MARS MRI
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MARS MRI is a magnetic resonance imaging technique invented in 2007 that uses view angle tilting and increased gradient strength to reduce metal artifacts. It allows for improved visualization of bone and soft tissues near hip or knee replacements, spinal hardware, wrist screws, and in other areas affected by metals. The technique provides higher quality images at costs of around Rs10,000 and scan times of 30-60 minutes. While it currently only works with T1 sequences, MARS MRI has advantages of reducing artifacts and distortion for assessing implant complications and tissues after surgeries or injuries.
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Functional free muscle transfer is a technique for reconstructing upper extremity function lost due to brachial plexus injuries, trauma, or other conditions. It involves transplanting a expendable donor muscle with its vascular pedicle and reinnervating it to restore motor function. The gracilis muscle is commonly used for reconstructing functions like elbow flexion, finger flexion/extension. The procedure requires microsurgical skills and careful attention to factors like minimizing ischemia time and securing strong tendon insertions. With rehabilitation, transplanted muscles can regain substantial strength and restore useful ranges of motion.
distalfemur-170720141254.pdf
This document provides an overview of distal femur fractures, including:
- The basic anatomy of the distal femur and forces around the knee joint.
- The types of distal femur fractures, which can be supracondylar, intercondylar, or complete articular breaks.
- Treatment options including non-operative management with casting, external fixation, and surgical fixation techniques like plating or intramedullary nailing.
- Potential complications from distal femur fractures include malunion, hardware issues, nonunion, and infection.
Distal femur fracture
This document provides an overview of distal femur fractures, including:
- Basic anatomy of the distal femur and forces around the knee joint.
- Types of distal femur fractures include supracondylar, intercondylar, and partial or complete articular fractures.
- Clinical features include a history of trauma, pain, swelling, and deformity. Investigations include x-rays and CT scans.
- Treatment options are non-operative with casting or skeletal traction, or operative with external or internal fixation techniques like plating or intramedullary nailing.
- Surgical techniques depend on the fracture type and include various approaches like anterolateral or lateral para patellar.
-
Tendon repair
This document discusses tendon anatomy, injury, and repair. It describes the composition and vascular supply of tendons. Common tendon injuries include open wounds requiring surgical repair and closed injuries causing deformities. The goals of repair are to reestablish tendon continuity and gliding function. Various suture techniques are discussed for end-to-end, end-to-side, and tendon-to-bone repairs. Post-operative rehabilitation aims to promote intrinsic healing while minimizing scarring through early controlled motion to optimize tendon gliding and range of motion recovery.
NCCT OR CECT PELVIS BONE.pptx, INDICATIONS OF PELVIS BONE
This document provides information about CT scans of the pelvis bone, including indications, contraindications, patient preparation, positioning, and imaging protocol. It describes the pelvis bone anatomy and functions. CT scanning is described as a fast, non-invasive imaging method that provides 3D images of the pelvis bone to evaluate fractures, hip abnormalities, and other conditions. The protocol involves topograms, axial imaging from the iliac crest to hips pre-and post-contrast administration, with parameters like slice thickness, interval, and reconstruction algorithms provided. Patient care after the scan is also outlined.
Principles of knee arthoscopy
Basic principle of Knee Joint arthroscopy and techniques for beginners. Basic Steps of Knee Joint Diagnostic arthroscopy and common complication following knee joint arthroscopy.
Pre-Prosthetic Surgeries
This document outlines pre-prosthetic surgeries, which are performed to create proper supporting structures for dental prosthetics. It discusses evaluating patients' bony and soft tissues to determine the needed procedures. Common pre-prosthetic surgeries are then described, including recontouring the alveolar ridges through simple alveoloplasty or Dean's intraseptal alveoloplasty. Other procedures covered are reducing maxillary tuberosities or tori, and frenectomies to address soft tissue abnormalities. The goal of these surgeries is to produce optimal supporting structures and tissues for successful dental prosthetics.
Ankle and foot arthrodesis
This document provides an overview of ankle arthrodesis, including:
- Indications for the procedure include pain, deformity, and instability from conditions like trauma, infection, arthritis.
- Surgical options include open arthrodesis with internal or external fixation, arthroscopic arthrodesis, and mini-open techniques.
