Post Polio Residual Palsy: Pathophysiology & Principles of RxAnisuddin Bhatti
Prof. Anisuddin Bhatti, Paeds Orthop Surgeon delivered lecture on Post Polio paralysis and deformities Part 1 on Pathophysio and principles of treatment, through Dr. Ziauddin University Hospital Clifton Karachi webinar on googel.meet, on 3rd April 2021. Acknowledge for material taken from Research papers, slideshare and books as referred in reference list.
Prof. Anisuddin Bhatti, Paediatric Orthopaedic Surgeon, Dr. Ziauddin University Hospital, Clifton campus Karachi, presented lecture on Congenital Clubfoot and PPV deformity evaluation & treatment. On 31 May 2021 to Resident's of AKUH and others. Acknowledged text & picture source as indicated in reference list.
Prof. Anisuddin Bhatti Cerebral Palsy case Orthopaedic Examination lecture o...Anisuddin Bhatti
Prof. Bhatti, Anis deliver on line lecture to Orthopaedic community & trainees, on CP Orthopaedic assessment, and case discussion.
It is acknowledged to take few pics borrowed from Prof. Sharaf Ibraheem of Malaysia and from Google along with some text as well.
Prof. Anisuddin Bhatti gave lectures to residents & Junior consultants on PostPolio Residual Paralysis part2 lower limb Reconstructive surgery on 17.04.202. Acknowledged for text and figures as such in reference list.
Prof. Anisuddin Bhatti, Paediatric Orthopaedic Surgeon @ Dr. Ziauddin University Hospital, Clifton, Karachi, presents webinar GAIT DISORDERS & ANALYSIS with Sp reference to Trendelenburg gat & Cerebral Palsy Spastic gaits
Dr. Anis Bhatti's Lecture on Clinical assessment of a cerebral palsy patient for orthopaedic surgery management. Dr. Ziuaddin university Hospital, Clifton, Karachi,Pakistan.
Post Polio Residual Palsy: Pathophysiology & Principles of RxAnisuddin Bhatti
Prof. Anisuddin Bhatti, Paeds Orthop Surgeon delivered lecture on Post Polio paralysis and deformities Part 1 on Pathophysio and principles of treatment, through Dr. Ziauddin University Hospital Clifton Karachi webinar on googel.meet, on 3rd April 2021. Acknowledge for material taken from Research papers, slideshare and books as referred in reference list.
Prof. Anisuddin Bhatti, Paediatric Orthopaedic Surgeon, Dr. Ziauddin University Hospital, Clifton campus Karachi, presented lecture on Congenital Clubfoot and PPV deformity evaluation & treatment. On 31 May 2021 to Resident's of AKUH and others. Acknowledged text & picture source as indicated in reference list.
Prof. Anisuddin Bhatti Cerebral Palsy case Orthopaedic Examination lecture o...Anisuddin Bhatti
Prof. Bhatti, Anis deliver on line lecture to Orthopaedic community & trainees, on CP Orthopaedic assessment, and case discussion.
It is acknowledged to take few pics borrowed from Prof. Sharaf Ibraheem of Malaysia and from Google along with some text as well.
Prof. Anisuddin Bhatti gave lectures to residents & Junior consultants on PostPolio Residual Paralysis part2 lower limb Reconstructive surgery on 17.04.202. Acknowledged for text and figures as such in reference list.
Prof. Anisuddin Bhatti, Paediatric Orthopaedic Surgeon @ Dr. Ziauddin University Hospital, Clifton, Karachi, presents webinar GAIT DISORDERS & ANALYSIS with Sp reference to Trendelenburg gat & Cerebral Palsy Spastic gaits
Dr. Anis Bhatti's Lecture on Clinical assessment of a cerebral palsy patient for orthopaedic surgery management. Dr. Ziuaddin university Hospital, Clifton, Karachi,Pakistan.
