Seminar on Osteonecrosis of femoral head.pptx
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Osteonecrosis of the femoral head is caused by a decrease in blood flow leading to cell death, fracture, and collapse of the joint surface. It commonly affects both hips in young patients. Untreated patients have an 85% chance of symptomatic collapse. Etiologies include idiopathic, genetic, metabolic and local factors. Diagnosis is made based on findings like crescent sign, sclerosis, cysts and loss of the spherical femoral head. Treatment aims to preserve the femoral head through early intervention using techniques like femoral head core decompression, non-vascularized bone grafting, biologics, vascularized bone grafting. Medical management is used for small asymptomatic lesions or when surgery is contraindicated and involves
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JC on CALCANEUM FRACTURE
1) The document discusses calcaneal fractures, which are the most common tarsal bone fractures, usually caused by an axial load.
2) CT scans and X-rays are used to classify the fractures based on the Sanders and Essex-Lopresti classifications, which identify involvement of the posterior facet joint.
3) Treatment depends on the classification and displacement. Non-operative treatment is used for non-displaced fractures while operative treatment with open reduction and internal fixation is used for displaced intra-articular fractures to restore the anatomy.
unstable trochanteric fracture
This document discusses unstable trochanteric hip fractures, factors that contribute to instability, and strategies to avoid pitfalls in treatment. It reviews literature on techniques such as the Evans method of restoring posteromedial cortical continuity and use of cephalomedullary nails to prevent fracture collapse. Unstable fracture patterns like reverse oblique fractures require special attention. Pre-operative planning using 3D CT is important to identify features like lateral wall thickness and posterior wall fractures. Intramedullary devices are generally better than extramedullary fixation like DHS for addressing unstable trochanteric fractures.
Plastic and reconstructive surgery presentation.pptx
This document provides an overview of plastic and reconstructive surgery techniques. It discusses various types of grafts and flaps used to manage soft tissue defects, including split thickness skin grafts, full thickness skin grafts, nerve grafts, tendon grafts, random flaps, axial flaps, pedicled flaps, and free flaps. Specific techniques are described for cross leg flaps, biceps femoris flaps, gastrocnemius flaps, soleus flaps, and peroneous brevis flaps to cover defects in the lower limbs. Key principles of plastic surgery like adequate debridement and minimal skin tension are also summarized.
TB SPINE.pptx
Tuberculosis of the spine, also known as Pott's disease, was first described in 1799. It is caused by the bacterium Mycobacterium tuberculosis which spreads hematogenously from a primary infection site to the spine. India has a high prevalence of spinal tuberculosis, accounting for around 1-3% of all TB cases. The disease most commonly affects the lower thoracic and upper lumbar spine. Clinical features include back pain, stiffness, deformity, and neurological deficits in advanced cases. Diagnosis involves imaging like X-rays and MRI to identify vertebral body destruction, as well as tests to detect M. tuberculosis from biopsy or aspirate samples. Advanced disease can compress the spinal cord, potentially causing parapleg
Fat Embolism.pptx
Fat embolism occurs when fat droplets enter the bloodstream and block small blood vessels following trauma or surgery involving long bones. It can affect the lungs, brain, and skin. Symptoms appear within 1-3 days and include respiratory distress, confusion, rash, and retinal changes. Diagnosis is based on clinical criteria involving these organ systems. Treatment is supportive with oxygen, ventilation if needed, and controlling cerebral swelling. Outcomes have improved but morbidity remains from respiratory failure or brain injury.
proximal humerus fracture fixation teaching
1. The functional outcomes of shoulder fracture surgery can be unpredictable due to the complex anatomy of the shoulder.
2. Key factors that guide the choice of treatment for proximal humeral fractures include patient characteristics and the nature of the fracture.
3. Rotator cuff tears in overhead athletes are often due to tensile overload and impingement, and may present as acute partial or complete tears.
Pelvis radiographs
A 48-year-old male was in a motorbike accident and suffered a pelvic fracture. He underwent surgery where the anterior column was fixed using a Matta plate after using traction pins and a Schanz screw to disimpact the femoral head. The posterior column was then fixed through a separate incision using a Matta plate and one third tubular plate, and skeletal traction was applied post-operatively.
