MIROS (Minimally Invasive Reduction and Osteosynthesis System
MIROS consists of four 2.5 mm thick and 50 cm long stainless steel or titanium wires the end
of which is introduced into a metallic clip.
Assumed that the MIROS might provide greater fracture stability and less complications
with respect to traditional percutaneous pinning (TPP).
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..
Osseous anatomy, Types of approaches(Position,landmarks,Incision,Superficial and Deep surgical dissection) , structures at risk, Extensile approaches with diagrams and eponymous .
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..
Osseous anatomy, Types of approaches(Position,landmarks,Incision,Superficial and Deep surgical dissection) , structures at risk, Extensile approaches with diagrams and eponymous .
MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
In this article, we present how to evaluate syndesmosis injury by a case discussion. We also review the current concepts of syndesmosis injury in ankle fracture especially intraoperative evaluation and how to set syndesmotic screw fixation.
presentation about minimally invasive bridge plating technique usage in pediatric femoral shaft fracture , showing a prospective case series study done over thirty child
MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
In this article, we present how to evaluate syndesmosis injury by a case discussion. We also review the current concepts of syndesmosis injury in ankle fracture especially intraoperative evaluation and how to set syndesmotic screw fixation.
presentation about minimally invasive bridge plating technique usage in pediatric femoral shaft fracture , showing a prospective case series study done over thirty child
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.
Functional and radiological assessment of displaced midshaft clavicle fractures treated through open reduction and internal fixation surgery using pre-contoured locking compression plates
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Similar to MIROS (Minimally Invasive Reduction and Osteosynthesis System®) (20)
DR. ARPAN CHAUDHARY
3rd YEAR PG RESIDENT,
M.S. ORTHOPAEDICS
SCREWS-HEAD, SHAFT, TIP,
RUN OUT, THREAD, TYPES OF SCREWS, CORTICAL SCREW, CANCELLOUS SCREW, CANNULATED CANCELLOUS SCREW, THE HERBERT SCREW, DYNAMIC HIP SCREW, PEDICAL SCREW, BIOABSORBABLE SCREW, LAG SCREW PRINCIPLE, TENSION BAND WIRING, GOETZE-RHINELANDER-BOHLER METHOD
REFERENCE- ANAND THAKUR
APPROACHES OF ILIUM, PUBIC SYMPHYSIS & SACROILLIAC JOINTCHAUDHARY ARPAN
THIRD YEAR PG RESIDENT,
M.S. ORTHOPAEDICS
muscles of the thigh, Gluteus medius, Gluteus maximus, Tensor fascia lat, Anterior and posterior Illium approaches for grafting, Anterior approach to the iliac wing and SI joint.
Anterior approach to the iliac wing and SI joint,
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
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.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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!
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
MIROS (Minimally Invasive Reduction and Osteosynthesis System®)
1. Percutaneous pinning of three or four-part
fractures of the proximal humerus in
elderly patients
in poor general condition:
MIROS® versus traditional pinning.
DR. ARPAN CHAUDHARY
Stefano Carbone & Mario Tangari & Stefano Gumina &
Roberto Postacchini & Andrea Campi &
Franco Postacchini
International Orthopaedics (SICOT) (2012) 36:1267–1273
2. ❑ The proximal humerus comprises four major parts (corresponding
to the four developmental ossification centres).
1. Anatomical head
2. greater tuberosity : site of insertion of three of the supraspinatus, infraspinatus and
teres minor.
3. lesser tuberosity : site of insertion of the remaining rotator cuff muscle, subscapularis.
4. shaft.
❑ The head is directed
predominantly medially,
superiorly by 130° and
anteriorly by 30°.
❑ The anatomical head and the
tuberosities make up the surgical
head of the humerus.
❑ The surgical neck of the humerus
lies at the junction of the surgical
head and the shaft.
3. ❑ The deltoid arises from the scapula and
clavicle and inserts into the deltoid
tuberosity.
❑Pectoralis major and teres major insert into
the lateral and medial edges of the bicipital
groove respectively.
Ligaments :
1) Coracohumeral ligament.
2) SGHL - Restraint to inferior
translation at 0° degrees of
abduction (neutral rotation).
3) MGHL - Resists AP translation in the
midrange (~45°) of abduction.
4) IGHL - Restraint to AP
translation at 90° degrees of
abduction
4.
