Proximal humerus fractures are common fractures, especially in older osteoporotic women. They can be classified using systems like Neer or AO/OTA. Nondisplaced fractures are typically treated non-operatively while displaced fractures may require closed or open reduction with fixation or prosthetic replacement depending on the age and health of the patient. Surgical treatment aims to restore anatomy and blood supply to the humeral head to reduce risks of complications like avascular necrosis, nonunion, and stiffness. Close postoperative rehabilitation is important for recovery of shoulder function.
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
a simplified version of periprosthetic fractures, easy to learn and understand with lots of images and classification. It includes hip, shaft of femur, knee, shoulder
Madelung deformity is an abnormality of the palmar ulnar part of the distal radial physis in which progressive ulnar and volar tilt develops at the distal radial articular surface, with dorsal subluxation of the distal ulna.
Madelung deformity is an abnormality of the palmar ulnar part of the distal radial physis in which progressive ulnar and volar tilt develops at the distal radial articular surface, with dorsal subluxation of the distal ulna.
fractures of the proximal humerus are among the most common fractures of the upper limb and management options are wide according many variables mostly the age.
it comprises of the anatomy, epidemiology, mechanism of injury and management options.
there is also the fracture classifications
management was grouped into operative and conservative
there is also a section for children.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. PROXIMAL HUMERUS FRACTURES
• Defined as fractures occurring at or proximal to surgical neck of
humerus
• m/c humerus fracture-45%
• Age > 65- 2nd M/C Fs of upper extremity
• Incidence increases with age
• F:M- 3:1
• Most of Pts are osteoporotic post menopausal woman
• Most fractures are nondisplaced(85%), good prognosis
• < 5% of paediatric fractures
3. ANATOMY
• 4 parts
• Head of humerus
• Greater tuberosity
• Lesser tuberosity
• Shaft
• 3 ossification centre's
- humeral head, GT, LT
4. ANATOMY
• GT-Supraspinatus, Infraspinatus & teres minor
• LT- Subscapularis
• intertubercular sulcus/ bicipital groove-tendon of the long head of the
biceps brachii
• “a lady between two majors”
• Surgical neck-axillary nerve and circumflex humeral vessels
5. ANATOMY
• Axillary nerve- Deltoid, teres mionor,
• Abduction
• Regimental badge area
• just antero inferior to glenohumoral joint. It is at risk of traction injury
and injury while anterior fracture-dislocation
6. ANATOMY
• Arcuate artery of Liang- supplies head
• Ascending branch of ACHA(anterior circumflex humeral artery) supplies
most of blood to articular segment
• Posterior circumflex humeral artery- blood supply to humeral head
7. MECHANISM OF INJURY
• Fall on outstretched arm
• Direct trauma
• Older Pt- low energy trauma(FOOSH)
• Young Pt-high energy trauma
• Indirect cause- seizures & electric shock
• Pathological- malignant/ benign lesions
8. DEFORMING FORCES
• GT is pulled posteromedially by supraspinatus and infraspinatus
tendons
• LT is pulled anteriorly and medially by Subscapularis tendons
• The shaft segment is pulled anteromedially by Pect. Major tendon
• Deltoid abducts the proximal fragment
9. CLINICAL FEATURES
• Pain may not be severe, as the fracture may be deeply impacted
• Signs of axillary nv/brachial plexus injury
•
29. LEGO SYSTEM BY HERTEL ET AL (BINARY
SYSTEM)
• Lego blocks
• 5 yes-or-no questions had to be answered concerning the 5
basic fracture planes:
• (1) Is there a fracture plane between the head and greater
tuberosity?
• (2) Is there a fracture plane between the greater tuberosity
and shaft?
• (3) Is there a fracture plane between the head and lesser
tuberosity?
• (4) Is there a fracture plane between the lesser tuberosity and
shaft?
• (5) Is there a fracture plane between the greater tuberosity
and lesser tuberosity?
Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral
head ischemia after intracapsular fracture of the proximal humerus.
J Shoulder Elbow Surg 2004;13:427-33. http://dx.doi.org/10.1016/j.
