The document discusses posttraumatic stiff elbow. It covers the pathology, classification, treatment options and postoperative care of stiff elbow. The key causes of stiff elbow are capsular contracture, osteophyte formation and myositis ossificans. Treatment options include nonsurgical methods like splinting or manipulation under anesthesia, as well as open or arthroscopic surgery to release soft tissue contractures. Early motion after injury or surgery is important to prevent stiffness.
This document discusses radial club hand, which is a congenital musculoskeletal anomaly caused by failed development along the radial border of the upper extremity. It presents the embryology, classification systems, clinical features, treatment recommendations, and surgical techniques for radial club hand. Specifically, it describes the deficient muscles, skeletal abnormalities including absent radius, neurovascular anomalies, and treatment approaches such as splinting, casting, tendon transfers, centralization of the carpus, and bilobed flaps procedures.
Recurrent Dislocation of patella -PAWANPawan Yadav
This document discusses recurrent patellar dislocation. It begins by defining recurrent patellar dislocation as the patella shifting laterally with minimal stress on knee flexion. It then discusses the anatomy and Q angle as well as predisposing causes such as increased Q angle, weak medial quads, and tight lateral structures. The document outlines clinical features, tests, x-ray findings, and treatment options including conservative immobilization and surgical procedures like realignment and patellectomy.
This document discusses mallet finger injuries, which involve disruption of the extensor tendon mechanism at the distal interphalangeal joint. It covers the anatomy of the finger extensor mechanism, classification of mallet finger injuries, clinical evaluation, treatment options including nonsurgical management with splinting and surgical repair or fixation, and management approaches for different types of acute mallet finger injuries.
The patellar tendon bearing prosthesis was invented in the 1950s as an improvement over the plug fit socket. It distributes pressure over specific areas of the residual limb that are better able to tolerate pressure, such as the patellar tendon, muscles, and bone. Areas with nerves, blood vessels, and less tissue are relieved of pressure. The prosthesis has a socket, foot assembly such as a SACH foot, shank to connect them, and a suspension like a strap to hold it in place. It provides control, weight bearing ability, and acceptance for amputees.
The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; as a limb-sparing technique to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques. It is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique.
Swan neck deformity is characterized by hyperextension of the proximal interphalangeal (PIP) joint and flexion of the distal interphalangeal (DIP) joint. It results from intrinsic tightness and extensor tendon imbalance caused by rheumatoid arthritis (RA). Management involves preventing further PIP hyperextension, restoring DIP extension, and addressing any underlying joint problems or deformities based on the classification and pathophysiology. Surgical options range from splinting to tendon procedures to joint replacement depending on the severity of the deformity and RA damage.
This document discusses radial club hand, which is a congenital musculoskeletal anomaly caused by failed development along the radial border of the upper extremity. It presents the embryology, classification systems, clinical features, treatment recommendations, and surgical techniques for radial club hand. Specifically, it describes the deficient muscles, skeletal abnormalities including absent radius, neurovascular anomalies, and treatment approaches such as splinting, casting, tendon transfers, centralization of the carpus, and bilobed flaps procedures.
Recurrent Dislocation of patella -PAWANPawan Yadav
This document discusses recurrent patellar dislocation. It begins by defining recurrent patellar dislocation as the patella shifting laterally with minimal stress on knee flexion. It then discusses the anatomy and Q angle as well as predisposing causes such as increased Q angle, weak medial quads, and tight lateral structures. The document outlines clinical features, tests, x-ray findings, and treatment options including conservative immobilization and surgical procedures like realignment and patellectomy.
This document discusses mallet finger injuries, which involve disruption of the extensor tendon mechanism at the distal interphalangeal joint. It covers the anatomy of the finger extensor mechanism, classification of mallet finger injuries, clinical evaluation, treatment options including nonsurgical management with splinting and surgical repair or fixation, and management approaches for different types of acute mallet finger injuries.
The patellar tendon bearing prosthesis was invented in the 1950s as an improvement over the plug fit socket. It distributes pressure over specific areas of the residual limb that are better able to tolerate pressure, such as the patellar tendon, muscles, and bone. Areas with nerves, blood vessels, and less tissue are relieved of pressure. The prosthesis has a socket, foot assembly such as a SACH foot, shank to connect them, and a suspension like a strap to hold it in place. It provides control, weight bearing ability, and acceptance for amputees.
The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; as a limb-sparing technique to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques. It is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique.
Swan neck deformity is characterized by hyperextension of the proximal interphalangeal (PIP) joint and flexion of the distal interphalangeal (DIP) joint. It results from intrinsic tightness and extensor tendon imbalance caused by rheumatoid arthritis (RA). Management involves preventing further PIP hyperextension, restoring DIP extension, and addressing any underlying joint problems or deformities based on the classification and pathophysiology. Surgical options range from splinting to tendon procedures to joint replacement depending on the severity of the deformity and RA damage.
This document provides an overview of hallux valgus, including its anatomy, causes, symptoms, diagnosis, and treatment options. Key points include:
- Hallux valgus is a lateral deviation of the great toe and medial deviation of the first metatarsal. It can cause pain over the bunion.
- Risk factors include heredity, footwear, ligament laxity, and pes planus. Diagnosis involves examining range of motion, deformity, and taking x-rays to measure angles.
- Treatment progresses from footwear modifications and stretching to various surgical procedures depending on severity, including distal soft tissue procedures, osteotomies, and joint fusion or replacement in severe cases.
SCOLIOSIS assessment, types and managementSyed Adil
Scoliosis is an abnormal curvature of the spine that can occur in childhood or adolescence. It involves lateral curvature in the coronal plane as well as spinal rotation in the axial plane. Scoliosis is classified as either structural or non-structural. Structural scoliosis is permanent and involves bony deformities, while non-structural scoliosis is temporary and only involves curvature. The most common type of scoliosis is idiopathic scoliosis, which develops in adolescence and accounts for 90% of scoliosis cases in children. Scoliosis is assessed using Cobb's angle measurement, Adam's forward bend test, and a scoliometer. Treatment may involve bracing or surgery depending on the severity
Osteotomy around the elbow is commonly performed to correct cubitus varus and cubitus valgus deformities. For cubitus varus, the most common cause is a malunited supracondylar fracture. Surgical options include lateral closing wedge osteotomy, oblique osteotomy with derotation, and medial opening wedge osteotomy with bone grafting. For cubitus valgus, causes include nonunion of a lateral condyle fracture. Surgical options are a closing wedge medial osteotomy or opening wedge lateral osteotomy. Complications of elbow osteotomy can include stiffness, persistent deformity, myositis ossificans, loss of fixation, and neurovascular injury.