5. Proximal Humerus Fractures
Epidemiology
Incidence
- 4-6% of all fractures
- third most common non-vertebral fracture pattern seen in the elderly.
- two-part surgical neck fractures are most common.
Demographics
- 2:1 female to male ratio
- increasing age associated with more complex fracture types
Risk factors
- osteoporosis
- diabetes
- epilepsy
-female gender
Mechanism : Low-energy falls in elderly with osteoporotic bone
: High-energy trauma young individuals
6. PATHOANATOMY :
vascularity of articular segment is more likely to be preserved if ≥ 8mm of calcar is
attached to articular segment.
Predictors of humeral head ischemia (Hertel criteria) :
<8 mm of calcar length attached to articular segment
disrupted medial hinge
increasing fracture complexity
displacement >10mm
angulation >45°
predictors of humeral head ischemia does not necessarily predict subsequent avascular
necrosiS
10. Non-operative :
Most fractures (90%) can usually be treated conservatively including:
• One-part fractures
• Impacted fractures of the surgical neck without severe angulation
• Two-, three- and four-part fractures with <30° angulation of the articular surface, and
good cortical contact with the shaft
• Any other fracture pattern with relevant patient factors: old age, low functional
requirements,diabetes, renal disease, alcohol abuse, psychiatric condition, dementia.
11. OPERATIVE :
❑ Absolute indications for surgery
• Fewer than 1% of fractures require urgent surgery.
These may include:
• open fractures
• fracture-dislocations
• fractures with associated vascular injury.
❑ Relative indications for surgery
Only a minority (around 10%) of fractures are likely to benefit from surgery to reconstruct or
replace the humeral head, including:
• two- or three-part fractures where the greater tuberosity is displaced by >1 cm
• ‘off-ended’ two-part fractures of the surgical neck
• two-, three- or four-part fractures where the articular surface has displaced by
>30°
• head-splitting fractures (may require a hemiarthroplasty).
12. SURGICAL TECHNIQUES :
Several reconstructive options are available:
• Percutaneous fixation.
• Open reduction and internal fixation.
• Nailing.
• Arthroplasty (Fig. 9.9): Certain fractures are not amenable to fixation due to a high level
of articular comminution or poor bone stock, particularly in elderly patients. In these
circumstances, a primary hemiarthroplasty should be considered.
14. ❑Treatment of three- or four-part fractures of the proximal humerus in elderly patients is still
controversial. While a few studies reported that non-operative management is associated
with poor results , a recent prospective, but not controlled, trial found it difficult to demonstrate
a significant advantage of surgical over non-operative management
❑ However, the fracture pattern, amount of displacement of the fragments, bone stock of the
upper humerus, preexisting rotator cuff disease or arthrosis and the patient’s age and general
condition are important factors in the choice of treatment.
❑ Percutaneous techniques may allow displaced fractures of the proximal humerus to be reduced
and stabilised by Kirschner wires (K-wires) alone or wires clamped into a locking device.
❑The advantages of these techniques are not only the possible preservation of vascular supply to
bone fragments, but also no blood loss and the possibility of surgery under brachial plexus block.
INTRODUCTION
15. MIROS (Minimally Invasive Reduction and Osteosynthesis System®)
❑ It allows correction of angular displacement and fixation of fracture fragments by means
of elastic K-wires locked in a metallic clip placed externally on the skin.
❑ Assumed that the MIROS might provide greater fracture stability and less complications
with respect to traditional percutaneous pinning (TPP).
❑ SO, A prospective study thus carried out to compare the MIROS to TPP for the treatment of
three- or four-part fractures of the upper end of the humerus of elderly patients
in ASA PS 3 or 4.
ASA PHYSICAL STATUS CLASSIFICATION SYSTEM
16. ❑Between 2007 and 2009, ASA PS three or four was assigned to 58 consecutive patients admitted
at two hospitals of a single town for fracture of the proximal humerus.
In one hospital the patients were treated with the MIROS, while in the other TPP was
performed.
❑There were 37 women and 21 men with a mean age of 76 years (68–93), the patients of the
two groups being matched for mean age, sex, mean ASA PS score and type of fracture
MATERIALS AND METHODS :
17. Classified according to the Neer system.
In complex fractures, CT scan with 3-D was performed.
In no patients were there local vascular or neural complications
Excluded :
fracture extending to the humeral diaphysis or the articular surface of the humeral head and
those with no active motion of the arm due to previous cerebrovascular diseases.
clinical evaluation and shoulder radiographs at three, six, 12 and 16 weeks.
