This document summarizes common lower limb fractures, including fractures of the femur (hip), tibia, fibula, patella, ankle, calcaneus, and metatarsals. It describes the location and classification of these fractures, along with examples of X-ray images demonstrating various fracture patterns such as femoral neck, tibial plateau, lateral malleolus, and Jones fractures of the 5th metatarsal. Classification systems are outlined for femoral neck, ankle, and calcaneal fractures based on their location and degree of displacement.
Presentation of common upper limb fractures and dislocations. Covering all the injuries from many sides (Definition - Classification - Mechanisms of injury - Clinical features - Radiological studies - Management - Complications)
Presentation of common upper limb fractures and dislocations. Covering all the injuries from many sides (Definition - Classification - Mechanisms of injury - Clinical features - Radiological studies - Management - Complications)
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
Colles fracture is the fracture at the distal end of radius, at its
cortico cancellous junction(about 2cm from the distal articular
surface).
It is not just the fracture of distal radius but the fracture
dislocation of the inferior radio-ulnar joint.
MRI imaging of knee joint -- from radiological anatomy to pathology. inspired from my dear professor Mamdouh Mahfouz, professor of radio diagnosis - Cairo university.
compound fracture tibia is common ortthopaedic problem so hereby providing a detailed management by consulting various orthopaedic books.
good luck..!!
1) Subtrochanteric Fracture
Subtrochanteric typically defined as area from lesser trochanter to 5cm distal fractures with an associated intertrochanteric component may be called peritrochanteric fracture.
*Unique Aspect
Blood loss is greater than with femoral neck or trochanteric fractures – covered with anastomosing branches of the medial and lateral circumflex femoral arteries branch of profunda femoris trunk.
2) Femoral Shaft Fracture
Femoral shaft fracture is defined as a fracture of the diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle
The femoral shaft is padded with large muscles.
- reduction can be difficult as muscle contraction displaces the fracture
- healing potential is improved by having this well-vascularized
*Age
-usually a fracture of young adults and results from a high energy injury
-elderly patients should be considered ‘pathological’ until proved otherwise
-children under 4 years the suspected possibility of physical abuse
*FRACTURES ASSOCIATED WITH VASCULAR INJURY
Warning signs of an associated vascular injury are
(1) excessive bleeding or haematoma formation; and
(2) paraesthesia, pallor or pulselessness in the leg and foot.
~Warm ischemia in 2-3H
~If > 6H – salvage not possible
*‘FLOATING KNEE’
Ipsilateral fractures of the femur and tibia may leave the knee joint ‘floating’
3) Distal Femoral Fracture
Defined as fractures from articular surface to 5cm above metaphyseal flare
*clinical feature
The knee is swollen because of a haemarthrosis – this can be severe enough to cause blistering later
Movement is too painful to be attempted
The tibial pulses should always be checked to ensure the popliteal artery was not injured in the fracture.
Reference: Apley's System of Orthopaedic and Fracture (9th edition)
Intertrochanteric fractures and its management with DHS or PFN or Arthroplasty
SUMMARY
We should be able to minimize the morbidity associated with an intertrochanteric fracture by:
• Recognizing the fracture pattern.
• Choosing the appropriate fixation device.
• Performing accurate reduction.
• Ideal implant placement.
• Being conscious of implant COSTS.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
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.
4. Proximal end
Intracapsular
Capital : Fracture of the head
Subcapital :below the femoral head
Transcervical :across the mid-femoral neck
Basicervical :across the base of the femoral neck.
These injuries (last three)may be correctly termed
fractures of the 'neck of femur' (NOF).
5. Extra Capsular
Intertrochanteric
Subtrochanteric
Shaft
Distal end
Supracondylar
Condylar
10. The Garden classification of femoral
neck fractures
Based on the degree of displacement on the anteroposterior
radiographs.
Differentiation has therapeutic as well as prognostic value.
Type I and II fractures have a low incidence of avscular
necrosis .
19. Fractures of lower end of femur
Extra-articular or supracondylar in which the fracture does
not extend to the knee joint line.
20.
21. Partial-articular / condylar
The fracture extends to the knee joint line but part of the
condyles remain attached to the femur shaft.
22.
23. Complete-articular or intercondylar
The fracture extends to the knee joint line but the
condyles are completely separated from the femur
shaft.
24.
25. Supracondylar Fractures
The lower fragment is drawn backward by the gastrocnemius
and plantaris, and the popliteal vessels and internal popliteal
nerve may either be wounded or stretched over its sharp
upper edge. The artery lying deepest is the most liable to
injury, then the vein, and finally the nerve.
32. Tibial plateau fractures
Fractures of the tibial plateau can be subtle or wide
displacement with varying degrees of comminution.
There may be depression of the plateau surface,
displacement of a fracture fragment or both.
Lipohaemarthrosis.
33. Lateral tibial plateau fracture
The fracture fragment is displaced and depressed from its normal
position
38. ANKLE FRACTURES
Lateral malleolar fractures
Lateral malleolar fractures are categorized according to their
position in relation to the distal tibiofibular syndesmosis at
the level of the ankle joint.
39. Weber fracture classification
Weber A = Distal to ankle joint
Weber B = At level of ankle joint
Weber C = Proximal to ankle joint
44. Maisonneuve fracture
Spiral fracture of the proximal third of the fibula associated
with a tear of the distal tibiofibular syndesmosis and the
interosseous membrane.
There is an associated fracture of the medial malleolus or
rupture of the deep deltoid ligament.
46. Osteochondral Fractures
Occasionally ankle trauma causes a fracture of the
talus bone surface. These 'osteochondral' injuries are
often subtle and so this area should be assessed
carefully on all post-traumatic ankle X-rays.