This document discusses shoulder instability, including definitions, anatomy, evaluation, and treatment. It defines instability as the inability to maintain the humeral head in the glenoid fossa, ranging from dislocation to laxity. Static stabilizers include the labrum and ligaments, while dynamic stabilizers are the rotator cuff and scapulothoracic muscles. Evaluation involves history, exam, and imaging to classify instability by direction, degree, and etiology. Treatment depends on classification but may include immobilization, rehabilitation, or surgical repair of labral tears or bone defects.
This document discusses limb length discrepancy (LLD), including its definition, causes, effects, evaluation, and management. LLD is when one lower limb is noticeably longer than the other. It is classified as structural or functional. LLD of 2.5 cm or more can cause back/hip/knee pain and gait abnormalities. Evaluation involves history, exam including block testing, and imaging like scansograms. LLD can be managed non-surgically with shoe lifts for small discrepancies or surgically with epiphysiodesis or bone lengthening depending on the severity.
Tendon transfers involve detaching a functioning muscle-tendon unit from its insertion and reattaching it to another tendon or bone to replace the function of a paralyzed muscle or injured tendon. The document discusses tendon transfers for various nerve palsies including radial nerve palsy, median nerve palsy, and ulnar nerve palsy. For radial nerve palsy, common transfers include the pronator teres muscle transferred to the extensor carpi radialis brevis tendon and the flexor carpi ulnaris muscle transferred to the extensor digitorum communis tendons. For median nerve palsy, the flexor digitorum superficialis tendon is often
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
This document discusses gamekeeper's thumb, which is a chronic injury to the ulnar collateral ligament of the thumb metacarpophalangeal joint. It can occur in gamekeepers from forcefully extending animal's necks or in skiers from falls onto an outstretched hand. The injury ranges from partial tears of the ligament to complete ruptures, which may involve an interposed tissue fragment that prevents healing. Treatment involves splinting for partial tears or surgical repair for complete tears, ideally within 3 weeks for best results.
this ppt provides a comprehensive review & exam oriented details
compiled from journals & old edition textbooks. because ITB contracture has become a rare presentation. & new edition books doesnt speak about it much...
This document discusses posterior cruciate ligament (PCL) tears. It begins with an overview of PCL anatomy and mechanisms of injury. It then covers clinical evaluation including physical examination tests like the posterior drawer test. Investigations like MRI are discussed. Finally, the document outlines management approaches for PCL tears, including non-operative treatment for mild injuries and surgical reconstruction or repair for more severe injuries. Surgical techniques like single versus double bundle reconstruction using autografts or allografts are compared. Post-operative rehabilitation protocols are also summarized.
The document discusses knee instability and describes the structure of the knee including the osseous, extra-articular, and intra-articular structures. It provides details on the menisci, ligaments including the ACL and PCL, and muscles. The document also covers causes of meniscal injuries, diagnostic tests, treatment options including non-operative treatment and surgical procedures like meniscectomy and repair.
The document discusses floor reaction orthoses (FRO). It defines an FRO as a custom plastic device that supports the ankle and foot from below the knee to the foot. An FRO works by holding the ankle in plantar flexion, which shifts the line of force from the ground reaction force behind the ankle and in front of the knee, generating extension at the knee. This allows patients with weak leg muscles to walk without knee buckling. FROs are indicated for patients with conditions like polio, cerebral palsy, or spinal cord injury that cause lower leg weakness. They provide knee stability during walking in a lightweight design.
Quadriceps contracture is caused by repeated intramuscular injections in the thigh during infancy, which leads to muscle ischemia, necrosis and fibrosis. This causes the quadriceps muscle to adhere to the bone and deep fascia, restricting knee flexion over time. Surgical release of the fibrosed muscles is usually needed to prevent late deformities and regain knee motion. Procedures aim to isolate and release the rectus femoris muscle from surrounding scar tissue using techniques like proximal release or quadricepsplasty. Postoperative physiotherapy is important for recovery.
Upper crossed syndrome is a postural condition caused by prolonged forward head positioning from activities like computer use, driving, and phone use. It involves tightness in the upper trapezius and levator scapula muscles crossing with tightness in the pectoralis muscles, and weakness in the deep cervical flexors crossing with weakness in the middle and lower trapezius. Exercises like foam rolling, rows, and chin tucks can help correct muscle imbalances, as can improving posture awareness and taking breaks from aggravating activities.
This document provides an overview of common hip deformities and surgical procedures used to treat hip issues in cerebral palsy patients. It discusses flexion, adduction, and subluxation/dislocation deformities and treatments like adductor tenotomy, iliopsoas recession/release, and varus derotational osteotomy. Flexion deformities are addressed with procedures like psoas lengthening while adduction issues are treated with soft tissue releases like adductor tenotomy. More severe cases may require bony procedures such as varus derotational osteotomy. Post-operative care focuses on physical therapy and positioning to improve hip range of motion.
This document discusses fracture diseases that can result from prolonged immobilization following fracture treatment. The principal fracture diseases include musculoskeletal issues like muscle weakness, atrophy, soft tissue contractures, osteoporosis, and joint stiffness. Prolonged immobilization can also lead to cardiovascular complications such as increased heart rate, circulatory dysfunction, orthostatic hypotension, and venous thromboembolism. Prevention of these fracture diseases focuses on proper fixation, early and frequent mobilization, muscle stretching and contraction, range of motion exercises, use of leg stockings, anticoagulant drugs, and changing patient positioning regularly.
Lower limb orthoses assist with gait, reduce pain, decrease weight bearing, control movement, and minimize deformities. They include foot orthoses and ankle-foot orthoses. Foot orthoses affect ground forces and gait rotation, and are used to treat various foot conditions like pes planus, pes cavus, metatarsalgia, and heel pain. Ankle-foot orthoses control ankle motion and provide stability, and include metal and plastic designs with options for plantar stops, dorsiflexion stops, and dorsiflexion assists.
This document provides an overview of patellofemoral pain syndrome. It defines the syndrome and discusses relevant anatomy, biomechanics, causes, clinical evaluation, imaging, and treatment options. Regarding treatment, non-operative options including rehabilitation are usually successful for 90% of cases. Surgical techniques are reserved for the remaining 10% and include arthroscopic procedures such as debridement and lateral release as well as bony procedures like tibial tubercle transfer to address malalignment issues.
