The document discusses the principles of fracture management. It covers fracture classification, emergency care including splinting and analgesia, and definitive treatment including closed and open reduction, immobilization methods like casting, traction, and fixation. The goals of treatment are to heal the bone in proper position and return function with minimal time, expense and complications. Classification systems help guide treatment and prognosis.
This document discusses definitive treatment of pelvic ring injuries (PRI). It defines instability as the inability to sustain loads required for patient mobilization without significant displacement. Bucholz classification is used to define injury patterns and treatment options. Type I injuries involve the anterior ring and are inherently stable, allowing non-operative treatment. Type II injuries are rotationally unstable and may require anterior fixation. Type III injuries are rotationally and vertically unstable, involving the posterior ring, and always require operative stabilization. Approaches can be anterior or posterior depending on the injury pattern and patient factors. Anterior plating or external fixation can be used for the anterior ring, while plates or screws are used for posterior ring fixation through anterior or posterior approaches.
This document discusses spinal orthosis and cervical orthosis. It provides information on the principles and indications of orthotic devices. Some key points include: orthotic devices are prescribed to improve function, relieve pain, and prevent/correct deformities. Proper fitting is important for comfort. Orthoses can immobilize joints and reduce weight bearing to aid healing. Cervical orthoses specifically are used to limit neck movement and muscle spasm after injuries or surgeries. Common types of cervical orthoses include soft collars, Philadelphia orthosis, and halo vest.
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.
This document discusses spinal orthosis and cervical orthosis. It provides an overview of the principles and indications for orthotic devices. Specifically, it outlines the functions of orthosis in relieving pain, immobilizing joints, reducing weight bearing, preventing and correcting deformities, and improving function. It also describes different types of cervical orthosis including soft collars, Philadelphia collars, and halo vests. The key objectives of spinal orthosis are to control spinal position, apply corrective forces, and aid stability.
This document provides information on the initial evaluation and management of orthopedic injuries. It defines types of injuries like fractures, dislocations, sprains and strains. It describes signs and symptoms, mechanisms of injury, and principles of splinting and immobilizing various fractures and injuries of the shoulder, upper arm, forearm, thigh, lower leg, ankle and foot. The document emphasizes the importance of assessing circulation, sensation and movement after injury and immobilization.
This document summarizes a study that evaluated outcomes of treating 38 patients with closed segmental tibial fractures using external fixation. Segmental tibial fractures involve two or more fracture lines separating the tibia into segments. The study assessed time to fracture healing, complications, and functional recovery. Most fractures (68%) healed without issues, while 24 fractures (32%) had complications like delayed or non-union that required further treatment, with most of these ultimately healing. The study concluded that external fixation is a suitable treatment for segmental tibial fractures, achieving an acceptable rate of healing and complications.
This document discusses tibial pilon fractures, which involve fractures of the distal tibial articular surface. Key points include:
1) The term "tibial pilon" was first used in 1911 to describe the distal tibia resembling a pestle. Pilon fractures account for 7-10% of tibial fractures and usually result from high-energy mechanisms.
2) Classification systems include the Rüedi-Allgöwer system (based on articular displacement/comminution) and the AO/OTA system (which further subdivides based on extra-articular involvement and comminution).
3) Treatment involves restoring tibial alignment, stabilizing the fracture to facilitate union,
This document discusses definitive treatment of pelvic ring injuries (PRI). It defines instability as the inability to sustain loads required for patient mobilization without significant displacement. Bucholz classification is used to define injury patterns and treatment options. Type I injuries involve the anterior ring and are inherently stable, allowing non-operative treatment. Type II injuries are rotationally unstable and may require anterior fixation. Type III injuries are rotationally and vertically unstable, involving the posterior ring, and always require operative stabilization. Approaches can be anterior or posterior depending on the injury pattern and patient factors. Anterior plating or external fixation can be used for the anterior ring, while plates or screws are used for posterior ring fixation through anterior or posterior approaches.
This document discusses spinal orthosis and cervical orthosis. It provides information on the principles and indications of orthotic devices. Some key points include: orthotic devices are prescribed to improve function, relieve pain, and prevent/correct deformities. Proper fitting is important for comfort. Orthoses can immobilize joints and reduce weight bearing to aid healing. Cervical orthoses specifically are used to limit neck movement and muscle spasm after injuries or surgeries. Common types of cervical orthoses include soft collars, Philadelphia orthosis, and halo vest.
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.
This document discusses spinal orthosis and cervical orthosis. It provides an overview of the principles and indications for orthotic devices. Specifically, it outlines the functions of orthosis in relieving pain, immobilizing joints, reducing weight bearing, preventing and correcting deformities, and improving function. It also describes different types of cervical orthosis including soft collars, Philadelphia collars, and halo vests. The key objectives of spinal orthosis are to control spinal position, apply corrective forces, and aid stability.
