Espondilolistesis istmica del adulto. clasificacion de wiltseArturo Gomez Cano
La espondilolistesis istmica del adulto se define como un desplazamiento vertebral causado por un defecto en el pars interarticularis. Generalmente ocurre en los niveles L5/S1 y L4/5, y a menudo conduce a síntomas radiculares debido a la compresión de la raíz nerviosa. El tratamiento incluye descompresión y fusión cuando el dolor es persistente e incapacitante y no ha respondido a 6 meses de tratamiento no quirúrgico.
This document reviews scaphoid fractures, including:
- Anatomy, blood supply, biomechanics and kinematics of the scaphoid bone
- Risk factors, classification, investigations and diagnosis of scaphoid fractures
- Treatment options for both acute scaphoid fractures and scaphoid nonunions including nonoperative treatment, operative fixation, bone grafting techniques and outcomes
- Vascularized bone grafting can achieve higher union rates for proximal pole scaphoid nonunions with avascular necrosis compared to non-vascularized grafts.
The document discusses scapular fractures, including their classification, mechanisms of injury, management guidelines, surgical approaches, challenges, and two case examples. Scapular fractures can be classified based on the location of the break, including the body, processes, neck, or articular surface. They often occur with other injuries to the chest, spine, or shoulders. Treatment depends on factors like displacement, risk of malunion, and whether the fracture disrupts the shoulder's stability. Surgery may involve plates, posterior or anterior approaches, and arthroscopic repair. Managing associated injuries and assessing stability of the scapula present challenges.
Espondilolistesis istmica del adulto. clasificacion de wiltseArturo Gomez Cano
La espondilolistesis istmica del adulto se define como un desplazamiento vertebral causado por un defecto en el pars interarticularis. Generalmente ocurre en los niveles L5/S1 y L4/5, y a menudo conduce a síntomas radiculares debido a la compresión de la raíz nerviosa. El tratamiento incluye descompresión y fusión cuando el dolor es persistente e incapacitante y no ha respondido a 6 meses de tratamiento no quirúrgico.
This document reviews scaphoid fractures, including:
- Anatomy, blood supply, biomechanics and kinematics of the scaphoid bone
- Risk factors, classification, investigations and diagnosis of scaphoid fractures
- Treatment options for both acute scaphoid fractures and scaphoid nonunions including nonoperative treatment, operative fixation, bone grafting techniques and outcomes
- Vascularized bone grafting can achieve higher union rates for proximal pole scaphoid nonunions with avascular necrosis compared to non-vascularized grafts.
The document discusses scapular fractures, including their classification, mechanisms of injury, management guidelines, surgical approaches, challenges, and two case examples. Scapular fractures can be classified based on the location of the break, including the body, processes, neck, or articular surface. They often occur with other injuries to the chest, spine, or shoulders. Treatment depends on factors like displacement, risk of malunion, and whether the fracture disrupts the shoulder's stability. Surgery may involve plates, posterior or anterior approaches, and arthroscopic repair. Managing associated injuries and assessing stability of the scapula present challenges.
This document discusses hip prosthesis replacements and issues related to them. It includes a link to information on dislocated hip prostheses from an orthopedic radiology site. It also links to a Fortune article about a $1 billion verdict against Johnson & Johnson related to faulty hip implants.
Minimally invasive total hip replacementTunO pulciņš
Minimally invasive total hip replacement (MITHR) uses a smaller incision of 6-10 cm compared to the standard incision. While MITHR results in less soft tissue damage and shorter hospital stays, it also has a longer learning curve for surgeons. Early in the learning curve, complication rates are higher for MITHR. With increased experience, surgeons can perform MITHR with outcomes equivalent to conventional THR. However, the evidence does not clearly support making MITHR the standard procedure over the conventional approach. Patient characteristics and surgeon experience should guide the choice of surgical approach.
Cemented versus uncemented fixation in total hip replacementTunO pulciņš
The document discusses and compares cemented versus uncemented fixation techniques in total hip replacement (THR). Cemented fixation uses acrylic polymer to lock the bone and implant together, while uncemented implants have rough, porous coatings to allow bone ingrowth. Some advantages of cemented fixation are that it is more suitable for obese patients, has a better outcome for displastic hips, and is better for patients with osteoporosis. However, uncemented fixation has a lower revision rate within 10 years, a low risk of femoral loosening once stable fixation occurs, and does not commonly cause osteolysis. Both techniques have benefits depending on the individual patient's needs.
