Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Can read freely here
https://sethiortho.blogspot.com/
Challenges and Solutions in
Management of Distal Humerus Fractures
Epidemiology
Anatomy
Classification
Controversies and Recent studies
Approach
Implants selection
Plate configuration
Ulnar nerve transposition
Role of total elbow arthroplasty in DHF
Role of hemiarthroplasty in DHF
Metaphyseal comminution –
Anatomic complexity of the distal humerus
Positioning of the plates
TBW –
Skin closure
Osteoporotic nature of the bone –
Less BMD/Thin metaphysis
Screw Pullout strength is low
DHF account for 2% of all adult fractures
The common pattern of fracture
Intraarticular and involves both columns
Bimodal distribution
Peak incidence in young male and in older female patients
Young male – High-velocity injury
Older female - Osteoporosis
The distal humerus is flattened and expanded bony structure
It is composed of lateral and medial columns with the trochlea situated between these columns.
The location of the trochlea is central rather than medial
Formed by Medial SCR + M/Epicondyle
The distal end has 450 angulation with humeral shaft
M/ Epicondyle gives attachment for MCL & Common Flexor Origin
The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection
Ulnar nerve
Formed by Lateral SCR and L/Epicondyle and Capitulum
Distal end has 200 with humeral shaft
L/ epicondyle gives attachment for LCL & common extensor origin
Its posterior surface is non articular and can be used as a site for a plate fixation
The lateral column curves anteriorly
Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus.
The medial column including the medial epicondyle is in line with the humeral shaft.
It forms the center of the triangle
It has 30 - 80 – external rotation & 250 anterior divergent with the shaft
It forms a 40 - 80 degree valgus direction
X-ray -
Anterior-posterior view
lateral View
Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture.
NCCT – Elbow
Articular surfaces
Position of the fracture fragments
useful for identifying impacted fracture fragments that make reduction challenging
Olecranon Osteotomy Approach – 52-57%
Triceps sparing VS Olecranon osteotomy approach
The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter
Smaller diameter of the humerus, permitting only one or two short screws for fixation.
Interruption of blood supply to the lateral column
blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
Incision or transection of bone.
Uses:-
to correct deformity.
to change shape of bone.
to redirect load trajectories in a limb so as to influence joint function.
Can read freely here
https://sethiortho.blogspot.com/
Challenges and Solutions in
Management of Distal Humerus Fractures
Epidemiology
Anatomy
Classification
Controversies and Recent studies
Approach
Implants selection
Plate configuration
Ulnar nerve transposition
Role of total elbow arthroplasty in DHF
Role of hemiarthroplasty in DHF
Metaphyseal comminution –
Anatomic complexity of the distal humerus
Positioning of the plates
TBW –
Skin closure
Osteoporotic nature of the bone –
Less BMD/Thin metaphysis
Screw Pullout strength is low
DHF account for 2% of all adult fractures
The common pattern of fracture
Intraarticular and involves both columns
Bimodal distribution
Peak incidence in young male and in older female patients
Young male – High-velocity injury
Older female - Osteoporosis
The distal humerus is flattened and expanded bony structure
It is composed of lateral and medial columns with the trochlea situated between these columns.
The location of the trochlea is central rather than medial
Formed by Medial SCR + M/Epicondyle
The distal end has 450 angulation with humeral shaft
M/ Epicondyle gives attachment for MCL & Common Flexor Origin
The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection
Ulnar nerve
Formed by Lateral SCR and L/Epicondyle and Capitulum
Distal end has 200 with humeral shaft
L/ epicondyle gives attachment for LCL & common extensor origin
Its posterior surface is non articular and can be used as a site for a plate fixation
The lateral column curves anteriorly
Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus.
The medial column including the medial epicondyle is in line with the humeral shaft.
It forms the center of the triangle
It has 30 - 80 – external rotation & 250 anterior divergent with the shaft
It forms a 40 - 80 degree valgus direction
X-ray -
Anterior-posterior view
lateral View
Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture.
NCCT – Elbow
Articular surfaces
Position of the fracture fragments
useful for identifying impacted fracture fragments that make reduction challenging
Olecranon Osteotomy Approach – 52-57%
Triceps sparing VS Olecranon osteotomy approach
The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter
Smaller diameter of the humerus, permitting only one or two short screws for fixation.
Interruption of blood supply to the lateral column
blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
Incision or transection of bone.
Uses:-
to correct deformity.
to change shape of bone.
to redirect load trajectories in a limb so as to influence joint function.
Principle of Deformity Correction in lower Limb Kaushal Kafle
A brief summary about the priniciple of deformity correction in paediatrics and adults with the effects of deformity, etiology, physiological deformity, clinical and radiological assessment, measurements of various lines and angles, various terminologies, preoperative templating, acute and gradual correction , osteotomy principle and techniques, methods of fixation and stabilization.
