RELEVENCE
• CLASSIFICATION
• CLINICAL PRESENTATION
• IMAGING
• MANAGEMENT
– Operative
– Approaches
– Implants
– Tips and tricks
INTRODUTION
• Fractures of the supracondylar and
intercondylar region of the femur.
• Bimodal distribution,
– Younger patients – High energy
– Elderly patients – Low energy
• A challenging fracture type to treat.
EPIDEMIOLOGY
• Less than 1% of all fractures
• 3 – 6% of femoral fractures
• Incidence – 37 per 100,000 population in USA.
• Non union rate 10 – 20% after plate fixation.
• Coon MS, Best BJ. Distal Femur Fractures. National Library of Medicine.
August 2021.
• Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review.
Injury. 2006 Aug;37(8):691-7.
ANATOMY
• Distal most 10- 15 cm of the femur. supracondylar
and condylar region.
• Medial condyle extends more distally and is more
convex than the lateral femoral condyle. This
accounts for the physiologic valgus of the femur.
• The lateral surface has a 10° inclination from the
vertical, while the medial surface has a 20–25° slope.
• Patello-femoral inclination approximately 10°
• In order to avoid joint penetration, screws should be
placed parallel to both the patellofemoral and
femorotibial joints planes.
Muscle attachments
• Shortening is due to the pull of the quadriceps
and hamstring muscles
• Varus and extension deformity is caused by
the pull of the adductors and gastrocnemius.
• Neuro-vascular bundle lie near the posterior aspect
of the distal femur.
• Vascular injuries occur in about 3% and nerve injuries
in about 1% of fractures of the distal femur.
CLASSIFICATION
• AO/OTA
CLINICAL PRESENTATION
• High energy trauma
• Older patients – low energy
• Swelling , Deformity
• Open fractures
• Neuro-vascular complications not uncommon
IMAGING
• Plain radiography
– AP
– Lateral
• CT
– Intra-articular fracture assessment
– Pre-op planning
– Identify osteochondral fragments
• Angiography
– ABI < 0.9
MANAGEMENT
• Non operative
– Non-displaced type A fractures
– Non- ambulatory / Inoperable
– Splint care / knee immobilizer / hinged knee brace
• Operative
– Any displacement / malalignment
– Intra-articular involvement
SURGICAL MANAGEMENT
• ORIF
• Retrograde IM nail
• External fixation
• Arthroplasty
Open Reduction & Internal Fixation
• Indications
– Intra-articular fractures
– Low Type A fractures
– Metaphyseal comminution
– Non-union
– Osteoporotic bones
Pre – operative Planning
‘Failing to plan is planning to fail’
• Implants
• Anatomical lateral locking plate
• Condylar variable angle locking
compression plate (VA-LCP)
• 95° angled blade plate
• 95° dynamic condylar screws
• lag screws / headless screws
• Other plates for adjunctive fixation
Pre – operative Planning
• Other devices and instruments
– Image intensifier
– Femoral distractor
– Reduction clamps
• Pointed clamps
• Collinear clamp
– Schanz pins
– K wi
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
Medial patellofemoral ligament.
stabilizer of patella during initial 30 degree of flexion.
More than 18 techniques of reconstruction described.
Runs in layer 2 on medial aspect of the knee.
Origin- 1.9mm anterior/3.8 mm distal to adductor tubercle.(Laparade JBJS- Am.07)
Insertion – proximal 2/3 of patella
Along Distal edge of VMO
Broad insertion over 28.2+_ 5.6 mm over proximal 2/3 patella.
Average length 59.8mm +_ 4.8mm.
Passive- Trochlear constraints
Depth ,length(Height)
Patellar engagement
Capsular ligamentous tethers, especially MPFL
(Hautamaa, Fithian et al. 1998)
Dynamic elements
Simulated muscle tension has little effect on patellar mobility. Regardless of flexion angle
(Scnavongers, Farahmand et al 2003
Can read freely here
https://sethiortho.blogspot.com/
DISTAL FEMUR FRACTURES
OVERVIEW
• INTRODUCTION
• EPIDEMIOLOGY
• ANATOMY AND IT’S RELEVENCE
• CLASSIFICATION
• CLINICAL PRESENTATION
• IMAGING
• MANAGEMENT
– Operative
– Approaches
– Implants
– Tips and tricks
INTRODUTION
• Fractures of the supracondylar and
intercondylar region of the femur.