Anterior cruciate ligament reconstruction- allograft versus autograftTunO pulciņš
1. The document compares allograft versus autograft options for anterior cruciate ligament (ACL) reconstruction surgery. Allografts use donor tissue while autografts use the patient's own tissue.
2. There are several factors to consider for each graft including patient characteristics, surgical factors, biological incorporation, and the risk of disease transmission. Younger, high-demand athletes often due better with autografts which incorporate faster and have lower re-tear rates.
3. However, allografts can be preferable for older, lower-demand patients due to benefits like avoiding donor site morbidity and faster return to activities of daily living. Overall graft selection requires weighing these various patient and graft-specific
Presacral venous plexus bleeding in patients with pelvic fracturesTunO pulciņš
1. The document discusses presacral venous plexus bleeding in patients with pelvic fractures and various methods to stop the bleeding.
2. Techniques used to stop bleeding include pelvic packing, use of sterile metallic thumbtacks, cauterization, suturing, and ligating bleeding vessels.
3. Damage control resuscitation principles are also described, including permissive hypotension, blood product transfusion in a 1:1:1 ratio, and rewarming.
Damage control surgery is a technique used for seriously injured patients that prioritizes short-term physiological recovery over anatomical reconstruction. It involves abbreviated laparotomy to control bleeding and contamination, followed by intensive care resuscitation to correct hypothermia, coagulopathy, and acidosis, and then definitive surgery within 36-48 hours. The goal is to prevent the "lethal triad" of hypothermia, acidosis, and coagulopathy that can lead to multiple organ failure and death in trauma patients.
1. 1
Elkoņa un plaukstas locītavas
artroskopija
Edgars Barlots
MF V
10.11.2015.
Recenzēja: Dr. Ēriks Ozols
2. 2
Elkoņa artroskopija ir «atslēgas
cauruma» tipa ķirurģija, kas ļauj
ieskatīties locītavā izmantojot
mazu kameru jeb artroskopu.
Elkoņa artroskopija
3. 3
Pirmo reizi aprakstīta 1930 gados.
No diagnostiskas metodes par ārstējošu procedūru.
Populāra tikai pēdējās 3 dekādes.
Nepārtraukta attīstība.
Paaugstināts komplikāciju riksks.
Elkoņa artroskopija
4. 4
Indikācijas turpina pieaugt, bet pašlaik iekļauj:
brīvi ķermeņi, osteofīti,
osteohondrāli bojājumi, sinovīts, locītavu kontraktūra,
valgus extension overload,
nestabilitāte locītavā, intraartikulāri lūzumi,
neizskaidrojamu sāpju diagnostika.
Indikācijas
7. 7
Proksimālais AL portāls.
Ļauj labāk aplūkot
radiokapitellāro locītavu nekā
no standarta portāla.
Labs punkts, lai sāktu
vizualizēt locītavu.
Riska struktūras: n.radialis(10-
14mm attālumā, pēc elkoņa
fleksijas)
8. 8
Standarta anteromediālais
portāls.
Standarta anteromediālais
ports.
Riska struktūras: n.cutaneus
antebrachii medialis (0-5mm)
n.medianus (5-13mm)
a.brachialis (15-20mm)
9. 9
Proksimālais mediālais
portāls.
Portāls iet tieši gar humerus,
lai izvairītos no n.medianus
bojājuma.
Visplašāk lietotais portāls.
Riska struktūras: n. cutaneus
antebrachii medialis (0-9mm).
n.medianus (7-20mm)
n.ulnaris (7-18mm)
16. 16
Anamnēze
40 gadus vecs vīrietis, pēc profesijas – namdaris.
Kopš kritiena jau 2 gadus bijušas sāpes elkoņa locītavā.
Sāpes bija gan asas, gan trulas un lokalizējās elkoņa
posterolaterālaja pusē.
Sāpes pastiprinājušās pēdējos 2 mēnešus.
Klīniskais gadījums
17. 17
Sāpes pie 110° fleksijas un pie pronācijas/supinācijas.
Nav lokāla pietūkuma un lokāla temp. paaugstināšanās.