Mean Value Articulator Classification
Classification According to Adjustability of Articulators:
Nonadjustable Articulators:
Semiadjustable Articulators:
implant-based prosthetic rehabilitation requires an understanding of associated anatomical structures. The ultimate predictability of an implant site is determined by the existing anatomy as related to dentition and the associated hard and soft tissues. Meticulous clinical assessment helps in determining the suitability of the potential site for implant placement. The purpose of this article is to present the clinical assessment for dental implants' placement to modulate peri-implant tissue characteristics in individual clinical need.
Similar to Principles of deformity correction (20)
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
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This document describes the acute management of AV block.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. Deformity
• Definition:
• It’s the position of a limb/Joint, from which it cannot be
brought back to its normal anatomical position.
3. Deformity
• Described as abnormalities of
• Length
• Angulation
• Rotation
• Translation
• The location, magnitude, and direction of the deformity
complete the characterization of a bony deformity
5. Evaluation of Deformity : X Rays
• Radiographs of the lower limbs:
• Long films (51 Inches)
• Frontal plane (AP view)(Patella Forward)
Sagittal plane (Lateral view)
6. Evaluation of Deformity : X Rays
• Radiographs of the lower limbs:
• Long films (51 Inches)
• Frontal plane (AP view)(Patella Forward)
Sagittal plane (Lateral view)
7. Evaluation of Deformity : X Rays
• Radiographs of the lower limbs:
• Long films (51 Inches)
• Frontal plane (AP view)(Patella Forward)
Sagittal plane (Lateral view)
8. Evaluation of Deformity : X Rays
• Radiographs of the lower limbs:
• Long films (51 Inches)
• Frontal plane (AP view)(Patella Forward)
Sagittal plane (Lateral view)
Square the Pelvis in case of
Limb Length discrepancy
10. AXIS
• Each long bone has 2 axis :-
Mechanical axis
Anatomical axis.
11. MECHANICAL AXIS
• Straight line connecting the joint
center points of the proximal &
distal joints.
• Its always a straight line whether in
frontal or sagittal plane.
12. ANATOMICAL AXIS
• Is mid diaphyseal line.
• In a normal bone, the
anatomic axis is a
single straight line.
• In a malunited bone
with angulation, each
bony segment can be
defined by its own
anatomic axis
13. Limb Alignment
• It involves assessment of the frontal
plane mechanical axis of the entire limb
rather than single bones
14. Limb Alignment
• Mechanical axis deviation (MAD) is measured
as the distance from the knee joint center to
the line connecting the joint centers of the
hip and ankle.
• Normally, 1 mm to 15 mm medial to the knee
joint center.
15. Joint Orientation Lines
• Line representing the orientation of a joint
in a particular plane /projection.
• ANKLE
Frontal : along the flat subchondral line of
tibial plafond.
Sagittal : line from distal tip of posterior lip
to tip of anterior lip.
16. Joint Orientation Lines
• Knee:
• FRONTAL : along the subchondral line of
tibial plateau.
• Line tangential to most distal point on the
femoral condyle.
• SAGITTAL : along flat subchondral line of
plateau.
Line connecting 2 points where the
condyles meet the metaphysis.
17. Joint Orientation Lines
• Hip:
• FRONTAL : from tip of greater trochanter to
center of femoral head.
• Also from the centre of femoral head along
the anatomical axis of the femoral neck
18. • The relation between anatomical or
mechanical axes and the joint
orientation lines can be referred to as
joint orientation angles
Joint Orientation Angles
19. Centre of Rotation of Angulation (CORA)
• The intersection of the proximal axis and
distal axis of a deformed bone is called
the CORA , which is the point about
which a deformity may be rotated to
achieve correction.
• Either Anatomical or Mechanical axis can
be used to identify CORA.
20. Centre of Rotation of Angulation (CORA)
• Correction of angulation by rotating the bone
around a point on the line that bisects the
angle of the CORA (the “bisector”) ensures
realignment of the anatomic and mechanical
axes without introducing an iatrogenic
translational deformity.
