1) The physis, also known as the growth plate, is located between the epiphysis and metaphysis of growing bones. It is responsible for the longitudinal growth of bones.
2) The physis contains several zones, including a germinal zone, proliferative zone, hypertrophic zone, and zone of provisional calcification. Blood is supplied to the physis from epiphyseal, perichondrial, and metaphyseal arteries.
3) Physeal injuries are classified using the Salter-Harris system. Type 1 and 2 fractures can usually be treated non-operatively, while more severe types often require open reduction and internal fixation.
Bone screws - Principles and biomechanics - Dr. Sachin MSachinMalayaiah1
The document discusses bone screws, including their anatomy, types, tips, diameters, threads, and insertion. It covers cortical screws, cancellous screws, locking screws, self-tapping vs. non-self-tapping screws, and drill bits. Heat generation during drilling and factors affecting it are also summarized. Drill bit failure and prevention are mentioned at the end.
The document discusses the titanium elastic nailing system (TENS) used to treat fractures in children. TENS involves the use of flexible titanium nails inserted into the medullary canal. It is primarily used for diaphyseal and metaphyseal fractures in children ages 3-15. The appropriate use of TENS depends on considering the child's age as well as the type and location of the fracture. TENS provides stability while allowing bending and early ambulation.
Kienbock disease is avascular necrosis of the lunate bone in the wrist that results from disrupted blood flow. It progresses through stages from isolated lunate involvement to fragmentation and collapse. Treatment aims to decompress and revascularize the lunate early on through osteotomies or tendon transfers, while later stages involve procedures like proximal row carpectomy or fusion to stabilize the wrist joint and prevent further degeneration. However, there is no single treatment that reliably achieves pain relief and preservation of function as the disease progresses.
This document summarizes the evolution of intramedullary nails for long bone fracture fixation from the 16th century to modern times. It describes the early use of wooden sticks and ivory implants, the introduction of metallic rods during WWI, and the development of modern locked intramedullary nails in the mid-20th century. Key figures who advanced nail design include Kuntscher, who introduced reamed nailing in 1940, and Russell and Taylor, who developed the first closed section interlocking nail in the 1980s. The document outlines the progression from first to fourth generation nails, incorporating improvements in materials, locking mechanisms, and designs to optimize stability and healing.
This document discusses nonunion of femoral neck fractures, which have a higher incidence in young patients compared to elderly patients. It defines nonunion and outlines the vascular anatomy and causes of nonunion. Classification systems for femoral neck fractures are described. Symptoms, investigations, and radiographic signs of nonunion are provided. Treatment options are discussed, including head-salvaging versus head-sacrificing procedures based on factors like patient age and viability of the femoral head. The Sandhu classification system for staging nonunion is presented along with recommended treatment approaches for each stage.
This article describes the treatment of 12 patients with intra-articular fractures of the proximal interphalangeal (PIP) joint or interphalangeal joint of the thumb using an external dynamic traction device. The device consisted of two K-wires inserted into the proximal and middle phalanges which were bent into hooks and engaged to provide traction across the fracture site, allowing early mobilization. Outcomes including range of motion, grip strength and patient satisfaction were good. The technique provides stable fixation while permitting early joint motion and avoids the risks of open reduction and internal fixation.
muscle pedicle grafting for delayed presentation of intra cpasular fracture neck of Femur.. a study of 65 cases in Osmania Medical College, Hyderabad, Telengana.
1) The physis, also known as the growth plate, is located between the epiphysis and metaphysis of growing bones. It is responsible for the longitudinal growth of bones.
2) The physis contains several zones, including a germinal zone, proliferative zone, hypertrophic zone, and zone of provisional calcification. Blood is supplied to the physis from epiphyseal, perichondrial, and metaphyseal arteries.
3) Physeal injuries are classified using the Salter-Harris system. Type 1 and 2 fractures can usually be treated non-operatively, while more severe types often require open reduction and internal fixation.
Bone screws - Principles and biomechanics - Dr. Sachin MSachinMalayaiah1
The document discusses bone screws, including their anatomy, types, tips, diameters, threads, and insertion. It covers cortical screws, cancellous screws, locking screws, self-tapping vs. non-self-tapping screws, and drill bits. Heat generation during drilling and factors affecting it are also summarized. Drill bit failure and prevention are mentioned at the end.
The document discusses the titanium elastic nailing system (TENS) used to treat fractures in children. TENS involves the use of flexible titanium nails inserted into the medullary canal. It is primarily used for diaphyseal and metaphyseal fractures in children ages 3-15. The appropriate use of TENS depends on considering the child's age as well as the type and location of the fracture. TENS provides stability while allowing bending and early ambulation.
Kienbock disease is avascular necrosis of the lunate bone in the wrist that results from disrupted blood flow. It progresses through stages from isolated lunate involvement to fragmentation and collapse. Treatment aims to decompress and revascularize the lunate early on through osteotomies or tendon transfers, while later stages involve procedures like proximal row carpectomy or fusion to stabilize the wrist joint and prevent further degeneration. However, there is no single treatment that reliably achieves pain relief and preservation of function as the disease progresses.
This document summarizes the evolution of intramedullary nails for long bone fracture fixation from the 16th century to modern times. It describes the early use of wooden sticks and ivory implants, the introduction of metallic rods during WWI, and the development of modern locked intramedullary nails in the mid-20th century. Key figures who advanced nail design include Kuntscher, who introduced reamed nailing in 1940, and Russell and Taylor, who developed the first closed section interlocking nail in the 1980s. The document outlines the progression from first to fourth generation nails, incorporating improvements in materials, locking mechanisms, and designs to optimize stability and healing.
This document discusses nonunion of femoral neck fractures, which have a higher incidence in young patients compared to elderly patients. It defines nonunion and outlines the vascular anatomy and causes of nonunion. Classification systems for femoral neck fractures are described. Symptoms, investigations, and radiographic signs of nonunion are provided. Treatment options are discussed, including head-salvaging versus head-sacrificing procedures based on factors like patient age and viability of the femoral head. The Sandhu classification system for staging nonunion is presented along with recommended treatment approaches for each stage.