This document provides information about stiff elbow, including its definition, causes, anatomy, classification systems, clinical evaluation, treatment options, and postoperative care. It defines stiff elbow as flexion less than 120 degrees and loss of extension greater than 30 degrees. Trauma is a common cause. The elbow is a highly constrained synovial hinge joint prone to stiffness. Treatment options include nonsurgical modalities like splinting or manipulation, as well as surgical options like contracture release, arthroscopic release, or total elbow arthroplasty in severe cases. The goals of treatment are to provide a pain-free, functional, and stable elbow.
This document summarizes distraction osteogenesis (DO), which is a process where new bone is formed between bone segments that are gradually separated. DO involves three phases: a latency phase, distraction phase where the bone is gradually separated, and consolidation phase where the new bone mineralizes. It discusses the history and applications of DO, including for lengthening of long bones and the mandible. Key advantages are that it allows for larger movements than traditional bone grafts and avoids prolonged fixation. Potential complications include non-compliance, pain, premature consolidation, and neurological damage.
This document summarizes distraction osteogenesis (DO), which is a process where new bone is formed between bone segments that are gradually separated. DO involves three phases: a latency phase, distraction phase where the bone is slowly separated, and consolidation phase where the new bone mineralizes. It discusses the history and applications of DO, including for lengthening of long bones and the mandible. Key advantages are that it allows for larger movements than traditional bone grafts and avoids prolonged fixation. Potential complications include non-compliance, pain, premature consolidation, and neurological damage.
This document provides an overview of hallux valgus, including its anatomy, causes, symptoms, diagnosis, and treatment options. Key points include:
- Hallux valgus is a lateral deviation of the great toe and medial deviation of the first metatarsal. It can cause pain over the bunion.
- Risk factors include heredity, footwear, ligament laxity, and pes planus. Diagnosis involves examining range of motion, deformity, and taking x-rays to measure angles.
- Treatment progresses from footwear modifications and stretching to various surgical procedures depending on severity, including distal soft tissue procedures, osteotomies, and joint fusion or replacement in severe cases.
SCOLIOSIS assessment, types and managementSyed Adil
Scoliosis is an abnormal curvature of the spine that can occur in childhood or adolescence. It involves lateral curvature in the coronal plane as well as spinal rotation in the axial plane. Scoliosis is classified as either structural or non-structural. Structural scoliosis is permanent and involves bony deformities, while non-structural scoliosis is temporary and only involves curvature. The most common type of scoliosis is idiopathic scoliosis, which develops in adolescence and accounts for 90% of scoliosis cases in children. Scoliosis is assessed using Cobb's angle measurement, Adam's forward bend test, and a scoliometer. Treatment may involve bracing or surgery depending on the severity
Osteotomy around the elbow is commonly performed to correct cubitus varus and cubitus valgus deformities. For cubitus varus, the most common cause is a malunited supracondylar fracture. Surgical options include lateral closing wedge osteotomy, oblique osteotomy with derotation, and medial opening wedge osteotomy with bone grafting. For cubitus valgus, causes include nonunion of a lateral condyle fracture. Surgical options are a closing wedge medial osteotomy or opening wedge lateral osteotomy. Complications of elbow osteotomy can include stiffness, persistent deformity, myositis ossificans, loss of fixation, and neurovascular injury.
This document discusses shoulder instability, including definitions, anatomy, evaluation, and treatment. It defines instability as the inability to maintain the humeral head in the glenoid fossa, ranging from dislocation to laxity. Static stabilizers include the labrum and ligaments, while dynamic stabilizers are the rotator cuff and scapulothoracic muscles. Evaluation involves history, exam, and imaging to classify instability by direction, degree, and etiology. Treatment depends on classification but may include immobilization, rehabilitation, or surgical repair of labral tears or bone defects.
This document discusses limb length discrepancy (LLD), including its definition, causes, effects, evaluation, and management. LLD is when one lower limb is noticeably longer than the other. It is classified as structural or functional. LLD of 2.5 cm or more can cause back/hip/knee pain and gait abnormalities. Evaluation involves history, exam including block testing, and imaging like scansograms. LLD can be managed non-surgically with shoe lifts for small discrepancies or surgically with epiphysiodesis or bone lengthening depending on the severity.
Tendon transfers involve detaching a functioning muscle-tendon unit from its insertion and reattaching it to another tendon or bone to replace the function of a paralyzed muscle or injured tendon. The document discusses tendon transfers for various nerve palsies including radial nerve palsy, median nerve palsy, and ulnar nerve palsy. For radial nerve palsy, common transfers include the pronator teres muscle transferred to the extensor carpi radialis brevis tendon and the flexor carpi ulnaris muscle transferred to the extensor digitorum communis tendons. For median nerve palsy, the flexor digitorum superficialis tendon is often
De Quervain's tenosynovitis is an inflammation of the tendon sheaths of the abductor pollicis longus and extensor pollicis brevis muscles in the wrist. It commonly affects women ages 30-50 and is caused by repetitive motions like knitting or computer use that strain the thumb and wrist. Symptoms include pain on the radial side of the wrist worsened by thumb movement. Conservative treatment involves splinting, anti-inflammatories, corticosteroid injections, and physical therapy exercises. Surgery may be considered if symptoms persist after several weeks of conservative care.
This document discusses gamekeeper's thumb, which is a chronic injury to the ulnar collateral ligament of the thumb metacarpophalangeal joint. It can occur in gamekeepers from forcefully extending animal's necks or in skiers from falls onto an outstretched hand. The injury ranges from partial tears of the ligament to complete ruptures, which may involve an interposed tissue fragment that prevents healing. Treatment involves splinting for partial tears or surgical repair for complete tears, ideally within 3 weeks for best results.
this ppt provides a comprehensive review & exam oriented details
compiled from journals & old edition textbooks. because ITB contracture has become a rare presentation. & new edition books doesnt speak about it much...
This document discusses posterior cruciate ligament (PCL) tears. It begins with an overview of PCL anatomy and mechanisms of injury. It then covers clinical evaluation including physical examination tests like the posterior drawer test. Investigations like MRI are discussed. Finally, the document outlines management approaches for PCL tears, including non-operative treatment for mild injuries and surgical reconstruction or repair for more severe injuries. Surgical techniques like single versus double bundle reconstruction using autografts or allografts are compared. Post-operative rehabilitation protocols are also summarized.