This document provides information on the initial evaluation and management of orthopedic injuries. It defines types of injuries like fractures, dislocations, sprains and strains. It describes signs and symptoms, mechanisms of injury, and principles of splinting and immobilizing various fractures and injuries of the shoulder, upper arm, forearm, thigh, lower leg, ankle and foot. The document emphasizes the importance of assessing circulation, sensation and movement after injury and immobilization.
This document summarizes a study that evaluated outcomes of treating 38 patients with closed segmental tibial fractures using external fixation. Segmental tibial fractures involve two or more fracture lines separating the tibia into segments. The study assessed time to fracture healing, complications, and functional recovery. Most fractures (68%) healed without issues, while 24 fractures (32%) had complications like delayed or non-union that required further treatment, with most of these ultimately healing. The study concluded that external fixation is a suitable treatment for segmental tibial fractures, achieving an acceptable rate of healing and complications.
This document discusses tibial pilon fractures, which involve fractures of the distal tibial articular surface. Key points include:
1) The term "tibial pilon" was first used in 1911 to describe the distal tibia resembling a pestle. Pilon fractures account for 7-10% of tibial fractures and usually result from high-energy mechanisms.
2) Classification systems include the Rüedi-Allgöwer system (based on articular displacement/comminution) and the AO/OTA system (which further subdivides based on extra-articular involvement and comminution).
3) Treatment involves restoring tibial alignment, stabilizing the fracture to facilitate union,
Fracture its types classification and manangmentMuhammad azeem
This document discusses fracture classification and management. It defines a fracture and describes how fractures are classified based on factors like whether they are open or closed, the degree of displacement, location, and number of fragments. The major classifications are closed fractures, open fractures, and physeal fractures. Closed fractures do not break the skin, while open fractures do. Fractures are also classified as reducible or non-reducible based on the number of fragments. The document outlines different types of closed fractures and discusses fracture reduction and management strategies.
1) The floating knee refers to ipsilateral fractures of the femur and tibia where the knee is disconnected from the rest of the limb. Type I injuries do not extend to the knee joint while Type II injuries involve the knee joint.
2) Treatment of Type I injuries typically involves nailing of both fractures to provide stability and allow early mobilization. Plating may be used if there is intra-articular involvement of the distal femur or tibia.
3) Outcomes depend on factors like the type of fracture, presence of soft tissue injuries, age, and whether the fractures are open or intra-articular. While surgical stabilization of both fractures can provide the best results, the treatment approach needs
This document provides an overview of knee anatomy and surgical procedures related to the meniscus, ACL, MCL, PCL, and patellofemoral joint. It begins with meniscal anatomy and function, then discusses factors in meniscal repair versus resection and different repair techniques. Next, it covers ACL anatomy and evidence on surgical treatment. It also discusses anatomy and treatments for MCL, PCL, and posterolateral corner injuries. Finally, it summarizes patellar instability including causes, assessment, and imaging. Key surgical procedures are highlighted throughout like ACL reconstruction techniques and options for cartilage repair.
1. The clavicle is the only long bone that lies horizontally in the body and connects the thorax to the shoulder girdle.
2. Clavicle fractures are classified based on their location as medial, middle, or lateral thirds. Common causes are falls on an outstretched hand or lateral shoulder.
3. Treatment depends on the fracture type and patient factors, ranging from sling immobilization to surgical fixation with plates or screws.
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
This document discusses the presentation and management of a 34-year-old man with a left tibial plateau fracture from trauma. It was found that he had normal sensation and motor function in the leg with normal pulses and no signs of compartment syndrome. The document then reviews the mechanisms, imaging, classification, treatment options including non-operative and operative management, prognosis, complications and surgical approaches for tibial plateau fractures.
Hip Dislocations: Ortho topic presentation 2018AkuilaWaradi
Hip dislocations are orthopedic emergencies that require prompt reduction to prevent complications. The most common type is posterior hip dislocation caused by high-energy injuries like motor vehicle accidents. Closed reduction techniques like the Allis or Bigelow maneuvers are generally attempted first, while open reduction may be needed for unstable or complex injuries. After successful reduction, the hip is immobilized and physical therapy begun to restore range of motion and strength without reinjury. Complications can include avascular necrosis, nerve palsies, and recurrent dislocations if not properly managed.
Subtrochanteric fractures occur in the region of the femur between the lesser trochanter and 5 cm distal to it. They are challenging injuries to treat due to strong muscle forces and high stresses in this region. Surgical stabilization with an intramedullary nail is usually recommended to provide rigid fixation while minimizing stress on the implant. Care must be taken to achieve and maintain an anatomical reduction to prevent complications like malunion and nonunion. Long-term bisphosphonate use may be associated with an increased risk of subtrochanteric fractures with a characteristic radiographic appearance.
Mipo- biomechanics and biology -Dr.S.Senthil Sailesh MS OrthoSenthil sailesh
1) MIPO technique preserves the blood supply to bone through submuscular plating and preservation of the endosteal blood supply.
2) Specimens that underwent MIPO showed good preservation of nutrient arteries and blood flow, unlike ORIF specimens which showed disruption.
3) Fracture healing requires good reduction of fragments, stabilization through methods like indirect reduction using traction or direct reduction with clamps, and maintaining stability through techniques like compression plating or lag screw fixation.