This article describes the treatment of 12 patients with intra-articular fractures of the proximal interphalangeal (PIP) joint or interphalangeal joint of the thumb using an external dynamic traction device. The device consisted of two K-wires inserted into the proximal and middle phalanges which were bent into hooks and engaged to provide traction across the fracture site, allowing early mobilization. Outcomes including range of motion, grip strength and patient satisfaction were good. The technique provides stable fixation while permitting early joint motion and avoids the risks of open reduction and internal fixation.
muscle pedicle grafting for delayed presentation of intra cpasular fracture neck of Femur.. a study of 65 cases in Osmania Medical College, Hyderabad, Telengana.
Growth plate & Various disorders affecting growth plate by Dr.VinayVenkat Vinay
This document summarizes a presentation on bone development and growth plate structure and function. It discusses the two types of ossification, intramembranous and endochondral, and describes the microscopic structure and zones of the growth plate. It also covers disorders that can affect the growth plate, including developmental dysplasias, metabolic conditions, infections, hormones, and trauma. Specific dysplasias discussed in detail include hereditary multiple exostosis, achondroplasia, hypochondroplasia, and dyschondrosteosis.
This document discusses various osteotomies around the hip joint. It begins with defining osteotomy and providing a brief history of important developments. It then explains the biomechanics of the hip joint and why osteotomies are effective. Several types and classifications of osteotomies are outlined. Specific procedures like McMurray's displacement osteotomy, Pauwel's varus osteotomy, and Schanz angulation osteotomy are described in detail. Contraindications and postoperative care are also mentioned.
Current Concepts in Treatment of Proximal Humerus Fractures washingtonortho
This document discusses treatment options for proximal humerus fractures, including surgical and nonsurgical approaches. It summarizes several studies comparing outcomes of locking plate fixation versus nonoperative treatment, finding an advantage in function but also higher reoperation rates for plating. Hemiarthroplasty is presented as an alternative for nonreconstructable fractures, though outcomes are variable and depend on factors like tuberosity healing. Technical considerations for hemiarthroplasty are reviewed, including the importance of restoring proper version and head size to optimize function and avoid complications.
This document discusses the treatment of intertrochanteric hip fractures with different fixation devices. It notes that cephalomedullary devices are preferable to dynamic hip screws for fractures with posteromedial comminution or subtrochanteric extension due to their ability to provide controlled collapse and reduce bending forces. The document emphasizes the importance of pre-operative planning, proper reduction techniques, and achieving a tip-apex distance under 25mm for successful fixation with cephalomedullary devices.
The document discusses nonunion fractures, including definitions, classifications, causes, investigations, and treatment options. A nonunion occurs when both endosteal and periosteal callus formation fails, leaving the fracture without signs of healing. Treatment depends on the type of nonunion and can involve nonoperative options like bracing or bone stimulators, or operative options like bone grafting, internal or external fixation, with the goal of achieving fracture healing.
This document discusses the treatment of distal femoral fractures. It describes the major muscle groups in the thigh, including the adductors, quadriceps, and hamstrings. It outlines four operative treatment options for distal femoral fractures: DCS/ORIF, DFLP, DFN, and external fixation. It provides details on the swashbuckler surgical approach for distal femoral fractures, including patient positioning, incision details, exposure of the distal femur, and closure. It also describes the technique for retrograde intramedullary nailing with DFN, including patient positioning, entry point location, and final nail position.
This document discusses the sequelae and management of septic arthritis. Septic arthritis results in inflammation and destruction of the joint space. This can lead to several orthopedic sequelae including joint destruction, bony or fibrous ankylosis, fractures, limb length discrepancy, and persistent infection. The management depends on factors like the patient's age, delay in treatment, and extent of joint involvement. Treatment may include conservative measures, surgical stabilization, deformity correction, lengthening procedures, or arthrodesis to achieve a stable, mobile joint without pain. Classification systems help guide treatment, with the goal of optimizing long term function and quality of life.
spine surgical approaches along with tb spine complicationsPramod Yspam
This document discusses the surgical management and approaches for spinal tuberculosis. Key points include:
- Surgical management includes debridement of diseased vertebrae, drainage of abscesses, arthrodesis for instability, and decompression for neurological complications.
- Common surgical approaches discussed for different spinal regions include anterior, posterior, anterolateral, costotransversectomy, and laminectomy.
- Indications for surgery include neurological deficits not improving with conservative treatment, mechanical instability, and prevention of severe kyphosis.
This document provides information on intertrochanteric fractures of the femur. It discusses the history, epidemiology, risk factors, anatomy, mechanisms of injury, classification systems, evaluation, and treatment options. Intertrochanteric fractures occur in the region between the greater and lesser trochanters and may extend into the subtrochanteric region. Treatment options include non-operative management with traction or operative fixation with devices like the dynamic hip screw, cephalomedullary nails, or plates. Classification systems help determine fracture stability and appropriate treatment.
Bilateral hip fractures are rare and usually result from high-energy trauma. This case report describes a 40-year old male who sustained simultaneous bilateral intertrochanteric hip fractures after his lower body was crushed in a motor vehicle accident. He underwent staged surgical fixation of the fractures with dynamic hip screws. Postoperative recovery was uncomplicated. While bilateral hip fractures pose risks, early surgical treatment and careful monitoring can lead to good functional outcomes even in active patients.
This document discusses elbow instability, including anatomy, stabilizing factors, classification, diagnosis, and management. It covers the soft tissue and bony anatomy of the elbow. Elbow stability relies primarily on the ulnohumeral joint, medial and lateral collateral ligaments. Injuries can range from subluxation to complete dislocation. Diagnosis involves clinical examination and imaging. Management depends on the injury, and may include repair, reconstruction, or fixation of bony and ligamentous injuries.