The document discusses knee instability and describes the structure of the knee including the osseous, extra-articular, and intra-articular structures. It provides details on the menisci, ligaments including the ACL and PCL, and muscles. The document also covers causes of meniscal injuries, diagnostic tests, treatment options including non-operative treatment and surgical procedures like meniscectomy and repair.
The document discusses floor reaction orthoses (FRO). It defines an FRO as a custom plastic device that supports the ankle and foot from below the knee to the foot. An FRO works by holding the ankle in plantar flexion, which shifts the line of force from the ground reaction force behind the ankle and in front of the knee, generating extension at the knee. This allows patients with weak leg muscles to walk without knee buckling. FROs are indicated for patients with conditions like polio, cerebral palsy, or spinal cord injury that cause lower leg weakness. They provide knee stability during walking in a lightweight design.
Quadriceps contracture is caused by repeated intramuscular injections in the thigh during infancy, which leads to muscle ischemia, necrosis and fibrosis. This causes the quadriceps muscle to adhere to the bone and deep fascia, restricting knee flexion over time. Surgical release of the fibrosed muscles is usually needed to prevent late deformities and regain knee motion. Procedures aim to isolate and release the rectus femoris muscle from surrounding scar tissue using techniques like proximal release or quadricepsplasty. Postoperative physiotherapy is important for recovery.
Upper crossed syndrome is a postural condition caused by prolonged forward head positioning from activities like computer use, driving, and phone use. It involves tightness in the upper trapezius and levator scapula muscles crossing with tightness in the pectoralis muscles, and weakness in the deep cervical flexors crossing with weakness in the middle and lower trapezius. Exercises like foam rolling, rows, and chin tucks can help correct muscle imbalances, as can improving posture awareness and taking breaks from aggravating activities.
This document provides an overview of common hip deformities and surgical procedures used to treat hip issues in cerebral palsy patients. It discusses flexion, adduction, and subluxation/dislocation deformities and treatments like adductor tenotomy, iliopsoas recession/release, and varus derotational osteotomy. Flexion deformities are addressed with procedures like psoas lengthening while adduction issues are treated with soft tissue releases like adductor tenotomy. More severe cases may require bony procedures such as varus derotational osteotomy. Post-operative care focuses on physical therapy and positioning to improve hip range of motion.
This document discusses fracture diseases that can result from prolonged immobilization following fracture treatment. The principal fracture diseases include musculoskeletal issues like muscle weakness, atrophy, soft tissue contractures, osteoporosis, and joint stiffness. Prolonged immobilization can also lead to cardiovascular complications such as increased heart rate, circulatory dysfunction, orthostatic hypotension, and venous thromboembolism. Prevention of these fracture diseases focuses on proper fixation, early and frequent mobilization, muscle stretching and contraction, range of motion exercises, use of leg stockings, anticoagulant drugs, and changing patient positioning regularly.
Lower limb orthoses assist with gait, reduce pain, decrease weight bearing, control movement, and minimize deformities. They include foot orthoses and ankle-foot orthoses. Foot orthoses affect ground forces and gait rotation, and are used to treat various foot conditions like pes planus, pes cavus, metatarsalgia, and heel pain. Ankle-foot orthoses control ankle motion and provide stability, and include metal and plastic designs with options for plantar stops, dorsiflexion stops, and dorsiflexion assists.
This document provides an overview of patellofemoral pain syndrome. It defines the syndrome and discusses relevant anatomy, biomechanics, causes, clinical evaluation, imaging, and treatment options. Regarding treatment, non-operative options including rehabilitation are usually successful for 90% of cases. Surgical techniques are reserved for the remaining 10% and include arthroscopic procedures such as debridement and lateral release as well as bony procedures like tibial tubercle transfer to address malalignment issues.
This document provides information about stiff elbow, including its definition, causes, anatomy, classification systems, clinical evaluation, treatment options, and postoperative care. It defines stiff elbow as flexion less than 120 degrees and loss of extension greater than 30 degrees. Trauma is a common cause. The elbow is a highly constrained synovial hinge joint prone to stiffness. Treatment options include nonsurgical modalities like splinting or manipulation, as well as surgical options like contracture release, arthroscopic release, or total elbow arthroplasty in severe cases. The goals of treatment are to provide a pain-free, functional, and stable elbow.
This document summarizes distraction osteogenesis (DO), which is a process where new bone is formed between bone segments that are gradually separated. DO involves three phases: a latency phase, distraction phase where the bone is gradually separated, and consolidation phase where the new bone mineralizes. It discusses the history and applications of DO, including for lengthening of long bones and the mandible. Key advantages are that it allows for larger movements than traditional bone grafts and avoids prolonged fixation. Potential complications include non-compliance, pain, premature consolidation, and neurological damage.
This document summarizes distraction osteogenesis (DO), which is a process where new bone is formed between bone segments that are gradually separated. DO involves three phases: a latency phase, distraction phase where the bone is slowly separated, and consolidation phase where the new bone mineralizes. It discusses the history and applications of DO, including for lengthening of long bones and the mandible. Key advantages are that it allows for larger movements than traditional bone grafts and avoids prolonged fixation. Potential complications include non-compliance, pain, premature consolidation, and neurological damage.
This document discusses fractures, including their definition, causes, types, clinical manifestations, diagnosis, management, and complications. It defines a fracture as a break in the continuity of bone structure. Fractures can be caused by trauma or pathology and are classified as open or closed, complete or incomplete. The clinical signs of a fracture include pain, swelling, deformity, and loss of function. Diagnosis involves history, physical exam, x-rays, and sometimes CT or MRI. Management focuses on realignment, immobilization, and rehabilitation through various methods like casting, traction, or surgery. Potential complications include delayed healing, nonunion, malunion, and infection.
fracture is the breakdown in the continutity of the bone alignment this has many types as the fracure this topic include its definition , etiology, pathophysiology, clinical menisfestation, diagnosis and its treatment which can be used by nursing students for taking care of the patient suffering from fracture and for learning for their examination and knowledge purpose
This document provides an overview of distraction osteogenesis. It discusses the history of distraction techniques dating back to the early 1900s. It then covers the indications, contraindications, advantages, and disadvantages of distraction osteogenesis. The document explains the biology and phases of distraction osteogenesis including osteotomy, latency, distraction, consolidation, and remodeling. It discusses variables in the distraction phase such as rate and rhythm. Overall, the document provides a high-level summary of distraction osteogenesis techniques and processes.