Patellar fractures can be classified as displaced or nondisplaced. Treatment depends on the type of fracture and may include casting, open reduction and internal fixation, or partial/total patellectomy. The rehabilitation goals are to restore full range of motion, improve muscle strength and balance especially of the quadriceps, and normalize gait. Long-term considerations include the potential for loss of correction, degenerative changes, quadriceps shortening, knee flexion contractures, and chondromalacia patella.
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.
Subtrochanteric femur fractures are challenging to treat due to deforming forces. Intramedullary nails are the gold standard treatment as they provide better biomechanical stability compared to plates. Multiple reduction techniques such as clamps, joysticks, and blocking wires may be needed to achieve and maintain anatomical alignment given the typical fracture deformity of varus and procurvatum. Complications include malunion, nonunion, infection, and implant failure, with early mortality rates around 10%. Proper surgical technique and implant selection are important to optimize outcomes for these difficult fractures.
This document discusses surgical procedures and postoperative management for joint injuries and diseases of the elbow. It describes common fractures of the elbow region including the radial head. Surgical options for fractures include open reduction and internal fixation, arthroscopic techniques, and radial head excision. The goals of surgery and rehabilitation are to relieve pain, restore alignment and stability, and regain strength and range of motion. Postoperative management involves immobilization, progressive range of motion and strengthening exercises. Total elbow arthroplasty is an option for severe arthritis.
Updated PCL, PLC and Knee Dislocation for Postgraduate Orthopaedic Course in ...Professor Deiary Kader
The document discusses the posterior cruciate ligament (PCL) and posterolateral corner (PLC) of the knee. It provides details on the anatomy, mechanisms of injury, clinical assessment, treatment, and complications for injuries to these structures. For PCL injuries, the strongest ligament in the knee, treatment involves conservative management for isolated acute injuries or reconstruction for chronic symptomatic injuries. For PLC injuries, addressing all injured ligaments is important as isolated treatment can fail. Reconstruction of the lateral collateral ligament, popliteus tendon, and popliteofibular ligament is recommended for chronic complete injuries.
The Lisfranc joint was named after a field surgeon who described an amputation through the joint due to gangrene from an injury sustained after a soldier fell from a horse. Lisfranc injuries account for less than 1% of fractures and can result from high-energy trauma or less stressful twisting injuries. Diagnosis can be difficult as swelling and pain in the midfoot region are often the only findings. Treatment involves immobilization for mild sprains but surgery within 1-2 days for fractures or dislocations to ensure proper healing and prevent long-term disability. Surgical techniques include open reduction and internal fixation to anatomically realign the bones which allows for better functional outcomes compared to fusion or casting.
This document discusses the challenges and solutions in the management of distal humerus fractures. Some key points:
- Distal humerus fractures are challenging due to metaphyseal comminution and the complex anatomy of the elbow joint.
- Surgical approaches such as the triceps-sparing and olecranon osteotomy approaches each have benefits and limitations.
- Parallel plate fixation has been shown to provide better stability than orthogonal plating, though both can achieve good outcomes.
- Techniques like ulnar nerve transposition and closed arch plate fixation aim to maximize stability while minimizing complications.
- Total elbow arthroplasty or hemiarthroplasty may be considered for unreconstructable fractures
This document discusses the management of clavicle fractures. It describes:
1) Non-operative and operative treatment options for middle-third clavicle fractures, including figure-of-eight bracing, slings, intramedullary fixation, and plate fixation.
2) Classification and treatment recommendations for distal-third clavicle fractures, including non-operative treatment for Types I-III and surgical options for Types IV-V.
3) Considerations for medial-third and pediatric clavicle fractures, noting most are treated non-operatively with immobilization.
4) Potential complications of treatment and techniques to minimize issues like pin migration, wound problems, and hardware failure.
In the elderly osteoporotic fractures although the principles are the same but some special considerations in management of the soft tissues and the bony injuries are considered.
The document discusses operative procedures for knee injuries, specifically ACL reconstruction and PCL surgery. It provides details on different graft options for ACL reconstruction including autografts from the patellar tendon, hamstrings and quadriceps tendon as well as allografts. It discusses techniques for graft harvesting, preparation and fixation. Complications of ACL reconstruction and their prevention are outlined. The document also discusses evaluation and treatment of PCL injuries as well as the anatomy and examination of the posterolateral corner complex of the knee.
This document provides an overview of diabetes, including:
1. It defines diabetes as a chronic metabolic disorder characterized by high blood glucose levels due to problems with insulin production or action.
2. It classifies diabetes into four main types - type 1, type 2, gestational diabetes, and secondary diabetes. Type 1 is caused by beta cell destruction while type 2 involves insulin resistance.
3. It describes the clinical features, risk factors, diagnostic criteria, complications and management of diabetes. The classic symptoms are polyuria, polydipsia and polyphagia. Complications include ketoacidosis, nephropathy and retinopathy if uncontrolled.