Guided Growth for Angular Knee Deformities in Nutritional Rickets ChildrenTamer El-Sobky
Nutritional rickets in children is a global health concern. It manifests in generalized skeletal deformities including angular or coronal plane knee deformities. Guided growth surgery is a recognized treatment option for angular knee deformities in general. However, there is insufficient citations on its use in the treatment of angular knee deformities in children with nutritional rickets. Rachitic lower limb deformities can be complex. They are usually multiostotic, multiapex and multiplane and require extensive corrective osteotomies. However osteotomies are fraught with complications and can be technically demanding. In this presentation we present our experience with the use of surgical guided growth as a minimally invasive treatment option to correct angular knee deformities in children with nutritional rickets.
Prof. Anisuddin Bhatti. Paediatric Orthopaedic surgeon presented this lecture as 4th in series of Dr. Ziauddin University karachi webinar series. Treatment principles & protocols of Open reduction in DDH in age over 8 years. especial reference given to Triple redirection osteotomies.
Mock Virtual Clinical examination on long case delivered through zoom.us @ CPSP lahore on 4.8.2020. Describe how to give long case in Covid situation without a real patient.
Prof. Anisuddin Bhatti describes spasticity management in Cerebral Palsy patients. Botulinum Toxin (BOTOX) therapy and its application techniques live demonstration given. lectured delivered on zoom.us on 13th September 2020 for Trainees & trainers at Pakistan. Acknowledged for few text material & pictures taken from google.com and E Blecks book on Cerebral Palsy.
Prof. Anisuddin Bhatti Paediatric Orthopaedic Surgeon Dr. Ziauddin University Hospital, Clifton, Karachi delivered lecture on DZU Webinar series Lecture 2 on Legg Calve Perthes. Declared few pics and material taken from google.
Prof Anisuddin Bhatti Paediatric orthopaedic surgeon Dr. Ziauddin University Hospital Clifton, Karachi delivered Lectures to trainees and Junior consultants on PERTHES' part-1, [Pathogenesis, Diagnosis, Classification and case discussion] on 20th February 2021, through Dr. Ziauddin Hospital Clifton Webinar series. Part-2 on Perthes' management to be delivered on 6th March 2021. he declares few pictures & material taken from Google.com and mostly his own patients
ALL (antero-lateral ligament) - extra articular ACL reconstruction - basicsMilind Tanwar
history, need, how to reconstruct, when to reconstruct.
References: *Bonasia, Davide Edoardo et al. "Anterolateral Ligament Of The Knee: Back To The Future In Anterior Cruciate Ligament Reconstruction". Orthopedic Reviews 7.2 (2015)
Biomechanical Results of Lateral Extra-articular
Tenodesis Procedures of the Knee:
A Systematic Review. Erik L. Slette, B.A., Jacob D. Mikula, B.S., Jason M. Schon, B.S., Daniel C. Marchetti, B.A.,
Matthew M. Kheir, B.S., Travis Lee Turnbull, Ph.D., and Robert F. LaPrade, M.D., Ph.D.
Guided Growth for Angular Knee Deformities in Nutritional Rickets ChildrenTamer El-Sobky
Nutritional rickets in children is a global health concern. It manifests in generalized skeletal deformities including angular or coronal plane knee deformities. Guided growth surgery is a recognized treatment option for angular knee deformities in general. However, there is insufficient citations on its use in the treatment of angular knee deformities in children with nutritional rickets. Rachitic lower limb deformities can be complex. They are usually multiostotic, multiapex and multiplane and require extensive corrective osteotomies. However osteotomies are fraught with complications and can be technically demanding. In this presentation we present our experience with the use of surgical guided growth as a minimally invasive treatment option to correct angular knee deformities in children with nutritional rickets.
Prof. Anisuddin Bhatti. Paediatric Orthopaedic surgeon presented this lecture as 4th in series of Dr. Ziauddin University karachi webinar series. Treatment principles & protocols of Open reduction in DDH in age over 8 years. especial reference given to Triple redirection osteotomies.
