This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Bone fractures are a very common orthopedic injury resulting from trauma and sudden loads or stresses applied to bones or a result from bones being weakened by certain diseases. More than 250,000 femur fracture patients are seen per year in the U.S. on average. Bone fractures are either a complete or partial break in a bone and in some cases a simple cast to immobilize the injury site is not enough to completely heal the fracture.
Immobilization from casts may not be enough to completely heal the fracture if a malunion (when both ends of the fractured bone misalign) occurs and/or if a non-union (when the fracture gap is too large and the fractured ends cannot re-attach to one another) occurs. In the case of a malunion or non-union, a possible solution to the problem is by surgically inserting an intramedullary rod into the center canal (diaphysial) region of the injured bone and fixating it into place with screws.
conventional plates including different functions of screws, modes of plate application, Compression Mode.
Neutralization Mode.
Buttress plate.
Antiglide plate.
Bridge plating or span plating.
Tension band.
prebending precountouring
working length
lag screw
AO principles
biological fixation
MIPO
This is a lecture presentation on applying external fixator on open fracture specially on tibia. This method is a classical method. Various new and dynamic fixators are there but the basics are the same.
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Bone fractures are a very common orthopedic injury resulting from trauma and sudden loads or stresses applied to bones or a result from bones being weakened by certain diseases. More than 250,000 femur fracture patients are seen per year in the U.S. on average. Bone fractures are either a complete or partial break in a bone and in some cases a simple cast to immobilize the injury site is not enough to completely heal the fracture.
Immobilization from casts may not be enough to completely heal the fracture if a malunion (when both ends of the fractured bone misalign) occurs and/or if a non-union (when the fracture gap is too large and the fractured ends cannot re-attach to one another) occurs. In the case of a malunion or non-union, a possible solution to the problem is by surgically inserting an intramedullary rod into the center canal (diaphysial) region of the injured bone and fixating it into place with screws.
conventional plates including different functions of screws, modes of plate application, Compression Mode.
Neutralization Mode.
Buttress plate.
Antiglide plate.
Bridge plating or span plating.
Tension band.
prebending precountouring
working length
lag screw
AO principles
biological fixation
MIPO
Screw and plates are most common used devices in orthopedics. However, sometimes we forget their principles, so this presentation hopes to review most their problems. Thank you for your attention!
A traditional manual therapy technique developed by John Upledger, involving bare hands and stretching the tension membrane so as to ease the tension within
Its a compilation of both traditional and recent advance techniques of not only assessing musculoskeletal but also cardiovascular and respiratory endurance as well as strength
Traction: a basic physiotherapy modality used for inducing space between the joints. this slideshow deals with various types of traction and its application to cervical, thoracic and lumbar spine.
the PPT Describes about various types of dysfunction in mechanical pattern as described by Janda's. it also describes about normal muscle slings prresent within the body and its compensation and decompensation patterns towards the adaptations of the body
this slideshow describes about the hip joint anatomy, biomechanics and its pathomechanics along with angles of hip joint. the slide show also briefs about the pelvic femoral rhythm in daily activities
Thoracic and rib cage anatomy, biomechanics, and pathomechanicsRadhika Chintamani
This slide show describes about thoracic and rib cage in detail with its anatomy, kinetics and kinematics along with force couple. the slideshow also describes about the pathology and pathomechanics related to the topic
Knee joint anatomy, biomechanics, pathomechanics and assessmentRadhika Chintamani
the knee complex complete anatomy, biomechanics, pathomechanics and its physical assessment in one single slideshow.a brief table given for easy understanding of what special test to be performed in which condition along with evidences of each special test.
small correction in slide number: 10
during flexion of tibia over femur in OKC; tibia glides and rolls posteriorly
during extension of tibia over femur in OKC: tibia glides and rolls anteriorly
A very old school of manual therapy which comprises of two main principle centralization and peripheralization thought given by Robin McKenzie. The slideshow explain theoretical and practical part of both entire spine and extremities as well
this is a slide show which gives in brief about anatomy and detailed description about biomechanics as well as pathomechanics of shoulder joint. various rhythms of shoulder complex are discussed as well along with the stability factors
Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.
