This document discusses classifications and treatment approaches for non-union fractures, including infected non-unions. It defines non-union as a halted healing process beyond the expected time frame. It then classifies non-infected and infected non-unions based on factors like vascularity, infection extent, and bone/tissue loss. Treatment goals are to eradicate infection, achieve bone union, and address soft tissue issues. Infection is treated with debridement and antibiotics while union is pursued through bone grafting, stimulation techniques, and stabilization. The Ilizarov method can simultaneously treat infection, union, and deformities through bone transport.
Imaging features of acute and chronic osteomyelitis are described in this PPT. Infective arthritis along with fungal infections of soft tissue are also covered very well. Special emphasis is given on tubercular infection of bone.
Imaging features of acute and chronic osteomyelitis are described in this PPT. Infective arthritis along with fungal infections of soft tissue are also covered very well. Special emphasis is given on tubercular infection of bone.
Fracture of shaft and distal part of Femoral bone by Dr. Ammar AlsabaeAmmar Alsbae
This ppt show the fracture of shaft and distal part ( condylar and supracondylar ) of femuarl bone which include anatomy , classification , clinical picture , diagnosis , treatment and complications .
This PPT prepared by Ammar Alsabae , A medical student , faculity of medicine , Taiz university . Yemen .
Fracture of shaft and distal part of Femoral bone by Dr. Ammar AlsabaeAmmar Alsbae
This ppt show the fracture of shaft and distal part ( condylar and supracondylar ) of femuarl bone which include anatomy , classification , clinical picture , diagnosis , treatment and complications .
This PPT prepared by Ammar Alsabae , A medical student , faculity of medicine , Taiz university . Yemen .
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. NON UNION
Definition
A state in which healing process comes to a halt
as judged by clinical & x-ray evidence, beyond
the stipulated period of healing for a particular
bone and fracture pattern due to mechanical or
biological failure
4. BASED ON THE EXTENT OF INFECTION
NON-INFECTED NON-UNION
INFECTED NON-
UNION
CLASSIFICATION OF NON UNION
5. CLASSIFICATION OF NON-INFECTED NON-UNION
HYPERTROHIC NON
UNION
Hypervascular
nonunions have shown
uptake of strontium-85,
which indicates a rich
blood supply in the ends
of the fragments
ATROPHIC NON
UNION
strontium-85 uptake in
these nonunions
indicate a poor blood
supply in the ends of
the fragments
6. HYPERTRROPHIC NON-UNION
1 “Elephant foot” nonunions
These are hypertrophic and rich in
callus. They result from insecure
fixation, inadequate immobilization, or
premature weight bearing in a reduced
fracture with viable fragments.
2 “Horse hoof” nonunions
These are mildly hypertrophic and
poor in callus. They typically occur after
a moderately unstable fixation with
plate and screws. The ends of the
fragments show some callus,
insufficient for union, and possibly a
little sclerosis.
3 Oligotrophic nonunions
These are not hypertrophic, but are
vascular, and callus is absent. They
typically occur after major displacement
of a fracture, distraction of the
fragments, or internal fixation without
Hypervascular nonunions.
A, “Elephant foot” nonunion.
B, “Horse hoof” nonunion.
C, Oligotrophic nonunion
7. AVASCULAR NON-UNION
1 Torsion wedge nonunions
These are characterized by the presence
of an intermediate fragment in which the
blood supply is decreased or absent. The
intermediate fragment has healed to one
main fragment but not to the other.
2 Comminuted nonunions
These are characterized by the presence
of one or more intermediate fragments that
are necrotic. The radiographs show absence
of any sign of callus formation.
3 Defect nonunions
These are characterized by the loss of a
fragment of the diaphysis of a bone. The
ends of the fragments are viable, but union
across the defect is impossible. As time
passes, the ends of the fragments become
atrophic.
4 Atrophic nonunions
These usually are the final result when
intermediate fragments are missing and scar
tissue that lacks osteogenic potential is left
in their place. The ends of the fragments
Avascular nonunions.
A, Torsion wedge nonunion.
B, Comminuted nonunion.
C, Defect nonunion.
D, Atrophic nonunion
8. Paley et al.classification of non-union
Type A nonunions
(<1 cm of bone loss)
A1, lax (mobile)
A2, stiff (nonmobile)
A2-1, no deformity
A2-2, fixed deformity.
Type B nonunions
(>1 cm of bone loss)
B1, bony defect, no
shortening
B2, shortening, no bony
defect;
B3, bony defect and
shortening.