- The goals of fusion are to relieve pain, create a stable foot, and position the ankle in 5 degrees of valgus and 5-10 degrees of external rotation.
- Potential complications include non-union, infection, nerve injury, and malunion. Outcomes studies found relief of pain but activity limitations remain.
Flexor tendon injury, management and rehabilitation
This document provides an overview of flexor tendon anatomy, healing, repair techniques, and rehabilitation. It describes the anatomy of flexor tendons and surrounding structures like pulleys. There are four phases of flexor tendon healing: reestablishing tendon fiber continuity, restoring gliding mechanisms, obtaining satisfactory motion. Repair can be primary, delayed primary, or secondary. Various suturing techniques like Strickland, Bunnell, and Kessler are described which aim to minimize gap formation and maximize strength for early motion protocols. The document emphasizes restoring normal tendon gliding and tension to optimize outcomes.
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Wrist drop
The radial nerve innervates the extensor muscles of the forearm and hand. Damage to the radial nerve causes wrist drop where the patient is unable to extend the wrist and fingers, impairing grasping. Symptoms include pain, numbness, weakness of hand grip and drooping of the wrist and fingers. Diagnosis involves assessing range of motion, imaging tests and electrodiagnostic tests. Treatment depends on the underlying cause but may include medications, injections, bracing and physical therapy.
Tourniquets
Tourniquets are devices used to control blood flow to an extremity during surgery. Various types of tourniquets have been developed throughout history including the Esmarch bandage and modern pneumatic tourniquets. Proper tourniquet placement and pressure are important to minimize complications like nerve injury, muscle injury, and bleeding. Tourniquet time should be limited to 1.5-2 hours to avoid local and systemic effects. Complications can be further reduced by following precautions during tourniquet application and use.
Torticollis
Torticollis is a twisting of the neck that can have several causes. In newborns, it is often due to injuries during birth or fetal positioning, while in older children it may result from neck injuries, infections, or other conditions. The document discusses the main types and causes of torticollis, including congenital muscular torticollis in newborns, self-limiting torticollis, trauma, infections, tumors, and certain drugs. Ultrasound is often used to diagnose congenital cases in newborns, while CT and MRI are used to diagnose other causes like trauma, infections, or tumors in older children. Treatment depends on the underlying cause but may include stretching, physical therapy
Thoracic outlet syndrome
Thoracic outlet syndrome occurs when the blood vessels or nerves in the thoracic outlet - the space between the lower neck and upper chest - become compressed. This can cause pain and numbness in the shoulders and neck as well as reduced pulse. It is commonly caused by anatomical variations like cervical ribs or muscle abnormalities that reduce the space available to the neurovascular structures passing through. Diagnosis involves clinical tests like Adson's maneuver and imaging like MRI. Treatment ranges from physiotherapy and analgesics for mild cases to surgical removal of the first rib and scalene muscles for more severe or progressive cases.
Tennis elbow
Tennis elbow, also known as lateral epicondylitis, is a tendinopathy of the common extensor tendon near the lateral epicondyle of the elbow. It results from repetitive microtears in the tendon due to overuse from activities involving forceful wrist extension. Clinically, it presents as lateral elbow pain that worsens with activities like handshaking or turning a doorknob. Physical examination reveals tenderness over the lateral epicondyle. While most cases resolve with conservative treatment like rest, NSAIDs, bracing, and physical therapy within 6-12 months, surgical debridement may be considered for persistent or recurrent cases.
Tendo achilles
The Achilles tendon connects the calf muscles to the heel bone and is active during walking, running, and jumping. It is vulnerable to rupture, which commonly occurs in the watershed area 2-6cm above the heel in males ages 25-50 during sports. Diagnosis involves physical exam findings like inability to raise the toes and a gap or defect being felt. Treatment options include immobilization in a cast or surgical repair, with the goal of restoring proper tension and length. Post-operative care focuses on protecting the repair during healing over 6 months using casts, braces, and physical therapy.