The document discusses fractures of the upper limb, specifically focusing on fractures of the elbow joint, radial head, and distal radius. It provides details on the anatomy, mechanisms of injury, classification systems, clinical presentation, treatment approaches, and potential complications for each type of fracture. For elbow fractures, closed and open reduction techniques are described for treating dislocations. Radial head fractures are classified using the Mason system and can be managed non-operatively or surgically with fixation or excision. Distal radius fractures commonly result from falls and involve the articular surfaces, with treatment depending on the degree of displacement.
The document discusses the Ilizarov external fixation technique for bone lengthening and reconstruction. It covers the biomechanics and components of the Ilizarov frame, how to assemble it, and the application process including corticotomy, distraction, compression, and bone transport. Potential complications are addressed as well as frame removal. The Ilizarov technique uses gradual tension applied by an external fixator to regenerate bone and soft tissue through the biological process of distraction osteogenesis.
Journal club: Etiopathology and Management of Stiff Knees: A Current Concept ...Dr.Anandu Mathews Anto
This document summarizes the causes, evaluation, and management of stiff knees. It discusses that stiffness can be caused by intra-articular or extra-articular injuries or issues. Arthroscopic lysis of adhesions is currently the preferred treatment approach when conservative measures fail, as it addresses intra-articular adhesions while avoiding the morbidities of open surgery. The procedure involves debridement of scar tissue from multiple compartments of the knee followed by manipulation under anesthesia. Post-operative physical therapy including range of motion exercises is important for recovery. While arthroscopy is effective for most cases, additional techniques like pie crusting of the quadriceps may be needed if flexion is still limited.
A mangled extremity refers to severe limb injury where viability is questionable. Emergent management prioritizes life-saving care. The decision to salvage or amputate is complex, considering scoring systems, nerve function, bone/joint integrity, and patient factors. If salvaged, options include debridement, fixation, flaps, and bone reconstruction. Amputation may provide better function than some salvaged limbs, especially with vascular/major injuries. The child's growth is also a key consideration.
The document discusses the anatomy, functions, and fractures of the patella bone. It describes the patella's location in front of the knee joint and role in improving knee extension. Common types of patellar fractures include open and closed fractures caused by direct impacts or twisting forces. Treatment involves immobilization, physical therapy to regain motion, and sometimes surgery like internal fixation using screws, plates or wires if the fracture is unstable. Post-operative rehabilitation focuses on early range of motion and weight bearing exercises while avoiding resisted extension for 6-12 weeks to allow healing.
This document provides an overview of fractures and dislocations of joints. It discusses the classification, signs, and treatment of fractures based on factors such as origin, location, complexity, and etiology. Conservative fracture treatment involves repositioning bone fragments, immobilization using plaster of Paris, and traction methods. Dislocations are also classified and the management involves reduction, immobilization, and restoring function. Common dislocations like the elbow, hip, and tibia are described. Overall, the document comprehensively summarizes the key features and approaches to fractures and dislocations.
PT Management of Fractures of Condyles of FemurNavKalsi1
This document discusses the management of fractures of the femoral condyles. It begins by classifying distal femur fractures, which include fractures of the femoral condyles. It then describes the conservative and surgical treatment options for supracondylar fractures and intercondylar fractures of the femur. Conservative treatment involves traction and casting, while surgical options include external or internal fixation devices. Post-treatment physiotherapy aims to restore range of motion, strength, and function. Exercises and weight bearing status progress over 16 weeks as healing allows. Potential complications are also outlined.
Humeral shaft fractures are common and can be associated with radial nerve injury. They are usually treated conservatively with hanging casts or braces, though surgery is sometimes needed for displaced or complex fractures. Key complications include non-union, joint stiffness, and radial nerve palsy. Careful clinical and radiographic examination is important to evaluate fracture pattern and nerve function.
This document provides information about mandibular osteotomy and genioplasty procedures. It discusses the goals of mandibular osteotomy which include establishing proper function, aesthetics, stability, and minimizing treatment time. The history of mandibular osteotomy is reviewed dating back to the 1840s. Details are given about the sagittal split ramus osteotomy technique including indications, contraindications, steps, fixation methods, advantages, and complications. Common complications addressed include edema, nerve injury, arthropathy, condylar sag, hemorrhage, infection, and relapse.
The document provides information on the muscles of mastication. It discusses the types, physical properties, embryology and classification of masticatory muscles. The four primary muscles - temporalis, masseter, lateral pterygoid, and medial pterygoid - are described in detail including their origins, insertions, actions, and clinical relevance. Accessory muscles like the digastric, mylohyoid and infrahyoid muscles are also covered. The chewing cycle and reflexes of the masticatory system are outlined.
The document summarizes a lecture on the Ilizarov external fixator. It discusses the history of its invention by Professor Gavril Ilizarov in Russia in the 1950s. It outlines the principles of distraction osteogenesis and details the components, application procedure, post-operative care, rehabilitation and removal of the Ilizarov fixator. Key indications for its use include limb lengthening, deformity correction, infected non-unions, and congenital pseudarthrosis. The document concludes with experiences using the Ilizarov technique at EMCH, including cases of infected non-unions and complex fractures.
The document provides information on the muscles of mastication. It discusses the various muscles involved in chewing like the temporalis, masseter, lateral and medial pterygoid. It describes the origin, insertion, nerve supply, actions and clinical importance of these primary muscles. It also touches upon the embryology, classification and functions of the muscles. Additionally, it explains the chewing cycle involving opening, closing and power strokes and the reflexes involved in mastication.
ANAMOLOUS SECONDARY GROWTH IN DICOT ROOTS.pptxRASHMI M G
Abnormal or anomalous secondary growth in plants. It defines secondary growth as an increase in plant girth due to vascular cambium or cork cambium. Anomalous secondary growth does not follow the normal pattern of a single vascular cambium producing xylem internally and phloem externally.