This document provides an overview of intramedullary nailing, including:
- Evolution from 1st to 3rd generation nails with improved stability and anatomical fit
- Classification by entry point and direction of insertion
- Biomechanical principles of load transfer and stability depending on nail design, number/location of locking screws, and reaming
- Applications for treating fractures of long bones and considerations for special circumstances
This document discusses pediatric femoral neck fractures. Key points:
- They are rare, accounting for less than 1% of pediatric fractures. Anatomy and blood supply make complications like avascular necrosis more common.
- Delbet classification includes 4 types based on fracture location. Type 1 is through the physis, Type 2 through the neck, Type 3 at the base of neck, and Type 4 is intertrochanteric.
- Treatment depends on type and stability but generally involves closed or open reduction and fixation or spica casting. Complications include avascular necrosis, coxa vara, premature physeal closure, and nonunion. Close follow up is needed due to risk of late complications.
1. Total hip arthroplasty has evolved significantly since its origins in the late 1800s through improvements in materials, designs, fixation methods, and surgical techniques.
2. Cementless fixation and improved bearing surfaces have led to improved implant survivorship and reduced osteolysis.
3. Current areas of focus include minimizing wear through novel bearing surfaces and coatings, inhibiting the cellular response to wear debris, and improving surgical techniques through minimal access approaches and computer navigation.
Principle of tension band wiring n its applicationRohit Kansal
1. The tension band technique converts tensile forces into compressive forces through the application of a tension band on the tension side of a bone.
2. Examples of where tension band fixation is commonly used include patella and olecranon fractures, as well as fractures of the greater tuberosity and greater trochanter.
3. Tension band wiring, plating, and external fixation can all function as tension bands by applying a compressive force across a fracture to promote healing.
This document provides information on scaphoid fractures, including anatomy, blood supply, biomechanics, mechanisms of injury, diagnosis, classification, prognosis, and treatment options. Scaphoid fractures are common injuries that can be difficult to diagnose and treat due to the scaphoid's anatomy and blood supply. Treatment depends on factors such as fracture location, stability, and timing of diagnosis, and may involve casting or surgical intervention like internal fixation or bone grafting. Complications can include nonunion, malunion, and post-traumatic arthritis if not properly treated.
This document outlines principles and considerations for the diagnosis and management of hand fractures and dislocations. It discusses specific injuries including fractures of the distal phalanx, mallet finger, phalanges, PIP joint, metacarpals, and thumb. Treatment approaches include splinting, closed and open reduction, and fixation methods depending on the injury type, location, stability, and degree of displacement. The importance of early mobilization is emphasized while minimizing soft tissue disruption.
This document provides an overview of intramedullary nailing principles. It discusses the history and evolution of intramedullary nails from wooden sticks and ivory pegs used in the 16th century to modern nails like the Russell-Taylor nail. It covers nail types, biomechanics, insertion techniques, and key design considerations like diameter, cross-section shape, curves, and locking mechanisms. The goal of intramedullary nailing is to provide stable internal splinting of long bone fractures through closed fixation techniques.
This document discusses the structure and growth disorders of the physis (growth plate). It begins by describing the structure of long bones and the two pathways of ossification - intramembranous and endochondral. It then focuses on the structure and microscopic anatomy of the physis, including its three zones - reserve, proliferation, and hypertrophy. Various disorders are then discussed like Gaucher's disease, diastrophic dysplasia, pseudochondroplasia, and others affecting the different zones of the physis. Treatment approaches for these conditions aim to improve function and correct deformities.
Epiphyseal injuries involve disruptions to the growth plate of long bones. The growth plate is responsible for longitudinal bone growth and consists of zones of cartilage cells. Various mechanisms can cause injuries, including fractures, tumors, infections, and repetitive stress. Injuries are classified using systems like Poland or Salter-Harris which describe the location and extent of the fracture. MRI is a useful imaging modality for evaluating epiphyseal injuries due to its ability to detect microfractures and provide diagnostic quality. Understanding epiphyseal anatomy and injury classifications is important for proper diagnosis and treatment.
Growth plate & Various disorders affecting growth plate by Dr.VinayVenkat Vinay
This document summarizes a presentation on bone development and growth plate structure and function. It discusses the two types of ossification, intramembranous and endochondral, and describes the microscopic structure and zones of the growth plate. It also covers disorders that can affect the growth plate, including developmental dysplasias, metabolic conditions, infections, hormones, and trauma. Specific dysplasias discussed in detail include hereditary multiple exostosis, achondroplasia, hypochondroplasia, and dyschondrosteosis.
This document discusses various osteotomies around the hip joint. It begins with defining osteotomy and providing a brief history of important developments. It then explains the biomechanics of the hip joint and why osteotomies are effective. Several types and classifications of osteotomies are outlined. Specific procedures like McMurray's displacement osteotomy, Pauwel's varus osteotomy, and Schanz angulation osteotomy are described in detail. Contraindications and postoperative care are also mentioned.
Current Concepts in Treatment of Proximal Humerus Fractures washingtonortho
This document discusses treatment options for proximal humerus fractures, including surgical and nonsurgical approaches. It summarizes several studies comparing outcomes of locking plate fixation versus nonoperative treatment, finding an advantage in function but also higher reoperation rates for plating. Hemiarthroplasty is presented as an alternative for nonreconstructable fractures, though outcomes are variable and depend on factors like tuberosity healing. Technical considerations for hemiarthroplasty are reviewed, including the importance of restoring proper version and head size to optimize function and avoid complications.
This document discusses the treatment of intertrochanteric hip fractures with different fixation devices. It notes that cephalomedullary devices are preferable to dynamic hip screws for fractures with posteromedial comminution or subtrochanteric extension due to their ability to provide controlled collapse and reduce bending forces. The document emphasizes the importance of pre-operative planning, proper reduction techniques, and achieving a tip-apex distance under 25mm for successful fixation with cephalomedullary devices.