Surgical site infections
Surgical site infections occur when bacteria enter through an incision made during surgery. They are classified as superficial, deep, or organ/space infections. Common causative agents include Staphylococcus aureus and Streptococcus pneumoniae. Factors that increase risk include patient health issues like malnutrition or diabetes as well as surgical factors like poor technique, inadequate prophylactic antibiotics, or an unclean operating environment. Diagnosis involves clinical signs plus lab and imaging tests. Treatment consists of antibiotics, wound debridement, and drainage. Prevention strategies focus on proper patient preparation, strict sterile techniques in the operating room, and careful post-operative wound care.
Spinal cord tractography
Diffusion tensor imaging (DTI) and fiber tractography are MRI techniques that can be used together to non-invasively visualize spinal cord tracts. DTI measures the anisotropic diffusion of water in tissue to infer the orientation of white matter tracts. Fiber tractography then generates 3D reconstructions of the tracts. This technique provides information about spinal cord injuries or other pathologies. However, it faces challenges from motion artifacts and has limitations when tracts converge or cross or are non-homogeneous. Despite this, DTI tractography can be used to prognosticate outcomes from spinal cord deformities, injuries, tumors, or myelopathies. Two case studies are described, one with a C6 burst fracture
Spina ventosa
Spina ventosa is a form of tuberculous dactylitis that affects the short tubular bones of the hands and feet in children. It occurs secondary to tuberculosis infection and presents as swelling and tenderness of the affected bone. Investigations may show leukocytosis and elevated inflammatory markers. Chest x-rays and bone x-rays can identify periosteal reaction, lytic lesions, or sclerosis. Biopsy is needed to confirm the diagnosis. A case report described a 13-year-old girl with left index finger pain, weight loss, and loss of appetite who was found to have spina ventosa on biopsy along with a tuberculoma seen on brain MRI. She was started on antitub
Snapping hip syndrome
There are three main types of snapping hip: external, internal, and intra-articular. External snapping hip is caused by increased tension in the iliotibial band over the greater trochanter with repeated flexion and extension. Internal snapping hip involves snapping of the iliopsoas tendon over the femoral head. Intra-articular snapping hip is caused by labral tears or loose bodies in the hip joint. Conservative treatments include rest, stretching, strengthening, and therapies like cold compression, while operative options involve procedures like Z-plasty of the iliotibial band or arthroscopic surgery to address intra-articular issues.
Scurvy
- Scurvy is a disease caused by vitamin C deficiency that results from a lack of vitamin C in the diet for several weeks. It impairs collagen formation and causes hemorrhaging in tissues.
- Symptoms include bleeding gums, loose teeth, bruising of the skin, and bone fractures. In infants, scurvy can cause pseudoparalysis and swelling over bones from subperiosteal hemorrhaging.
- Diagnosis is based on low vitamin C blood levels and x-ray findings of bone changes like the white line of Fraenkel. Treatment involves vitamin C supplementation in doses of at least 200mg daily until recovery is complete.
Screws in orthopedics
This document provides an overview of screws in orthopedic surgery. It discusses the history of screw development from ancient times through modern innovations in materials. The anatomy of a screw is described in detail, including the head, shaft, thread, tip, and special features like pitch, diameter, and cannulation. Different types of screws are compared based on their properties and intended uses in cortical versus cancellous bone. Special screw designs like Herbert screws, lag screws, and dynamic hip screws are also briefly mentioned.
Sacral chordoma
Sacral chordoma is a rare, slowly growing malignant tumor that arises from remnants of the notochord, usually occurring in the sacrum. It accounts for 1-4% of all malignancies and is the most common primary malignancy of the sacrum. Patients typically experience lower back pain worsening with sitting in their 5th-7th decade. Imaging shows a destructive lytic lesion in the sacrum. Complete surgical resection is the primary treatment, but recurrence is common due to the locally aggressive nature, leading to poor long-term survival rates.
Robotics in orthopedics
This document discusses the use of robots in orthopaedic surgery. It describes how robotic systems can improve accuracy of bone cuts and component placement compared to manual surgery. Both autonomous and haptic robotic systems are presented. Applications discussed include unicondylar knee replacement using the Mako robotic arm and spinal pedicle screw placement using the Renaissance system. While robotic surgery may provide benefits like increased accuracy, it also has drawbacks such as high costs and long-term outcomes have not proven superiority over manual techniques.
