This document provides an overview of osteoporosis including its definition, characteristic features, classification, contributing factors, clinical manifestations, investigations, diagnosis, and treatment. Some key points:
- Osteoporosis is a skeletal disorder characterized by low bone mass and deterioration of bone tissue, resulting in fragile bones and increased fracture risk. It is defined by the WHO as a bone density 2.5 standard deviations below the mean for young healthy adults.
- It is asymptomatic until a fracture occurs. Common fractures are of the distal radius, vertebral bodies, and hip. Risk factors include age, sex, family history, smoking, alcohol, low body weight, and estrogen deficiency.
- Diagnosis involves investigations
Knee pain is an extremely common complaint, and there are many causes.
Family physicians, Orthopedic surgeons and internist, Pediatricians and other doctors frequently encounter patients with knee pain.
Knee pain is an extremely common complaint, and there are many causes.
Family physicians, Orthopedic surgeons and internist, Pediatricians and other doctors frequently encounter patients with knee pain.
OSTEOPOROSIS:A Barebone guide to diagnosis and managementGovindRankawat1
“Progressive systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk”
True Definition: bone with lower density and higher fracture risk
WHO: utilizes Bone Mineral Density as definition (T score <-2.5)
Osteoporosis is silent because there are no symptoms initially.
The most common are fractures of the spine, hip, and wrist.
Osteoporosis is not an inevitable part of aging, but is a disease that can be prevented and treated, provided it is detected early.
The main goal of treating osteoporosis is to prevent such fractures in the first place.
Bare bone term used for “necked bone with necked eye”
“There is clearly a problem of underdiagnosis and undertreatment of osteoporosis and we want to raise awareness about the risk factors for osteoporosis so that those who need treatment get treatment”.
Learning Objectives
Utilize recent recommendations for osteoporosis prevention and treatment and how to apply them in practice.
Explain controversies surrounding pharmacologic osteoporosis therapy including side effects and the risk/benefit ratio of therapy.
Determine when and how to utilize the current pharmacologic therapies including anabolic versus anti-resorptive approaches and how to transition or discontinue treatment
Osteoporosis only causes symptoms when it is far advanced.
Symptoms include loss of height, deformed spine (“dowager’s hump”), unexplained back pain, and fractures.
It is best to detect problems at an early stage, when treatment is most effective.
The best test for detecting osteoporosis is bone densitometry, done with a technique called “Dual-energy X-ray Absorptiometry” or DXA.
Osteopenia refers to decreased bone mass.
Osteoporosis refers to osteopenia (reduced bone strength/mass) that is severe enough to increase the risk of fracture.
According to WHO, osteoporosis is defined as bone mineral density that falls 2.5 standard deviation below mean for young healthy adult of same sex and race.
Osteoporosis associated fractures :
These are adulthood fractures of any bones (chiefly hip and vertebral fractures) in the setting of trauma less than or equal to fall from standing height with exception of fingers, toes, face and skull.
Drugs associated with osteoporosis
Alcohol
Glucocorticoids
Anticoagulants
Anticonvulsants
Chemotherapy
Excess thyroxine
Endocrine disorders
Cushing syndrome
Hyperparathyroidism
Thyrotoxicosis
Diabetes mellitus (both type I and II)
Acromegaly
CATEGORIZATION OF OSTEOPOROSIS
A.Primary
Idiopathic
Postmenopausal
Senile/age related
B. Secondary (Diseases)
Hypogonadal state, endocrine disorders, nutritional and gastrointestinal disorders, rheumatologic disorders, hematological disorders/malignancy, inherited disorders and others.
Usually asymptomatic until fracture occurs
Vertebral and hip fracture common by simple fall
Loss of height due to multiple vertebral fracture and other deformities like lordoisis, kyphoscoliosis.
Fracture of femur neck, pelvis or spine causes deep vein thrombosis and pulmonary embolism, pneumonia.