Deep Behavioral Phenotyping in Systems Neuroscience for Functional Atlasing a...Ana Luísa Pinho
Functional Magnetic Resonance Imaging (fMRI) provides means to characterize brain activations in response to behavior. However, cognitive neuroscience has been limited to group-level effects referring to the performance of specific tasks. To obtain the functional profile of elementary cognitive mechanisms, the combination of brain responses to many tasks is required. Yet, to date, both structural atlases and parcellation-based activations do not fully account for cognitive function and still present several limitations. Further, they do not adapt overall to individual characteristics. In this talk, I will give an account of deep-behavioral phenotyping strategies, namely data-driven methods in large task-fMRI datasets, to optimize functional brain-data collection and improve inference of effects-of-interest related to mental processes. Key to this approach is the employment of fast multi-functional paradigms rich on features that can be well parametrized and, consequently, facilitate the creation of psycho-physiological constructs to be modelled with imaging data. Particular emphasis will be given to music stimuli when studying high-order cognitive mechanisms, due to their ecological nature and quality to enable complex behavior compounded by discrete entities. I will also discuss how deep-behavioral phenotyping and individualized models applied to neuroimaging data can better account for the subject-specific organization of domain-general cognitive systems in the human brain. Finally, the accumulation of functional brain signatures brings the possibility to clarify relationships among tasks and create a univocal link between brain systems and mental functions through: (1) the development of ontologies proposing an organization of cognitive processes; and (2) brain-network taxonomies describing functional specialization. To this end, tools to improve commensurability in cognitive science are necessary, such as public repositories, ontology-based platforms and automated meta-analysis tools. I will thus discuss some brain-atlasing resources currently under development, and their applicability in cognitive as well as clinical neuroscience.
ESR spectroscopy in liquid food and beverages.pptxPRIYANKA PATEL
With increasing population, people need to rely on packaged food stuffs. Packaging of food materials requires the preservation of food. There are various methods for the treatment of food to preserve them and irradiation treatment of food is one of them. It is the most common and the most harmless method for the food preservation as it does not alter the necessary micronutrients of food materials. Although irradiated food doesn’t cause any harm to the human health but still the quality assessment of food is required to provide consumers with necessary information about the food. ESR spectroscopy is the most sophisticated way to investigate the quality of the food and the free radicals induced during the processing of the food. ESR spin trapping technique is useful for the detection of highly unstable radicals in the food. The antioxidant capability of liquid food and beverages in mainly performed by spin trapping technique.
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
BREEDING METHODS FOR DISEASE RESISTANCE.pptxRASHMI M G
Plant breeding for disease resistance is a strategy to reduce crop losses caused by disease. Plants have an innate immune system that allows them to recognize pathogens and provide resistance. However, breeding for long-lasting resistance often involves combining multiple resistance genes
Comparing Evolved Extractive Text Summary Scores of Bidirectional Encoder Rep...University of Maribor
Slides from:
11th International Conference on Electrical, Electronics and Computer Engineering (IcETRAN), Niš, 3-6 June 2024
Track: Artificial Intelligence
https://www.etran.rs/2024/en/home-english/
Current Ms word generated power point presentation covers major details about the micronuclei test. It's significance and assays to conduct it. It is used to detect the micronuclei formation inside the cells of nearly every multicellular organism. It's formation takes place during chromosomal sepration at metaphase.
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
The debris of the ‘last major merger’ is dynamically youngSérgio Sacani
The Milky Way’s (MW) inner stellar halo contains an [Fe/H]-rich component with highly eccentric orbits, often referred to as the
‘last major merger.’ Hypotheses for the origin of this component include Gaia-Sausage/Enceladus (GSE), where the progenitor
collided with the MW proto-disc 8–11 Gyr ago, and the Virgo Radial Merger (VRM), where the progenitor collided with the
MW disc within the last 3 Gyr. These two scenarios make different predictions about observable structure in local phase space,
because the morphology of debris depends on how long it has had to phase mix. The recently identified phase-space folds in Gaia
DR3 have positive caustic velocities, making them fundamentally different than the phase-mixed chevrons found in simulations
at late times. Roughly 20 per cent of the stars in the prograde local stellar halo are associated with the observed caustics. Based
on a simple phase-mixing model, the observed number of caustics are consistent with a merger that occurred 1–2 Gyr ago.
We also compare the observed phase-space distribution to FIRE-2 Latte simulations of GSE-like mergers, using a quantitative
measurement of phase mixing (2D causticality). The observed local phase-space distribution best matches the simulated data
1–2 Gyr after collision, and certainly not later than 3 Gyr. This is further evidence that the progenitor of the ‘last major merger’
did not collide with the MW proto-disc at early times, as is thought for the GSE, but instead collided with the MW disc within
the last few Gyr, consistent with the body of work surrounding the VRM.
Phenomics assisted breeding in crop improvementIshaGoswami9
As the population is increasing and will reach about 9 billion upto 2050. Also due to climate change, it is difficult to meet the food requirement of such a large population. Facing the challenges presented by resource shortages, climate
change, and increasing global population, crop yield and quality need to be improved in a sustainable way over the coming decades. Genetic improvement by breeding is the best way to increase crop productivity. With the rapid progression of functional
genomics, an increasing number of crop genomes have been sequenced and dozens of genes influencing key agronomic traits have been identified. However, current genome sequence information has not been adequately exploited for understanding
the complex characteristics of multiple gene, owing to a lack of crop phenotypic data. Efficient, automatic, and accurate technologies and platforms that can capture phenotypic data that can
be linked to genomics information for crop improvement at all growth stages have become as important as genotyping. Thus,
high-throughput phenotyping has become the major bottleneck restricting crop breeding. Plant phenomics has been defined as the high-throughput, accurate acquisition and analysis of multi-dimensional phenotypes
during crop growing stages at the organism level, including the cell, tissue, organ, individual plant, plot, and field levels. With the rapid development of novel sensors, imaging technology,
and analysis methods, numerous infrastructure platforms have been developed for phenotyping.
ESPP presentation to EU Waste Water Network, 4th June 2024 “EU policies driving nutrient removal and recycling
and the revised UWWTD (Urban Waste Water Treatment Directive)”
2. Introduction
• The normal range of flexion extension of elbow is 0°–145°.
• The functional range of motion required for daily activities is 30°–
130° of flexion extension and 50° of supination to 50° of pronation.
• Stiffness of elbow is defined as flexion <120°and loss of extension
>30°
3. Pathology
• MORREY, Regan and Reilly postulated three potential factors for an elbow
stiffness –
1. Complex articular congruity,
2. Brachialis muscle covering the elbow and predisposing it to MO, and
3. Prolonged immobilization in the presence of unstable fixation.
Intrinsic contractures are due to intraarticular pathology.