Mock Virtual Clinical examination on long case delivered through zoom.us @ CPSP lahore on 4.8.2020. Describe how to give long case in Covid situation without a real patient.
Prof. Anisuddin Bhatti describes spasticity management in Cerebral Palsy patients. Botulinum Toxin (BOTOX) therapy and its application techniques live demonstration given. lectured delivered on zoom.us on 13th September 2020 for Trainees & trainers at Pakistan. Acknowledged for few text material & pictures taken from google.com and E Blecks book on Cerebral Palsy.
Prof. Anisuddin Bhatti Paediatric Orthopaedic Surgeon Dr. Ziauddin University Hospital, Clifton, Karachi delivered lecture on DZU Webinar series Lecture 2 on Legg Calve Perthes. Declared few pics and material taken from google.
Prof Anisuddin Bhatti Paediatric orthopaedic surgeon Dr. Ziauddin University Hospital Clifton, Karachi delivered Lectures to trainees and Junior consultants on PERTHES' part-1, [Pathogenesis, Diagnosis, Classification and case discussion] on 20th February 2021, through Dr. Ziauddin Hospital Clifton Webinar series. Part-2 on Perthes' management to be delivered on 6th March 2021. he declares few pictures & material taken from Google.com and mostly his own patients
ALL (antero-lateral ligament) - extra articular ACL reconstruction - basicsMilind Tanwar
history, need, how to reconstruct, when to reconstruct.
References: *Bonasia, Davide Edoardo et al. "Anterolateral Ligament Of The Knee: Back To The Future In Anterior Cruciate Ligament Reconstruction". Orthopedic Reviews 7.2 (2015)
Biomechanical Results of Lateral Extra-articular
Tenodesis Procedures of the Knee:
A Systematic Review. Erik L. Slette, B.A., Jacob D. Mikula, B.S., Jason M. Schon, B.S., Daniel C. Marchetti, B.A.,
Matthew M. Kheir, B.S., Travis Lee Turnbull, Ph.D., and Robert F. LaPrade, M.D., Ph.D.
Tendon ruptures of the biceps brachii, one of the dominant muscles of the arm, have been reported in the United States with increasing frequency. Ruptures of the proximal biceps tendon make up 90-97% of all biceps ruptures and almost exclusively involve the long head.
Why Ponseti Technique in Clubfoot management MARCH 2022.pptxAnisuddin Bhatti
Prof Anisuddin Bhatti. Paediatric Orthopaedic surgeon presented talk on Why Ponseti Technique, Concept Evolution in Clubfoot treatment. Presented in AKUH Orthopaedic Review course. March 2022. Acknowledged for some text material & photo taken from published literature
Principles, pitfalls & problems of Paediatrics Fractures AKU 2023.pptxAnisuddin Bhatti
Dr. Anisuddin Bhatti Paediatric Orthopaedic Surgeon DR. Ziauddin University Karachi presented talk on Paediatric fractures principles of treatment at AKU karachi on August 2023 in Orthopaedic Review course. Acknowledged for some text material & photo taken from Published literature.
Dr. Anisuddin Bhatti Paediatric Orthopaedic Surgeon DR. Ziauddin University Karachi presented talk on Congenital Vertical Talus at AKU karachi on August 2023 in Orthopaedic Review course. Acknowledged for some text material & photo taken from Published literature.
Principles of Containment in PERTHES AKU August 2023.pptxAnisuddin Bhatti
Prof. Anisuddin Bhatti Paediatric Orthopaedic surgeon Dr. Ziauddin University hospital Clifton Karachi Pakistan Presented how to take clinic examination short case on Congenital Knee dislocation, at AKU Karachi Orthopaedic Review course on August .2023. Acknowledged for some text 7 Photo taken from Published literature.
Prof. Anisuddin Bhatti Paediatric Orthopaedic surgeon Dr. Ziauddin University hospital Clifton Karachi Pakistan Presented Principles & practice in Clubfoot at AKU Orthopaedic Review Course. October 2023. Acknowledged for Some text material & Photo taken from Global Health publication on Ponseti Clubfoot treatment & internet media.
