Fractures of the proximal radius in children most commonly result from a fall on an outstretched arm. These fractures involve the radial head, neck or metaphysis. Non-displaced or minimally displaced fractures can usually be treated non-operatively with immobilization and range of motion exercises once pain subsides. Operative treatment is considered for fractures with over 2mm displacement, angulation over 45 degrees in children under 10 or 30 degrees in older children, or those with instability or limited motion after closed treatment. Surgical options include closed or open reduction with pins, screws or plates to restore alignment and stability. Outcomes depend on the degree of initial displacement and need for manipulation, with minimally angulated fractures having the
The document provides information on patellar dislocation, including:
- Anatomy of the patella and patellofemoral joint.
- Causes of patellar instability including anatomical abnormalities, trochlear dysplasia, and injury mechanisms.
- Evaluation of patients with patellar instability focusing on the integrity of the medial patellofemoral ligament and examining for patella alta.
- Imaging techniques used to assess patellar instability including x-rays, MRI, and CT which evaluate trochlear morphology, patellar height, and tracking.
This document discusses various surgical approaches to the hip joint, including anterior, anterolateral, lateral, and posterior approaches. It provides details on the Smith-Peterson anterior approach, including patient positioning, incision location in the internervous plane between the sartorius and tensor fascia latae muscles, and exposure of the hip joint capsule. It also describes the Watson-Jones anterolateral approach, including positioning the greater trochanter at the edge of the table, incising the fascia lata posterior to the tensor fasciae latae, and reflecting muscles to expose the joint capsule and femoral head. Finally, it outlines the lateral approach, with incision centered over the greater trochan
The document describes the Modified Broström Procedure for treating unstable ankles. It discusses how ankle instability is graded from I to III based on the amount of instability present. It notes that grade I and some grade II ankles may be treated conservatively through physical therapy and bracing, while grade III typically requires surgical reconstruction. The Modified Broström Procedure is described as restoring stability through anatomic repair of the ligaments while preserving range of motion and the peroneal tendons. It involves attaching the extensor retinaculum to reinforce the repaired ligaments and correct subtalar instability.
This document provides information on Monteggia fracture-dislocations, including:
- Classification into 4 main types based on the direction of the ulnar fracture and radial dislocation. Type 1 is the most common.
- Description of injury mechanisms, radiographic evaluation, treatment approaches including closed or open reduction of fractures and dislocations, and casting.
- Complications like neglected fractures and nerve injuries. Variations like Monteggia equivalents and revisions to the classification system are also discussed. Surgical techniques for addressing chronic cases, like annular ligament reconstruction and ulnar osteotomies, are covered.
Ligamentotaxis principle in the treatment of intra articular fractures of dis...Sitanshu Barik
This study assessed the correlation between radiological outcomes and functional outcomes in 45 patients treated with external fixation for intra-articular fractures of the distal radius. Good or acceptable restoration of radial length and palmar slope on radiographs post-operatively was found to produce good to excellent functional results regardless of fracture type. While poor radiological outcomes did not always lead to poor function, maintenance of radial length and correction of palmar tilt were important for functional outcomes. The study concluded that achieving good function is more important than surgical precision on radiographs alone.
Pilon fractures involve crushing injuries to the tibial plafond where the tibia meets the ankle. They are usually caused by high-energy impacts like falls or car accidents. Treatment depends on the fracture classification but commonly involves initial stabilization with external fixation followed by limited internal fixation once swelling subsides, in order to reduce complications. The goals are to restore anatomy, alignment and joint stability while avoiding further soft tissue damage.
The document describes the anatomy and surgical procedures for lengthening the Achilles tendon. It discusses:
- The anatomy of the gastrocnemius and soleus muscles which connect to form the Achilles tendon
- Indications for Achilles tendon lengthening including contracture and limited ankle range of motion
- Surgical techniques including gastrocnemius recession, intramuscular recession, and various Achilles tendon lengthening procedures
- Post-operative casting is typically used to maintain the correction
The document provides information on patellar dislocation, including:
- Anatomy of the patella and patellofemoral joint.
- Causes of patellar instability including anatomical abnormalities, trochlear dysplasia, and injury mechanisms.
- Evaluation of patients with patellar instability focusing on the integrity of the medial patellofemoral ligament and examining for patella alta.
- Imaging techniques used to assess patellar instability including x-rays, MRI, and CT which evaluate trochlear morphology, patellar height, and tracking.
This document discusses various surgical approaches to the hip joint, including anterior, anterolateral, lateral, and posterior approaches. It provides details on the Smith-Peterson anterior approach, including patient positioning, incision location in the internervous plane between the sartorius and tensor fascia latae muscles, and exposure of the hip joint capsule. It also describes the Watson-Jones anterolateral approach, including positioning the greater trochanter at the edge of the table, incising the fascia lata posterior to the tensor fasciae latae, and reflecting muscles to expose the joint capsule and femoral head. Finally, it outlines the lateral approach, with incision centered over the greater trochan
The document describes the Modified Broström Procedure for treating unstable ankles. It discusses how ankle instability is graded from I to III based on the amount of instability present. It notes that grade I and some grade II ankles may be treated conservatively through physical therapy and bracing, while grade III typically requires surgical reconstruction. The Modified Broström Procedure is described as restoring stability through anatomic repair of the ligaments while preserving range of motion and the peroneal tendons. It involves attaching the extensor retinaculum to reinforce the repaired ligaments and correct subtalar instability.