Obesity is defined as having a body mass index over 30. It is caused by an imbalance between calorie intake and expenditure. Diagnosis involves measuring BMI, waist circumference, and potentially blood tests. Complications include diabetes, high blood pressure, heart disease, and psychological issues. Management involves diet, exercise, behavior changes, prescription medications, and potentially weight loss surgery. Prevention focuses on daily exercise and maintaining a healthy diet.
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Similar to principle of fracture managment-1-app6892.pdf
Fracture its types classification and manangmentMuhammad azeem
This document discusses fracture classification and management. It defines a fracture and describes how fractures are classified based on factors like whether they are open or closed, the degree of displacement, location, and number of fragments. The major classifications are closed fractures, open fractures, and physeal fractures. Closed fractures do not break the skin, while open fractures do. Fractures are also classified as reducible or non-reducible based on the number of fragments. The document outlines different types of closed fractures and discusses fracture reduction and management strategies.
1) The floating knee refers to ipsilateral fractures of the femur and tibia where the knee is disconnected from the rest of the limb. Type I injuries do not extend to the knee joint while Type II injuries involve the knee joint.
2) Treatment of Type I injuries typically involves nailing of both fractures to provide stability and allow early mobilization. Plating may be used if there is intra-articular involvement of the distal femur or tibia.
3) Outcomes depend on factors like the type of fracture, presence of soft tissue injuries, age, and whether the fractures are open or intra-articular. While surgical stabilization of both fractures can provide the best results, the treatment approach needs
This document provides an overview of knee anatomy and surgical procedures related to the meniscus, ACL, MCL, PCL, and patellofemoral joint. It begins with meniscal anatomy and function, then discusses factors in meniscal repair versus resection and different repair techniques. Next, it covers ACL anatomy and evidence on surgical treatment. It also discusses anatomy and treatments for MCL, PCL, and posterolateral corner injuries. Finally, it summarizes patellar instability including causes, assessment, and imaging. Key surgical procedures are highlighted throughout like ACL reconstruction techniques and options for cartilage repair.
1. The clavicle is the only long bone that lies horizontally in the body and connects the thorax to the shoulder girdle.
2. Clavicle fractures are classified based on their location as medial, middle, or lateral thirds. Common causes are falls on an outstretched hand or lateral shoulder.
3. Treatment depends on the fracture type and patient factors, ranging from sling immobilization to surgical fixation with plates or screws.
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
This document discusses the presentation and management of a 34-year-old man with a left tibial plateau fracture from trauma. It was found that he had normal sensation and motor function in the leg with normal pulses and no signs of compartment syndrome. The document then reviews the mechanisms, imaging, classification, treatment options including non-operative and operative management, prognosis, complications and surgical approaches for tibial plateau fractures.
Hip Dislocations: Ortho topic presentation 2018AkuilaWaradi
Hip dislocations are orthopedic emergencies that require prompt reduction to prevent complications. The most common type is posterior hip dislocation caused by high-energy injuries like motor vehicle accidents. Closed reduction techniques like the Allis or Bigelow maneuvers are generally attempted first, while open reduction may be needed for unstable or complex injuries. After successful reduction, the hip is immobilized and physical therapy begun to restore range of motion and strength without reinjury. Complications can include avascular necrosis, nerve palsies, and recurrent dislocations if not properly managed.
Subtrochanteric fractures occur in the region of the femur between the lesser trochanter and 5 cm distal to it. They are challenging injuries to treat due to strong muscle forces and high stresses in this region. Surgical stabilization with an intramedullary nail is usually recommended to provide rigid fixation while minimizing stress on the implant. Care must be taken to achieve and maintain an anatomical reduction to prevent complications like malunion and nonunion. Long-term bisphosphonate use may be associated with an increased risk of subtrochanteric fractures with a characteristic radiographic appearance.
Mipo- biomechanics and biology -Dr.S.Senthil Sailesh MS OrthoSenthil sailesh
1) MIPO technique preserves the blood supply to bone through submuscular plating and preservation of the endosteal blood supply.
2) Specimens that underwent MIPO showed good preservation of nutrient arteries and blood flow, unlike ORIF specimens which showed disruption.
3) Fracture healing requires good reduction of fragments, stabilization through methods like indirect reduction using traction or direct reduction with clamps, and maintaining stability through techniques like compression plating or lag screw fixation.
Patellar fractures can be classified as displaced or nondisplaced. Treatment depends on the type of fracture and may include casting, open reduction and internal fixation, or partial/total patellectomy. The rehabilitation goals are to restore full range of motion, improve muscle strength and balance especially of the quadriceps, and normalize gait. Long-term considerations include the potential for loss of correction, degenerative changes, quadriceps shortening, knee flexion contractures, and chondromalacia patella.
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.
Subtrochanteric femur fractures are challenging to treat due to deforming forces. Intramedullary nails are the gold standard treatment as they provide better biomechanical stability compared to plates. Multiple reduction techniques such as clamps, joysticks, and blocking wires may be needed to achieve and maintain anatomical alignment given the typical fracture deformity of varus and procurvatum. Complications include malunion, nonunion, infection, and implant failure, with early mortality rates around 10%. Proper surgical technique and implant selection are important to optimize outcomes for these difficult fractures.