Prof. Anisuddin Bhatti Paediatric Orthopaedic surgeon Dr. Ziauddin University hospital Clifton Karachi Pakistan Presented how to take clinic examination short case on Clubfoot Deformity, at HMC complex Peshawer on 24.11.2023
Prof. Anisuddin Bhatti Paediatric Orthopaedic surgeon Dr. Ziauddin University hospital Clifton Karachi Pakistan Presented how to take clinic examination short case on Congenital Knee dislocation, at HMC complex Peshawer on 24.11.2023
Prof. Anisuddin Bhatti Orthopaedic & Paediatric Orthopaedic surgeon Dr. Ziauddin University hospital Clifton Karachi Pakistan Presented how to take clinic examination long case on Cerebral Palsy patient, at HMC complex Peshawer on 24.11.2023
Mock Clinical Examination Long case Acetabulum frx.pptxAnisuddin Bhatti
Prof. Anisuddin Bhatti Orthopaedic & trauma surgeon Dr. Ziauddin University hospital Clifton Karachi Pakistan Presented how to take clinic examination long case on Acetabulum fracture, at HMC complex Peshawer on 24.11.2023
Prof. Anisuddin Bhatti Paediatric Orthopaedic Surgeon Dr. Ziauddin University Hospital Clifton Presented Mock Examination technique short case on Clubfoot at HMC Peshawer on 24.11.2023
Mock Examination Short case CKD to long case.pptxAnisuddin Bhatti
Prof. Anisuddin Bhatti Paediatric Orthopaedic Surgeon Dr. Ziauddin University Hospital Clifton Karachi Pakistan presented How to take Short case on congenital Dislocated knee at MOCK Examination at HMC Peshawer on 24.11.2023
Prof. Anisuddin Bhatti Paediatric Orthopaedic Surgeon Dr. Ziauddin University Hospital Clifton Karachi, Pakistan Presented Mock Clinical Examination on CP long case at Hayatabad Medical Complex Peshawer on 24.11.2023.
Bhatti's Functional Scoring System for Developmental Dysplastic HipsAnisuddin Bhatti
Prof. Anisuddin Bhatti, Paediatric Orthopaedic Surgeon, Ziauddin University Hospital, Clifton, Karachi, Pakistan, Innovated a new scoring system for evaluation of Post open reduction DDH (Developmental Dysplastic Hips). The Bhatti's Functional Scoring System elaborates eastern life styles especially daily accustomed sitting habits. BFSS is a comprehensive system that evaluate functional limitations, Range of motion, endurance, limp, and trendelenburg gait if any.
3a ddh open reduction principles & protocolsAnisuddin Bhatti
Prof. Anisuddin Bhatti, Paeds Orthopaedic surgeon, Dr. Ziauddin University Hospital Clifton Karachi, Pakistan, delivered lecture on Developmental Dysplastic Hips Treatment principles, protocols and procedures on 21.11.2020. he elaborated on principles /protocols of Open reduction. elaborated in detail on Catteral test of stability, Salters osteomy & Pemberton Osteotomy.He also gave example of disaster if principles of open reduction are violated.this lecture series on DDH was mostly for trainees and young Orthop surgeons.
2 ddh principles & protocols of rx. 0 12 m age Anisuddin Bhatti
Prof. Anisuddin Bhatti, Paeds Orthopaedic Surgeon @ Dr. Ziauddin University Hospital, Clifton Karachi Pakistan, delivered a lecture on Developmental Dysplastic Hip: Principles & protocols of Rx in age less than a year. This was a second lecture in Webinar series of DZU on DDH.third lecture on Principles of DDH surgery shall be delivered after fortnight on Friday November 20th, 2020 @ 09:00-10:00 on DZU webinar through google.