9. WEILAND CLASSIFICATION OF INFECTED NONUNION
Based on the extend of infection
type 1
characterised by open and exposed bone without
osseous infection but with soft tissue infection
type 2
characterised by circumferential cortical and
endostesl infection with often and invlocrum
surroundind a sequestrum
type 3
characterised by cortical-endosteal infection
associated with a segmental bone defect.
10. CIERNY MADAR CLASSIFICATION
Cierny and Mader developed a classification system for
chronic osteomyelitis, based on physiological and
anatomical criteria, to determine the stage of infection.
Based on host
class A- NORMAL
class B- COMPROMISED
class C-PROHIBITIVE
Based on anatomy
type 1-MEDULLARY
type 2-SUPERFICIAL
type 3-LOCALISED
type 4-DIFFUSE
pairing of these forms 12 clinical stages
Clinical Stage
(Type+ Class = Clinical Stage)
11. UMIAROV’S CLASSIFICATION OF
INFECTED NON-UNION
based on the viability of bone ends, the presence of
limb shortening, the presence of bone, and soft
tissue defect.
- type 1 the nonunion is normotrophic without
shortening
- type 2 the nonunion is hypertrophic with shortening
- type 3 the nonunion is atrophic with shortening
- type 4 the nonunion is atrophic with bone and soft
tissue defect, in general as a result of an
open
fracture
12. G.S KULKARNI CLASSIFICATION OF
INFECTED NON UNION
Severity of infection
Apposition of fragments
Presence or absence of deformity.
13. G.S KULKARNI CLASSIFICATION OF
INFECTED NON UNION
TYPE I:
fragments in apposition with mild infection and
with or with out implant
TYPE II:
Fragments in apposition with severe infection
with large or small wound.
TYPE III:
Severe infection with a gap or deformity or
shortening.
3A defect with loss of full circumference
3B defect in > 1/3 of cortex
3C infected nonunion with deformity.
14. GORDON’S CLASSIFICATION
TYPE A
Tibial defects and non unions without significant
bone
loss
TYPE B
tibial defects greater than 3 cm with an intact fibula
TYPE C
tibial defect greater than 3 cm without intact fibula
15. MAY’S CLASSIFICATION
-it focuses on the status of tibia after bone and soft tissue
debridement
-it helps to estimate the length of rehabilitation period before
ambulation
16. NON-DRAINING/
DRY/QUIESCENT
-- nondraining for at least
3 months
-- requires 1 stage
treatment
DRAINING/ACTIVE
--drainig with abscess and
fever
-- Requires 2 stage
treatment
-- stage 2 after a period
of 10-20 days
17. How infection causes non union??
1. Dissection of pus through planes and periosteum-
devascularising th ends
2. Fragmentation and dissolution of fracture
haematoma
3. Inflammatory mediators promotes fibrous tissue
formation
4. If fixation was done then implant failure occurs
destabilization the fragments
5. Increase catabolic response at # ends
18. PATHOGENESIS
OSTEOMYELITIS
thrombosis of blood vessel
of haversian canals
bone sclerosis and dead
bone.
Butterfly fragments become sequestrii,
isolated & devitalized by pus &
INFECTED GRANULATION TISSUE
20. DIAGNOSIS OF INFECTED NON UNION
1. Pain and mobility at fracture site
2. Raised local temperature
3. Discharging sinus
4. Scar healed by secondary intension with
“puckering”
5. Irregularity of bone showing osteomyelitis
23. GOAL 1 : ERADICATE INFECTION
INCREASE HOST RESISTANCE :
Correct host morbidity
-control blood sugar level in diabetic
-smoking cessation
-treatment of liver or renal malfunction
-optimising nutrition
-treatment of chronic disease
Antibiotic therapy according to culture sensitivity
reports.
- systemic antibiotic therapy
24. LOCAL CONTROL OF INFECTION
DECREASE INFECTION LOAD:
• thorough debridement of dead and necrotic tissue
• closed suction antibiotic ingress and egress irrigation systems.
• negative suction drainage system.
INCREASE LOCAL HOST RESISTANCE:
• PMMA antibiotics beads
• biodegradable antibiotic delivery system
25. GOAL 2 : TO ACHIEVE UNION
• ADDING BIOLOGY
– Aspirated stem cells (with or without expansion)
– Demineralized Bone Matrix
– Autogenous Cancellous Graft
– Growth Factors
• Platelet derived
• Recombinant BMPs
• Gene Therapy
EXTERNAL STIMULI
-low intensity ultrasound therapy
-electric and electromegnetic therapy
26. • Aspirated iliac crest stem cells has
been shown to enhance the activity of
osteoconductive grafts.
