1) Meniscus injuries are among the most common orthopedic injuries seen in practice, with an incidence of 61 cases per 100,000 people per year. Arthroscopic partial meniscectomy is one of the most common orthopedic procedures.
2) Meniscal tears can be classified based on location and pattern. Common types include bucket handle tears, longitudinal vertical tears, radial tears, and root tears. MRI is the gold standard for diagnosis.
3) Treatment depends on the type and stability of the tear. Unstable tears may be treated with meniscectomy or repair, while stable tears can be managed non-surgically with physical therapy. The goal of surgical treatment is to deb
it comprises of the anatomy, epidemiology, mechanism of injury and management options.
there is also the fracture classifications
management was grouped into operative and conservative
there is also a section for children.
Can read freely here
https://sethiortho.blogspot.com/
Challenges and Solutions in
Management of Distal Humerus Fractures
Epidemiology
Anatomy
Classification
Controversies and Recent studies
Approach
Implants selection
Plate configuration
Ulnar nerve transposition
Role of total elbow arthroplasty in DHF
Role of hemiarthroplasty in DHF
Metaphyseal comminution –
Anatomic complexity of the distal humerus
Positioning of the plates
TBW –
Skin closure
Osteoporotic nature of the bone –
Less BMD/Thin metaphysis
Screw Pullout strength is low
DHF account for 2% of all adult fractures
The common pattern of fracture
Intraarticular and involves both columns
Bimodal distribution
Peak incidence in young male and in older female patients
Young male – High-velocity injury
Older female - Osteoporosis
The distal humerus is flattened and expanded bony structure
It is composed of lateral and medial columns with the trochlea situated between these columns.
The location of the trochlea is central rather than medial
Formed by Medial SCR + M/Epicondyle
The distal end has 450 angulation with humeral shaft
M/ Epicondyle gives attachment for MCL & Common Flexor Origin
The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection
Ulnar nerve
Formed by Lateral SCR and L/Epicondyle and Capitulum
Distal end has 200 with humeral shaft
L/ epicondyle gives attachment for LCL & common extensor origin
Its posterior surface is non articular and can be used as a site for a plate fixation
The lateral column curves anteriorly
Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus.
The medial column including the medial epicondyle is in line with the humeral shaft.
It forms the center of the triangle
It has 30 - 80 – external rotation & 250 anterior divergent with the shaft
It forms a 40 - 80 degree valgus direction
X-ray -
Anterior-posterior view
lateral View
Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture.
NCCT – Elbow
Articular surfaces
Position of the fracture fragments
useful for identifying impacted fracture fragments that make reduction challenging
Olecranon Osteotomy Approach – 52-57%
Triceps sparing VS Olecranon osteotomy approach
The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter
Smaller diameter of the humerus, permitting only one or two short screws for fixation.
Interruption of blood supply to the lateral column
blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
it comprises of the anatomy, epidemiology, mechanism of injury and management options.
there is also the fracture classifications
management was grouped into operative and conservative
there is also a section for children.
Can read freely here
https://sethiortho.blogspot.com/
Challenges and Solutions in
Management of Distal Humerus Fractures
Epidemiology
Anatomy
Classification
Controversies and Recent studies
Approach
Implants selection
Plate configuration
Ulnar nerve transposition
Role of total elbow arthroplasty in DHF
Role of hemiarthroplasty in DHF
Metaphyseal comminution –
Anatomic complexity of the distal humerus
Positioning of the plates
TBW –
Skin closure
Osteoporotic nature of the bone –
Less BMD/Thin metaphysis
Screw Pullout strength is low
DHF account for 2% of all adult fractures
The common pattern of fracture
Intraarticular and involves both columns
Bimodal distribution
Peak incidence in young male and in older female patients
Young male – High-velocity injury
Older female - Osteoporosis
The distal humerus is flattened and expanded bony structure
It is composed of lateral and medial columns with the trochlea situated between these columns.
The location of the trochlea is central rather than medial
Formed by Medial SCR + M/Epicondyle
The distal end has 450 angulation with humeral shaft
M/ Epicondyle gives attachment for MCL & Common Flexor Origin
The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection
Ulnar nerve
Formed by Lateral SCR and L/Epicondyle and Capitulum
Distal end has 200 with humeral shaft
L/ epicondyle gives attachment for LCL & common extensor origin
Its posterior surface is non articular and can be used as a site for a plate fixation
The lateral column curves anteriorly
Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus.