Prof. Anis Bhatti lecture on DDH evaluation & screening ProtocolsAnisuddin Bhatti
Prof. Anisuddin Bhatti, Paediatric Orthopaedic Surgeon, Dr. Ziauddin University Hospital Clifton Karachi, presented webinar on Developmental dysplastic hip, series 1. on <meet.google.com> on 16.10.2020. Presentation mostly for trainees & jr. consultants. He explained in detail, pathoanatomy, screening protocols, ultrasonography & radiological evaluation of DDH cases.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Post Polio residual Palsy & Deformities part3 Upper limb
1. POST POLIO
DEFORMITY &
PARALYSIS
Par t.3
UPPER LIMB
Reconstructive Surgery
Anisuddin Bhatti
Professor, Dr. Ziauddin Hospital, Clifton
President Rt, Paeds Ortho Society Pakistan &
POA
Focal Person, Ponseti International, Pakistan
Ziauddin Hospital, Webinar Series
SUNDAY, 18th April 2021
3. POSTPOLIO DEFORMITIES & RESIDUAL PARALYSIS
Before Embarking to Reconstructive surgery, it is
necessary to have detailed understanding &
knowledge of:
• Pathologic process
• Pathoanatomy of deformity
• Clinical Assessment
• Principles of Reconstructive Surgery
• Regional Deformities
• Management principles
• Case Discussion
Physiolone.com
4. DECISION MAKING
FACTORS
The most important factors that need attention
before embarking to reconstructive surgery
• Age of the patient,
• Functional assessment of limbs & spine
• Socioeconomic background.
• Radiographic examinations.
5. FUNCTIONAL ASSESMENT
1. Muscle Charting / power grades
2. Extent of contractures and
deformities
3. Ambulatory Status & Posture
4. LLD - Shortening of the limb
follow
6. EXTENT OF CONTRACTURES & DEFORMITIES
• Trendelenburg test
• Thomas test
• Ober / Yount’s test
• Ankle & Foot deformity
evaluation
• Pelvis & spinal curvatures
Slideshare
https://www.slideshare.net/AnisuddinBha
tti1/anis-bhatti-cp-2-clinical-assesment-
2020
Youtube https://youtu.be/IWLnWJ2P-3g
follow
7. AMBULATORY STATUS
• Observation of Gait /
Gait Lab Analysis
• Abductor Lurch
• Extensor Lurch
• Hand to Knee Gait
• The Calcaneus Gait
• Foot Drop Gait
• Short Limb Gait
Slide share
https://www.slideshare.net/AnisuddinBhatti1/4
anisbhatti-gait-disorders
youtube
https://youtu.be/96fZsU5SyYY
follow
8. PROGNOSTIC FACTORS
• i. Severity of initial paralysis
• ii. Diffuseness of its regional distribution
• Iii. Expectations & support
• Iv. Resources availibilty
• In general, the more extensive the paralysis in the
first 10 days of illness the more severe the ultimate
disability.
9. OPTIONS: RECONSTRUCTIVE SURGERY
1. Release of contractures : Fasciotomies &
Capsulotomies
II. Re-establishment of power by:
a) Tendon transfer to prevent deformities
b) Muscle transplantation: to replace a
paralyzed muscle
III. Stabilization of a relaxed or flail joint by:
(a) Tenodesis
(b) Construction of Bone block
Tenodesis of Achilles tendon to fibula
Posterior bone block
10. OPTIONS : RECONSTRUCTIVE SURGERY
IV. Correction of Deformities by
a) Osteotomies b) Arthrodesis
V. Limb lengthening (Ilizarov techniques to
release contracture & Limb Lengthening)
VI. Joint replacement surgery
VII. Correction of pelvic obliquity & Spine
deformity & stabilization
13. SHOULDER
Before imbarking to Reconstructive surgery
Important to understand Biomechanis,
Assesment forParalysed muscles & availble substitute
14. SAHA’S 1967
BIOMECHANICAL CLASSIFICATION
OF SHOULDER GIRDLE MUSCLES
Prime Movers 1. Deltoid
2. Pectoralis Major
• Bulky muscles
• Act on long lever
• Clavicular head exert major
force for abduction
Steering Group:
Superior Sterer
Supra Spinatus • By virtue of their
insertions near articular
surface & Neck-shaft axis
• Steer the head on
Gelenoid Surface.
