1. The Masquelet technique is a two-stage procedure used to treat bone defects and non-unions. In the first stage, radical debridement is performed and a cement spacer is implanted to induce membrane formation. In the second stage, the membrane and spacer are removed and the defect is filled with bone graft contained by the induced membrane.
2. The induced membrane forms a chamber that vascularizes the graft and prevents resorption. It expresses growth factors that aid bone regeneration. Keys to success include thorough debridement, stable fixation, adequate soft tissue coverage, and membrane protection of graft at the second stage.
3. The technique is indicated for defects from trauma, infection, or tumor resection.
Surgical Approaches to Acetabulum and PelvisBijay Mehta
Important surgical approaches to acetabulum and pelvis are described.
Ilioinguinal approach, Modified Stoppa Approach, Kocher lagenbeck Approach, Ilifemoral approach and extensile approaches are well illustrated and described.
Surgical Approaches to Acetabulum and PelvisBijay Mehta
Important surgical approaches to acetabulum and pelvis are described.
Ilioinguinal approach, Modified Stoppa Approach, Kocher lagenbeck Approach, Ilifemoral approach and extensile approaches are well illustrated and described.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
In this article, we present the general principle of management Periprosthetic fracture after arthroplasty according to the "Unified” or “Comprehensive” classification system. We especially review the current concepts of periprosthetic hip and knee fractures.
This video explains Lumbar Disc Replacement in Detail. When degenerative disc disease begins to affect the spine this is called degenerative disc disease. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Lumbar Disc Replacement feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
Distal femur fractures what makes it complex ,dr mohamed ashraf,hod orthopae...drashraf369
distal femur fractures are notorious for post operative complications due to malreduction and improper fixation.unless plan and execute a sound and stable fixation,this injury will lead to undesirable results.dr mohamed ashraf HOD orthopaedics govt TD medical college is presenting how to avoid complications in surgical management of these fractures..
Masquelet technique for management of large bone defects.Kushi Rithvic
The Masquelet's technique is a viable option in the management of large defects of long bones as much as 25 cms of defects. It is a two stage procedure.
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
In this article, we present the general principle of management Periprosthetic fracture after arthroplasty according to the "Unified” or “Comprehensive” classification system. We especially review the current concepts of periprosthetic hip and knee fractures.
This video explains Lumbar Disc Replacement in Detail. When degenerative disc disease begins to affect the spine this is called degenerative disc disease. This video highlights the history, epidemiology, and treatment options both conservative and surgical. If you or someone you know needs to be seen in regards to Lumbar Disc Replacement feel free to look us up online www.beverlyspine.com or www.santamonicaspine.com OR call toll free 1-8SPINECAL-1
Distal femur fractures what makes it complex ,dr mohamed ashraf,hod orthopae...drashraf369
distal femur fractures are notorious for post operative complications due to malreduction and improper fixation.unless plan and execute a sound and stable fixation,this injury will lead to undesirable results.dr mohamed ashraf HOD orthopaedics govt TD medical college is presenting how to avoid complications in surgical management of these fractures..
Masquelet technique for management of large bone defects.Kushi Rithvic
The Masquelet's technique is a viable option in the management of large defects of long bones as much as 25 cms of defects. It is a two stage procedure.
Cartilage is derived (embryologically) from mesenchyme. . Chondroblasts produce the intercellular matrix as well as the collagen fibres. Chondroblasts that become imprisoned within this matrix become chondrocytes. The articular surface of most synovial joints are lined by hyaline cartilage
Releasing Incisions Using Upward-Motion Scissors Technique for Flap Mobilizat...MD Abdul Haleem
Journal Club Presentation - Releasing Incisions Using Upward-Motion Scissors Technique for Flap Mobilization for Guided Bone Regeneration or Periodontal Surgery: Technical Introduction and a Case Report.
Reconstructive periodontal therapy
Some of the slides may appear Blank/White/Black, those are the Videos that I added in the presentation.
Kindly Ignore those slides.
Slide 35
References
Tornetta P. Rockwood and Green's fractures in adults. Philadelphia: Wolters Kluwer; 2020.
Buckley R, Moran C, Apivatthakakul T. AO principles of fracture management. Davos Platz, Switzerland: AO Foundation; 2017.
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!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- 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
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
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. INTRODUCTION
• INDUCED MEMBRANE TECHNIQUE
• Masquelet’- 1986, first case series in 2000
• 2 step procedure for boe defects and non
unions.
4.
5. The Masquelet technique- Two staged
• At the first operation,
– Radical soft tissue and bone debridement
– (PMMA) cement spacer is implanted at the site of the bone
defect
– Limb is stabilised with an external fixator.
– soft tissue envelope is repaired .
• The cement spacer has two roles.