This document provides information on Monteggia fracture-dislocations, including:
- Classification into 4 main types based on the direction of the ulnar fracture and radial dislocation. Type 1 is the most common.
- Description of injury mechanisms, radiographic evaluation, treatment approaches including closed or open reduction of fractures and dislocations, and casting.
- Complications like neglected fractures and nerve injuries. Variations like Monteggia equivalents and revisions to the classification system are also discussed. Surgical techniques for addressing chronic cases, like annular ligament reconstruction and ulnar osteotomies, are covered.
Ligamentotaxis principle in the treatment of intra articular fractures of dis...Sitanshu Barik
This study assessed the correlation between radiological outcomes and functional outcomes in 45 patients treated with external fixation for intra-articular fractures of the distal radius. Good or acceptable restoration of radial length and palmar slope on radiographs post-operatively was found to produce good to excellent functional results regardless of fracture type. While poor radiological outcomes did not always lead to poor function, maintenance of radial length and correction of palmar tilt were important for functional outcomes. The study concluded that achieving good function is more important than surgical precision on radiographs alone.
Pilon fractures involve crushing injuries to the tibial plafond where the tibia meets the ankle. They are usually caused by high-energy impacts like falls or car accidents. Treatment depends on the fracture classification but commonly involves initial stabilization with external fixation followed by limited internal fixation once swelling subsides, in order to reduce complications. The goals are to restore anatomy, alignment and joint stability while avoiding further soft tissue damage.
The document describes the anatomy and surgical procedures for lengthening the Achilles tendon. It discusses:
- The anatomy of the gastrocnemius and soleus muscles which connect to form the Achilles tendon
- Indications for Achilles tendon lengthening including contracture and limited ankle range of motion
- Surgical techniques including gastrocnemius recession, intramuscular recession, and various Achilles tendon lengthening procedures
- Post-operative casting is typically used to maintain the correction
Osteotomies around the hip are surgical procedures used to correct biomechanical alignment and load transmission across the hip joint. They involve removing a portion of bone. The goals are to improve femoral head coverage, containment, motion, relieve pain, and correct leg length discrepancies. Different types of osteotomies target the proximal femur or pelvis. Proximal femoral osteotomies are classified based on anatomical location and degree of displacement. Pelvic osteotomies aim to redirect the acetabulum and include Salter, Sutherland, Steel/Tonnis, and Ganz/Bernese procedures. Key considerations for each procedure include indications, approach, osteotomy cuts made, advantages/disadv
This document discusses elbow instability, including anatomy, stabilizing factors, classification, diagnosis, and management. It covers the soft tissue and bony anatomy of the elbow. Elbow stability relies primarily on the ulnohumeral joint, medial and lateral collateral ligaments. Injuries can range from subluxation to complete dislocation. Diagnosis involves clinical examination and imaging. Management depends on the injury, and may include repair, reconstruction, or fixation of bony and ligamentous injuries.
This document discusses knee contractures, their causes, and treatment methods. It begins by defining knee contracture and noting that it can be difficult to differentiate intra-articular and extra-articular components clinically or radiographically. Common causes are discussed, including fractures and immobilization. Treatment methods include manipulation under anesthesia, quadricepsplasty techniques like Thompson and Judet quadricepsplasty, and newer mini-invasive or arthroscopy assisted approaches. Postoperative management focuses on early mobilization and physical therapy. Good outcomes are noted with gains in range of motion, though extension lags can sometimes occur.
This document describes the surgical steps for ACL reconstruction using a hamstring autograft. The key steps include:
1. Arthroscopic examination and addressing other lesions.
2. Harvesting the gracilis and semitendinosus tendons from the thigh.
3. Preparing bone tunnels in the femur and tibia.
4. Passing the graft through the tunnels and fixing it in place with interference screws to reconstruct the ligament.
Retrograde tibiotalocalcaneal nailing provides a novel single-stage approach to addressing hindfoot arthritis associated with tibial malunion or nonunion. The technique involves correcting tibial alignment via osteotomy and fusing the ankle and subtalar joints using a retrograde nail. In a study of 25 patients, all malunions and nonunions healed without loss of correction. Hindfoot alignment and function were restored, with 94% of patients reporting being satisfied or extremely satisfied. The technique provides an alternative to external fixation or staged procedures for treating this complex problem.
This document discusses recurrent dislocation of the patella. It begins with relevant anatomy of the patella and its stabilizers. Predisposing factors for dislocation include increased Q angle, trochlear dysplasia, and patella alta. Clinical features include pain, a feeling of instability, and positive apprehension and grind tests. Radiographs can evaluate patellar height and alignment. Management includes initial immobilization and rehabilitation, with surgery considered for recurrent or unstable cases. Surgical options are categorized based on risk/reward, and include soft tissue procedures like medial repair/MPFL reconstruction or distal realignment procedures like the Elmslie-Trillat operation. The key is identifying the underlying pathology and tailoring
The document discusses the hip joint issues seen in cerebral palsy, including progressive hip subluxation and dysplasia. It outlines the evaluation of hip problems including range of motion, imaging, and determining if the problem is femoral, acetabular, or both. Surgical options are described for addressing soft tissue contractures, bony deformities, and joint instability. The goals of treatment are stated as achieving a stable reduced joint with functional range of motion while minimizing pain and protecting the joint. Case examples are presented to illustrate some of the challenges over the long term in managing hip problems in cerebral palsy.