Of the original patients, 6 were lost to the latest follow-up ( 2 had died and 4 did not attend for
assessment), thus leaving 28 patients in the MIROS group and 26 in the TPP group.
The shoulder function was evaluated using the Constant Score (CS) method. The patients were
also asked to rate the result of surgery with the subjective shoulder value (SSV) method.
18. MIROS consists of four 2.5 mm thick and 50 cm long stainless steel or titanium wires the end
of which is introduced into a metallic clip.
The latter has a diameter of 20 mm and contains a screw that is tightened to lock the wires.
Supraclavicular brachial plexus block given. Fracture Reduced.
K-WIRES from GT, HEAD & PROXIMAL METAPHYSIS.
Bending of Kwires to lock them into the external clip, which was placed at least 2 cm from the
skin of the deltoid area.
19. Once the clip was blocked, it was possible to slightly correct the varus or valgus position of
the humeral head by compressing or distracting the K-wires into the metallic clip.
They were then cut and the screw inside the clip was tightened.
Post-operatively a sling was applied.
The MIROS was removed five or six weeks after the operation
20. TPP :
❑ TPP was performed according to the technique first described by Jaberg et al. using five
terminally threaded 2.5-mm Schanz pins.
❑ The edges of the pins were bent manually and left outside the skin. Post-operatively, patients
wore a sling for three or four weeks.
❑ The pins were removed five or six weeks after the operation.
POST-OP :
❑ In the MIROS group pendulum exercises were begun a mean of four days after surgery and
passive assisted exercises two weeks post-operatively. Passive motion was progressively
increased depending on the patient’s tolerance.
❑ In the TPP group, passive shoulder motion was started three or four weeks depending on the
type of fracture and active motion five or six weeks after surgery
Fisher’s exact test was used to compare the proportions and
Student’s t test for average values; p values <0.05 were
deemed to be statistically significant. Multiple regression
analysis was performed to identify potential associations
between dependent variables (CS and SSV) and independent
variables (type of fracture, complications).
21. 1). OPERATIVE TIME 37.3 MIN 40.1 MIN
2). FLUROSCOPY TIME 76 SECS 50 SECS
3). CS SCORE MORE+++ LESS++
4). SSV SCORE MORE+++ LESS++
5). COMPLICATION RATE 10.7 26.9
6). ROM OF MIROS IN FOLLOW UP MORE THAN TPP
7). ABDUCTION STRENGTH OF MIROS IN FOLLOW UP MORE THAN TPP
8). 1/2 PINS COME OUT PARTIALLY FROM HUMRUS IN 5 PTS – REMOVED WITHOUT LOSS OF REDUCTION
9). MIROS – 1 PT HAS MODERATE LOSS OF FRACTURE REDUCTION
10). TPP- 1 PT HAS INFECTION-ANTIBIOTICS
11). 4 PT HAS AVN – 3 DO NOT ASK FOR OPERATIVE BCZ ACCEPTABLE CONDITION
12). A STATISTICALLY SIGNIFICANT DIFFERENCE BETWEEN THE TWO GROUPS WAS FOUND
FOR OVERALL COMPLICATIONS, PIN MOBILISATION AND PIN TRACT INFECTION (P<0.05).
13). IN BOTH GROUPS, THE MULTIPLE REGRESSION ANALYSIS SHOWED THAT THE VARIABLES THAT
INFLUENCED THE CS AT THE LATEST FOLLOWUP WERE THE TYPE OF FRACTURE [THREE- VS FOUR-PART
FRACTURES (P00.03)] AND COMPLICATIONS (P<0.001).
MIROS TPP
RESULTS :
22. RESULTS :
The Subjective Shoulder Value (SSV) is a patient estimation of the function in their afflicted
shoulder, relative to their completely normal shoulder, expressed as a percentage.
23.
24. IN CONCLUSION :
Study shows that, although TPP can be a valid treatment for three- or
four-part fractures, the MIROS gives better results.
However, both types of treatment imply closed reduction of the
fracture, which can be a very demanding procedure that may fail to
provide a satisfactory reduction, particularly in four-part injuries.
Therefore, not only in the young, but also in the middle-aged patient
with no general comorbidities, ORIF should generally be preferred to
percutaneous pinning.