• Exert Stablizing force
• Have limited lifting force
Horizontal Anterior steerer Sub Scapularis
Horizontal Posterior Steerer Infra Spinatus
Teres Minor
15. Depressor Group:
Intermediate Group 1. Pectoralis Major
Sternal Head
2. Latissimus Dorsi
3. Teres Major
• Rotates Humeral
head during
elevation &
the head towards
later part.
• Also Exert week
steering force on
the head
SAHA’S 1967
BIOMECHANICAL CLASSIFICATION
OF SHOULDER GIRDLE MUSCLES
16. SAHA, 1967
PATTERN OF THE UPPER LIMB PARALYSIS
& SHOULDER JOINT SUBLUXATION
Group Muscles Involved Joint Subluxation
I
Serat. Ant, Levator Scap,
Rhomboids, Trapizius, Deltoid
Rotators
May or may not be present
II
Deltoid Anterior & mid part
rotators, other girdle musce
normal
May or may not be present
III
Same as II + elbow fexor palsy &
Supinator palsy
Often present
IV
Partial palsy of Trapizius,
Seratus,etc. GlenoHumeral
muscles of elbow, wrist &
Always resent
V
Flail upper limb Present
17. Rx: PPR Paralysis & Substitutes
Paralysed Muscle Action required Substitutes
Supra Spinatus Superior Glider 1. Levator Scapulae.
Preferable due to same
direction & length of
fibers.
2. Sternocliedomasto
d
3. Scaleneus anterior
/ medius
4. Scalenus Capitus
18. Rx: PPR Paralysis & Substitutes
Paralysed Muscle Action required Substitutes
Sub Scapularis Anterior Glider 1. Upper 2
of Seratus Ant.
2. Pectoralis Minor
3. Pectoralis Major
Whole /part
Infra Spinatus Posterior Glider, acting
from behind
1. Lati dorsi
2. Teres Major
19. DELTOID PALSY
TENDON AND MUSCLE TRANSFERS
Classic methods:
•Bateman Trapezius Transfer. Single muscle transfer,
without consideration to the functions of the steering muscles.
•Arthrodesis of the Shoulder
When there is, paralytic subluxation or dislocation of
shoulder with extensive paralysis of the scapulohumeral
muscles.
20. DELTOID PALSY:
BATEMAN TRAPEZIUS TRANSFER
• Spine of scapula osteotomised
near its base in obliquity distal
& lateral.
• Split atrohic deltoid
• Roughen deep surface of
acromion, spine &
corresponding area of humerus.
• Resect lateral end of clavicle.
• Anchor acromion to humerus
as far distaly as possible with 2-
3 screw.
Source; Campbell Operative Ortopaedics
21. DELTOID PALSY:
SAHA’S TRANSFER OF TRAPEZIUS
• Entire insertion of
Trapizius along with
attached lateral end of
clavicle, A-C joint &
Acromion & adjacent part
of scapular spine to be
anchored to lateral aspect
of humerus distal to
tuberosity by two screws.
22. PARTIAL DELTOID PALSY:
HARMON TRANSFER OF DELTOID
A.Posterior part of deltoid is
functioning, middle & anterior part
Paralyzed.
B.Posterior functioning part of
deltoid transferred over atrophic
anterior deltoid.
“Mechanism: Transferred posterior part of deltoid
overlying atrophic anterior part, when contracts, it
prevents anterior dislocation of shoulder and
exerts more direct abduction force than in its
23. ARTHRODESIS
PRE-REQUISITES
Followin a shoulder fusion the scapulothoracic
motion will serve as a substitute for
glenohumeral joint motion, hence following
Primary pre-requisites are very important to have:
• Normal motor strength of the trapezius and
serratus anterior
• Normal function of the hand
Best to delay Shoulder fusion until epiphyseal closure has taken
place. Source: Benjamin Josef
24. SHOULDER ARTHRODESIS
OPTIMUM POSITION
AAOS Recommendation
Most acceptable position:
• 500 of abduction,
• 200 of flexion,
• 250 of internal rotation.