The document discusses posterior malleolus fractures of the ankle. It summarizes that CT scan is important for evaluating these fractures and determining treatment. While fragment size was traditionally used to dictate treatment, the focus should be on restoring joint congruity. A posteromedial surgical approach allows fixation of fractures that extend into the medial malleolus, like Haraguchi type II fractures. This approach provides good outcomes while avoiding complications when used to address complex posterior malleolus fractures.
Carpal instability and perilunate dislocationdhidhi george
The document discusses carpal instability and perilunate dislocations. It begins with the anatomy of the wrist joint and ligaments. It then covers various patterns of carpal instability including scapholunate dissociation, lunotriquetral dissociation, and perilunate dislocations. Treatment options discussed include closed reduction, ligament repair/reconstruction, limited wrist fusions, and total wrist fusion.
Osteotomy around the elbow is commonly performed to correct cubitus varus and cubitus valgus deformities. For cubitus varus, the most common cause is a malunited supracondylar fracture. Surgical options include lateral closing wedge osteotomy, oblique osteotomy with derotation, and medial opening wedge osteotomy with bone grafting. For cubitus valgus, causes include nonunion of a lateral condyle fracture. Surgical options are a closing wedge medial osteotomy or opening wedge lateral osteotomy. Complications of elbow osteotomy can include stiffness, persistent deformity, myositis ossificans, loss of fixation, and neurovascular injury.
The document provides information on recurrent patellar dislocation, including:
- Anatomy of the patella and its attachments
- Static and dynamic stabilizers of the patella
- Causes of patellar instability such as trochlear dysplasia, patella alta, increased Q angle
- Mechanisms of injury for acute vs recurrent dislocations
- Evaluation methods like the apprehension test, patellar glide test, and imaging views
The pulseless pink hand after supracondylar fracture humerusujjalrajbangshi
The document compares two management strategies - observation versus immediate surgical exploration - for children who have a pulseless but well-perfused hand after closed reduction of a Gartland type III supracondylar humerus fracture. Of 19 children, 11 were observed and 8 underwent immediate exploration. In the observation group, the pulse returned within 3 months in 7 children but 4 later required exploration, where the brachial artery and median nerve were found trapped in the fracture site. In the exploration group, the pulse returned within 24 hours in 6 of 8 children. The document concludes that an associated neurological deficit suggests nerve and vessel entrapment, making immediate exploration preferable to avoid permanent nerve damage.
This case report describes a 21-year old female patient with a 10-year history of habitual left patellar dislocation. Examination found lateral subluxation of the patella in flexion and reduced range of motion. X-rays showed patella baja on the left side and lateral dislocation of the patella. The patient underwent a proximal and distal soft tissue realignment procedure involving lateral release, medial reinforcement, and partial medialization of the patellar tendon. Post-operatively, the patella was centrally located with improved range of motion and stability. Habitual patellar dislocation is rare in adults and can be treated with soft tissue realignment surgery to reinforce the medial structures and release tight
This document discusses the treatment of distal femoral fractures. It describes the major muscle groups in the thigh, including the adductors, quadriceps, and hamstrings. It outlines four operative treatment options for distal femoral fractures: DCS/ORIF, DFLP, DFN, and external fixation. It provides details on the swashbuckler surgical approach for distal femoral fractures, including patient positioning, incision details, exposure of the distal femur, and closure. It also describes the technique for retrograde intramedullary nailing with DFN, including patient positioning, entry point location, and final nail position.
This document provides an overview of hip deformities in cerebral palsy and various surgical procedures used to treat them. It discusses hip subluxation and dislocation, risk factors, and treatments like adductor releases and varus derotational osteotomies. It then describes the details of the combined one-stage correction procedure known as the "San Diego procedure", which involves a lateral femoral osteotomy and anterior pericapsular pelvic osteotomy to realign the hip. Diagrams illustrate the surgical steps of each approach. The goal of these interventions is to prevent progressive hip deformity and dislocation in cerebral palsy patients.
This document discusses septic arthritis of the hip in children. It defines septic arthritis and notes that the hip is the most commonly infected joint in children. Early diagnosis and treatment is important to prevent joint damage. Signs include limping, groin pain, and limited hip movement. Treatment involves identifying the organism, administering sensitive antibiotics, and potentially surgery. Long term sequelae can include joint deformities, leg length discrepancies, and arthritis. Various classification systems and treatment approaches are presented. Prevention of septic arthritis through early diagnosis and management is emphasized.
Use of local antibiotic depot (stimulan)mangalparihar
This document discusses local antibiotic delivery using Stimulan, a synthetic calcium sulfate hemihydrate. It begins by introducing Dr. Mangal Parihar and describing his credentials. It then discusses Stimulan's advantages over traditional calcium sulfate forms, including its purity, pH, and ability to elute antibiotics at high concentrations over an extended period. Studies showing Stimulan's ability to elute antibiotics like moxifloxacin, fusidic acid, and daptomycin at levels above the MIC for pathogens like MRSA are summarized. The document concludes by describing Stimulan's potential benefits for treating bone infections by providing sustained, high local antibiotic levels directly at the site of infection.
This document discusses high tibial osteotomy (HTO), a procedure that corrects knee alignment to relieve pressure from arthritic areas. It was first described in 1961 and involves cutting and reshaping the tibia to transfer weight from an arthritic to a healthier area of cartilage. The document outlines indications, contraindications, techniques like closing wedge and opening wedge osteotomy, management of the fibula, fixation methods, advantages and disadvantages of different techniques, expected results, and potential complications. HTO is a well-established procedure for unicompartmental knee arthritis with typical satisfactory results in 80% of cases.