JOURNAL CLUB ON FLEXOR TENDON INJURIES.pptx
This journal club discusses flexor tendon injuries and rehabilitation. Flexor tendon injuries occur frequently in the hand and restoration of finger function is challenging. The presentation reviews flexor tendon anatomy, zones of injury, surgical techniques for repair, and post-operative rehabilitation protocols focusing on early passive motion to minimize adhesions while allowing healing. Complications like rupture and contractures are discussed along with a case study example of "Jersey finger" injury. The key messages are that early repair, adherence to post-op rehabilitation, and preservation of the pulley system lead to the best functional outcomes.
Solution to Rotator Cuff Deficient Shoulder.ppt
This document discusses the principles of reverse shoulder replacement. It begins by describing the components of the rotator cuff. It then explains how rotator cuff tears can lead to instability and superior subluxation of the humeral head. The concept of the reverse shoulder replacement, developed by Professor Grammont, is introduced as a way to medialize the center of rotation and increase deltoid function to restore force balance. The document outlines the clinical assessment, surgical technique, rehabilitation, and results of the reverse shoulder replacement procedure.
Proximal tibia fracture
A 50-year-old male patient presented with a right proximal tibia fracture. He underwent spanning external fixation on March 28th and was discharged on March 30th but readmitted on April 10th. On April 11th he underwent the first stage of surgery which included open reduction and internal fixation of the right proximal tibia fracture under C-arm guidance.
Bone tumors.pptx
- Bone tumors can be benign, intermediate, or malignant. Location, size, margins, and other radiographic features help determine tumor type and appropriate treatment.
- Evaluation involves history, exam, imaging like x-rays, and biopsy. Staging evaluates spread and guides prognosis and treatment planning.
- Treatment depends on tumor type but may include surgery, chemotherapy, and radiotherapy. The goal is complete resection while preserving limb function through techniques like endoprosthetic replacement.
Scrubbing and Gowning
Surgical scrubbing and gowning is done to reduce bacteria on hands and forearms to a safe level before surgery. The document outlines the scrubbing process which involves removing jewelry, trimming nails, and washing hands and forearms with antimicrobial soap. It describes scrubbing in a timed or counted strokes method for 5 minutes while keeping hands raised. The ideal surgical scrub reduces bacteria, has persistent effects under gloves, and is non-irritating to skin.
POSTOPERATIVE FEVER
This document discusses postoperative fever, defining it as a temperature above 38°C or 39°C on consecutive or any postoperative days, respectively. It describes the pathophysiology of fever as an inflammatory response to surgery rather than necessarily indicating infection. It outlines criteria for systemic inflammatory response syndrome (SIRS) and discusses various potential causes of immediate, acute, subacute, and delayed postoperative fevers. Evaluation involves assessing vital signs, examination of wounds/lines/tubes, and ordering relevant labs and imaging. Treatment focuses on identifying and removing infection sources, providing IV fluids and antibiotics as needed. The take-home points are that fever alone does not prove infection and may resolve spontaneously within a week after surgery.
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Basics of Electrocardiogram
CONTENTS
●Conduction System of the Heart
●What is ECG or EKG?
●ECG Leads
●Normal waves of ECG.
●Dimensions of ECG.
● Abnormalities of ECG
CONDUCTION SYSTEM OF THE HEART
ECG:
●ECG is a graphic record of the electrical activity of the heart.
●Electrical activity precedes the mechanical activity of the heart.
●Electrical activity has two phases:
Depolarization- contraction of muscle
Repolarization- relaxation of muscle
ECG Leads:
●6 Chest leads
●6 Limb leads
1. Bipolar Limb Leads:
Lead 1- Between right arm(-ve) and left arm(+ve)
Lead 2- Between right arm(-ve) and left leg(+ve)
Lead 3- Between left arm(-ve)
and left leg(+ve)
2. Augmented unipolar Limb Leads:
AvR- Right arm
AvL- Left arm
AvF- Left leg
3.Chest Leads:
V1 : Over 4th intercostal
space near right sternal margin
V2: Over 4th intercostal space near left sternal margin
V3:In between V2 and V4
V4:Over left 5th intercostal space on the mid
clavicular line
V5:Over left 5th intercostal space on the anterior
axillary line
V6:Over left 5th intercostal space on the mid
axillary line.
