This document discusses the sequelae and management of septic arthritis. Septic arthritis results in inflammation and destruction of the joint space. This can lead to several orthopedic sequelae including joint destruction, bony or fibrous ankylosis, fractures, limb length discrepancy, and persistent infection. The management depends on factors like the patient's age, delay in treatment, and extent of joint involvement. Treatment may include conservative measures, surgical stabilization, deformity correction, lengthening procedures, or arthrodesis to achieve a stable, mobile joint without pain. Classification systems help guide treatment, with the goal of optimizing long term function and quality of life.
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
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
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
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
Distal femur fractures what makes it complex ,dr mohamed ashraf,hod orthopae...drashraf369
distal femur fractures are notorious for post operative complications due to malreduction and improper fixation.unless plan and execute a sound and stable fixation,this injury will lead to undesirable results.dr mohamed ashraf HOD orthopaedics govt TD medical college is presenting how to avoid complications in surgical management of these fractures..
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
Distal femur fractures what makes it complex ,dr mohamed ashraf,hod orthopae...drashraf369
distal femur fractures are notorious for post operative complications due to malreduction and improper fixation.unless plan and execute a sound and stable fixation,this injury will lead to undesirable results.dr mohamed ashraf HOD orthopaedics govt TD medical college is presenting how to avoid complications in surgical management of these fractures..
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
Brief discussion regarding management of physiotherapy, pharmacotherapy, orthosis, principles of orthopedic surgical managements, addressing problems at hip, knee and ankle, soft tissue release procedures, osteotomies, timing of surgery, complications, prognosis, hip at risk signs, birthday syndrome, role of botulinum toxin, upper extremity involvement, contracture release.
Congenital Pseudoarthrosis of Tibia and Blounte’s Disease.pptxKaushal Kafle
Congenital Pseudoarthrosis of Tibia and Blounte’s Disease, etiopathogenesis , cause of lowerlimb deformity and bowing in kids, treatment, prognosis and outcome, Tachdijans Padeiatric Orthopedics
Review of common fractures encountered in children and what makes them different from adult fractures. This presentation will best benefit undergraduate medical and paramedical students
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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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!
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
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.
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
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Septic arthritis sequelae.
1. SEPTIC ARTHRITIS SEQUELAE
Dr Sabique
Junior Resident
Dept of Orthopaedics , GMC Calicut
Moderator – Dr Manoj kumar CV
Assistant professor , orthopaedics
2. Septic arthritis
• Pathologic microbial invasion of joint space f/b
inflamation
• Syn :
▫ Pyogenic arthritis
▫ Infective arthritis
▫ Suppurative arthritis
3. Pathogenesis
• Synovial inflammation
• Joint cavity is distended with neutrophil and
fibrin exudates
• Mesothelium lining of synovial mem is
destroyed, replaced by granulation tissue
• Articular erosion by chondrolysis occurs
• Subsequent growth plate damage, dislocation of
joint, avascular necrosis with bony or fibrous
ankylosis
4. • Vascular tamponade produced by increased
intra articular pressure is main cause for
avascular necrosis of Capital femoral epiphysis
5. Sequelae of septic arthritis
• Depends upon age of occurrence and delay in
treatment
• Neonates and infants, proximal femoral
epiphysis may not developed, if septic arthritis
untreated, leading to complete destruction and
unstable hip – TOM SMITHS’S ARTHRITIS
10. Poor prognostic factors
1. Infection that occurred before 22 weeks of age
2. Prematurity
3. Symptoms lasted longer than 4 days
4. Delay in diagnosis (3days)
19. TREATMENT OF SEPTIC ARTHRITIS
SEQUELAE
• Need to be delayed
1. Danger of reactivation of old infection
2. Strength and general states of bone improves
with time
3. Status of proximal femur and femoral head
should be definitely determined
4. High chance of remodelling – minor
deformities getting corrected
20. Conservative
1. Moderate coxa magna
2. Coxa vara <100, coxa valga <150
3. Resolving avascular necrosis femoral head which
has not yet undergone major deformities
Abduction cast, bracing, traction
- Till reossification is considered sufficient for
unprotected weight bearing
21. Surgical management
1. To stabilise joint
2. To correct deformity
3. To equalize length
4. Retain mobility
5. Relieve pain if present and minimize the risk of
pain developing later
22. To stabilise hip
• Arthodesis
• Pelvic osteotomies
• Proximal femoral osteotomies
• Trochanteric arthroplasty
• Harmon or L’episcopo reconstruction
23. To correct deformity
• Realignment / Derotation Osteotomies
• Flexion adduction contracture
▫ Soft tissue release /adductor tenotomy
• Ankylosed in flexion and adduction
▫ Intertrochanteric osteotomy fixing hip in 300
flexion and 200-300 abduction
24. To equalize length
• Soft tissue release
• Osteotomies
• Epiphysiodesis of other limb (for anticipated
discrepency of 2.5-5 cm)
• Lengthening of involved limb (discrepancy > 5-
6cm ) – Ilizarov’s
25. To stabilise hip
TROCHANTERIC ARTHROPLASTY
• Described by colonna
• Trochanter placed into acetabulum
• Abductors transferred distally
• Femur angulated
• Unsatisfactory in 1/3rd patients below 6yr and
virtually all patients above 6yr
26.