BEST SEMINAR, BEST SEMINAR FOR POST GRADUATE, PPT FOR POST GRADUATE, PPT FOR UNDER GRADUATE, PPT FOR COCSIZE NITES, NOTES OF THE DAY.
NOTES OF THE DAY, NOTES WITH HEAVEY NOTES, HEAVEY CONSISE NOTES, THIS IS THE WORK OF ART AND KNOWLWDGE. VERY WELL PRESENTED SEMINART OF PRIME IMPORTANCE. ITE THE BEST EVER SEEN.
This document discusses fractures and dislocations around the elbow in pediatric patients. It focuses on elbow fractures, which are very common injuries in children, accounting for approximately 65% of pediatric trauma cases. Supracondylar fractures of the humerus are the most common type of elbow fracture in children. The document describes the classification, physical exam findings, radiographic evaluation, treatment considerations, and surgical technique for fixation of these fractures. Thorough physical exam and documentation of neurovascular status is emphasized due to risk of associated injuries.
Osteotomies around the hip are surgical procedures used to correct biomechanical alignment and load transmission across the hip joint. They involve removing a portion of bone. The goals are to improve femoral head coverage, containment, motion, relieve pain, and correct leg length discrepancies. Different types of osteotomies target the proximal femur or pelvis. Proximal femoral osteotomies are classified based on anatomical location and degree of displacement. Pelvic osteotomies aim to redirect the acetabulum and include Salter, Sutherland, Steel/Tonnis, and Ganz/Bernese procedures. Key considerations for each procedure include indications, approach, osteotomy cuts made, advantages/disadv
This document discusses elbow instability, including anatomy, stabilizing factors, classification, diagnosis, and management. It covers the soft tissue and bony anatomy of the elbow. Elbow stability relies primarily on the ulnohumeral joint, medial and lateral collateral ligaments. Injuries can range from subluxation to complete dislocation. Diagnosis involves clinical examination and imaging. Management depends on the injury, and may include repair, reconstruction, or fixation of bony and ligamentous injuries.
This document discusses knee contractures, their causes, and treatment methods. It begins by defining knee contracture and noting that it can be difficult to differentiate intra-articular and extra-articular components clinically or radiographically. Common causes are discussed, including fractures and immobilization. Treatment methods include manipulation under anesthesia, quadricepsplasty techniques like Thompson and Judet quadricepsplasty, and newer mini-invasive or arthroscopy assisted approaches. Postoperative management focuses on early mobilization and physical therapy. Good outcomes are noted with gains in range of motion, though extension lags can sometimes occur.
This document describes the surgical steps for ACL reconstruction using a hamstring autograft. The key steps include:
1. Arthroscopic examination and addressing other lesions.
2. Harvesting the gracilis and semitendinosus tendons from the thigh.
3. Preparing bone tunnels in the femur and tibia.
4. Passing the graft through the tunnels and fixing it in place with interference screws to reconstruct the ligament.
Retrograde tibiotalocalcaneal nailing provides a novel single-stage approach to addressing hindfoot arthritis associated with tibial malunion or nonunion. The technique involves correcting tibial alignment via osteotomy and fusing the ankle and subtalar joints using a retrograde nail. In a study of 25 patients, all malunions and nonunions healed without loss of correction. Hindfoot alignment and function were restored, with 94% of patients reporting being satisfied or extremely satisfied. The technique provides an alternative to external fixation or staged procedures for treating this complex problem.
This document discusses recurrent dislocation of the patella. It begins with relevant anatomy of the patella and its stabilizers. Predisposing factors for dislocation include increased Q angle, trochlear dysplasia, and patella alta. Clinical features include pain, a feeling of instability, and positive apprehension and grind tests. Radiographs can evaluate patellar height and alignment. Management includes initial immobilization and rehabilitation, with surgery considered for recurrent or unstable cases. Surgical options are categorized based on risk/reward, and include soft tissue procedures like medial repair/MPFL reconstruction or distal realignment procedures like the Elmslie-Trillat operation. The key is identifying the underlying pathology and tailoring
The document discusses the hip joint issues seen in cerebral palsy, including progressive hip subluxation and dysplasia. It outlines the evaluation of hip problems including range of motion, imaging, and determining if the problem is femoral, acetabular, or both. Surgical options are described for addressing soft tissue contractures, bony deformities, and joint instability. The goals of treatment are stated as achieving a stable reduced joint with functional range of motion while minimizing pain and protecting the joint. Case examples are presented to illustrate some of the challenges over the long term in managing hip problems in cerebral palsy.
The document discusses posterior malleolus fractures of the ankle. It summarizes that CT scan is important for evaluating these fractures and determining treatment. While fragment size was traditionally used to dictate treatment, the focus should be on restoring joint congruity. A posteromedial surgical approach allows fixation of fractures that extend into the medial malleolus, like Haraguchi type II fractures. This approach provides good outcomes while avoiding complications when used to address complex posterior malleolus fractures.
Carpal instability and perilunate dislocationdhidhi george
The document discusses carpal instability and perilunate dislocations. It begins with the anatomy of the wrist joint and ligaments. It then covers various patterns of carpal instability including scapholunate dissociation, lunotriquetral dissociation, and perilunate dislocations. Treatment options discussed include closed reduction, ligament repair/reconstruction, limited wrist fusions, and total wrist fusion.