• All points that lie on the bisector can be
considered to be CORAs because angulation
about these points will result in realignment
of the deformed bone
21. Evaluation of the Various Deformity Types
• Length
• Clinically
• Radiologically
22. Evaluation of the Various Deformity Types
• Angulation
• Characterized by Magnitude and direction of apex
• Identification of the CORA is key in characterizing
angular deformities and planning their correction
• Angulation can be in Frontal plane or in sagittal
plane or in oblique plane
24. Evaluation of the Various Deformity Types
• Rotation
• Clinically
• Radiologically
• Axial CT scans
• Characterised by
• Position
• Magnitude
25. Evaluation of the Various Deformity Types
• Translation
• Clinically
• Radiologically
• Axial CT scans
• Characterised by
• Plane
• Direction
• Magnitude
• Level
26. Treatment
• Following evaluation, the deformity is characterized by
its
• type (length, angulation, rotational, translational, or
combined),
• the direction of the apex (anterior, lateral, posterolateral,
etc.),
• the orientation plane,
• It’s magnitude,
• and the level of the CORA
27. Osteotomies
• An osteotomy is used to separate the deformed bone
segments to allow realignment of the anatomic and
mechanical axes.
• The ability of an osteotomy to restore alignment depends on
• location of the CORA
• Axis about which correction is performed (the correction axis),
• Location of the osteotomy
28. Results when using osteotomy
A.The CORA, the correction axis, and the osteotomy all lie at
the same location; the bone realigns through angulation
alone, without translation.
B.The CORA and the correction axis lie in the same location
but the osteotomy is proximal or distal to that location; the
bone realigns through both angulation and translation.
C.The CORA lies at one location and the correction axis and
the osteotomy lie in a different location; correction of
angulation results in an iatrogenic translational deformity.
29. Wedge osteotomy
• The type of wedge osteotomy is determined by the
location of the osteotomy relative to the locations of the
CORA and the correction axis
30. Wedge osteotomy
A.Opening wedge osteotomy.
• The CORA and correction axis lie on the cortex
on the convex side of the deformity.
• The cortex on the concave side of the deformity
is distracted to restore alignment, opening an
empty wedge that traverses the diameter of
the bone.
• Opening wedge osteotomy increases final bone
length.
31. Wedge osteotomy
B. Neutral wedge osteotomy.
• The CORA and correction axis lie in the middle of
the bone.
• The concave side cortex is distracted and the
convex side cortex is compressed.
• A bone wedge is removed from the convex side.
• Neutral wedge osteotomy has no effect on final
bone length.
32. Wedge osteotomies
C. Closing wedge osteotomy.
• The CORA and correction axis lie on the concave
cortex of the deformity.
• The cortex on the convex side of the deformity is
compressed to restore alignment, requiring removal
of a bone wedge across the entire bone diameter.
• A closing wedge osteotomy decreases final bone
length.
33. Dome Osteotomy
• In a dome osteotomy, the osteotomy site
cannot pass through both the CORA and
the correction axis. Thus, translation will
always occur when using a dome
osteotomy.
34. Dome Osteotomy
Ideally, the CORA and correction axis are
mutually located with the osteotomy
proximal or distal to that location such
that the angulation and obligatory
translation that occurs at the osteotomy
site results in realignment of the bone
axis.
35. Dome Osteotomy
When the CORA and correction axis are
not mutually located, a dome osteotomy
through the CORA location results in a
translational deformity.
36. Dome osteotomy
the CORA and correction axis are mutually located with
the osteotomy distal to that location in all of these
examples.
A.Opening dome osteotomy.
The CORA and correction axis lie on the cortex on the
convex side of the deformity.
Opening dome osteotomy increases final bone length.
37. Dome osteotomy
B. Neutral dome osteotomy.
The CORA and correction axis lie in the middle of the
bone.
Neutral dome osteotomy has no effect on final bone
length..
38. Dome osteotomy
C. Closing dome osteotomy.
The CORA and correction axis lie on the concave cortex of
the deformity.
A closing dome osteotomy decreases final bone length
It can result in significant overhang of bone that may
require resection
39. Treatment By Deformity type : Length
• Acute distraction or compression methods obtain
immediate correction of limb length by acute
lengthening with bone grafting or acute shortening,
respectively
• Gradual correction techniques for length deformities
typically use Ilizarov external fixation/ LRS
40. Treatment By Deformity type : Angulation
• Correction of angulation deformities involves
making an osteotomy, obtaining realignment of the
bone segments, and securing fixation during healing.
• Alternatively, the correction may be made gradually
using external fixation to both restore alignment and
provide stabilization during healing
41. Treatment By Deformity type : Rotation
• Correction of a rotational deformity requires an
osteotomy and rotational realignment followed by
stabilization.
42. Treatment By Deformity type : Translation
• Translational deformities may be
corrected in one of three ways.
The hip joint center is located at the center of the femoral head.
The knee joint center is half the distance from the nadir between the tibial spines to the apex of the intercondylar notch on the femur.
The ankle joint center is the center of the tibial plafond.
MAD >15 mm medial to the knee midpoint varus malalignment
MAD lateral to the knee midpoint valgus malalignment
Magnitude of translation is measured as the horizontal distance from the proximal segment's anatomic axis to the distal segment's anatomic axis at the level of the proximal end of the distal segment