This position is functional, that allows the
patient to reach the face and top of the
head with the elbow flexed.
Variation n females:
• 300 of abduction,
• 5-100 of flexion
• 450 of internal rotation
The lesser degree of abduction is
functionally compensated for by
fusing it in greater internal
rotation.
Caution: Shoulder should never be fused in external rotation
because the limb will be positioned in an awkward and functionally poor position.
25. OPTIMUM POSITION
VERY CRITICAL TO ACHIVE, FOR A GOOD FUNCTIONAL LIMB
Caution: Shoulder should never be fused in external rotation
because the limb will be positioned in an awkward and functionally poor position.
Sourse. Deborah Allen.
Orthobullet.com
Post Operative Splint
Source:
https://shoulderelbow.org/2017/06/23/shoulder-
fusion-arthrodesis/
27. POST OPERATIVE OUTCOME WITH OPTIMAL POSITION
ACTA CHIRURGIAE ORTHOPAEDICAE ET
TRAUMATOLOGIAE ČECHOSL.,
78, 2011, p. 161 - 164
Source:
Arthrodesis for flail Shoulder
Benjamin Josef.
J. Children Orthop. Oct 2015.
28. PP RESIDUAL PARALYSIS
ELBOW AND FOREARM
MUSCLE AND TENDON
TRANSFERS TO
RESTORE
ELBOW FLEXION
Steindler’s FlxorPlasty
Clark’s Transfer of Part of Pectoralis Major
Brooks & Seddon Transfer of Pectoralis Major
Tendon
Bunnell’s Transfer of SCM muscle
Sipra’s transfer of Pectoralis Minoe
Bunnell & Carrll Anterior transfer of Triceps
Tendon
Hovanin’s Transfer of Lattisimus Dorsi
29. MUSCLE AND TENDON TRANSFERS TO RESTORE
ELBOW FLEXION
Flexorplasty: Bunnell modification of Steindler Anterior transfer of the triceps tendon
Bunnell and Carroll,
30. BROOKS & SEDDON TRANSFER
• Biceps origine detached
proximaly in groove,
Mobilised distaly to
tuberosity at Radius.
• Loop of Biceps tendon
Passed throud ditached
insertion of Pectoralis Major,
detached as close to bone
as possible
• Tendon Anchored througth
distal tendon of Biceps
31. HOVNANIAN TRANSFER OF LATI DORSI
A.Normal Anatomy of
Axila
B. Skin Incision
C. Origin & belly of
Lattisimus Dorsi
transferred to arm
Origin has been sutured
to biceps tendon and to
other suture distal to
elbow joint
32. POSTERIOR DELTOID TRANSFERS TO RESTORE
ELBOW EXTENSION
Triceps Paralysis Substitue Procedure
Requirment:
A good triceps is
essential, however,
to crutch walking
or to shifting the
body weight to
hands during such
activities as
moving from a
to a wheelchair.
Posterior Deltoid MOBERG’s
POSTERIOR
DELTOID
TRANSFER
33. SUPINATOR DEFORMITY
RESTORE PRONATION
Zancoli Rerouting Biceps tendon for
Supination Deromity
A. 1. Dorsal Skin Incision
2.Anterior incision to expose biceps
tendon & radial head
B. Exposure of introsseous membrane by
retracting dorsal muscles lateraly
C. Line at B shows Z-plasty incision to be
made in Biceps tendon. Introsseous
membrane divided at a.
D. At c. Biceps tendon divided by Z
plasty, distal segment has been
rerouted around radial neck medially,
and ends of tendon are sutured
together. Traction on tendon will
now pronate forearm as
indicated by arrow.