The document discusses nonunion fractures, including definitions, classifications, causes, investigations, and treatment options. A nonunion occurs when both endosteal and periosteal callus formation fails, leaving the fracture without signs of healing. Treatment depends on the type of nonunion and can involve nonoperative options like bracing or bone stimulators, or operative options like bone grafting, internal or external fixation, with the goal of achieving fracture healing.
This document discusses the treatment of distal femoral fractures. It describes the major muscle groups in the thigh, including the adductors, quadriceps, and hamstrings. It outlines four operative treatment options for distal femoral fractures: DCS/ORIF, DFLP, DFN, and external fixation. It provides details on the swashbuckler surgical approach for distal femoral fractures, including patient positioning, incision details, exposure of the distal femur, and closure. It also describes the technique for retrograde intramedullary nailing with DFN, including patient positioning, entry point location, and final nail position.
This document discusses the sequelae and management of septic arthritis. Septic arthritis results in inflammation and destruction of the joint space. This can lead to several orthopedic sequelae including joint destruction, bony or fibrous ankylosis, fractures, limb length discrepancy, and persistent infection. The management depends on factors like the patient's age, delay in treatment, and extent of joint involvement. Treatment may include conservative measures, surgical stabilization, deformity correction, lengthening procedures, or arthrodesis to achieve a stable, mobile joint without pain. Classification systems help guide treatment, with the goal of optimizing long term function and quality of life.
spine surgical approaches along with tb spine complicationsPramod Yspam
This document discusses the surgical management and approaches for spinal tuberculosis. Key points include:
- Surgical management includes debridement of diseased vertebrae, drainage of abscesses, arthrodesis for instability, and decompression for neurological complications.
- Common surgical approaches discussed for different spinal regions include anterior, posterior, anterolateral, costotransversectomy, and laminectomy.
- Indications for surgery include neurological deficits not improving with conservative treatment, mechanical instability, and prevention of severe kyphosis.
This document provides information on intertrochanteric fractures of the femur. It discusses the history, epidemiology, risk factors, anatomy, mechanisms of injury, classification systems, evaluation, and treatment options. Intertrochanteric fractures occur in the region between the greater and lesser trochanters and may extend into the subtrochanteric region. Treatment options include non-operative management with traction or operative fixation with devices like the dynamic hip screw, cephalomedullary nails, or plates. Classification systems help determine fracture stability and appropriate treatment.
Bilateral hip fractures are rare and usually result from high-energy trauma. This case report describes a 40-year old male who sustained simultaneous bilateral intertrochanteric hip fractures after his lower body was crushed in a motor vehicle accident. He underwent staged surgical fixation of the fractures with dynamic hip screws. Postoperative recovery was uncomplicated. While bilateral hip fractures pose risks, early surgical treatment and careful monitoring can lead to good functional outcomes even in active patients.
This document discusses elbow instability, including anatomy, stabilizing factors, classification, diagnosis, and management. It covers the soft tissue and bony anatomy of the elbow. Elbow stability relies primarily on the ulnohumeral joint, medial and lateral collateral ligaments. Injuries can range from subluxation to complete dislocation. Diagnosis involves clinical examination and imaging. Management depends on the injury, and may include repair, reconstruction, or fixation of bony and ligamentous injuries.
This document provides an overview of intramedullary nailing, including:
- Evolution from 1st to 3rd generation nails with improved stability and anatomical fit
- Classification by entry point and direction of insertion
- Biomechanical principles of load transfer and stability depending on nail design, number/location of locking screws, and reaming
- Applications for treating fractures of long bones and considerations for special circumstances
This document discusses pediatric femoral neck fractures. Key points:
- They are rare, accounting for less than 1% of pediatric fractures. Anatomy and blood supply make complications like avascular necrosis more common.
- Delbet classification includes 4 types based on fracture location. Type 1 is through the physis, Type 2 through the neck, Type 3 at the base of neck, and Type 4 is intertrochanteric.
- Treatment depends on type and stability but generally involves closed or open reduction and fixation or spica casting. Complications include avascular necrosis, coxa vara, premature physeal closure, and nonunion. Close follow up is needed due to risk of late complications.
1. Total hip arthroplasty has evolved significantly since its origins in the late 1800s through improvements in materials, designs, fixation methods, and surgical techniques.
2. Cementless fixation and improved bearing surfaces have led to improved implant survivorship and reduced osteolysis.
3. Current areas of focus include minimizing wear through novel bearing surfaces and coatings, inhibiting the cellular response to wear debris, and improving surgical techniques through minimal access approaches and computer navigation.
Principle of tension band wiring n its applicationRohit Kansal
1. The tension band technique converts tensile forces into compressive forces through the application of a tension band on the tension side of a bone.
2. Examples of where tension band fixation is commonly used include patella and olecranon fractures, as well as fractures of the greater tuberosity and greater trochanter.
3. Tension band wiring, plating, and external fixation can all function as tension bands by applying a compressive force across a fracture to promote healing.
This document provides information on scaphoid fractures, including anatomy, blood supply, biomechanics, mechanisms of injury, diagnosis, classification, prognosis, and treatment options. Scaphoid fractures are common injuries that can be difficult to diagnose and treat due to the scaphoid's anatomy and blood supply. Treatment depends on factors such as fracture location, stability, and timing of diagnosis, and may involve casting or surgical intervention like internal fixation or bone grafting. Complications can include nonunion, malunion, and post-traumatic arthritis if not properly treated.
This document outlines principles and considerations for the diagnosis and management of hand fractures and dislocations. It discusses specific injuries including fractures of the distal phalanx, mallet finger, phalanges, PIP joint, metacarpals, and thumb. Treatment approaches include splinting, closed and open reduction, and fixation methods depending on the injury type, location, stability, and degree of displacement. The importance of early mobilization is emphasized while minimizing soft tissue disruption.