A type of manual therapy in which the muscle or the joint is altered and placed in a position of comfort for certain duration after which the pain disappears completely or gets reduced. this slide show explains about the principles, mechanism and Phases of PRT
Massage of therapeutic form is beneficial in many conditions like stroke, flaccidity, muscle tightness, spasm etc.
it has many physiological effects along with many types for different conditions as well as different body areas.
it is another taping technique which inhibits or control the movement. it is helpful in postural correction and movement pattern correction as well. usually used clinically
Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapyRadhika Chintamani
Sacroiliac joint: mostly commonly affected joint due to its smaller articular surfaces. this slideshow briefs about its anatomy, biomechanics i.e. movements and axis, muscles, ligaments around it, types of dysfunction of SI joints, its special test and manual therapy management of the dysfunctions.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
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.
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
2. CONTENTS
• Definition
• Types
• Principles of surgical treatment
• Biomaterials of fracture fixation
• Biomechanics of implant design and fracture fixation
• Pins and wire fixation
• Screw fixation
• Screw and plate fixation
• Intramedullary nail fixation
• External fixation
• Prosthesis
3. DEFINITION
• A surgical procedure that stabilizes and joins the ends of fractured
bones by internally placed mechanical devices such as metal plates,
pins, rods, wires etc.
4. INTERNAL FIXATION
• Pin and wire fixation
• Screw fixation: Screws (Transcortical cross screw fixation
also called as cancellous screw or cortical screw)
• Plate and screw fixation
• Intramedullary nail fixation
5. LAMBOTTE’S PRINCIPLES OF SURGICAL
TREATMENT OF FRACTURES
• Anatomical reduction
• Stable internal fixation
• Preservation of blood supply
• Active, pain-free mobilization of adjacent muscles and joints
6. METHODS OF APPLYING
• Exposure of the fracture
• Reduction of fracture
• Provisional stabilization of fracture:
• Definitive stabilization of fracture:
7. BIOMATERIALS USED FOR FRACTURES
STABILIZATION
Metals
•316 stainless steel- iron,
chrominum and nickel
•titanium aluminium vanadium
alloys
•commercial pure titanium
•tantalum
Bioabsorbable materials
• Polyglycolic acid(PGA)
• Vicryl
• Polydioxanone(PDS)
• Polylevolactic acid (PLLA)
• poly(D, L-lactic acid)(PDLLA)
8. FACTORS AFFECTING THE BIOMECHANICAL
PROPERTIES OF BIOABSOBABLE POLYMERS
• Chemical composition
• Manufacturing processes
• Physical dimensions environmental
• Time
9. INDICATIONS FOR ABSORBABLE FIXATION
DEVICES
• Metatarsal osteotomies
• Metacarpal and metatarsal fusions
• Malleolar fractures
• Osteochondritis dissecans
• Fractures of radius and olecranon
• Epiphyseal fractures
• Ruptures of ulnar collateral ligament of thumb
12. TENSION BAND WIRING
• A form of internal fixator
which converts the
distraction forces into
compressive forces thus
beneficial in healing.
Usually this is used in
stellate fractures.
13. SCREW ANATOMY
• Inner diameter(only the shaft
without threads)
• Outer diameter (with threads)
• Pitch: angle between the
threads.
• Lead
• Threads:
14. SCREW FIXATION
Types
Machine screws
•whole length threaded
•can be self tapping
•used primarily to fasten hip compression screw devices to shaft of femur
ASIF screws
•Cortical screws
•Cancellous screws
•Self-tapping, self-drilling screws
•Locking screws
15. BIOMECHANICS OF SCREW FIXATION
a. To increase the strength of the screw and resist the fatigue
Increase the root diameter
b. To increase the pull out strength of screw in the bone: by increasing;
- Outer diameter
- Decreasing inner diameter
- Increasing thread density
- Increasing thickness of the cortex
- Using cortex with more density
16. CANNULATED SCREWS
• Space within the screw which guides the wire to reach the target.