This document discusses surgical procedures and postoperative management for joint injuries and diseases of the elbow. It describes common fractures of the elbow region including the radial head. Surgical options for fractures include open reduction and internal fixation, arthroscopic techniques, and radial head excision. The goals of surgery and rehabilitation are to relieve pain, restore alignment and stability, and regain strength and range of motion. Postoperative management involves immobilization, progressive range of motion and strengthening exercises. Total elbow arthroplasty is an option for severe arthritis.
Updated PCL, PLC and Knee Dislocation for Postgraduate Orthopaedic Course in ...Professor Deiary Kader
The document discusses the posterior cruciate ligament (PCL) and posterolateral corner (PLC) of the knee. It provides details on the anatomy, mechanisms of injury, clinical assessment, treatment, and complications for injuries to these structures. For PCL injuries, the strongest ligament in the knee, treatment involves conservative management for isolated acute injuries or reconstruction for chronic symptomatic injuries. For PLC injuries, addressing all injured ligaments is important as isolated treatment can fail. Reconstruction of the lateral collateral ligament, popliteus tendon, and popliteofibular ligament is recommended for chronic complete injuries.
The Lisfranc joint was named after a field surgeon who described an amputation through the joint due to gangrene from an injury sustained after a soldier fell from a horse. Lisfranc injuries account for less than 1% of fractures and can result from high-energy trauma or less stressful twisting injuries. Diagnosis can be difficult as swelling and pain in the midfoot region are often the only findings. Treatment involves immobilization for mild sprains but surgery within 1-2 days for fractures or dislocations to ensure proper healing and prevent long-term disability. Surgical techniques include open reduction and internal fixation to anatomically realign the bones which allows for better functional outcomes compared to fusion or casting.
This document discusses the challenges and solutions in the management of distal humerus fractures. Some key points:
- Distal humerus fractures are challenging due to metaphyseal comminution and the complex anatomy of the elbow joint.
- Surgical approaches such as the triceps-sparing and olecranon osteotomy approaches each have benefits and limitations.
- Parallel plate fixation has been shown to provide better stability than orthogonal plating, though both can achieve good outcomes.
- Techniques like ulnar nerve transposition and closed arch plate fixation aim to maximize stability while minimizing complications.
- Total elbow arthroplasty or hemiarthroplasty may be considered for unreconstructable fractures
This document discusses the management of clavicle fractures. It describes:
1) Non-operative and operative treatment options for middle-third clavicle fractures, including figure-of-eight bracing, slings, intramedullary fixation, and plate fixation.
2) Classification and treatment recommendations for distal-third clavicle fractures, including non-operative treatment for Types I-III and surgical options for Types IV-V.
3) Considerations for medial-third and pediatric clavicle fractures, noting most are treated non-operatively with immobilization.
4) Potential complications of treatment and techniques to minimize issues like pin migration, wound problems, and hardware failure.
In the elderly osteoporotic fractures although the principles are the same but some special considerations in management of the soft tissues and the bony injuries are considered.
The document discusses operative procedures for knee injuries, specifically ACL reconstruction and PCL surgery. It provides details on different graft options for ACL reconstruction including autografts from the patellar tendon, hamstrings and quadriceps tendon as well as allografts. It discusses techniques for graft harvesting, preparation and fixation. Complications of ACL reconstruction and their prevention are outlined. The document also discusses evaluation and treatment of PCL injuries as well as the anatomy and examination of the posterolateral corner complex of the knee.
Similar to principle of fracture managment-1-app6892.pdf (20)
This document provides an overview of diabetes, including:
1. It defines diabetes as a chronic metabolic disorder characterized by high blood glucose levels due to problems with insulin production or action.
2. It classifies diabetes into four main types - type 1, type 2, gestational diabetes, and secondary diabetes. Type 1 is caused by beta cell destruction while type 2 involves insulin resistance.
3. It describes the clinical features, risk factors, diagnostic criteria, complications and management of diabetes. The classic symptoms are polyuria, polydipsia and polyphagia. Complications include ketoacidosis, nephropathy and retinopathy if uncontrolled.
Obesity is defined as having a body mass index over 30. It is caused by an imbalance between calorie intake and expenditure. Diagnosis involves measuring BMI, waist circumference, and potentially blood tests. Complications include diabetes, high blood pressure, heart disease, and psychological issues. Management involves diet, exercise, behavior changes, prescription medications, and potentially weight loss surgery. Prevention focuses on daily exercise and maintaining a healthy diet.
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This document provides information on emergency care and triage. It discusses the principles of emergency care which include providing care without delay and using triage to prioritize patients. Triage involves sorting patients into categories of emergent, urgent, and non-urgent based on the seriousness of their conditions. The document then describes the triage process in more detail, outlining the different color codes used to categorize patients and the types of injuries that fall under each code. It also discusses the purposes of triage, how it is performed, and the roles of triage team members in an emergency situation.