27.
28. Harmon or L’Episcopo reconstruction
• Head is destroyed but remnant of neck covered
by unossified hyaline cartilage
• Upper end of femur split in sagittal plane and
medial fragment is angulated
29.
30. Pelvic osteotomies
• Salters osteotomy
• Chiari osteotomy
• Pemberton osteotomy
• Degas osteotomy
• Provides supports for the proximal femur when
head and neck is absorbed
31. Proximal femoral osteotomy
SCHANZ OSTEOTOMY
• Angulation at ischial tuberosity level
• Turn Shaft from adducted to abducted position
• Useful when remnant of neck which remain in
acetabulum is large enough
• Decrease lurch and increase functional limb
length.
32.
33. Pelvis support osteotomy
• Double level femoral osteotomy
• Eliminates trendelenberg and short limb gait in
young adults with unstable hip
• 1. Proximal valgus extension osteotomy at the
level where femur abuts pelvis
• 2. Distal osteotomy to restore the limb
alignment bringing knee and ankle joint lines in
coronal plane
34.
35. To correct deformity
• Intertrochanteric varus osteotomy – coxa valga
• Valgus osteotomy
• Derotation osteotomy
36.
37. To Releive pain
• If a near normal relationship between femoral
head and acetabulum cannot be restored and if
movement of hip produces pain
1. Arthrodesis – abolish movement at hip
2. Excise deformed femoral head remnant
38. EXCISION OR GIRDLESTONE
ARTHROPLASTY
• Excision of head and neck upto intertrochanteric
line
• Remove infection, relieve pain, good range of
motion
• Instability, shortening avg of 3.5cm, limping
39. ARTHRODESIS
• Provide stable painless hip
• 300 flexion, 0-50 abduction, 150 external rotation
• Abbot and Fischer arthrodesis – 3 stage
▫ Deformity correction - traction
▫ Arthrodesis in 450 abduction
▫ Final positioning with subtrochanteric osteotomy
40. ILIZAROV’S HIP RECONSTRUCTION
• Includes
▫ Proximal femoral pelvic support osteotomy
▫ Gradual distraction at distal femoral osteotomy
• Addresses
▫ Hip stability
▫ Abductor insufficiency
▫ Limb length discrepancy
41.
42.
43. Total hip arthroplasty
• Definite procedure after skeletal maturity
• Loosening, failure, dislocation, fracture,
infection
• Excessive scarring, wasting and inadequate soft
tissue cover, malalignment and component
mismatch
• ILIOFEMORAL DISTRACTION AND TOTAL
HIP ARTHROPLASTY
48. Management algorithm according to
choi classification
• Type 1A – Observation
• Type 1B – Individualise containment
• Type 2A – containment (pelvic osteotomy),
trochanteric epiphysiodesis in childhood or
trochanteric advancement at skeletal maturity
• Type 2B – realignment femoral osteotomy +
growth arrest of PFE to prevent recurrence +
contralateral epiphysiodesis
49. • Type 3A – realignment femoral osteotomy with
derotation component
• Type 3B – valgus osteotomy + bone grafting
• Type 4A - <6yr – harmon operation, distal
tansfer of GT and abductors
>6yr – treat like type 4 B
• Type 4B - <6yr – trochanteric arthroplasty +
varus osteotomy + acetabuloplasty
>6yr – Ilizarov’s reconstruction
osteotomy
50.
51. Take home
• Septic arthritis is an emergency – life threatening
as well as crippling
• Early diagnosis and intervention halt progression
of disease enabling normal life
• Prevention of complications and sequelae should be
prioritized.
• Sequelae – appropriate and timely intervention
aiming at a PAINLESS, STABLE and MOBILE
JOINT
52. Referance
• Campell’s operative orthopaedic
• Tachdjian’s paeditric orthopaedics
• Pediatric orthopedic deformities – Frederic shapiro
• Essential orthopaedics – varshney
• Paediatric orthopaedics – benjamin joseph
• Pathogenesis and sequels septic arthritis of hip in
children – Balaji zacharia
• Management of sequelae of septic arthritis – dr greg
firth
• Davangere notes
• Internet
Abduction and adduction contracture of 100 cause apparent length inequality of 3cm
Numerous advancemnt in component design and technique by knowing patho anatomy of deformed and hypoplastic proximal femur and acetabulum
STAGED TECHNIQUE TO ESTABLISH NORMAL ANATOMY , GRADUAL DISTRACTION PRODUCE LENGTHENING OF CONTRACTED ABDUCTORS