The medial column including the medial epicondyle is in line with the humeral shaft.
It forms the center of the triangle
It has 30 - 80 – external rotation & 250 anterior divergent with the shaft
It forms a 40 - 80 degree valgus direction
X-ray -
Anterior-posterior view
lateral View
Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture.
NCCT – Elbow
Articular surfaces
Position of the fracture fragments
useful for identifying impacted fracture fragments that make reduction challenging
Olecranon Osteotomy Approach – 52-57%
Triceps sparing VS Olecranon osteotomy approach
The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter
Smaller diameter of the humerus, permitting only one or two short screws for fixation.
Interruption of blood supply to the lateral column
blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
Meniscus surgery is either to repair meniscus or to ressect it.
Earlier menissectomy was the regular surgery done by arhroscopic surgeon for meniscus injury,but now meniscus repair is on increasing trends in the arthroscopic surgeon for meniscus injury.
Discoid meniscus is a congenital abnormality of the lateral compartment of the knee and not only a big meniscus
The leading cause of non traumatic snapping and extension deficit in children and adolescents
Clinical examination is more sensitive and specific for diagnosis
MRI is a good tool for diagnosis
Meniscal preserving surgeries are recommended to avoid degenerative arthritis
Long-term follow-up studies are needed to determine the effects of meniscal Saucerization and repair on the risk of OA.
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.
Meniscus surgery is either to repair meniscus or to ressect it.
Earlier menissectomy was the regular surgery done by arhroscopic surgeon for meniscus injury,but now meniscus repair is on increasing trends in the arthroscopic surgeon for meniscus injury.
Discoid meniscus is a congenital abnormality of the lateral compartment of the knee and not only a big meniscus
The leading cause of non traumatic snapping and extension deficit in children and adolescents
Clinical examination is more sensitive and specific for diagnosis
MRI is a good tool for diagnosis
Meniscal preserving surgeries are recommended to avoid degenerative arthritis
Long-term follow-up studies are needed to determine the effects of meniscal Saucerization and repair on the risk of OA.
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.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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.
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!
2. How far we haven’t come
• “…It is, however, a clinical
fact that one of the semilunar
cartilage, usually the internal
one, does occasionally
become loosened from its
attachments; and, in
consequence, this body is
liable to be displaced either
forwards or backwards, and
so to interfere with the proper
movements of the knee-
joint…”
1838 - 1907
3. • Among most common injuries seen in orthopedic practice
• 61 cases per 100,000 per year
• Arthroscopic partial menisectomy one of the most common
orthopedic procedures
Epidemiology
4. Pathoanatomy
• Overview
– Crescent shaped and have
triangular cross section
– Fibers have circumferential
orientation
– Anterior and posterior root
attachments prevent extrusion
– Lateral covers 84% of the
condylar surface, 12mm wide, 3-
5mm thick
– Medial covers 64%, 10mm wide,
3-5mm thick
5. • Vascularity
– Genicular arteries
– 50% vascularized at birth
– 10-25% in adults
– Makes healing very difficult
– 3 vascular zones
• Red-red
• Red-white
• White-white
Pathoanatomy
6. • Collagen Organization
– Circumferential fibers
– Radial Fibers
– Fine superficial layer
around outside
Pathoanatomy
7. • Load Sharing
– Increases contact area between femur and tibia
– Decreases contact stress on articular cartilage
• Increases congruity
• Provides stability
• Aids in lubrication
Meniscal function
8. • In extension, 50% of the load is absorbed
• At 90 flexion, 90% load-sharing
• Beyond 90, forces predominate through posterior horns
Biomechanics
9. – Meniscal excursion with
knee flexion
• 11.2 mm excursion of
lateral meniscus
• 5.1 mm excursion of
medial meniscus
– Capsule
– Deep MCL
– Coronary ligament
Meniscal Excursion
10. • Complete removal of meniscus
results in 2-3X increase in
contact stress
• Removal of inner 1/3 = 10%
reduction in contact area and
65% increase in stress
• Increase loss of meniscal tissue
= increase contact stress
• Medial meniscal root tears have
pressures similar to complete
meniscectomy
Biomechanics
11. • History
– Twisting injury with change in direction in younger patients
– Squatting or falling in older patients
– Acute tear usually has insidious swelling
– Joint line location
– Mechanical complaints
Evaluation
12. • Small effusion
• Joint Line Tenderness
• McMurray
• Apley
• Thessaly
• ROM generally normal
– Bucket handle block
– Tight due to effusion
Physical Exam
17. • Plain films to assess for bony
injury and OA
• MRI is the gold standard of
diagnosis
Imaging
18. • Typically seen in younger patients
• High association with ACL tears
• 90% of LVT in MM and 83% in LM are associated with ACL tears
Longitudinal Vertical Tears
19.