Osteotomy around the elbow is commonly performed to correct cubitus varus and cubitus valgus deformities. For cubitus varus, the most common cause is a malunited supracondylar fracture. Surgical options include lateral closing wedge osteotomy, oblique osteotomy with derotation, and medial opening wedge osteotomy with bone grafting. For cubitus valgus, causes include nonunion of a lateral condyle fracture. Surgical options are a closing wedge medial osteotomy or opening wedge lateral osteotomy. Complications of elbow osteotomy can include stiffness, persistent deformity, myositis ossificans, loss of fixation, and neurovascular injury.
The document provides information on recurrent patellar dislocation, including:
- Anatomy of the patella and its attachments
- Static and dynamic stabilizers of the patella
- Causes of patellar instability such as trochlear dysplasia, patella alta, increased Q angle
- Mechanisms of injury for acute vs recurrent dislocations
- Evaluation methods like the apprehension test, patellar glide test, and imaging views
The pulseless pink hand after supracondylar fracture humerusujjalrajbangshi
The document compares two management strategies - observation versus immediate surgical exploration - for children who have a pulseless but well-perfused hand after closed reduction of a Gartland type III supracondylar humerus fracture. Of 19 children, 11 were observed and 8 underwent immediate exploration. In the observation group, the pulse returned within 3 months in 7 children but 4 later required exploration, where the brachial artery and median nerve were found trapped in the fracture site. In the exploration group, the pulse returned within 24 hours in 6 of 8 children. The document concludes that an associated neurological deficit suggests nerve and vessel entrapment, making immediate exploration preferable to avoid permanent nerve damage.
This case report describes a 21-year old female patient with a 10-year history of habitual left patellar dislocation. Examination found lateral subluxation of the patella in flexion and reduced range of motion. X-rays showed patella baja on the left side and lateral dislocation of the patella. The patient underwent a proximal and distal soft tissue realignment procedure involving lateral release, medial reinforcement, and partial medialization of the patellar tendon. Post-operatively, the patella was centrally located with improved range of motion and stability. Habitual patellar dislocation is rare in adults and can be treated with soft tissue realignment surgery to reinforce the medial structures and release tight
This document discusses the treatment of distal femoral fractures. It describes the major muscle groups in the thigh, including the adductors, quadriceps, and hamstrings. It outlines four operative treatment options for distal femoral fractures: DCS/ORIF, DFLP, DFN, and external fixation. It provides details on the swashbuckler surgical approach for distal femoral fractures, including patient positioning, incision details, exposure of the distal femur, and closure. It also describes the technique for retrograde intramedullary nailing with DFN, including patient positioning, entry point location, and final nail position.
This document provides an overview of hip deformities in cerebral palsy and various surgical procedures used to treat them. It discusses hip subluxation and dislocation, risk factors, and treatments like adductor releases and varus derotational osteotomies. It then describes the details of the combined one-stage correction procedure known as the "San Diego procedure", which involves a lateral femoral osteotomy and anterior pericapsular pelvic osteotomy to realign the hip. Diagrams illustrate the surgical steps of each approach. The goal of these interventions is to prevent progressive hip deformity and dislocation in cerebral palsy patients.
This document discusses septic arthritis of the hip in children. It defines septic arthritis and notes that the hip is the most commonly infected joint in children. Early diagnosis and treatment is important to prevent joint damage. Signs include limping, groin pain, and limited hip movement. Treatment involves identifying the organism, administering sensitive antibiotics, and potentially surgery. Long term sequelae can include joint deformities, leg length discrepancies, and arthritis. Various classification systems and treatment approaches are presented. Prevention of septic arthritis through early diagnosis and management is emphasized.
Use of local antibiotic depot (stimulan)mangalparihar
This document discusses local antibiotic delivery using Stimulan, a synthetic calcium sulfate hemihydrate. It begins by introducing Dr. Mangal Parihar and describing his credentials. It then discusses Stimulan's advantages over traditional calcium sulfate forms, including its purity, pH, and ability to elute antibiotics at high concentrations over an extended period. Studies showing Stimulan's ability to elute antibiotics like moxifloxacin, fusidic acid, and daptomycin at levels above the MIC for pathogens like MRSA are summarized. The document concludes by describing Stimulan's potential benefits for treating bone infections by providing sustained, high local antibiotic levels directly at the site of infection.
This document discusses high tibial osteotomy (HTO), a procedure that corrects knee alignment to relieve pressure from arthritic areas. It was first described in 1961 and involves cutting and reshaping the tibia to transfer weight from an arthritic to a healthier area of cartilage. The document outlines indications, contraindications, techniques like closing wedge and opening wedge osteotomy, management of the fibula, fixation methods, advantages and disadvantages of different techniques, expected results, and potential complications. HTO is a well-established procedure for unicompartmental knee arthritis with typical satisfactory results in 80% of cases.
BEST SEMINAR, BEST SEMINAR FOR POST GRADUATE, PPT FOR POST GRADUATE, PPT FOR UNDER GRADUATE, PPT FOR COCSIZE NITES, NOTES OF THE DAY.
NOTES OF THE DAY, NOTES WITH HEAVEY NOTES, HEAVEY CONSISE NOTES, THIS IS THE WORK OF ART AND KNOWLWDGE. VERY WELL PRESENTED SEMINART OF PRIME IMPORTANCE. ITE THE BEST EVER SEEN.
This document discusses fractures and dislocations around the elbow in pediatric patients. It focuses on elbow fractures, which are very common injuries in children, accounting for approximately 65% of pediatric trauma cases. Supracondylar fractures of the humerus are the most common type of elbow fracture in children. The document describes the classification, physical exam findings, radiographic evaluation, treatment considerations, and surgical technique for fixation of these fractures. Thorough physical exam and documentation of neurovascular status is emphasized due to risk of associated injuries.