jse.2004.01.034
30. LEGO SYSTEM
• assessed the humeral head vascularity in the context of different
fracture plane locations
• Hertel et al emphasized the importance of the location of fracture
planes, rather than the specific number of fracture fragments
31. HGLS CLASSIFICATION SYSTEM:-(
CODMAN'S MODIFICATION OF HERTEL' S
SYSTEM)
• A fracture plane is represented by a
hyphen (-)
Codman E. Fractures in relation to the subacromial bursa. In: Codman E,
32. TREATMENT
Minimally displaced fractures- One part fractures
• Non-operative
• Sling immobilization/swathe for comfort
• Early range of motion when pain permits(usually after 1-2weeks)
• Pendulum exercises and gentle isometric strengthening of biceps and triceps to compress
fracture fragments
• After 3-4 weeks-supine passive flexion and external rotation exercises may be added
• 4-5 weeks-overhead pulley exercises
• 6-8 weeks- strengthening
• Resistive exercises started b/w 6-12 weeks
• Full ROM and function is expected outcome by 1 year
33. TWO PART FRACTURES :-
• Anatomic neck fractures
• Rare
• Difficult to treat by closed reduction
• For younger Pt- ORIF
• For older Pt- Hemiarthroplasty due to risk of avascular necrosis of humeral head
34. TWO PART FRACTURES
(SURGICAL NECK FRACTURES)
• Non operative-
• Angulated/displaced surgical neck fractures which are stable( move as a
unit)
• In lower demand Pt
• Severely debilitated pt
• Those who can not tolerate surgery
• Closed reduction and percutaneous pin
35. TWO PART FRACTURES
(SURGICAL NECK FRACTURES)
• Closed reduction and percutaneous pin
• Indications-
• Pt with good bone quality
• Noncomminuted/ minimally comminuted fractures that can be reduced by
closed means
• Contraindications-
• Severe comminution
• Osteopenia
36. TWO PART FRACTURES
(SURGICAL NECK FRACTURES)
• Advantages
• Avoidance of devascularisation of fracture fragments
• Minimization of injury to blood supply of humeral head
• Reduced operative morbidity
• Disadvantage-
• Risk of nerve injury- axillary
• Pin loosening
• Pin migration
• Inability to move the arm
• Risk of pin migration
• Loss of reduction
37. TWO PART FRACTURES
(SURGICAL NECK FRACTURES)
• ORIF
• IM device
• Plate and screws
• Prosthetic replacement
• For PT with extreme osteopenia
• May be hemiarthroplasty, total shoulder, or reverse shoulder prosthesis
38. TWO PART FRACTURES
(GT FRACTURES)
• often associated with anterior dislocation
• Reduces to good position once the shoulder is relocated
• If it does not reduce, the fragment can be reattached through a
small incision interosseous sutures, or in young hard bone-
cancellous screws
• ORIF with /without rotator cuff repair is indicated for GT fractures
which are displaced >5-10 mm
• Otherwise, they may develop non union/ subacromial impingement
39. TWO PART FRACTURES
(LT FRACTURES)
• Must rule out associated Posterior dislocation
• May be treated closely unless displaced fragment blocks internal
rotation
40. THREE PART FRACTURES
• Usually involve displacement of surgical neck and GT
• Unstable due to opposing muscle forces- so closed reduction and its
maintenance is often difficult.
• In active Pts it is best managed by ORIF
• Younger Pt- attempt ORIF using plate and srews
• replacement- indicated in elderly
41. FOUR PART FRACTURES
• Very severe injuries with a high risk of complications like
• Vascular injury
• Brachial plexus damage
• Injuries of chest wall
• (later) Avascular necrosis of humeral head
• In younger Pts, an attempt should be made at reconstruction by ORIF if head is
within glenoid fossa and there appears to be soft tissue continuity
• Fixation can be done with locking plate and screws, sutures and /or wire fixation
• Primary prosthetic replacement- indicated in elderly
42. FRACTURE-DISLOCATIONS
• Fracture-dislocations:-
• 2 part FD:-
• May be treated closed after shoulder reduction
• 3 and 4 part-
• ORIF in younger
• Prosthetic replacement in older
• Brachial plexus and axillary artery are in proximity to humeral head fragment with anterior fracture
dislocation
• Recurrent dislocation is rare following fracture union
• Prosthetic replacement of anatomic neck fracture dislocation is recommended because of high
incidence of osteonecrosis
• May be associated with increased incidence of Myositis ossificans with repeated attempts at closed
reduction
43. ARTICULAR SURFACE FRACTURES
• Hill-sach's and reverse Hill sach's
• Pt with > 40% of humeral head involvement - may require replacement
• <40 years - ORIF should be considered initially, if possible
44. • Studied 231 pt
• >16 years
• Follow up- 2 years
• Results-
• No significant difference b/w surgical treatment compared with nonsurgical
treatment
Rangan, Amar, et al. "Surgical vs nonsurgical treatment of adults with displaced
fractures of the proximal humerus: the PROFHER randomized clinical
trial." Jama 313.10 (2015): 1037-1047.
46. • Constant and Murley score
• excellent (score 86-100), good (score 71-85), fair (score 56-70) and
poor (0-55).
• conservatively treated patients- 75.69
• close reduction and percutaneous K wire fixation -82.79
• open reduction and internal fixation with anatomical locking plate -73.6.
47. SURGICAL CONSIDERATIONS
• Pt position-
• Supine
• beach chair position
• Allows weight of arm to facilitate fracture reduction
• Prosthetic replacement is usually performed
48. SURGICAL CONSIDERATIONS
• Surgical approach-
• Deltopectoral
• Allows for extensile approach to proximal humerus
• ORIF/ arthroplasty is well performed through this approach
• Deltoid split:-
• Allows for easier plate placement on GT and requires fewer assistants to
retract deltoid muscle
49. COMPLICATIONS
• Vascular injury
• Infrequent(5-6%)
• m/c sit- axillary artery(proximal to ACHA)
• Incidence high in older individuals due to atherosclerosis and loss of vessel
elasticity
• Neural injury
• Brachial plexus injury- 6%
• Axillary nv injury-
• Vulnerable with anterior fracture dislocation, because the nerve nv courses
on the inferior capsule and is prone to traction injury or laceration
50. COMPLICATIONS
• Chest injury
• Intrathoracic dislocation may occur with surgical neck fracture-
dislocations
• Pneumothorax
• Haemothorax
• Myositis ossificans:-
• Uncommon
• Ass with chronic unreduced fracture dislocations, repeated
attempts at closed reductions
• May also be related to timing of surgery and deltoid split
approaches
51. COMPLICATIONS
• Shoulder stiffness
• May be minimized with an aggressive, supervised physical therapy regimen
and may require open lysis of adhesions for recalcitrant cases
• Avascular necrosis-
• 10-30% in 3 part fractures
• 10-50% in 4 part fractures
• High in anatomic neck fractures
• Hertel criteria
• Metaphyseal extension of humeral head < 8mm 97% predictive
value
• Medial hinge disruption of > 2mm, and