20.
21. • This is a LVT with central
margination
• Most frequent type of
displaced tear
• Double PCL
• Double Anterior Horn
• Absent Bow
Bucket Handle Tears
22.
23. • Involves the free edge and propagates peripherally
• Usually degenerative
• Older patients
Horizontal Tears
24.
25.
26. • Also involve free edge, but path is perpendicular to long axis
• Drastically affect ability to resist hoop stresses
• Deeper the tear, the more drastic the biomechanical consequences
Radial Tears
34. • Goal is to debride tear and leave
stable rim
• Preservation is ideal
• 80% satisfactory function at 5 yrs
• Lateral debridement = faster
degeneration
Meniscectomy
35. • Predictors of Positive Result
– < 40yo
– Normal alignment
– Minimal arthritis at initial scope
– Single fragment tear
Meniscectomy
37. Open Repair
• Rarely used
• Numerous studies have proven reduced surgical morbidity
with arthroscopic repair
• Reserved for peripheral tears in the posterior horn
38. Inside-out Repair
• Suture passed on either side
of tear with needle cannula
• Suture is brought out of
capsule
• A small skin incision is made
• Suture is tied down to capsule
• Posterior Horn Repairs
39. • Sutures passed through the
meniscus from the outside
• Eliminates need for larger
incision
• Generally suited for anterior
repair
• Studies have shown similar
results with both techniques
Outside-In Repair
40. • All-inside repair devices were
developed to reduce surgical
time, prevent complications
resulting from external
approaches, and allow access to
tears of the posterior horn
• Fourth-generation repair devices
allow placement of sutures in the
meniscus without the aid of an
external incision or a suture
fixator system
All Inside
41. • Self-adjusting, with the anchor
located behind the capsule and
with a sliding knot that can be
tensioned appropriately by the
surgeon
• Mechanical studies show
comparable strength to outside-
in sutures
All Inside
42.
43.
44.
45. Outcomes
• Success rates for all techniques reported 70-95%
• Second-look scopes show lower success rates of 45-91%
• Ligamentous laxity decreases success rate to 30-70%
• 90% success reported in conjunction with ACL repair
47. Transplantation
• Indications:
– Recurrent pain after partial or total debridement
– symptomatic with ADLs
– <50yo
• Contraindications:
– Malalignment
– Laxity
– Inflammatory arthritis
– Advanced OA
48. Outcomes
• Widely varying reports of success (Country differences)
• Subjective improvement in tibiofemoral pain
• No clear long-term benefit in preventing OA has been
established
• Grafts seem to do better when placed with a bone block
• Preserving some peripheral rim helps to avoid extrusion
• Variety of meniscal scaffold options being investigated in
animals
O’Connor’s textbook of arthroscopic surgery, Philadelphia, 1984.
Thompson (1991) studied meniscal motion with 3-dimensional MRI and cinematic MRI. Medial meniscal excursion was approximately 5.1 mm, and lateral meniscal excursion, 11.2 mm. The posterior horn excursion has been noted to be less than that of the anterior horn, both medially and laterally. The posterior oblique ligament is firmly attached to the posterior medial meniscus, thereby limiting its displacement and rotation.
Thompson WO, Thaete FL, Fu FH, Dye FF. Tibial meniscal dynamics using three dimensional reconstruction of magnetic resonance images. Am J Sports Med. 1991;19:210-216.
http://www.kneejointsurgery.com/html/meniscus/anatomy.html