Normal ECG:
Waves of ECG:
P Wave
•P Wave is a positive wave and the first wave in ECG.
•It is also called as atrial complex.
Cause: Atrial depolarisation
Duration: 0.1 sec
QRS Complex:
•QRS’ complex is also called the initial ventricular complex.
•‘Q’ wave is a small negative wave. It is continued as the tall ‘R’ wave, which is a positive wave.
‘R’ wave is followed by a small negative wave, the ‘S’ wave.
Cause:Ventricular depolarization and atrial repolarization
Duration: 0.08- 0.10 sec
T Wave:
•‘T’ wave is the final ventricular complex and is a positive wave.
Cause:Ventricular repolarization Duration: 0.2 sec
Intervals and Segments of ECG:
P-R Interval:
•‘P-R’ interval is the interval
between the onset of ‘P’wave and onset of ‘Q’ wave.
•‘P-R’ interval cause atrial depolarization and conduction of impulses through AV node.
Duration:0.18 (0.12 to 0.2) sec
Q-T Interval:
•‘Q-T’ interval is the interval between the onset of ‘Q’
wave and the end of ‘T’ wave.
•‘Q-T’ interval indicates the ventricular depolarization
and ventricular repolarization,
i.e. it signifies the
electrical activity in ventricles.
Duration:0.4-0.42sec
S-T Segment:
•‘S-T’ segment is the time interval between the end of ‘S’ wave and the onset of ‘T’ wave.
Duration: 0.08 sec
R-R Interval:
•‘R-R’ interval is the time interval between two consecutive ‘R’ waves.
•It signifies the duration of one cardiac cycle.
Duration: 0.8 sec
Dimension of ECG:
How to find heart rhytm of the heart?
Regular rhytm:
Irregular rhytm:
More than or less than 4
How to find heart rate using ECG?
If heart Rhytm is Regular :
Heart rate =
300/No.of large b/w 2 QRS complex
= 300/4
=75 beats/mins
How to find heart rate using ECG?
If heart Rhytm is irregular:
Heart rate = 10×No.of QRS complex in 6 sec 5large box = 1sec
5×6=30
10×7 = 70 Beats/min
Abnormalities of ECG:
Cardiac Arrythmias:
1.Tachycardia
Heart Rate more than 100 beats/min
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- 1. Dr. Shubhanshu Guide - Dr John Mukhopadhaya
- 2. History
- 3. Introduction Osteonecrosis of the femoral head (ONFH) is the final common pathway of a series of derangements Decrease in blood flow I. cellular death II. Fracture III. collapse of the articular surface
- 4. in young 60% B/L Spontaneous regression is rare Untreated patients :collapse 67% in asymptomatic and 85% of symptomatic.
- 7. Etiology Idiopathic Genetic Metabolic factors Local factors
- 17. Cresent Sign Sclerosis Cystic changes Loss of spherical weight bearing dome Partial collapse of head Lytic lesion
- 28. Algorithm for the management and treatment of patients with osteonecrosis of the femoral head. ONFH: Osteonecrosis of the femoral head; FHCD: Femoral head core decompression; NVBG: Non vascularized bone graft; BA: Biologic agents; VBG: Vascularized bone graft;
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- 30. Medical Management For small, asymptomatic lesion When surgery is contraindicated or declined
- 31. Medical Management Anabolic androgenic steriod Motomura et al found incidence of steroid induced osteonecrosis using combination of warfarin, probucol. Enoxaparin- 12wks prevent progression of stage 1 & 2 ONFN on 2 year followup Ilioprost- in bone marrow syndrome and ON
- 32. Medical Management Alendronate: Agrawala et al reported that improvement in pain Bisphosphonates for pain invovement Pulsed Electromagnetic field stimulation
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