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Gout is a crystal deposition disease caused by elevated uric acid levels (hyperuricemia) leading to the deposition of monosodium urate crystals in joints and tissues. It is the most common inflammatory joint disease in men over 50. Risk factors include family history, alcohol consumption, obesity, and renal impairment. Acute gout attacks typically involve sudden severe pain, swelling, and redness in the first metatarsophalangeal joint. Diagnosis involves identifying urate crystals in synovial fluid or tissue samples. Treatment involves nonsteroidal anti-inflammatory drugs for acute flares and long-term urate-lowering therapy such as allopurinol or febuxostat to prevent future attacks
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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3. Introduction
Defintion :A fracture is a break in the
structural continuity of bone.
• It may be no more than a crack, a crumpling
or a splintering of the cortex; more often the
break is complete and the bone fragments are
displaced.
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4. • Anisotropic
– Mechanical properties dependent upon direction of
loading
– Bone is weakest in shear, then tension, then
compression.
• Viscoelastic
– Sensitive to the speed at which the load is applied
• Wolff’s law
– The ability to adapt, by changing its size, shape, and
its structure, to the mechanical demands placed on it
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Basic Biomechanics of bone
5. CLASSIFICATION OF FRACTURES
Classifying fractures into those with similar
features
advantages:
it allows treatment or prognosis and
it facilitates a common dialogue between
surgeons and others
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7. Classification of fracture
Based on the cause
(1) injury;
(2) repetitive stress
(3) abnormal weakening of the bone
(pathological’fracture).
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8. Fracture due to trauma
fracture can happpen after injuries like
MVA,guns,fall down….
High vs low energy trauma
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9. Stress fracture
• When exposure to stress and deformation is
repeated and prolonged, resorption occurs
faster than replacement and leaves the area
liable to fracture
• patients with chronic inflammatory diseases
who are on treatment with steroids or
methotrexate.
• most often seen in the tibia , fibula or
metatarsal
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10. Pathological
• Fractures may occur even with normal
stresses if the bone has been weakened by a
change in its structure
• the causes are,
* local bone diseases
–osteomyelitis ,cysts , tumours
*generalized bone diseases
_oseoporosis,hyperthyroism,paget’s ,OI
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11. Mechanism of injury
• Direct
– Tapping
– Crushing
– Penetrating
• Indirect
– Traction or Tension
– Angulation
– Rotational
– Compresion
– Combination
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13. AO/OTA system
Müller and colleagues ;An
alphanumeric
classification based on
anatomy
“A classification is useful
only if it considers the
severity of the bone lesion
and serves as a basis for
treatment and for
evaluation of the
results.” Maurice E
Müller
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14. CONT….
In this system, the first digit specifies the bone
(1 = humerus, 2 = radius/ulna, 3 = femur,
4 = tibia/fibula) and the
second the segment
(1 = proximal, 2 = diaphyseal, 3 = distal, 4 = malleolar).
A letter specifies the fracture pattern (for the diaphysis:
A = simple, B = wedge, C = complex; for the
metaphysis: A = extra-articular, B = partial articular,
C = complete articular).
Two further numbers specify the detailed morphology
of the fracture
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18. Diaphyseal Fractures
• Type A
– Simple fractures with two
fragments
• Type B
– Wedge fractures
• Type C
– Complex fractures with no
contact between main
fragments
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22. Fracture displacement
• Displacement of fracture fragments caused by
force of injury,gravity or muscle pull
• Discribed by translation, alignment, rotation
and altered length
• Always describe distal fragment in relation to
proximal fragment
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23. Translation (shift) – The
fragments may be
shifted sideways,
backward or forward in
relation to eachother
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24. conti
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Angulation
Extent to which Fx
fragments are not
anatomically aligned
• In a angular fashion
Convention: describe
angulation as the direction
the apex is pointing relative
to anatomical long axis of
the bone (e.g. apex medial,
apex valgus)or direction of
distal fragment
R Tibial shaft Fx b/w prox &
middle thirds, angulated apex
lateral or varus angulation
26. Rotation (twist) – One of the fragments may
be twisted on its longitudinal axis; the bone
looks straight but the limb ends up with a
rotational deformity.
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27. 7/10/2015 birhanu 27
Rotation
Normal PA view of hip
Greater trochanter in profile
PA view of rotated hip Fx
Greater trochanter
perpendicular to film
28. Length – The fragments may be distracted and
separated,or they may overlap, due to muscle
spasm,causing shortening of the bone
Excessive shortening is a hallmark of more
severe soft-tissue injury
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29. Managment
the Advanced Trauma Life Support (ATLS)
guidelines with attention to Airway, Breathing
and Circulation on presentation
The patient should be optimally resuscitated
before any fracture treatment is considered
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30. • The treatment of fractures may be divided
into three phases:
emergency care,
definitive treatment, and
rehabilitation.