INVESTIGATIONS FOR OSTEOPOROSIS
DXA (Dual energy X-ray absorptiometry)
Quantitative CT
Ultrasound
Urea, creatinine and electrolytes
Liver function test and albumin
Renal function test
Full blood count, ESR
Serum calcium and phosphate
Serum vitamin D and alkaline phosphate
Serum PTH
Thyroid function test
Testosterone, estrogen and gonadotropins
Serum cortisol
Bone biopsy
Plain radiography not diagnostic
Following non pharmacological approaches are taken:
Exercise
Appropriate calcium and vitamin D intake (Calcium 1000mg/day and vitamin D 800 IU/daily)
Cessation of smoking
Limit/ Quit alcohol intake
Get up and go exercise
Hip protectors to reduce the risk of fracture.
Pharmacological agents
Bisphosphonates ( decrease osteoclast activity)
Postmenopausal hormone replacement therapy
Denusumab (anti- RANKL antibody)
Anti- sclerostin antibodies
Cathepsin k antibodies
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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.
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.
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!
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
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.
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.
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
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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
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.
1. OSTEOPOROSIS
DR. Md Akbar Khan MS(ORTHO)
Asst. Prof of Orthopaedics
ACSR Govt Medical College, Nellore
2. Jean Lobstein – coined the term & described its
pathoanatomy.
Osteoporosis is a major public health problem,
which results in substantial morbidity,
mortality and high costs.
Silent disease – patients unaware of ongoing
bone loss which is asymptomatic.
Fracture may be the first symptom
INTRODUCTION
3. Skeletal disorder characterized by low bone
mass & micro-architectural deterioration of
bone tissue which results in increased bone
fragility and fracture susceptibility.
WHO definition – Bone density that falls 2.5
SD below the mean for young healthy adults
of same race & gender
DEFINITION
4. Reduced bone mass
Reduced mineralization
Micro architectural deterioration of bone tissue
There is
Subnormal osteoid production
Excessive rate of de-ossification
Subnormal osteoid mineralization
CHARACTERISTIC FEATURES
6. Normal – BMD not more than 1 SD
Osteopenia - 1 to 2.5 below SD
Osteoporosis - 2.5 below SD
Severe Osteoporosis – With fragility fractures
WHO GRADING
7. PRIMARY OSTEOPOROSIS
Type I - Postmenopausal osteoporosis
Type II - Senile osteoporosis
Idiopathic - Premenopausal and Younger
CLASSIFICATION
9. Non-modifiable
Peak bone mass
Female sex
Caucasian race
Advanced age
Family history
Potentially modifiable
Cigarette smoking & Alcoholism
Estrogen deficiency
Low body weight
Low calcium intake
Lack of physical activity
CONTRIBUTING FACTORS
10. Bone formation & bone resorption - (2 Process)
Osteoclast (bone resorbing cells) & Osteoblast (bone
forming cells) - (2 Type of Cells)
Parathormone & Vitamin D - (2 Biomolecules)
Cortical & Trabecular bones - (2 Types of Bones)
Investigations – Markers of bone formation &
resorption (2 Marker Investigations)
Treatment – Drugs which enhance bone formation &
decrease resorption (2 Types of Drugs)
BALANCING ACT BETWEEN
11. Fragility fractures / Insufficiency fractures
Outcome depends on
Bone density
Severity of fall
In three most common fractures
Distal radius – Fall > Density
Vertebral body – Density > Fall
Hip fractures – Fall & Density play equal role
OSTEOPOROTIC FRACTURES
12. Risk Factors :
Increased age
Female gender
Estrogen deficiency
Inadequate calcium intake
Low bone density (osteopenia)
Low body weight
History of fractures in adult life
History of fractures in first-degree relative
Smoking and alcohol use
Lack of physical activity
OSTEOPOROTIC FRACTURES
13. Osteoporosis is usually asymptomatic until
fracture occurs.
May present as backache of varying degrees of
severity
Spontaneous fracture
Collapse of vertebrae
Loss of height is common
Thoracic kyphosis
CLINICAL MANIFESTATIONS
14. Osteoporosis is usually asymptomatic until
fracture occurs.