1. Mechanical - Prevents fibrous tissue invasion
2. Biological - Induction of the surrounding membrane that will
revascularise the bone graft and prevent its resorption.
6. The Masquelet technique- Two staged
• At the second stage,
– 6–8 weeks later
– the cement spacer is carefully removed
– the formed ‘‘induced membrane’’ is minimally disturbed
– defect is filled with morcellised cancellous autotlogous bone
graft (with additional bone graft substitutes, 1:3)
– Bone is stabilized.
7. • INDUCED MEMBRANE- The pseudosynovial membrane
– formed around the cement spacer (as a foreign body
reaction- first stage)
– acts as a chamber around the bony defect to contain the
bone graft and stimulate bone regeneration (second stage).
• Induced membrane becomes highly vascularised
• Growth factors
– VEGF
– TGF-beta 1
– BMP-2.
• prevents resorption of cancellous bone graft and
• positive effect on consolidation of the defect.
8.
9.
10.
11. Keys for good outcome- Stage 1
1. Thorough debridement and irrigation
2. Edges of the bone fragments should be healthy with a viable
bleeding .
3. Appropriate fixation of the bone defect
– Temporary external fixator
4. Meticulous pin site care
5. Cement should be placed inside the canal and over the edges
6. Soft tissue envelope should have adequate blood supply.
12. 7. Cement spacer loaded with antibiotics- INU
8. Good soft tissue coverage is essential
– free tissue transfer may be required.
9. Wound closure must not be under tension.
13.
14.
15.
16. Keys for good outcome- Stage 2
1. CULTURE prior to administration of antibiotics intra-
operatively.
2. Membrane must be incised with caution
3. The cement spacer is removed with a saw or an osteotome
4. The IM canal is prepared with hand reamers or a curette
5. All non-vital tissues must be removed.
6. Depending on the size adequate volume of graft material
should be available.
17. 7. Autologous bone graft can be obtained from the iliac crest or from
the intramedullary canal using the Reamer/Irrigator/Aspirator (RIA)
8. For large defects, can be augmented with allograft or bone
substitutes
9. Bone graft material can be enhanced with osteoprogenitor cells
(from bone marrow aspirate) or with osteoinductive growth factors
(commercially available BMPs.)
10. The membrane must be closed to ensure that the graft material is
contained into the chamber
11. Adequate mechanical stability must be provided
12. Soft tissue coverage should be adequate and wound closure
should be performed without tension.
18.
19.
20.
21.
22. INDICATIONS
• Bone defects secondary to
– Chronic osteomyelitis
– Tumour excision
– Traumatic bone loss
– Septic non union
– Aseptic non-unions
24. ADVANTAGES
• Induced membrane plays an important role in
revascularisation and bone formation and consolidation
• Cancellous bone graft can be used even if the recipient site
has initially been irradiated or infected or in cases of
malignancy
• The graft can be augmented with cells, growth factors,
allograft or other bone substitutes depending.
• Length of the defect is maintained.
25. DISADVANTAGES
• Two different interventions.
• Availability of the autograft
– Limited
– Donor site morbidity
• Supplementary procedures for soft tissue transfer
26.
27. • 628 papers were identified
• Age >15 years
• Follow up > 12 months
• 17 studies, 427 patients
28. FIGURES
• Mean age -39 years ( 15-84)
• Males – 82.7 %
• Mean follow up – 16 months ( 6-264)
• Tibia – 67.2 %, Fibula- 12.9 %, Femur – 19.4 %
• Metaphysis – 62 %
29. • Mean defect – 5.53 cm ( 0.6 to 26 cm )
– < 2 cm - 15
– 2-5 cm - 99
– 5-10 cm - 114
– 10 cm - 61
• Antiobiotics – 62.5 %
• External fixator- 36.8
• Soft tiisue construction – 36.5 %
31. COMPLICATIONS
• 49.6 % ( 15 to 100 % )
• Superficial SSI – 4.9 %
• Deep – 4.4 %
• Failure ( infection or non union ) – 18 %
– Non union of graft
– Failure of graft maturation
– Resorption of graft
– Refracture
• Another intervention – 26.7 %
34. COMPARISON
• Healing time is independent of the length.
• Better accepted as exernal fixators can be
avoided.
• No micrsurgical intervention .
• Less ressitant to torsional and bending forces.
35. LIMITATIONS OF THE STUDY
• Failed to look in to the comorbidities of the patients
– Diabetes mellitus
– Peripheral vascular disease
– Immunocompromised condtions
– Malignancy
• Failed to compare the follow up time and size of the
defect
• No distinction between infected and non infected
• Majority are retrospective studies.
Moreover, as the spacer behaves as a foreign body, absence of infection after two months is an excellent witness of adequate local conditions for bone grafting.