• The intrinsic limits from deep to superficial are joint surface incongruity,
osteophytes, synovitis and joint capsule, and ligaments contracture
Extrinsic contractures are extraarticular pathology.
• The extrinsic causes of joint limitation are contractures of muscle-tendon
units, fascial/fibrous supporting tissue that are not tendons or ligaments and
skin.
Heterotopic bone also limits motion but is a metaplasia of the above-
mentioned structures.
4. Kay’s classification
Is based on the offending structure:
• Type 1 - soft tissue contracture
• Type 2 - soft tissue contracture with ossification
• Type 3 - nondisplaced articular fracture with soft tissue contracture
• Type 4 - displaced articular fracture with soft tissue contracture
• Type 5 - posttraumatic bony bars.
5. Pathology Of Posttraumatic Capsule Contracture
• The number of myofibroblast increased 4–5 times in the joint capsule
of patients with contractures. Myofibroblasts are modified fibroblasts
which have a function of contraction
• The levels of messenger RNA (mRNA) for Type 1 and Type 3 collagen
and matrix metalloproteinases (MMP) 1 and 13 were significantly
increased in the contracture joint capsule
• The levels of mRNA for transforming growth factor (TGF-β1), extra
domain A of fibronectin, and connective tissue growth factor are
significantly increased in contracture joint capsule. All these factors are
upregulators of myofibroblasts.
• Also, α-TNF specifically modulates the functions of myofibroblasts
through regulation of PGE2 synthesis and therefore plays a crucial
role in the pathogenesis of joint capsule contracture.
6. Myofibroblasts-mast Cell-Neuropeptide Axis of fibrosis.
• This proposed mechanism is consistent with pain (neuropeptide) and
inflammation (neuropeptide and mast cells) associated with injury and
early healing phase which later gives way to contracture formation
(myofibroblasts).
Injury
Neuropeptides (SP)
Activates mast cells
Activates fibroblasts and myofibroblasts
Capsule contracture
7. Myositis ossificans
• MO/HO is the formation of mature lamellar bone in soft tissue structures
and not deposition of amorphous calcium salts in the soft tissues.
• It is histologically identical to mature bone but is metabolically more active
and lacks a true periosteal layer.
• It is formed by stimulation of pluripotent stem cells, which produce osteoid
and then mineralizes.
The risk factors for the development of MO are
• Concomitant head injury,
• Forceful and repeated manipulations,
• Multiple surgical interventions within 1st week of injury,
• Thermal burns,
• Longer time to surgery, and
• Longer time to mobilization after surgery
8. Malunions and nonunions
• Malunions and nonunions of the distal humerus, proximal ulna, and
radial head contribute to elbow stiffness in different ways.
• The coronoid and olecranon fossae can be crowded due to malunion,
fibrosis, implants, myositis mass, and callus.
• Anterior shear fractures of distal humerus and radial head fractures
commonly malunite to cause stiffness.
9. Clinical Examination And Imaging
• Detailed history and physical examination should be taken before
proceeding further.
• Plain radiographs- AP,LAT,OBLIQUE views are useful to see joint
congruity, osteophytes,loose bodies, and myositis mass.
• A CT scan can delineate all these much better.
• MRI is rarely required in the evaluation of a stiff elbow
10. Prevention of elbow stiffness
• It is important to start the elbow motion early after injury or surgery.
• Early motion can be initiated by active exercise or continuous passive
motion (CPM) with or without nerve blocks.
• However, sometimes when elbow movements cannot be started early
the elbow should be splinted in extension. Splinting the elbow in
extension creates enough pressure within the tissues around the
elbow to minimize the bleeding and extravasation of fluid.
• Recently, botulinum toxin A has been used intraoperatively after
fracture fixation and also after contracture release to prevent elbow
stiffness in postoperative period
11. Prevention of Myositis ossificans
Can be done by three methods:-
• 1. Disrupting the signal pathways – PGEs and bone morphogenetic proteins
are required for formation of ectopic bone. NSAIDs lower the formation of
PGEs by inhibiting the enzyme COX. That is why drugs such as
indomethacin, ibuprofen, and naproxen are used for prevention of
myositis.
• 2. Altering the relevant progenitor cell in the target tissue – stem cells are
very sensitive to radiation and irradiation prevents them to differentiate
into osteoblasts. Radiation dose of 600–100cGy is used to prevent MO.
• 3. Modifying the environment conducive to HO – sodium etidronate
inhibits angiogenesis needed for mineralization and can prevent
ossification.
• Radiation therapy can be combined with NSAIDs to prevent HO. However,
in the presence of a fracture, used with caution since they can cause
nonunion. Etidronate is rarely used as it predisposes to osteomalacia.
12. Nonsurgical treatment
• This modality is suitable for minimal contractures, contracture of the
duration of 6 months or less, and nonosseous reason of stiffness.
• The different modalities which can be used are serial casting, static
splinting, dynamic splinting, CPM, manipulation, and botulinum toxin A.
• Static progressive splints (turnbuckle splints) place the tissues at
maximally tolerable load and then as the tissues stretch, the load
decreases. This uses the viscoelastic properties of the tissues; tissue
tension decreases over time when placed at a constant length.
• The dynamic splints use springs or rubber bands. They employ the
principles of creep; changing length under constant load.
• The goal of both the methods is to produce plastic deformation of tissues
leading to permanent lengthening.
• It is suggested that static progressive stretching three times 30 min/day
in each direction should be the first line of treatment in patients with
posttraumatic and postsurgical elbow stiffness. If it fails or is not
applicable due to osseous reasons of stiffness, surgical intervention
should be considered.
13. • Manipulation of elbow under anesthesia can be beneficial in some,
but it has its own risks.
• It was done at an average time of 40 days after surgery.
Complications include:
• Transient ulnar nerve palsy,
• Periarticular fractures, and
• HO.
• The benefit of all the modalities is highest in the first 3 months.
However, it continues till 1 year.
14. Surgical treatment
Indicated when there is a
• Failure of nonsurgical treatment,
• Bony block to movements,
• Flexion contracture is >30°, and flexion is <130°
• It may be carried out for lesser deficiencies if it interferes with the
patient’s lifestyle or vocation.
The patient should be preferably treated within 1 year of onset of
stiffness to obtain good results.