May present as backache of varying degrees of
severity
Spontaneous fracture
Collapse of vertebrae
Loss of height is common
Thoracic kyphoses
CLINICAL MANIFESTATIONS
17. Urine Calcium
Low (<50mg/24 hrs)
Osteomalacia, Malnutrition, Malabsorption
High (300mg/24 hrs)
↑ renal calcium leak -Males with osteoporosis
Absorptive hypercalciuria - Idiopathic
Granulomatous disease
Malignancy and diseases with ↑ bone turnover
INVESTIGATIONS
18. Serum & Urine immuno-electrophoresis
Multiple myeloma
Urinary N – Telopeptide (NTX)
Marker of bone resorption
>40 n mol high turnover
25- hydroxy vitamin D & 1,25 hydroxy vitamin Dlevels
Liver Disease, Renal Osteodystrophy
Monitor response to anti-osteoporotic treatments
INVESTIGATIONS
19. Ca PO4 ALP
Osteoporosis N N/↓ N
Hyperparathyroidism ↑ ↓ ↑
Paget’s disease N or ↑ N / ↑ ↑↑
Osteomalacia N/ ↓ ↓ ↑
Osteogenesis Imperfecta N N N/ ↑
Multiple Myeloma N/ ↑ N/ ↑ N
INVESTIGATIONS
21. Principal tensile & compressive trabeculae on hip X Ray
Grade VI to Grade I
Grade VI:
Normal trabecular groups are visible
Upper end of femur is occupied by cancellous bone
Grade V:
Both Trabeculae is accentuated
Ward's triangle appears prominent
Grade IV:
principal tensile trabeculae are markedly reduced
can be traced from lateral cortex to upper part of femoral neck
SINGH’S INDEX
22. Grade III:
There is break in continuity of principal tensile trabeculae
opposite greater trochanter
Grade II:
Only principal compressive trabeculae stand out prominently
Remaining trabeculae have been essentially absorbed
Grade I:
Principal compressive trabeculae are markedly reduced in
number and are no longer prominent
Grade 6 normal
Grade 3 definite osteoporosis
Grade 1 is severe osteoporosis
SINGH’S INDEX
28. Amount of bone matter per cubic centimeter of
bone
Reported in Three terms – Gm/ mm3
,T score &
Z score
Measured by
Dual Energy X Ray Absortiometry
Qualitative Ultrasound
Qualitative Computer Tomography
BONE MINERAL DENSITY
29. Recommendation for bone density measurements:
Estrogen-deficient women at clinical risk.
Individual with vertebral abnormalities - plain film
More than 3 months of steroid treatment
Primary hyperparathyroidism
Monitoring of drug therapy
Women who have multiple risk factors
Postmenopausal women who is not on estrogen
replacement.
Pt. with strong Family History of osteoporosis.
All women age>65.
BONE MINERAL DENSITY
30. X ray photons of different energy
Sites recommended by WHO
Total proximal femur
Femoral neck
Lumbar spine
Radius with evidence of
OA / surgery at
other 3 sites
DUAL ENERGY X RAY ABSORTIOMETRY
32. Emits ultrasonic waves
Attenuation of waves which predict strength
of bone
Measured in calcaneum
At present outdated due to errors
QUALITATIVE ULTRASOUND
33. Mainly for spine
Specifically analysis trabecular bone
Less precise than DEXA
More radiation
Costlier than DEXA
QUALITATIVE COMPUTER TOMOGRAPHY
34. Key to management is prevention.
Prevention of osteoporosis is a misnomer
It is actually prevention of fractures by the time
the patient already have osteoporosis
Increasing public awareness about importance
and risks involved helps
Altering personal and dietary habits
Regular physical activity(3-4 hrs/week)
Peri-menopause & postmenopause: calcium+
oestrogen – weight bearing exercises.
PRIMARY PREVENTION
35. Use handrails on stairs, Bathroom
Keep rooms free of clutter
Keep floors clean but not slippery
Wear supportive, low-heeled shoes.
