1. A 22-year old male presented with increasing pain and swelling in his right ankle following a motorcycle accident 10 days prior.
2. Examination revealed swelling, tenderness, crepitus, and deformity in the right ankle. X-rays showed a fracture of the talus body.
3. Talar body fractures are serious intra-articular injuries that involve both the ankle and subtalar joints. They require careful reduction and fixation to restore joint congruity and prevent long-term complications like avascular necrosis and arthritis.
Please find the power point on Fracture of Talus with well diagrammatic explanation from very reliable sources. If you need such a power point on different topics related with MBBS then please write it on comment section. Thank you
presentation on how to manage fracture talus surgically.various fracture types fixation demonstrated by dr mohamed ashraf,HOD govt TD medical college alleppey kerala india
Please find the power point on Fracture of Talus with well diagrammatic explanation from very reliable sources. If you need such a power point on different topics related with MBBS then please write it on comment section. Thank you
presentation on how to manage fracture talus surgically.various fracture types fixation demonstrated by dr mohamed ashraf,HOD govt TD medical college alleppey kerala india
Calcaneum fracture- pathoanatomy & various fracture patternGirish Motwani
DR. GIRISH MOTWANI
Consultant Foot & Ankle surgeon (Paediatric & Adult)
1)Sushrut Hospital, Research Centre & PostGraduate Institute of Orthopaedics, Nagpur west
2)Aman hospital,Nagpur east
3)South point clinic, Nagpur south
Calcaneum fracture- pathoanatomy & various fracture patternGirish Motwani
DR. GIRISH MOTWANI
Consultant Foot & Ankle surgeon (Paediatric & Adult)
1)Sushrut Hospital, Research Centre & PostGraduate Institute of Orthopaedics, Nagpur west
2)Aman hospital,Nagpur east
3)South point clinic, Nagpur south
Total Hip replacement for Ankylosing Spondylitis: Planning & Execution Vaibhav Bagaria
Performing Total Hip replacement in Ankylosing Spondylitis requires a well thought of strategy. Preoperative planning, Inventory ordering, positioning, cup and stem orientation all play a role.
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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
2. • 22 yr old male came with complaints of pain
in the right ankle x 10 days
• Apparently well 10 days prior to the
presentation when he sustained injury ( RTA-
bike)
• C/o pain + and swelling +
• Progressively increasing
• Aggrevated due to movements
3. On examination
• Swelling +
• Tenderness+
• Crepitus+
• Vascular status+
• No neurological deficits
• Deformity
• ROM
4.
5.
6. young, active, and mobile population
History of high velocity injury present
Clinically :-
• Intense pain , unable to move ankle, Gross
edema and echymosis usually present
• When there is subluxation or dislocation the
normal contours of ankle and hind foot are
distorted
7.
8. PARTS OF TALUS
1. HEAD
2. NECK
3. BODY
4. LATERAL PROCESS
5. POSTERIOR PROCESS
9.
10.
11.
12.
13. • Roman Times- The heel bone of horse was
used as dice and was called Taxillus. This
Word evolved into Talus
• Year 1919-Anderson – reported the first series
of talar neck fractures in World War I pilots
and coined the term Aviators Astragalus
14. • 0.1 to 0.85% of all fractures
• 5 to 7 % of foot fractures
• 60 % is covered with articular cartilage
15. BODY OF TALUS
5 surfaces:
1. superior surface
2. Inferior surface
3.medial surface
4. lateral surface
5.posterior surface
16. NECK
• Constricted potion of bone between the body
and the oval head .
• Angle of medial deviation is 15 to 20 degree in
adults
• Plantar deviation is 24 degree approx
• Neck body angle is 150 degree in adults
• Relatively thin diameter makes it weaker area
and hence more vulnerable to fractures
17. TARSAL CANAL
Formed of sulcus of inferior surface of talus and superior sulcus of
calcaneum
Contents-
artery of tarsal canal and talocalcaneal interosseous ligament
18. • Posterior process has a medial and lateral tubercle
separated by a groove for the flexor hallucis longus
tendon
19. FRACTURE TALUS ANATOMICAL CLASSIFICATION OF
TALUS FRACTURE :-
1. Talar neck fracture
2. Talar body fracture
3. Talar head fracture
4. Lateral process fracture
5. Posterior process fracture
20. Talar body fractures
• intra-articular injuries (ankle and subtalar
joints)
• high-energy axial compression.