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32. Splinting
• One of the most highly taught and least
frequently obeyed
• Adequate splinting is desirable for the following reasons:
– Further soft-tissue injury (especially to nerves and vessels)
may be averted and, most importantly, closed fractures are
saved from becoming open.
– Immobilization relieves pain.
– Splinting may well lower the incidence of clinical fat
embolism and shock.
– Patient transportation and radiographic studies are
facilitated.
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33. Types of splints
Improvised Splints
Excuse should never be used that no splints were
available. Almost anything rigid can be pressed into
service-walking sticks, umbrellas, slats of wood-padded
by almost any material that is soft.
Conventional Splints
– Basswood Splints
– Universal Splints
– Cramer Wire Splints
– Thomas Splints
– Inflatable Splints
– Structural Aluminum Malleable (SAM) Splints
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35. Definitive Managment
The objectives of the treatment of a fracture
are to have the bone heal in such a position
that the function and cosmesis of the
extremity are unimpaired and to return
patients to their vocation and avocations in
the shortest possible time with the least
expense.
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37. Reduction
• The sooner the reduction of a fracture is
attempted the better,
• Before embarking on the manipulative
reduction, adequate x-ray films must be
obtained to determine what the objectives
of the manipulation are to be or if, indeed,
a reduction is necessary.
• X ray _rules of two
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38. Reduction
• Methods of reduction
1. Closed
1. Gravity
2. Manipulation
2. Open
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39. Closed reduction
indication
1. all minimally displaced fractures,
2. most fractures in children
3. fractures that are not unstable after
reduction and can be held in some form of
splint orcast
4. Unstable fractures can also be reduced using
closed methods prior to stabilization with
internal or external fixation.
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40. contraindicated
1. There is no significant displacement.
2. The displacement is of little concern (eg,
humeral shaft).
3. No reduction is possible (eg, comminuted
fracture of the head and neck of humerus)
4. The reduction, if gained, cannot be held (eg,
compression fracture of the vertebral body)
5. The fracture has been produced by a traction
force (eg, displaced fracture of the patella).
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41. Conti…..
• To achieve a reduction, the following steps
usually are advised:
– apply traction in the long axis of the limb;
– reverse the mechanism that produced the fracture;
and
– align the fragment that can be controlled with the one
that cannot.
• This is most effective when the periosteum and
muscles on one side of the fracture remain intact;
the soft-tissue strap prevents over-reduction
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43. OPEN REDUCTION
Operative reduction of the fracture under direct
vision
First step in internal fixation
indicated:
1) when closed reduction fails,
(2)when there is a large articular fragment that
needs accurate positioning or
(3) for traction (avulsion) fractures in which the
fragments are held apart.
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44. Immobilization
• Methods
1. Splint
a. Body strapping
b. External splint
c. POP
2. Continuous mechanical traction
3. Fixation
a. External
b. Internal
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45. Immobilization by POP
POP Casts
– Upper extremity Casts
– Lower extremity Casts
– Patellar tendon-bearing
casts
– Cast braces
– Hip and Shoulder spica
POP splints
– Slabs dorsal/volar
– Posterior gutters
Fiberglass Casts
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46. 7/10/2015 birhanu 46
There are three principles that apply to the
treatment of unstable fractures with a cast
Utilization of intact soft tissues
Three-point fixation
Hydrostatic pressure
47. three-point fixation
is achieved by molding the wet cast in a similar manner
to the way the fracture was reduced initially. Two of
these three points, therefore, are applied by the hands.
• Two forces acting alone cannot stabilize a fracture; a
third force must be present. This third force is supplied
by the portion of the cast over the proximal portion of
the limb With overreduction, the bridge is under the
greatest tension and the reduction is even more stable
• A straight cast will usually contain a crooked bone; a
curved cast will generally contain a well-aligned
bone.
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50. Immobilization by POP
• Complication of cast
1. Plaster sore
2. Compartment syndrome
3. Burn
4. Thrombophilibits
5. Redisplacement
6. Joint stiffness
7. Allergic rxn
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51. FUNCTIONAL BRACING
using either plaster of Paris or one of the lighter
thermoplastic materials,
prevents joint stiffness while still permitting fracture
splintage and loading
Segments of a cast are applied only over the shafts of
the bones, leaving the joints free; the cast segments
are connected by metal or plastichinges that allow
movement in one plane.
The splints are ‘functional’ in that joint movements
are much less restricted than with conventional casts
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52. • used most widely for fractures of the femur or tibia,
but
• since the brace is not very rigid, it is usually applied
only when the fracture is beginning to unite, i.e. after
3–6 weeks of traction or conventional plaster.
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54. Immobilization by traction
• Some fractures are so unstable that maintenance of
a reduction by plaster-of-Paris casts is impossible, or
casts may be, for one reason or another, impractical.
In these circumstances the bone can be reduced and
held to length by means of continuous traction,
provided a soft-tissue linkage still exists.
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55. Cont……
• Traction is applied to the limb distal to the
fracture,so as to exert a continuous pull in the long
axis of the bone, with a counterforce in the opposite
direction
• This is particularly useful for shaft fractures that are
oblique or spiral and easily displaced by muscle
contraction.