Don’t walk in socks; floppy slippers
Install ceiling lighting in bedrooms
Use rubber matt in shower/tub
Check posture in mirror often
38. Anti resoptive class of Drugs
Calcium/Vitamin D
Bisphosphonates
Calcitonin
Selective Estrogen Receptor Modulators (SERMS)
Anabolic Drugs
Parathyroid Hormone
Sodium fluoride & Strontium Renelate
Other Agents
Vitamin K2-7 fortified calcitriol & Denosumab
MEDICALTREATMENT
39. Mechanism of action
Binds to the surface of hydroxyapatite crystals
and inhibits its resorption
First line of treatment in postmenopausal
osteoporosis
Side effects
Gastrointestinal intolerance
Esophagitis
Bone pain
BISPHOSPHONATES
40. Once a week (oral)
Alendronate –35mg (prevention) & 70 mg treatment
Risedronate - 35mg (prevention) & 50 mg treatment
Once a month (oral)
Ibandronate - 150 mg
Once In 3 months (Intravenous)
Ibandronate - 3 mg / 3 ml over 15 – 30 sec
Once in a year(Intravenous)
Zolendronate -5 mg / 100 ml infusion over 15–20 min
BISPHOSPHONATES
41. Salmon Calcitonin Nasal Spray
For postmenopausal osteoporosis
200 IU once a day intranasal, alternating nostrils
Side effects – nasal mucosal irritation
SERM’S (Raloxifene)
For postmenopausal osteoporosis - 150 mg
Recombinant Human PTH ( Teriparatide)
Produced genetically engineered E. Coli
Injection - 750 micrograms
Calcium & Vitamin D supplements to correct imbalance
Other Agents
42. Sodium Fluoride & Strontium Renelate
Increase bone mass by inhibiting osteoclasts
Stimulate osteoblasts
Vitamin K2-7 fortified calcitriol & calcium
combinations
Denosumab
monoclonal antibody binds with RANK Ligand
Inhibits bone resorption
Other Agents
43.
44. GOALS
Improve quality of life
Give a stable fixation
Early mobilization & weight bearing
SURGICAL TREATMENT
46. Without opening fracture site & without
disturbing biomechanics
Use of longer plate with less no of screws –
greater stability
BIOLOGICAL FIXATION
47. Interlocking nails , tension band constructs
Moved from conventional plating, DCP & LC-
DCP to Interlocking nails & LCP
These bones have poor holding power of screws
Bones are like tough spring
Interlocking nails & LCP locking the screws to
plates creating angular stable devices,
diminishing screw holding power of bone
LOAD SHARING IMPLANTS
Maintaining a home environment that reduces the risk of falling is important. The next two slides list helpful considerations that patients should be made aware of.
Use handrails on stairs, in bathroom
Keep rooms free of clutter
Keep floor surfaces clean but not slippery
Wear supportive, low-heeled shoes. Do not walk in socks or floppy slippers
Use 100 watt bulbs in all rooms
Install ceiling lighting in bedrooms
Use rubber matt in shower/tub
Keep a flashlight at bedside
Check posture in mirror often
The quickest and easiest way to comprehend internal locking constructs is by using the external fixator as an analogy.
A internal locking construct is very similar to a “low profile” internal ex-fix. The main difference between the two is that the internal locking construct is positioned closer to the bone surface to increase position holding strength, and to also offset the bending moments and stress an ex-fix is typically exposed to when in use.
In addition to this analogy, we should bring to your attention terms such as ‘fixed position constructs,’ “fixed angle devices”, “locking screw and locking plate constructs”, all of these are frequently used to describe internal fixators. Incidentally fixed angle devices are not a new concept. Can anyone name a few?
Blade plates,
Dynamic hip screws
Dynamic condylar screws
With all this in mind, often the question arises…. Is an internal fixator any better than conventional plating? What are the benefits?
Liegt die herkömmliche Platte im Bereich der Schrauben nicht gut am Knochen an, kann es zum belastungsbedingten Abkippen kommen
To achieve fixed angles, a locking screw for an internal fixator incorporates one critical design feature, threads on the head of the screw. This is the main difference between standard cortex screws and locking screws. These threads screw into a matching thread on a plate when inserted.
However, other enhancements are also evident in specific locking screw designs, namely a larger core diameter (for resisting bending loads), a tighter thread pitch and a radial preload similar to that of the AO self drilling and tapping Schanz screw used in external fixators. Locking screws can be both bicortical and unicortical. however screws which are used in a unicortical manner, can feature self-drilling and self tapping tips.