35. COMMON PATTERN PPRP:
HAND & WRIST
Pattern Thumb Fingers Wrist
I Weak / Paralysed
Opposition & Abduction.
Normal long flexor ?
extensor
Weak Intrinsics,
Normal Long flexors /
Extensors
Normal flexors /
extensors
II Paralysed Intrinsic &
weak long flexors /
Exensors
Paralysed Intrinsics.
Weak long flexors /
Extensors
Normal / Weak
Extensors. Normal
Flexors ( at least FCU)
III Completely paralysed
except grade 1-2 power
in long flexor or extensor
Paralysed Intrinsic,
Partialy functioning long
flexors with grade 2-3
power in 1or 2 fingers
Wrist Drop
36. HAND
COMMON PATTERN
Pattern Paralysis
I Thenar muscle paralysis
Normal Thumb extensor & Flexor
Finger & Wrist motors also functional
II Thenar Paralysis
Weak thumb long flexors & extensors
Paralyzed finger intrinsics
Weak finger flexors
Normal wrist motors
37. Pattern I Palsy of Hand
• Thenar paralysis
• normal thumb extensor & Flexors
• Finger & Wrist normal Motors
Pattern II Palsy Hand
• Thenar paralysis
weak thumb long flexor &
extensor
• Paralysed finger inrinsic
weka finger flexor
• Normal wrist motors
Source: M. Sai Krishna. M.Pardhasaradhi
38. DEFORMITIES: WRIST & HAND
1. Flexion and ulnar deviation of wrist with or without
fixed contracture.
2. Volar subluxation of the midcarpal articulation
contributing to or the cause of the above
deformity.
3. Thumb web contracture
4. Trapeziometacarpal (or carpometacarpal) joint
contracture
5. MCP joint extension contracture of 2 or more
39. HAND & WRIST
RECONSTRUCTION FOR PATTERN I
OPPONENSPLASTY
Procedure oTansfers
Opponens Plasty oFlexor digitorum sublimis of the ring finger
opponensplasty
oExtensor carpi ulnaris (ECU) opponensplasty
oPalmaris longus (PL) opponensplasty
Hypothenar muscle
opponensplasty (Huber
1921)
Abductor digiti minimi
(ADM Transfer)
Palmaris longus transfer
to rerouted extensor pollicis
brevis
40. RECONSTRUCTION FOR PATTERN II PARALYSIS
RECONSTRUCTIN FOR THENAR MUSCLES PPARALYSIS
• Extensor indicis (El) opponensplasty is done if the
extensor indicis is at least grade 4 or the PL is
transferred to the rerouted distal EPS tendon,
alternatives as in pattern I.
• For Paralyzed Finger Intrinsics (Claw Fingers):
oPL
oECRL
oECRB
41. Poor Opposition of
Thumb, Opponence
Pollicis palsy.
Pulp to Pulp opposition
restored after
opponenspalsy with flexor
digitorum superficialis
transfer.
B e n j a m i n J o s e f . S O U R C E J . C H I L D R E N O R T H O P . O C T 2 0 1 5 .
42. RECONSTRUCTION FOR PATTERN III, PARALYSIS
1st Stage
• For thenar muscle paralysis, the
trapeziometacarpal arthrodesis for
intermetacarpal bone graft procedure is done to
maintain thumb in fixed palmar abduction.
• For the weak finger intrinsics (claw), volar
capsulodesis is done at the same stage.
• Followed by a 3 wks of plaster immobilization.
43. RECONSTRUCTION FOR PATTERN III PARALYSIS
2nd Stage To improve flexion of the fingers and thumb
• The FDP tendon slips are side-stitched or tenodesed to each other at the
distal forearm so that whatever available flexion power there is can be
evenly distributed for all fingers.
3rd Stage Drop Wrist
• When the pronator or a strong superficialis tendon is available, the transfer
of either of these to the ECRB tendon provides wrist extension.
• The available FCU or FCR can also be transferred to the EDC and EPL for
finger and thumb extension