• There are few commercially available
Recombinant BMP proved to be
effective treating nonunions.
27. Bone grafting in infected non union
Onlay bone grafting:
graft applied or laid on the surface
of a bone
Inlay bone grafting:
By the inlay technique a slot or
rectangular defect is created in the
cortex of the host bone, usually A graft
the same size or slightly smaller is then
fitted
into the defect.
Single onlay dual onlay
Cancellous
Insert graft
28. Papinaeu method of bone grafting
Stage I: Radical debridement
Stage II: bone grafting
Stage III: skin coverage.
29. HARMONS’ POSTEROLATERAL GRAFT
Bone grafting on the
interosseous membrane
to obtain a long
synostosis with fibula,
spanning the tibial
defect.
30. Free vascularised bone transfer
Rib, fibula, iliac crest.
Isolation of a segment
of contra lateral fibula
with attached nutrient
artery and vein.
Length of graft should
be 4 cm longer than
defect to allow 2 cm
overlap at the proximal
and distal ends.
31. ULTRASOUND THERAPY
fracture site.
it cause increases in cellular activity at osteotomy
sites and increases in mineralization of the bone and
metabolic activity.
It promotes bone healing because it stimulates the
genes involved in inflammation and bone
regeneration.
It increases blood flow through dilation of capillaries
and enhancement of angiogenesis, increasing the
flow of nutrients to the
Used : for 20 min / day
32. ELECTRICAL AND ELECTROMAGNETIC
STIMULATION
used for 3 or more hours per day has been
successful in healing nonunions of long and short
bones, open or closed fractures, long-standing
nonunions, infected nonunions, and those with
fracture gaps up to 1 cm.
33. The three methods of administering
electric stimulation are shown in this
diagram.
(a) Direct current (DC): A cathode is
implanted at the fracture site which is
attached to either a subcutaneous
power source or an external power
source to generate an electric field at
the fracture site.
(b) Capacitive coupling(CC): Two
capacitive coupled electrodes are
situated on the skin on either sides of
the fracture site. An external power
source is then attached to the
electrodes, which induces an electric
field at the fracture site.
(c) Inductive coupling (IC): An
electromagnetic current carrying coil is
placed on the skin overlying the
fracture site, which is attached to an
external power source. The coil
generates a magnetic field, which
induces an electrical field at the fracture
site.
34. GOAL NO.3
SOFT TISSUE PROBLEMS:
The transfer of vascularized muscle tissue improves
the local biological environment by bringing in a
blood supply that is important in the host's defense
mechanisms and for antibiotic delivery and osseous
and soft tissue healing
DEFORMITY AND SHORTENING:
- Ilizarov is the gold standard treatment to correct
deformity and shortening and eradicate infection at
the same time
35. TREATMENT PROTOCOL (AO BASED)
queiscent nonunion
use of short term antibiotic prophylaxis
excise dead bone and scarred ,non vascularised soft tissue
remove loose hardware
correct alignment
perform cancellous bone grafting if required
stabilise using plate or intramedullary devise or external
fixator
mobilise adjacent joints by physiotherapy
QUEISCENT NON
UNION
36. ACTIVE NON UNION
STAGE 1
thorough debridement
- excise and debride
- drain using closed suction irrigation
- antibiotics beads and i.v. antibiotics
- stabilize with external fixator
STAGE 2 after 10-20 days
shingling and cancellous bone auto graft.
STAGE 3
additional bone graft ,muscle or skin pedicle flap can
be used
37. Shingling and cancellous bone
grafting
Shingling Cancellous bone graft
Shingling:a process by which ends of the fracture
Fragments are decorticated subperiosteally forming many
Small osteoperiosteal flaps.
38. ELIMINATION OF INFECTION IN ILIZAROV
METHOD
Resection of infected bone and subsequent
intercalary bone lengthening
gradual bone transport of one wall of the cavity
Controlled osteogenesis, filling of cavities by newly
formed tissue
39. A corticotomy is performed to fracture the bone into two segments, and
the two bone ends of the bone are gradually moved apart during the
distraction phase, allowing new bone to form in the gap.
When the desired or possible length is reached, a consolidation phase
follows in which the bone is allowed to keep healing.