15. Open contracture release
• The approach to the elbow joint could be
Medial, Lateral, or Anterior depending on the pathology, previous skin
incisions, and need for ulnar nerve decompression.
• There could be separate skin incisions for medial and lateral approach
or a single posterior skin incision.
• Whatever be the approach, every effort is made to preserve the
lateral collateral ligament and the anterior band of MCL. This is
important to maintain the stability of the joint.
16. (a) Lateral column procedure –
Proximal to the elbow joint, approach is between the humerus and
ECRL anteriorly and the humerus and triceps posteriorly.
Distal to the joint, this approach is between ECRL and ECRB.
Posteriorly, the capsule is incised and olecranon and olecranon fossa
reapproached.
Anteriorly, the muscle mass is taken off the capsule, which is then
excised.
Any osteophyte, loose body, or fibrous tissue is also taken off
Limitation- limited view on medial side,a separate incision on the
medial side is required.
17. (b) Medial column approach –
The ulnar nerve is isolated and mobilized.
Posteriorly, the posterior band of MCL is cut and excised to improve
flexion beyond 100°. The triceps is reflected off the humerus, and
posterior elbow capsule is cut.
Anteriorly, the brachialis is raised off the humerus after cutting the
medial septum. The anterior half of the flexor-pronator muscle mass is
raised from the medial epicondyle in continuation with the distal
brachialis. The medial anterior capsule is excised
Any osteophyte, loose body, or fibrous tissue is removed.
18. (c) Anterior approach –
a curvilinear incision starting superolaterally and ending inferomedially
is made.
The structures to be protected are medial and lateral antebrachial
cutaneous nerves, brachial artery, median, radial, and
musculocutaneous nerves.
Medially, the interval between the common flexors and biceps is
developed.
Laterally, the interval between brachioradialis and biceps is developed.
The brachialis is then isolated and separated from the anterior capsule.
Capsule can then excised, and rarely brachialis may have to be
detached distally to gain extension.
19. Results:
• Ring et al. reported that open elbow capsulectomy restores a near
100° arc of motion. Second elbow surgery provided only a limited
additional gain in movements.
• Yu et al. carried out a study to know the effect of radial head excision
and radial head replacement in stiff elbows.They found that both
resection and prosthetic replacement with open arthrolysis were
feasible and gave equal outcomes. They recommended that if elbow
is stable, resection is preferable to replacement.
• Koh et al. reported good results of surgical release of a stiff elbow
that develops after internal fixation of intercondylar fracture
humerus.However, they cautioned against refracture when the
implants were removed at the same sitting.
20. • HO is generally considered a negative predictor for outcome after
open release.
• the outcomes of elbow release after complete ankylosis due to HO
were similar to the release after partial ankylosis due to HO. Hence,
the degree of ankylosis due to HO did not matter in the final
outcome.
• They also found that the HO tends to recur more when there is a
neurological etiology.
• Functional range was poor if surgery was delayed beyond 12 mnths.
• Various authors showed results of HO excision were better when
done before 6 months. However, these were cases without
neurogenic origin of HO.
21. Hinged external fixator
• This modality is used when the collateral ligaments are damaged
after the release of stiff elbow. The ligament deficit may be on one
side or it may be global.
• Various studies used the hinged external fixator after the release of
ligaments and showed an improvement of arc of motion of 87° to
101°.
22. Arthroscopic release
• Suitable for mild to moderate contractures, with the absence of HO,
articular incongruity, and ulnar nerve symptoms/prior transposition.
• When a posterior band of MCL needs to be released in the presence
of flexion limited below 100°, it may be performed through a small
incision medially without opening the joint or by the arthroscopic
method.
• In the presence of capsular fibrosis, the distension of capsule is
minimal and that makes visualization inside the joint difficult and also
places the neurovascular structures very close to the joint and are at
risk.
23. Interposition arthroplasty
• Indication: joint incongruity in a young patient.
• A lateral approach is generally used and capsule is excised. Bone ends
are contoured with a burr. The articular surface of distal humerus is
resurfaced using autologous fascia lata, autologous skin, or allograft
Achilles tendon. The ligaments are repaired and an articulated fixator
is applied.
24. Total elbow arthroplasty
• It is a salvage procedure for stiff elbows in old people
• A linked semiconstrained design is most suitable.
• There is no high-level guideline to choose a particular surgical
procedure for the stiff elbows.
25. Postoperative care
• The success of treatment is dependent on patient’s understanding
and willingness to comply with a rigorous postoperative protocol.
• Supervised physiotherapy of the operated elbow.
• Limb elevation and anti-inflammatory drugs.
• It is important that the movements of the elbow are started early to
avoid adhesion formation and recurrence of stiffness.
26. • The easiest method of mobilization of elbow is passive manipulation
in the early phase and then active assisted exercises in the later
phase.
• Initiate passive manipulations of elbow on the 1st or 2nd
postoperative day.
• Both flexion and extension are gained simultaneously and not one
after the other. No effort is made to gain supination or pronation if
the ipsilateral wrist is also stiff after trauma.
• Active/active-assisted range of motion by the 4th or 5th
postoperative day.
27. Adjuncts to physiotherapy
• Cryotherapy/ice packs – these can help to decrease the swelling of
the part and hence the local pain. They can also help to reduce the
requirement of analgesics
• Continuous passive motion – the role is debatable. There are reports
which claim benefits of CPM in the postoperative period. The
proponents of this modality consider almost mandatory to employ it in
the postoperative period. However, there are reports which consider it
nonessential.
• The progressive static splints are useful after 6 weeks. It can be
applied in flexion or extension during night depending on the deficit
• Use of intraarticular steroid, MUA, or botulinum toxin A can be
performed.
The physical therapy after surgery can be continued till 12 months
after surgery or a plateau is reached
28. CONCLUSION
• The elbow has been traditionally splinted in 90° of flexion after surgery.
However, it has been shown that splinting in extension creates enough
pressure within tissues around the elbow joint that it prevents
extravasation of fluid and minimizes the bleeding.
• Early surgery and early mobilization help to prevent ho
• Conservative treatment can help when the stiffness <6 mnths, minimal,
and nonosseous in nature.
• No guidelines regarding the choice of the procedure. It is mostly
dependent on the surgeon’s choice and to a lesser extent on the pathology
of stiff elbow.
• Traditionally passive exercises have been considered detrimental to the
elbow joint. But now, they form a part of the physiotherapy program and
are started early when active exercises are difficult to perform due to pain.