• Features of this type of screw are:
i. Greater inner root diameter
ii. Smaller thread width
17. PLATE AND SCREW FIXATION
• This type of fixation converts tensile forces
to compression forces on the convex side of
an eccentrically loaded bone
• Tension band across the fracture on the
tension side of bone
Main Functions of the plate:
• Internal splinting of the bone
• Follows principle that: the bone protects
plate
18. • Axial compression (Key and Charnley)
• Plates- causes reduction of fracture with open techniques,
thus providing stability for early function of muscle tendon
units and joints
• Disadvantages: high chances of refracture, osteoporosis,
plate irritation and rarely immunological reaction
19. Functions of plate and screw fixation
• Plates- neutralize deforming forces
• Require contouring to maintain optimal stability of fracture reduction
Various Plate Designs
ON THE BASIS OF ANATOMY
• Semitubular: one third and one quarter tubular plates
• T plates
• L plates
• Spoon plates
• Dynamic compression plates
• Cobra arthrodesis plates
• Perbent periarticular plates
20. Functionally Plates are categorized as
• Neutralization plates
• Compression plates
• Buttress plates
• Bridge plates
21. NEUTRALIZING PLATE
FUNCTIONS:
• Conjunction with
interfragmentary screw fixation
• Neutralizes torsional, bending
and shear forces
• Fractures with butterfly or
wedge-type fragments
• Compression not applied
through screw holes
23. BUTTRESS PLATING
• Functions:
• Negates compression and shear
forces that occur with
metaphyseal-epiphyseal fractures
• Frequently used in conjunction
with interfragmentary screw
fixation
24. BRIDGE PLATING
FUNCTIONS:
• Used to span comminuted unstable fracture or bony defect in which
anatomical reduction and rigid stability of fracture cannot be restored
by fracture reduction
25. LOCKING PLATES
• Hybrid of plate technology and percutaneous bridge plating
using screws as a fixed angle device
• Hybrid fashion with locked and unlocked screws
• Provide adequate load bearing strength to avoid medial and
lateral plating in distal femur, proximal tibia and tibial plateau.
26. BIOMECHANICS OF PLATE FIXATION
• Bending stiffness is proportional to the thickness (h) of the plate to the
third power
height/thickness (h)
base(b)
• I= bh3
/12
• Allows bending of plate with applied load
• Fatigue failure if fracture doesn’t heal. Eg: Recon plates for clavicle
fracture
BONE
27. BONE SCREW PLATE
FIXATION
• Bone via compression load: compressive load
acting on bone is important in bone healing.
Also, the plate protects the amount of load
acting on the bone.
• Closer the plate to the bone: greater the
friction between bone and plate, thus
providing low stability to the fracture site.
• Screw closest to the fracture site opposes the
most amount of force
• Construct rigidity of plate screw fixation
decreases as the distance between the inner
most screw increases
• Number of screw recommended on each side
Place No. of
screws
Forearm 3
Humerus 3-4
Tibia 4
Femur 4-5
28. TIME OF METAL REMOVAL
Bone fracture Time after implantation (months)
Malleolar 8-12
Tibial pilon 12-18
Tibial shaft
plate
intramedullary nail
12-18
18-24
Tibial head 12-18
Patellar, tension band 8-12
Femoral condyles 12-24
Femoral plates:
- single plates
- double plates
24-36
From mo18, in 2 steps (interval, 6 mo)
Intramedullary nail 24-36
Peritrochantric and femoral neck fractures 12-18
Pelvis(only in case of complaints) From 10th
month onwards
Upper extremity(optional) 12-18
29. INTRAMEDULLARY NAIL FIXATION
Satisfactory stabilization of a fracture by intramedullary fixation is
possible under following circumstances
• Non-comminuted fractures: Unlocked nails
• Locked intramedullary nailing techniques should allow nailing of
fractures to within 2 to 4 m of the joint
• The type of nail and degree of reaming varies with Curvature of the
bone
• There are two basic types of IM nails;
a. Centromedullary
b. Condylocephalic
Types of IM Nailing fixation are;
a. Dynamic
b. Static
c. Double locked
30. BIOMECHANICS OF INTRAMEDULLARY
NAILING
• Controls bending and rotational deformation, but allows nearly full
axial load transfer by bone
• Conversion of static mode to dynamic mode by removing screws from
longest fragments