• which reduces fracture fragments through ligamentotaxis
(ligament pull)
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56. Immobilization by traction
Methods
1. Skin traction
– Used
– for children
– for adults temporarily
– Weight more than 5Kg result in skin slough
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57. 2.Traction by gravity – This applies only to upper
limb injuries.
e.g
a U-slab with wrist sling for humeral shaft fracture
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58. 3.Skeletal traction – A stiff wire or pin is inserted
– Sites
– Distal femur – may result tethering of quadriceps
– proximal tibial – safest site
– Distal tibia
– Calcanus - difficult to eradicate calcaneal infection
– Olecranon
– cranium
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59. Indications
1.Vertically unstable fractures of the pelvic ring where external fixation
cannot maintain vertical stability,
2.Fractures of the acetabulum with minimal displacement where internal
fixation is not indicated,Unstable fractures of the acetabulum
3.Fractures of the hip (basilar neck, intertrochanteric, or subtrochanteric)
where local soft-tissue or bone conditions or systemic conditions
contraindicate surgerythe shaft and supracondylar area
4.Fractures of of the femur for which internal or external fixation is
contraindicated
5.Comminuted fractures of the tibial plateaus where traction is necessary to
maintain alignment and facilitate early motion, and where internal or
external fixation is not possible or feasible.
6.Fractures of the shaft of the tibia and fibula where delay in initial treatment
or unacceptable shortening in a plaster cast requires correction.
6.Comminuted pylon fractures
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61. external fixator
Stabilize a fracture at a distance
from frature site with out
further soft tissue damage
Indication
1. # with extensive soft tissue
injury
2. Comminuted & unstable #
3. Segmental defect
4. Infected #
5. Emergency use in pelvic #
6. Fixation of Polytrauma
patients
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62. Technique
the bone is transfixed above and below the fracture with
screws or tensioned wires and these are then connected to
each other by rigid bars.
permit adjustment of length and alignment after application
on the limb.
Knowledge of ‘safe corridors’ is essential so as to avoid
injuring nerves or vessels;
the entry sites should be irrigated to prevent burning of the
bone
The fracture is then reduced by connecting the various groups
of pins and wires by rods.
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65. Biology and biomechanics
Mechanical stability:absolute vs relative
Absolute stability; is defined as rigid fixation that
does not allow any micromotion between the
fractured fragments under physiologic loading
Relative stability; allows limited motion at the
fracture site under functional loading(locked
intramedullary nail, bridge plate, or external fixator)
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67. indications
1 .Fractures that cannot be reduced except by operation.
2. Fractures that are inherently unstable and prone to re-displace
after reduction (e.g. mid-shaft fractures of the forearm and some
displaced ankle fractures).
3.fracture liable to be pulled apart by muscle action (e.g.
transversefracture of the patella or olecranon).
4. Fractures that unite poorly and slowly, principally fractures of the
femoral neck.
5. Pathological fractures in which bone disease may prevent healing
6. Multiple fractures where early fixation
7. Fractures in patients who present nursing
difficulties (paraplegics, those with multiple
injuries and the very elderly)
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68. Screws
Screws are the basic and most efficient tool for internal
fixation, especially in combination with plates.
A screw is a powerful element that converts rotation into
linear motion.
some common design features
A central core that provides strength
A thread that engages the bone and is responsible for the
function and purchase
A tip that may be blunt or sharp, self-cutting or self-drilling
and -cutting
A head that engages in bone or a plate
A recess in the head to attach the screwdriver
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70. classification
They are typically named according to their design,
function, or way of application.
Design (partial or fully threaded, cannulated, self
tapping, etc.)
Dimension of major thread diameter (most commonly
used: 1.5-mm, 2.0-mm, 2.7-mm, 3.5-mm, 4.5-mm, 6.5-
mm, 7.3-mm, etc.)
Area of typical application (cortex, cancellous bone,
bicortical or monocortical)
Function (lag screw, locking head screw, position screw,
Interlocking screw, Anchor screw, Poller screw etc.)
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73. plate
Function
1.Neutralization – when used to bridge afracture and supplement the
effect ofinterfragmentary lag screws; the plate is to resist torque and
shortening.
2. Compression – Axial compression of a transverse fracture of a forearm
bone is best obtained by a compression plate
3. Buttressing (anti glide)– any secondary displacement of an oblique
fracture in the metaphysis of bones (e.g. in treating fractures of the
proximal tibial plateau)
4.Bridging :comminuted diaphyseal or metaphyseal fractures that are not
suited for intramedullary nailing
5.Tension band: in fracture around proximal femor where the are
compressive force in lateral aspect and tensile ones on medial aspect
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80. Soft tissue managment
• Every fracture is associated to a certain extent
with injury to the tissues surrounding the bone
• “every fracture is a soft tissue injury where the
bone happens to be broken,”
• As a rule, it is much safer to temporarily
immobilize the zone of injury by traction or more
adequately by an external fixator, postponing
definitive fixation until the soft tissues have
recovered.
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