Lokāls saspringums tika konstatēts elkoņa
posterolateralajā pusē. It īpaši anconeus trijstūrī.
Nav neirovaskulāra deficīta. Radioloģiskie izmeklējumi un
asinsanalīzes bija normālas.
Objektīvi
18. 18
Diagnostiska elkoņa artroskopija tika veikta
ar pacientu lateral decubitus pozīcijā[1].
Artroskops tika ievadīts ancouneus
trijstūrī,
Ārstēšana
[1] https://www2.aofoundation.org/wps/portal/surgery?showPage=preparation&contentUrl=srg/21/03-
Preparation/21-Pos-
Lateral.jsp&bone=Radius&segment=Proximal&preparation=Lateral%20decubitus%20position&Lang
uage=en
19. 19
Tika izmantots 4 mm 30° artroskops.
http://www.proendoscopy.com/index.php?route=product/product&product_id=550
Ārstēšana
20. 20
Spieķa kaula galviņā tika atrasts labi saskatāms skrimšļa defekts.
3 pakāpe pēc International Cartilage Repai Society(ICRS) skalas.
Skrimšļa defekts tika novērsts aizvācot nekrotiskos audus un
mikrolūzumu. Tika veikta abrāzijas hondroplastija ar termālo
hondroplastiju.
http://cartilage.org/society/publications/icrs-score/
21. 21
3. Pakāpes skrimšļa defekts
uz radii galviņas locītavas
virsmas
http://www.hindawi.com/journals/crior/2012/4782
14/
22. 22
3. Pakāpes skrimšļa defekts
uz radii galviņas locītavas
virsmas
http://www.hindawi.com/journals/crior/2012/4782
14/
24. 24
473 artroskopijas 18 gadu ilgā
periodā.
4(0,8%) smagas komplikācijas.
40(11%) vieglas(prolongēta
drenāža, virspusēja infekcija,
pārejošas kontraktūras, pārejošas
nervu paralīzes).
J Bone Joint Surg Am. 2001 Jan;83-A(1):25-34.
Complications of elbow arthroscopy.
Kelly EW1, Morrey BF, O'Driscoll SW.
25. 25
»Vispārīgā anestēzija (ļauj muskuļiem relaksēties un novietot
pacientu uz vēdera vai sānu pozīcijā)
»Reģionālā anestēzija (var tikt lietota, bet tā neļauj ātri izvērtēt
nervu funkcijas pēc operācijas un pacientam šīs pozīcijas var
būs neērtas)
Anestēzija
26. 26
Pirmā artroskopija veikta 1979.gadā.
Plašāk pielietota tikai 80-to gadu vidū.
Plaukstas artroskopijas pēdējie 20 gadi.
Geissler, William (2005). Wrist Arthroscopy. New York: Springler-Verlag. ISBN 978-0387208978.
Plaukstas locītavas artroskopija
33. 33
211 plaukstas artroskopijas
2(0,9%) smagas komplikācijas
9(4,3%) vieglas komplikācijas
Visas vieglās komplikācijas izzuda pirmajās apskatēs ar
konservatīvu ārstēšanu.
J Hand Surg Am. 2004 May;29(3):406-11.
Complications of wrist arthroscopy.
Beredjiklian PK1, Bozentka DJ, Leung YL, Monaghan BA.
34. 34
Dorsal Radial portals. Portāli tiek veidoti starp
dorsālo ekstensoru nodalījumiem.
• 1-2 portāls:
• Starp 1. un 2. ekstensoru nodalījumiem
• Anatomiskajā tabakdozē
• Netiek bieži lietoti.
• 3-4 portāls:
• Starp 3. un 4. ekst. nodalījumiem
• Distāli no Listēra paugura.
• Primārais skata punkts.
• 4-5 portāls:
• Starp 4. un 5. ekst. nodalījumu. Galvenokārt priekš
instrumentiem un TFCC vizualizēšanai
• 6R portāls:
• Radiālaja pusē no ekstensor carpi ulnatis(ECU). Priekš
TFCC labošanas .
• 6U portāls:
• Ulnārajā pusē no ekstensor carpi ulnaris(ECU). Priekš
TFCC labošanas .
Slutsky, D. J. (2012). "Current Innovations in Wrist
Arthroscopy". The Journal of Hand Surgery 37 (9)