This document provides an overview of intramedullary nailing principles. It discusses the history and evolution of intramedullary nails from wooden sticks and ivory pegs used in the 16th century to modern nails like the Russell-Taylor nail. It covers nail types, biomechanics, insertion techniques, and key design considerations like diameter, cross-section shape, curves, and locking mechanisms. The goal of intramedullary nailing is to provide stable internal splinting of long bone fractures through closed fixation techniques.
This document discusses the structure and growth disorders of the physis (growth plate). It begins by describing the structure of long bones and the two pathways of ossification - intramembranous and endochondral. It then focuses on the structure and microscopic anatomy of the physis, including its three zones - reserve, proliferation, and hypertrophy. Various disorders are then discussed like Gaucher's disease, diastrophic dysplasia, pseudochondroplasia, and others affecting the different zones of the physis. Treatment approaches for these conditions aim to improve function and correct deformities.
Epiphyseal injuries involve disruptions to the growth plate of long bones. The growth plate is responsible for longitudinal bone growth and consists of zones of cartilage cells. Various mechanisms can cause injuries, including fractures, tumors, infections, and repetitive stress. Injuries are classified using systems like Poland or Salter-Harris which describe the location and extent of the fracture. MRI is a useful imaging modality for evaluating epiphyseal injuries due to its ability to detect microfractures and provide diagnostic quality. Understanding epiphyseal anatomy and injury classifications is important for proper diagnosis and treatment.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Bone is a mineralized connective tissue that forms the endoskeleton of vertebrates. It has both compact and spongy structures and develops through either membranous or endochondral ossification. Bone is made up of osteoprogenitor cells, osteoblasts, osteocytes, and osteoclasts. Osteoblasts form new bone tissue while osteoclasts resorb old or damaged bone. The intricate blood supply through nutrient arteries is essential for bone growth and healing. Fractures heal through the formation of a hematoma, fibrocartilaginous callus, bony callus, and remodeling into secondary bone.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Bone is a living tissue composed of collagen, proteins, and hydroxyapatite crystals. Bone remodeling is carried out by osteoblasts, osteoclasts, and osteocytes through a basic multicellular unit process where bone is resorbed and formed at equal rates. During remodeling, osteoclasts resorb bone through the secretion of acids and proteases, while osteoblasts form new bone matrix through the deposition of collagen and minerals. The remodeling cycle maintains bone strength and mineral homeostasis.
Cartilage is a specialized connective tissue containing cells called chondrocytes that secrete an extracellular matrix. There are three main types of cartilage - hyaline, elastic, and fibrocartilage - each with different compositions and locations in the body. Growth plate fractures often result from sprains and strains in growing children and involve the growth plates located at the ends of long bones.
This document defines and describes various types of movement terms, bones, and cartilage. It discusses:
1) Flexion, extension, abduction, adduction, rotation, pronation, and supination as different types of joint movements.
2) The classification of bones into long bones, short bones, flat bones, irregular bones, and sesamoid bones based on their shape. It provides examples of bones that fall into each category.
3) The composition, structure, and development of bone tissue through membranous and endochondral ossification. It also discusses some clinical considerations regarding bone such as epiphyseal plate disorders and rickets.
Legg-Calve-Perthes disease is a childhood condition caused by temporary loss of blood supply to the femoral head. It most commonly affects boys ages 4-8 and can cause deformity of the femoral head. Early containment of the femoral head via casts or surgery can prevent deformation and minimize long-term arthritis risk. Prognosis depends on the Herring classification, with surgery beneficial for lateral pillar group B/C cases after age 8. The goal of treatment is to maintain femoral head congruency and minimize secondary osteoarthritis.
Cartilage is a specialized connective tissue containing cells called chondrocytes that secrete an extracellular matrix. There are three main types of cartilage - hyaline, elastic, and fibrocartilage - each with different compositions and locations in the body. Growth plates are areas of cartilage at the ends of long bones that allow for bone growth in children through endochondral ossification as cartilage is replaced by bone.
Cartilage is a specialized connective tissue containing cells called chondrocytes that secrete an extracellular matrix. There are three main types of cartilage - hyaline, elastic, and fibrocartilage - each with different compositions and locations in the body. Growth plates are areas of cartilage at the ends of long bones that allow for bone growth in children through endochondral ossification as cartilage is replaced by bone.
Basic mechanism of craniofacial growth /certified fixed orthodontic courses b...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Paediatric orthopaedic fracture; dislocation -lec 9 (june 2016) n.c.yasser Amr
Paediatric bone has unique properties compared to adult bone including less density, more porosity, and thicker periosteum. These properties lead to different fracture patterns and healing processes in children. Key areas of paediatric long bones include the epiphysis, physis, and metaphysis. The periosteum also plays an important role in healing. Remodelling allows paediatric fractures to reshape over time with growth. Certain injuries to the physis can cause deformities if not addressed.
Simple bone cysts, also known as unicameral bone cysts, are fluid-filled cavities within bone that typically occur in the long bones of children ages 4-10. They enlarge during growth but become inactive after skeletal maturity. Active cysts develop near the growth plate and can cause pathologic fractures. Treatment involves curettage to remove the cyst lining and bone grafting to prevent fractures and reduce the risk of recurrence.
1. Physeal (or growth plate) fractures make up 15-30% of long bone fractures in children and involve the epiphysis, physis, and metaphysis.
2. The Salter-Harris classification system categorizes physeal fractures based on the location of the fracture line.
3. Immediate closed reduction is recommended when possible to anatomically realign the physis and prevent growth disturbances. Open reduction may be needed for more complex fractures.
Growth and development are complex processes involving both quantitative and qualitative changes over time from conception to maturity. Several theories attempt to explain the factors influencing craniofacial growth, including genetic determinism, functional matrix theory, and neurotrophic influences. Prenatal growth involves defined periods of ovum, embryo, and fetus development, characterized by formation of germ layers and organogenesis. Postnatal growth includes bone growth through intramembranous or endochondral ossification, influenced by sutural growth, remodeling, and displacement of facial structures.