48. Calcaneal Fractures
Falling from height can lead to severe calcaneal fractures,
which may be accompanied by axial loading fractures of the
spine.
Calcaneal fractures due to a fall from height are often
comminuted and intra-articular.
49. Bohler’s Angle
A line is drawn from the tuberosity to the most superior part
of the posterior facet.
Another line is drawn from the most superior part of the
facet to the anterior process.
Normally the angle created is between 20 and 40 degrees.
If the angle is less than 20 degrees, this indicates depressed
fracture.
51. The critical angle of Gissane
It is formed by a line along the lateral margin of the posterior
facet and another line extending anterior to the beak of the
calcaneus. The normal value is 95 to 105 degrees with an
increase representing posterior facet collapse
52.
53. Types of calcaneal fractures
Intra and Extrarticular fractures on the basis of subtalar joint
involvement.
Intrarticular fractures are more common and involve the
posterior talar articular facet of the calcaneus.
Extrarticular fractures are less common, and located
anywhere outside the subtalar joint.
54. The Sanders system classification
Is the most commonly used system for categorizing
intrarticular fractures.
Classifies these fractures into four types, based on the location
of the fracture at the posterior articular surface.
55. TYPES
TTyyppee II ffrraaccttuurreess are non-displaced fractures (displacement <
2 mm).
TTyyppee IIII ffrraaccttuurreess consist of a single intrarticular fracture that
divides the calcaneus into 2 pieces.
TTyyppee IIIIII ffrraaccttuurreess consist of two intrarticular fractures that
divide the calcaneus into 3 articular pieces.
TTyyppee IIVV ffrraaccttuurreess consist of fractures with more than three
intrarticular fractures.
56.
57. Metatarsal Fractures
Oblique fracture of 5th metatarsal shaft
5TH Metatarsal base fracture
Metatarsal stress fractures
Stress fractures of the metatarsals are common in athletically
active individuals. These may not be visible on initial X-rays
but follow up images show periosteal stress reaction. This
has the appearance of fusiform bone expansion.
58.
59. NORMAL UNFUSED 5TH METATARSAL bone apophysis is
aligned more longitudinally along the bone
Intracapsular fracture - Subcapital –AP
Shenton&apos;s line is disrupted
Increased density of the femoral neck is due to overlapping - impacted bone
The lesser trochanter is more prominent than usual - due to external rotation of the femur g3
subcapital
Intertrochanteric fracture
A fracture line runs between the trochanters
There is comminution with separation of the lesser trochanter
Note the fracture does not involve the femoral neck
Subtrochanteric fracture
This fracture passes distal to the trochanters
The femoral neck remains intact
g1
Garden 4
Spiral fracture with posterior angulation, lateral displacement and shortening
There is rotation of the distal femur so the knee faces laterally
X-rays of the proximal femur (not shown) did not reveal further injury
Injury occurred in a road traffic crash
Pathological femoral shaft fracture
Transverse fracture with rotational displacement and shortening
Patient with known history of widespread bone metastases - note the abnormal bone texture
Injury occurred after a trivial fall
supracondylar
Fracture medial condyle
Knee - Fabella
A fabella is a normal sesamoid bone of the lateral head of gastrocnemius tendon - not to be mistaken for a fracture or loose body
Bipartite patella
The patella is bipartite (in 2 parts) - a common normal variant
Patellar fracture - Lateral
Increased density separating the fat pads indicates a joint effusion due to leakage of blood (haemarthrosis)
Tibial plateau fracture - AP
(Same patient as below)
Lateral tibial plateau fracture
The fracture fragment is displaced and depressed from its normal position (dotted line)
Tibial plateau fracture - Lateral
(Same patient as above)
No visible fracture line
Depressed tibial plateau contour (arrow)
Lipohaemarthrosis (fat and blood in the joint)
Tibial and fibular fracture
Comminuted fractures of the tibial and fibular shafts with medial displacement and posterior angulation
X-rays of the distal end of the bones (not shown) did not reveal further injury
Tibial stress fracture
Periosteal stress reaction are signs of stress injury (often not present on the initial X-ray)
History of chronic pain worsened by activity
Toddler&apos;s fracture
Fine spiral line through the tibial shaft
This toddler presented with refusal to weight-bear Often there is little or no displacement and the fracture line is very subtle
Lateral malleolus fracture example - AP
Soft tissue swelling laterally (asterisks)
Transverse fracture of fibular tip (Weber A)
The ankle joint remains aligned normally
Bimalleolar fracture - AP
Transverse medial malleolus fracture
Lateral malleolus fracture - at level of ankle joint (Weber B)
Joint widened medially due to lateral displacement of the talus
Trimalleolar fracture - AP and Lateral
1 - Medial malleolus fracture
2 - Lateral malleolus fracture - proximal to the ankle and extending up the fibula (Weber C fracture)
3 - Posterior malleolus fracture
The joint is unstable and widened anteriorly (arrowheads) and at the distal tibiofibular syndesmosis (asterisk)
The talus is displaced posteriorly and laterally along with the medial and lateral malleolus bone fragments
Maisonneuve fracture - Ankle AP
(Same case as below)
1 - Disruption of the medial ankle joint with small bone avulsion
2 - Disruption of the distal tibio-fibular syndesmosis
No fibular fracture is visible at the ankle raising the suspicion of a proximal fibular fracture
Spiral comminuted fracture of the proximal fibula
Osteochondral fracture
Loss of the normal talar dome cortex contour due to an osteochondral fracture
Bohler’s angle may be aberrant with displaced extraarticular and intraarticular fractures
The critical angle is more specific for intraarticular distortion.
Depression of the articular surface of the posterior subtalar joint (red line) from its normal position (green line)
NORMAL UNFUSED 5TH METATARSAL bone apophysis is aligned more longitudinally along the bone