Elbow fractures are common in children, with supracondylar humerus fractures representing about 60% of cases. Physical exam should assess for tenderness, deformity, neurovascular status, and compartment syndrome. Radiographs can further classify supracondylar fractures as nondisplaced (Type 1), angulated with intact posterior cortex (Type 2), or completely displaced (Type 3). Type 2 and 3 fractures typically require closed or open reduction with percutaneous pinning. Complications can include malunion, loss of motion, and nerve injuries. Lateral condyle and medial epicondyle fractures may also require open reduction and internal fixation if significantly displaced.
This document discusses forearm diaphysial fractures in adults. It begins by describing the anatomy and biomechanics of the forearm. It then discusses the epidemiology of forearm fractures, including that they most commonly occur in males ages 15-39 from high-energy trauma. It classifies fractures based on location and describes common fracture patterns like Monteggia and Galeazzi fractures. The document outlines how to assess and manage patients, including indications for operative versus non-operative treatment. Surgical techniques like plate fixation are described. Finally, potential postoperative complications are mentioned.
The document discusses the anatomy and common injuries of the elbow joint. It begins with the bones and ligaments that form the elbow joint. It then describes the muscles that flex, extend, supinate, and pronate the elbow. Common fractures discussed include fractures of the medial epicondyle, lateral epicondyle, radial head, coronoid process, olecranon, and elbow dislocations. Treatment options like splinting, open reduction internal fixation, and elbow replacement are covered. Pulled elbow, or subluxation of the radial head in children, is also summarized.
This document discusses various fractures around the elbow joint. Radial head and neck fractures most commonly result from a fall on an outstretched arm. Clinical features include swelling, limited range of motion, and point tenderness over the radial head. Elbow dislocations, which can occur with fractures, require prompt reduction due to risk of nerve and vascular injury. Management depends on the specific fracture but may include splinting, surgery, or gentle exercises after initial immobilization.
The document discusses fractures of the humerus bone, which has three parts - proximal, mid shaft, and distal. Shaft fractures of the humerus are common in adults from falls and in children. Distal humerus fractures are rare and occur after age 40 from force through the flexed elbow. Treatment depends on the type and location of the fracture, ranging from splinting, casting, and bracing for nondisplaced fractures to open reduction and internal fixation for displaced fractures. Complications can include nerve and blood vessel injuries as well as joint stiffness.
This document provides an overview of proximal humerus fractures, including:
- The mechanisms, classification, clinical features, imaging studies, and management approaches for various types of proximal humerus fractures.
- Key types include undisplaced one-part fractures treated non-operatively, greater tuberosity fractures which often require surgery for displacement, and three-part fractures which are unstable and may require operative fixation.
- Surgical neck fractures can often be treated non-operatively if minimally displaced, while displaced or angulated fractures may need closed or open reduction and internal fixation.
Dear all,
This ppt contains the cause, types, clinical and radiological features, treatment and complication of forearm bone fractures, Monteggia and Galeazzi fracture. I hope this is useful to you.
Thank you
This document provides an overview of supracondylar humerus fractures in children. It discusses the anatomy of the elbow, epidemiology of these fractures, mechanisms of injury, clinical evaluation, radiographic evaluation, classification of fractures, management approaches, and postoperative care. The majority of these fractures in children are extension-type injuries that occur in 5-10 year olds and can be classified into 3 types based on displacement. Types 1 and 2 are typically treated with closed reduction and percutaneous pinning while type 3 often requires open reduction.
This document discusses fractures of the distal radius, including Colles' fractures (transverse fractures with dorsal displacement), Smith's fractures (volar displacement), and Barton's fractures (dorsal or volar rim avulsions). Treatment depends on the fracture type and degree of displacement/fragmentation. Displaced fractures may be reduced manually or surgically with K-wires, plates, or external fixation. Outcomes depend on restoring length, alignment, and congruity while allowing early motion. Complications include malunion, nonunion, instability, and arthritis.
Radial Head Excision technique Operation .pptxHanun15
Radial head excision is indicated for low demand patients with continued pain from an isolated radial head fracture. It is contraindicated in children, unstable injuries, or terrible triad injuries of the elbow. Complications include proximal migration of the radius, wrist pain and weakness, and elbow instability. The radial head receives its blood supply from vessels in the periosteum, so gentle closed reduction is preferred to avoid further threatening the blood supply when possible. Avascular necrosis can occur if the blood supply is disrupted, leading to pain and stiffness over time. Non-union or mal-union of the radial head are rare but can be treated with exercises, osteotomy, or radial head resection depending on symptoms.
This document summarizes different types of distal radius fractures, including Colles fractures and Smith fractures. Colles fractures involve a hyperextended and radially deviated wrist from a fall, often appearing as a "dinner fork" deformity. Smith fractures are the reverse with volar angulation from the wrist flexed in a fall. Treatment options are also summarized, indicating nonoperative treatment for nondisplaced or minimally displaced fractures using splinting or casting, while operative indications include displaced articular fractures, nerve injuries, or multiple injuries. Nonoperative techniques involve closed reduction and splinting or casting the wrist in slight flexion for 6 weeks.
The document discusses fractures of the forearm and carpal bones. It describes fractures of the radial head, shaft fractures, Monteggia fracture dislocations which involve both the ulna and radial head, Galeazzi fracture dislocations of the distal radius and ulna, and fractures of the distal radius and ulna. Treatment depends on the type and location of the fracture, with options including splinting, casting, closed reduction, and open reduction with internal fixation for displaced or complex fractures. Complications may include non-union, malunion, reduced range of motion, and instability.