Reverse shoulder arthroplasty
Reverse shoulder arthroplasty involves replacing the humeral head and glenoid fossa with prosthetics to alter the center of rotation and increase deltoid tension and function. It is indicated for rotator cuff tear arthropathy, proximal humeral fractures in the elderly, failed shoulder replacements, and other conditions. The procedure involves an deltopectoral approach to expose the joint, removal of the humeral head and shaping of the glenoid, then implantation of the glenosphere and humeral cup components. Outcomes are best for osteoarthritis and worse for trauma or revision cases. Complications can include infection, nerve injury, implant loosening or breakage.
Prolapsed intervertebral disc
The intervertebral disc consists of three main components: the cartilage end plates, the nucleus pulposus, and the annulus fibrosus. Degeneration of the intervertebral disc is a natural aging process but can be exacerbated by factors like poor nutrition, trauma from sports or injuries, and biomechanical factors related to posture and repetitive microtrauma. The degenerative process typically begins with softening of the nucleus pulposus and weakening of the annulus fibrosus, which can lead to protrusion or extrusion of the nucleus through tears in the annulus. Eventually fibrosis and calcification may occur as the body attempts to repair the degenerated disc.
Pre operative care
The document outlines the steps involved in pre-operative care, which includes conducting a pre-anaesthetic checkup of the patient's medical history and current health status. A series of blood investigations, imaging tests like ECG, ultrasound, and radiological tests are performed. The patient's medication needs and consent for the procedure are also addressed. The pre-operative preparation involves both physical and psychological preparation of the patient by explaining the procedure and potential complications to calm them before surgery.
Plantar fascitis
Plantar fasciitis is a painful condition caused by inflammation of the plantar fascia, a thick ligament connecting the heel to the toes. The pain is usually felt on the bottom of the foot near the heel and is worst upon waking or after long periods of sitting. Repeated microtears in the fascia from overuse can cause degeneration and inflammation. Risk factors include obesity, excessive running or prolonged standing, especially with inadequate foot support. Treatment focuses on reducing inflammation and strain through stretching, orthotics, night splints, and physical therapy exercises.
Pigmented villonodular synovitis
Pigmented villonodular synovitis is an idiopathic overgrowth and pigmentation of the synovial membrane that most commonly affects the knee joint. It presents with pain, swelling, stiffness, and recurrent atraumatic hemorrhaging in the joint. Diagnosis is made through arthroscopic biopsy showing characteristic chocolate-colored lesions. Treatment involves surgical synovectomy or radiation therapy, with recurrence being a potential complication.
Pes cavus
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
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MARS MRI
- 1. MARS MRI
- 2. • MARS MRI-Metal artifact reduction sequence magnetic resonance imaging. • Invented by professor Phil and Anthony butler in 2007 in new Zealand. • Principle-View angle tilting in combination with increased gradient strength • Cost-Rs10,000 • Time taken-30-60 minutes
- 3. Clinical applications of MARS MRI technique • 1)Hip- • After hip replacement surgery to assess the peri prosthetic soft tissues • To localise the methylmethacrylate cement within the medullary space of the femur and acetabulum prior to revision surgery. • Post operative neck femur fracture to see for AVN. • Post operative assessment after resection of bone tumours and reconstruction.
- 4. • 2)Knee- • After total knee arthroplasty to visualise the periprosthetic bone and soft tissue structures • After acl reconstruction surgery with implants to visualise structures. • 3)Spine- • Patients with spinal fixation hardware may develop complications like spinal cord compression,nerve root compression,instability and infection.MARS technique is useful to allow visualisation of vertebral bodies and spinal canal contents.
- 5. • 4Wrist- • To see for scaphoid AVN after Herbert screw fixaton for scaphoid fractures. • Other indications-To study cancers,Vascular diseases causing stroke.
- 6. Advantages of this technique • 1)It reduces the size and intensity of the artefacts from magnetic field distortion. • 2)Improved image quality. • 3)View angle tilting removes geometric distortion. • 4)Signal to noise ratios were lower.
- 7. Disadvantages • 1)At present it can only be used for T1 sequences • 2)Slight blurring has been reported which may rarely occur.
- 8. Conclusion • MARS technique appears to hold great promise for significantly reducing distortion around implants in the musculoskeletal system.
- 9. • Thank you