This document provides an overview of cranial and facial development from prenatal through postnatal periods. It discusses how the cranium develops from both membranous and cartilaginous components, and how growth occurs after birth through processes like sutural growth, cortical drift and synchondrosis elongation. Premature fusion of sutures or synchondroses can lead to craniosynostosis and impact midfacial development and dental alignment. Genetic syndromes associated with abnormal skull growth are also mentioned.
Postnatal growth of the skull and jaws _ Dr. Nabil Al-ZubairNabil Al-Zubair
The document discusses postnatal growth of the skull and jaws. It describes several mechanisms of bone growth, including endochondral ossification where bone replaces cartilage, and intramembranous ossification where bone is laid down directly by periosteum. Growth centers in the cranial base include synchondroses like the spheno-occipital synchondrosis. The maxilla enlarges through deposition at the tuberosities and alveolar development. Mandibular growth occurs through condylar growth and alveolar development, with two-thirds of growth complete by age 10. Growth is controlled by genetic and environmental factors.
This document discusses the etiology, pathophysiology, and response to musculoskeletal infections. It begins by covering the common causes of musculoskeletal infections like injury or malnutrition. It then describes the different pathophysiological processes for osteomyelitis in adults versus children and septic arthritis. Key points include how pediatric osteomyelitis often results from hematogenous spread to the metaphysis due to vascular anatomy. This can lead to subperiosteal abscess formation and bone devascularization. The dominant pathogens are also described.
Bones grow in length through endochondral ossification at the epiphyseal plate. Chondrocytes proliferate and are replaced by bone on the diaphyseal side, increasing bone length over time. Many factors influence bone growth, including nutrients, hormones, and weight-bearing exercise. Bones also remodel throughout life, with osteoclasts resorbing old bone and osteoblasts depositing new bone to maintain strength.
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
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2. Content
• Structure and Composition
• Growth influencing factors
• Pathology
• Injury
In detail
briefly
3. 1. The physis
Primary function of growth cartilage
Primary function of growth cartilage is the continuous and controlled
elaboration of a solid scaffold (calcified cartilage) in preparation for
bone deposition.
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Embryological development
The cartilaginous precursors (anlagen) of the long
bones appear early in embryonic life.
4. The cartilaginous anlage is invaded in its central
segment by blood vessels.
This process results in ossification of the
cartilage, producing the early diaphyseal bone.
The histological specimen here is of a young rat’s
tibia.
5. By 13 weeks, in the human fetus, the
primary ossification in the diaphyses can
be seen clearly.
6. Postnatal development
Postnatally, the next skeletal event is the
invasion of the cartilaginous end caps
(epiphyses) by blood vessels, resulting in
the formation of the epiphyseal ossific
nuclei (secondary ossification centers).
7. 2. Physeal structure
The cartilaginous zones between the bony
diaphysis and the ossifying epiphyses
differentiate into complex chondral organs –
the physes.
Each physis is highly organized into
transverse zones
8. Physeal zones
These zones are respectively, from epiphysis to
metaphysis:
The reserve zone
The zone of proliferation
The zone of hypertrophy
The zone of provisional ossification
Each zone contributes different aspects of
longitudinal growth.
9. Vascular anatomy of physis
Trueta, of Oxford, England, first described the
vascularity of the physis. He noted that no
significant vessel pierced the physeal disc and
that there exist no significant anastomoses
between the epihyseal and metaphyseal vascular
trees within the bone.
10. The portion of the physis adjacent to the
epiphysis is nourished by diffusion from the
epiphyseal circulation and the zone of
provisional ossification is supplied by the
metaphyseal circulation.
11. The effect of this is that any shearing
disruption of the physis, which usually occurs
through the zone of hypertrophy, leaves each
of the separated portions of the physis with a
functional vascular supply.
1.The reserve zone and the proliferation zone are rich
in surrounding ground matrix and hence the cells are
attached strongly to each other.
2. The zone of calcification is strong due to the calcium
deposits
Hence the relatively weaker area is the zone of
hypertrophy where the cells are hypertrophying with
minimal matrix tissue
why through the zone of hypertrophy?
12. There are some epiphyses that are totally covered by articular
cartilage, notably at the proximal femur and the proximal
radius, where the vessels feeding the epiphysis are bound
down tightly to the perichondrium of the periphery of the
physis.
In such sites, a shear injury of the physis is highly likely to
devascularize the epiphysis and thereby deprive the reserve and
proliferating zones of the physis of nutrition. This commonly results in
physeal growth arrest and avascular necrosis of the affected
epiphysis.
Dale and Harris Type of blood suppy-TYPE A
14. 3. Functional anatomy of
growth cartilages
The reserve zone of the physis lies adjacent to the bone of
the secondary ossific center: it comprises small, scattered
round cells, densely nucleated, and with an abundant
endoplasmic reticulum, a clear indication that they are
actively synthesizing protein.
Their function remains obscure – they do not proliferate at
any rate that could contribute to the cell populations of the
other zones of the physis.
Longitudinal growth
15. The proliferating zone of the physis is the zone in
which the cells reproduce more rapidly and the
more mature ones align themselves in columns, in
preparation for hypertrophy.
16. The proliferating zone cells are the
fundamental “power-house” of the
physis. If they cease to reproduce, for
example if deprived of nutrients as a
result of lost blood supply to the
epiphysis, then longitudinal growth will
cease.
18. The hypertrophic cells each
lie in a lacuna, separated
longitudinally by septa and
laterally by interterritorial
matrix.
19. As the cells mature, they enlarge: this
enlargement is greater in length than in
width and it is this increase in their
longitudinal dimensions that is the
principle factor resulting in longitudinal
bone growth.