This document discusses fractures of the forearm and wrist. It begins by describing olecranon fractures, classifying them based on displacement and stability. It notes that undisplaced fractures are treated nonoperatively while displaced fractures require operative fixation. Radial head and neck fractures as well as fractures of the radius and ulna shaft are also discussed. Distal radius fractures are classified using the AO system and treatment may involve closed or open reduction. Specific fractures of the wrist like scaphoid and Bennett fractures are outlined along with treatment principles for metacarpal and phalangeal injuries. Overall, the summary provides an overview of different forearm, wrist and hand fractures and guidelines for nonoperative and operative management.
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Proximal radius fractures in children
1. ASSESSMENT OF FRACTURES OF THE
PROXIMAL RADIUS IN CHILDREN
By :-
Dr OPENDER SINGH KAJLA
RNT MEDICAL COLLEGE, UDAIPUR
2. INTRODUCTION
• Fractures of the proximal radius in skeletally immature patients usually involve the metaphysis
or physis.
• True isolated radial head fractures are rare.
• Fractures of the radial neck account for slightly more than 1% of all children’s fractures.Radial
neck fractures make up approximately 5% of elbow fractures in children.
• Radial head fractures are uncommon, and when they occur usually are Salter–Harris type IV
injuries.
• The median age at injury is 9 to 10 years in the pediatric population.
• There is little difference in the occurrence rates between males and females22,40,68
; however, this injury
seems to occur on an average approximately 2 years earlier in girls than in boys.
3. MECHANISM OF
INJURY
• Fractures of the proximal radius most commonly occur after a fall on an outstretched arm with
elbow extended and valgus stress at the elbow.
• The cartilaginous head absorbs the force and transmits it to the weaker physis or metaphysis
of the neck.
• These fractures characteristically produce an angular deformity of the head with the neck.
• Vostal showed that in neutral, the pressure is concentrated on the lateral portion of the head
and neck. In supination, the pressure is concentrated anteriorly, and in pronation it is con-
centrated posteriorly.
• Proximal radial fractures also may occur in association with elbow.
5. Associated Injuries with Fractures
of the Proximal Radius
• Can occur concomitantly with distal humerus, ulna, radial shaft, or distal radius
fractures.
• Fractures in combination with ulnar fractures often are part of the Monteggia fracture
pattern.
• Portends a poor prognosis for patients with proximal radius fractures with higher rates
of persistent stiffness and pain compared to those with isolated proximal radius
fractures.
• The posterior interosseous nerve (PIN) wraps around the proximal radius and
occasionally can be injured in association with proximal radius fractures.
6. Signs and Symptoms of Fractures
of the Proximal Radius
• The pain is usually increased with forearm supination and pronation
more so than with elbow flexion and extension.
• Displaced fractures frequently result in visible bruising or
ecchymosis on the lateral aspect of the elbow with significant soft
tissue swelling.
• Neurologic examination should in particu- lar evaluate the PIN,
which can be affected by fractures of the proximal radius.
• In a young child, the primary complaint may be wrist pain, and
pressure over the proximal radius may accentuate this referred wrist
pain.2
The wrist pain may be secondary to radial shortening and
subsequent distal radioulnar joint dysfunction.
7.
8. Imaging and Other Diagnostic Studies for Fractures of the Proximal Radius
• Displaced fractures are easy to evaluate on AP and Lateral views of elbow X-rays.
• Some variants in the ossification process can resemble a fracture. Most of these involve the
radial head, although a step-off also can develop as a normal variant of the metaphysis.
• There may be a persistence of the secondary ossification centers of the epiphysis.
Comparison views of the contralateral elbow are useful for evaluation of unusual ossification
centers after an acute elbow injury.
• If elbow cannot be extended due to pain then one view is taken with the beam perpendicular
to the distal humerus, and the other with the beam perpendicular to the proximal radius.
9. Oblique view/ Radio-capitellar view
• For minimally displaced
fractures.
• Suggested by Greenspan et al
and Hall- Craggs et al.
• This view projects the radial
head anterior to the coronoid
process and is especially
helpful if full supination and
pronation views are difficult to
obtain because of acute injury.
10.
11.
12. • The diagnosis of a partially or completely displaced
fracture of the radial neck may be difficult in
children whose radial head remains unossified.88
• The only clue may be a little irregularity in the
smoothness of the proximal metaphyseal
margin.
• Displacement of supinator fat or anterior/posterior
humeral fat pad may indicate fracture but not
always.
• MRI is best in these cases.
• Arthrogram, ultrasound, or MRI are helpful to
assess the extent of the displacement and the
accuracy of reduction in children with an unossified
radial epiphysis.
13. • In the preossification stage, on the AP radiograph, the edge of the metaphysis of
the proximal radius slopes distally on its lateral border.
• This angulation is normal and not a fracture.
• In the AP view, the lateral angulation varies from 0 to 15 degrees, with the average
being 12.5 degrees.
• In the lateral view, the angulation can vary from 10 degrees anterior to 5 degrees
posterior, with the average being 3.5 degrees anterior .
• Radial head fractures can be associated with ligament injuries so MRI should be
considered if displacement occurs in serial radiographs.