• Bimodal distribution,
– Younger patients – High energy
– Elderly patients – Low energy
• A challenging fracture type to treat.
EPIDEMIOLOGY
• Less than 1% of all fractures
• 3 – 6% of femoral fractures
• Incidence – 37 per 100,000 population in USA.
• Non union rate 10 – 20% after plate fixation.
• Coon MS, Best BJ. Distal Femur Fractures. National Library of Medicine.
August 2021.
• Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review.
Injury. 2006 Aug;37(8):691-7.
ANATOMY
• Distal most 10- 15 cm of the femur. supracondylar
and condylar region.
• Medial condyle extends more distally and is more
convex than the lateral femoral condyle. This
accounts for the physiologic valgus of the femur.
• The lateral surface has a 10° inclination from the
vertical, while the medial surface has a 20–25° slope.
• Patello-femoral inclination approximately 10°
• In order to avoid joint penetration, screws should be
placed parallel to both the patellofemoral and
femorotibial joints planes.
Muscle attachments
• Shortening is due to the pull of the quadriceps
and hamstring muscles
• Varus and extension deformity is caused by
the pull of the adductors and gastrocnemius.
• Neuro-vascular bundle lie near the posterior aspect
of the distal femur.
• Vascular injuries occur in about 3% and nerve injuries
in about 1% of fractures of the distal femur.
CLASSIFICATION
• AO/OTA
CLINICAL PRESENTATION
• High energy trauma
• Older patients – low energy
• Swelling , Deformity
• Open fractures
• Neuro-vascular complications not uncommon
IMAGING
• Plain radiography
– AP
– Lateral
• CT
– Intra-articular fracture assessment
– Pre-op planning
– Identify osteochondral fragments
• Angiography
– ABI < 0.9
MANAGEMENT
• Non operative
– Non-displaced type A fractures
– Non- ambulatory / Inoperable
– Splint care / knee immobilizer / hinged knee brace
• Operative
– Any displacement / malalignment
– Intra-articular involvement
SURGICAL MANAGEMENT
• ORIF
• Retrograde IM nail
• External fixation
• Arthroplasty
Open Reduction & Internal Fixation
• Indications
– Intra-articular fractures
– Low Type A fractures
– Metaphyseal comminution
– Non-union
– Osteoporotic bones
Pre – operative Planning
‘Failing to plan is planning to fail’
• Implants
• Anatomical lateral locking plate
• Condylar variable angle locking
compression plate (VA-LCP)
• 95° angled blade plate
• 95° dynamic condylar screws
• lag screws / headless screws
• Other plates for adjunctive fixation
Pre – operative Planning
• Other devices and instruments
– Image intensifier
– Femoral distractor
– Reduction clamps
• Pointed clamps
• Collinear clamp
– Schanz pins
– K wi
neglected proximal humerus fractures-a surgical challenge, dr mohamed ashraf...drashraf369
neglected proximal humerus fractures are a nightmare for trauma surgeons due to its poor outcome.dr mohamed ashraf enumerate and demonstrate the surgical challeneges and tips and tricks of surgical management of these fractures
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
16. FEW WORDS ABOUT FEMORAL
NOTCHING – GUJARATHI GRADING
• GRADE 1 – OUTER
TABLE OF ANTERIOR
CORTEX
• GRADE 2 – OUTER
AND INNER TABLE
OF ANTERIOR
CORTEX
17. FEMORAL NOTCHING –
GUJARATHI GRADING
• GRADE 3-violation
of upto 25% of
medullary canal
• GRADE 4-violation
of upto 50% of
medullary canal
18. FEMORAL COMPONENT- CR/ PS
• POSTERIOR STABILISED
• BONE LOSS/CUT
• CAM AND POST NOT
VISIBLE ON X RAY
19. FEMORAL COMPONENT- CR
• CRUCIATE RETAINING
• NO BONE CUT
• ONLY PEGS FOR FIXATION
• NO BOX IN FEMORAL
COMPONENT
33. Risk factors of Heterotropic
Ossification
• Pre existing HO
• Hypertrophic OA
• Ankylosing spondylitis
• DISH
• Surgical factors- splitting
quadriceps tendon, striping
of soft tissue on anterior
aspect femur
34. Heterotropic ossification
• 1- upto 5 cm2
• 2- more than 5cm2
• 3- 2+near femur, restricts
knee flexion, needs surgery
• visible on x ray after 5
weeks.