20. The most mature hypertrophic cells lie
adjacent to the zone of provisional
ossification.
At this junction the hypertrophic cells
undergo programmed cell death –
apoptosis.
21. The programmed cell death begins with the ingrowth
of capillary buds into the cell lacuna.
Also at this level, the septa and the interterritorial
matrix start to calcify.
22. Cells within the walls of the invading capillaries
send pseudopodia through the adjacent
septum into the lacuna of the most mature
hypertrophic cell, which then dies.
This is an active process, triggered by a
stimulus that is ill-understood.
23. The interterritorial matrix of some of
the cylinders occupied by the
capillary loops, is broken down by
chondroclasts, thereby enlarging the
channels.
24. Diametric growth
There is a specialized fibrous area surrounding the periphery of the
growth plate, comprising the groove of Ranvier and the perichondrial
ring of LaCroix. There are cells in this area that are specialized
chondrocytes, which increase laterally by appositional growth, thereby
resulting in an increase in the diameter of the physis as maturity
progresses.
27. 1.Growth Factors and Local Regulators Associated with Growth Plate Maturation and/or Epiphyseal Fu
Ihh-indian headge hog
Runx- a transcription factor
29. • 2. Hormones Involved in Growth Plate Maturation and
Epiphyseal Fusion-
• Estrogen-promote accelerated physeal senescence
• androgen-stimulate growth in early age and accelerate physeal
closure in late phase of puberty
• growth hormone
• IGF-1
30. Mechanical factors
• Heuter-Volkmann law-history
In the skeletally immature, bone growth is relatively inhibited in areas of
increased pressure and relatively stimulated in areas of decreased pressure or
tension.
Also, the rate of inhibition during compression across physis is more than the
rate of bone growth when distraction is applied across physis
31. Pathology
• Disorders affecting growth plate can be classified as
• Developmental dysplasias
• Metabolic
• Hormonal
• Infections
• traumatic
32. Developmental Dysplasias
• Osteochondrodysplasias refer to abnormalities of cartilage or bone
growth and development
How to evaluate disproportionate short stature
1.Full set of xrays of skull,spine,pelvis,extremities,hands,feet
2.Identify location of lesion within each bone-
epiphysis,metaphysis,diaphysis
3.Recogonition o unique pattern of abnormal skeletal ossification
4.Review of serial radiographs taken at different age
34. ⚫The chondro-osteodystropathies can be broadly classified
according to the recognizable clinical and x- ray
findings.,as follows:-
⚫1.Dysplasias with predominantly physeal and
metaphyseal changes
⚫2.Dysplasias with predominant epiphyseal changes.
35. Dysplasias with predominant physeal and
metaphyseal changes
⚫In these disorders there is abnormal physeal
growth,defective metaphyseal modelling and
shortness of tubular bones.
⚫The axial skeleton is also affected but the limbs are
disproportionately short compared to spine.
⚫The conditions are:-
37. Hereditary Multiple
Exostosis(Disphyseal Aclasias)
⚫This is the most common&least disfiguring of all the
skeletal dysplasias.
⚫The underlying fault is unrestrained transverse growth of
the physeal plate.
i) poorly modelled,broadened metaphysis,with sessile or
pedunculated exostoses arising from the cortices.
ii)A bony mottled appearance around a bony excrescence
indicates calcification in the cartilage cap
38.
39. Achondroplasia (Autosomal dominant)
⚫In this condition.,the adult height is usually around 122
cm(48 inches)
⚫This is the commonest form of abnormal short stature.
⚫The main pathology lies in the abnormal
endochondral longitudinal growth.
⚫The physis show diminished,and less regular cell
proliferation which accounts for diminished length of
tubular bones.
40. ⚫The main fault is the point mutation in the gene coding for
fibroblast growth factor receptor 3.,which plays key role in
endochondral cartilage growth.
⚫X-ray findings:-i)The tubular bones are short,with wide
metaphysis and physeal lines are irregular.,with normal
epiphysis.
⚫ii)The proximal limb bones are disproportionately
affected(rhizomelia),changes are also seen in wrist and
hands,where the metaphyses are broad and cupshaped.
⚫These features are best defined on CT/MRI.
41. Hypochondroplasia
⚫This is a very mild form of achondroplasia.
⚫There will be shortness of stature and noticeable
lumbar lordosis.
⚫Head&face are not affected.
42. Dyschondrosteosis
⚫autosomal dominant defect.
⚫disproportionate shortening of limbs.,but it is mainly the
middle segments(forearms and legs)which are
affected(mesomelia).
⚫Stature is reduced but not as markedly as in
achondroplasia.
⚫The most characteristic X-ray findings are shortening of
forearms and leg bones,bowing of radius and which may
reqiure operative treatment.
43. Metaphyseal chondroplasia (Dysostosis)
⚫This describes a type of short limbed dwarfism in
which bony abnormality is virtually confined to
metaphysis.
⚫The epiphysis are unaffected but the metaphyseal
segments adjacent to the growth plates are broadened and
mildly scalloped.,somewhat resembling rickets.
44. Dyschondroplasia
(Enchondromatosis;Ollier’s disease)
⚫defective transformation of physeal cartilage columns
into bone.
⚫ i)Typically this disorder is unilateral.,indeed only one limb
or even one bone is involved.
⚫ii)An affected limb is short,and if the growth plate is
asymmetrically involved,the bones grows bent.
⚫The condition is not inherited.
45. ⚫The characteristic X-ray change is radiolucent
streaking extending from the physis into the
metaphysis.,the apperance of
persistent,incompletely ossified cartilage
columns trapped in bone.
46. Maffucci’s
Syndrome
⚫This rare disorder is characterized by development of
multiple enchondromas and soft tissue hemangiomas of
skin & viscera.
⚫Lesions appear during childhood; boys and girls are
affected with equal frequency.