14. xray showing lateral angulation of
proximal radius Arthrogram of same patient showing
displaced radial head
15. Chambers Classification of Proximal Radial Fractures
Group I: Primary Displacement of the Radial Head
A. Valgus fractures
1. Type A—Salter–Harris type I and II injuries of the proxi-
mal radial physis
2. Type B—Salter–Harris type IV injuries of the proximal
radial physis
3. Type C—Fractures involving only the proximal radial
metaphysis
B. Fractures associate with elbow dislocation
1. Type D—Reduction injuries
2. 2. Type E—Dislocation injuries
Group II: Primary Displacement of the Radial Neck
A. Angular injuries(Monteggia typeIII variant)
B. Torsional injuries
Group III: Stress Injuries
16.
17.
18. A: Acute injury films revealing small
displacement of radial head fracture on the
flexed elbow anteroposterior (AP) view and
subtle posterior subluxation not originally
appreciated on the lateral view.
B: Follow-up radiographs at 1 week noted more
difficulty interpreting the AP view in cast, and
more radiocapitellar posterior displacement on
the lateral view.
19. An MRI scan (C) was ordered urgently
and revealed a marked effusion and intra-
articular displacement of radial head
fracture and posterior radiocapitellar
subluxation.
D: Open reduction internal fixation was
performed to anatomically align the radial
head fracture and reduce the joint.
24. Increasing grade has generally been associated with poorer outcomes with both nonoperative and ope
25. PATHOANATOMY AND APPLIED ANATOMY RELATING TO FRACTURES OF
THE PROXIMAL RADIUS
• In the embryo, the proximal radius is well defined by 9 weeks of gestation.
• By 4 years of age, the radial head and neck have the same contours as in an
adult.
• Ossification of the proximal radius epiphysis begins at approximately 5 years of
age as a small, flat nucleus.
• This ossific nucleus can originate as a small sphere or it can be bipartite, which
is a normal variation and should not be misinterpreted as a fracture.
• No ligaments attach directly to the radial neck or head. The radial collateral
ligaments attach to the annular ligament, which originates from the radial side
of the ulna.
• The articular capsule attaches to the proximal third of the neck.
• Thus, only a small portion of the neck lies within the articular capsule.
28. Nonoperative Treatment of Fractures of the Proximal Radius
Indications/Contraindications :-
• Nonoperative treatment is indicated for the majority of proximal radius fractures.
• Radial neck angulation of 30 to 45 degrees generally remodels and conservative treatment
will lead to good results.
• It is critical to assess forearm rotation, and if a block to full rotation is appreciated
operative treatment should be considered. Intra- articular aspiration of hematoma and
injection of local anesthetic can assist with pain relief and assessment of range of motion.
• Patients not requiring closed reduction should be immobilized for comfort for a short
period of time to allow for comfort and soft tissue healing.
• This is generally 1 to 3 weeks based on extent of injury and age.
• After fracture pain has subsided patients should work on progressively increasing range
29. Closed Reduction Techniques
• Patterson’s manipulative technique.
• Kaufman et al. technique - elbow is manipulated in the flexed position.
• Neher and Torch reduction technique
• The Israeli technique.
• Esmarch bandage wrap technique - as an adjunct to all techniques. Helps in easy reduction.
• Monson technique - proximal fragment should be held by annular ligament. Radius shaft is
reduced.
• Radial neck angulation should be reduced to less than 45 degrees in children under 10 years
of age and less than 30 degrees in children greater than 10 years of age.
• The radiocapitellar joint should be congruent.
• The elbow joint must be stable to stress.
• Early range of motion should be encouraged once the acute pain has resolved, generally
30.
31. An assistant uses both thumbs to place a laterally directed force on the proximal radial shaft
while the surgeon applies a varus stress to the elbow. Simultaneously, the surgeon uses his
other thumb to apply a reduction force directly to the radial head
32.
33.
34.
35.
36. Operative Treatment of Fractures of the Proximal Radius
Indications/Contraindications :-
• Indicated in situations where acceptable alignment cannot be
achieved with closed means, or if there is persistent elbow
instability or restricted range of motion after closed treatment.
• Operative treatment should be considered when :-
A. Displacement remains over 2 mm,
B. angulation is greater than 45 degrees (age < 10) or greater than
30 degrees (age > 10), and for open injuries.
• Nerve palsy is generally not an indication for surgery because
most will recover function over time.
41. Leverage techniqueLeverage technique of instrument-
assisted closed reduction of the
proximal radius
(A). Intraoperative AP
fluoroscopy image demonstrating
angulated radial neck fracture
(B). K-wire inserted at fracture
site and levering proximal
fragment into a reduced position
(C). Same wire driven through the
opposite cortex to hold reduced
position of the proximal fragment
(D).AP view of elbow following
pin removal in clinic showing
anatomic alignment of proximal
46. Plate fixation
Open reduction internal fixation
of a proximal radius fracture
(A). AP radiograph of an 11-
year-old female with elbow
dislocation and radial neck
fracture
(B). Lateral radiograph of the
same patient.
C: Lateral radiograph in splint
after closed reduction showing
persistent radiocapitellar sublux-
ation. Examination under
anesthesia demonstrated very
unstable elbow joint and
therefore decision made to
proceed with open reduction
internal fixation
(D). Lateral radiograph after open
47.
48. predictors of results after treatment. A higher incidence of good
outcomes is found in patients who do not require fracture
manipulation (closed or open) and present with fractures with
minimal angulation and displacement.68,108 For patients having
operative treatment, closed methods generally lead to improved
results compared to open treatments. This is again largely because
of increased severity of fractures requiring open reduction. In
certain cases, however, open treatment is pre- ferred and small
case series demonstrates improved results with open treatment in
appropriately selected patients.