47. Dysplasias with predominantly epiphyseal
changes
⚫This group of disorders is characterized by abnormal
development and ossification of epiphysis,resulting in
distortion of bone ends.
⚫Various dysplasias are enlisted as follows
⚫1.Multiple Epiphyseal Dysplasia
⚫2.Spondyloepiphyseal Dysplasia
⚫3.Dysplasia epiphysealis Hemimelica
⚫4.Chondrodysplasia Punctata(Stippled Epiphysis)
⚫5.Mucopolysaccharidoses
48. Multiple Epiphyseal Dysplasia
⚫There is widespread involvement of the epiphyses but the
vertebrae are not at all, or only mildly affected.
⚫C/F:- first sign-delay in walking
⚫Children are below average height and the parents
may have noticed that the lower limbs are
disproportionately short compared to the trunk
49.
50. ⚫X-Ray:-delay in appearance of ossification centres
⚫When they do appear-small, fragmented,mottled and flattened
⚫Proximal femur is most affected.
⚫Acetabular changes are seen in Med (vs perthes)
51. Spondyloepiphyseal
Dysplasia(SED)
⚫Short trunk+rhizomelic+melomelic with sparing of hands and feet
⚫wellmarked vertebral changes – delayed ossification,
flattening of the vertebral bodies (platyspondyly), irregular ossification of the ring
epiphyses and indentations of the end-plates (Schmorl’s nodes).
53. DYSPLASIA EPIPHYSEALIS
HEMIMELICA(TREVOR’S DISEASE)
⚫non-hereditary disease that is characterized by
osteochondromas arising from the epiphyses
⚫It’s a sporadic disorder which usually appears at the
ankle or knee.
⚫The child (most often a boy) presents with a bony
swelling on one side of the joint;
⚫several sites may be affected – all on the same side in
the same limb, but rarely in the upper limb.
54. CHONDRODYSPLASIA
PUNCTATA(STIPPLED EPIPHYSIS)
⚫Stippled calcifications within epiphysis in infancy+ short
stature+dry scaly skin+ heart defects+cataracts
⚫The characteristic x-ray feature is a punctate stippling of the
cartilaginous epiphyses and apophyses.This disappears by the
age of 4 years but is often followed by epiphyseal
irregularities and dysplasia.
56. RICKETS
⚫Rickets refer to the condition where it occurs before
closure of growth plate so that abnormalities of skeletal
growth are super-imposed.
57. Renal Oseodystrophy
⚫The bone changes are due to combination of
hyperparathyroidism,osteitis
fibrosa,osteomalacia,osteosclerosis,osteoporosis and
peripheral new bone formation.
⚫The bone changes are associated with extraskeletal
calcification.
⚫C/F:-stunted growth,very low body weight,dwarfism at
puberty,toxic inhibition of growth plates,slip of the capital
femoral epiphysis.
58. Hormonal
⚫The various hormonal disorders which affect the
growth plate are:-
⚫1.Hypopituitarism
⚫2.Hyperpitutarism
⚫3.Hypothyroidism
⚫The clinical effects of these hormonal imbalances
mainly depend upon the stage of skeletal maturity at
which the abnormality occurs.
59. Hypopituitarism
⚫Anterior pituitary hyposecretion results in development of two
distinct clinical disorders.
⚫1.Lorain Syndrome:- The predominant effect is on
growth.
⚫Proportionate dwarfism is seen.,sexual development may be
unaffected.
⚫2.Frohlich’s adiposogenital syndrome:-There is delayed
skeletal maturity associated with adiposity and immaturity of
the secondary sexual characters.
⚫weakness at the physis combined with disproportionate
adiposity may result in epiphyseal
displacement(epiphysiolysis/slipped epiphysis) at the hip or
knee.
60. Infections
⚫Acute osteomyelitis-almost invariably a disease of
children.,organisms usually settle in metaphysis,most often in
proximal tibia or at proximal/distal femur.
⚫C/F:-severe pain,fever,malaise & toxaemia in neglected
cases.
⚫Metaphyseal tenderness and resistance to joint movement
can be seen.
⚫Compensatory increase in activity of physis of affected site is
seen due to hyperemia after acute osteomyelitis
62. Salter and Harris described 5 patterns of injury to
the physis:
Type I – a physeal shear without bony injury
Type II – a partial physeal shear associated
with a largely vertical metaphyseal bony
fracture
Type III – a partial physeal shear plus an epiphyseal
fracture.
Type IV – a vertical fracture plane passing through the
epiphysis, the physis and the metaphysis.
Type V – a physeal and metaphyseal crush injury,
destroying the related portion of the physis: sometimes
evident by a small metaphyseal bulge. Such injuries are
frequently diagnosed in retrospect
63. 1)There exist also complex multiplanar injuries of the physis,
epiphysis and metaphysis, not categorized by Salter and Harris.
Such complex injuries are exemplified by the
triplane group of injuries seen at the distal tibial
physis.
Disadvantages of salter and harris
2)No significant prognostic value
64. Peterson classification(1994)
• Sound anatomical basis
• Type 1-minor involvement
• Type 2- to progressive more involvement
• Type 3 –to complete transphyseal disruption
• Type 4 –to transphyseal disruption with epiphyseal fracture that
ensures damage to the germinal layer of cells
• Type 5 –to longitudinal disruption of the epiphysis, physis and
metaphysis
• Type 6 – to removal or loss of some of the physeal cartilage
67. Summery
• Anatomy and development of physis
• Physeal growth
• Physeal vascularity
• Hormonal and mechanical factors influencing physis
• Heuter Volkmann law
• Physeal pathology including developmental disorders infections
trauma
68. References
1. Ao reference
2. Epiphyseal growth plate fractures by Hamilton A Peterson
3. Tachdjian’s Pediatric Orthopedics-5th edition
4. Hyphenated history: the Hueter-Volkmann law.
Article in American journal of orthopedics (Belle Mead, N.J.) ·
December 1997