• The dorsally directed plantar force distal to
the talus may lead to a more posterior
fracture that involves the talar body rather
than the neck
21.
22.
23. AP and lateral
lateral process fractures
Canale View
optimal view of talar necK and body maximum equinus
15 degrees pronated
Xray 75 degrees cephalad from horizontal
24.
25.
26. Brodén view
Lat process # ,subtalar joint for any irregularity or
impaction fractures of the undersurface of the
talus.
• Beam aimed cephalad 10–40 degrees with respect
to the vertical with the foot in neutral position and
internally rotated at varying degrees from 20 to 60
degrees with respect to the vertical .
27.
28.
29.
30. CT SCAN
• congruity of the subtalar joint
• significant fractures of the inferior aspect of
the talus, better on CT scan
• nondisplaced talus fractures as well as to
delineate the fracture pattern and degree of
displacement
34. PATHOLOGY
• Occur with axial load and a foot with muscles
in tension holding the foot in a rigid position.
• motor vehicle crashes cause the foot to be
axially loaded with the foot plate of the car
impacting a dorsiflexed foot on the brake
pedal.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44. • Deltoid branches are important to supply blood to
the medial talar neck and talar body.
• Branches from the dorsalis pedis supply the talar
head and most of the dorsal talar neck.
• The artery of the tarsal canal coming from
branches off of the posterior tibial artery supply
most of the talar body.
• The peroneal artery has the least contribution
laterally.
45. Müller/AO classification
• C1, C2 and C3 ascending order of severity.
• prognosis is progressively worse.
• A multifragmentary fracture with many
fragments bearing articular cartilage becomes
exceedingly difficult to reduce
46. • Ankle joint
involvement (C1)
osteochondral
injury to the
superior dome of
the body of the
talus.
AVN 0- 13%
51. Boyd and Knight Classification
TYPE 1
• Shearing injury
CORONAL/ SAGITAL
TYPE 2
HORIZONTAL
52. Conservative management
• Undisplaced talar body fractures
• nonambulatory patients
• multiple comorbidities
short leg casting for 6 weeks until fracture
union.
Full weight bearing is allowed at the time of
complete radiographic union, usually after 8–
10 weeks.
53. • every unsuccessful attempt at closed
reduction increases the damage to the
already compromised ST
• Therefore, open reduction should be
considered even in high risk patients.
54. Techniques of reduction
1. First step to reconstruct the talar dome is to dis-engage all
the fracture fragments
2. Visualize the subtalar joint and clear the debris
3. Elevate and graft impacted fractures
4. Impaction on the subtalar side should be addressed first
5. Reduce the fracture fragments and pin them into place
6. Talar dome is reduced from posterior to anterior and from
lateral to medial .
Only after complete reduction of the body permanent fixation
should be done
7. Permanent fixations should lie in the medial or lateral gutter
55. Surgical Management
• Main goal in the treatment of talar body
fractures is to restore the joint congruity of
the tibiotalar and subtalar joints.
• Even in severely comminuted fractures
attempts should be made to restore at least
the tibiotalar joint
56. CLOSED REDUCTION
• Knee &foot flexed and varus
• Pin through calcaneum
• Direct pressure on body
• Per cut screw fixation and casting
57.
58.
59. COMMINUTED FRACTURES OF BODY
• Difficult to treat
• Accurate replacement of fragments is near
impossible
• Long term results- bad.
In such cases talectomy along with calcaneotibial
fusion is prefferred. gives patient painless and
stable walking foot
61. ADVANTAGES OF TIBIO TALAR ARTHRODESIS
OVER CALACANEOTIBIAL FUSION
• Position of foot is unchanged
• Weight bearing thrust is placed on more or
less normal undisturbed joint tissue.
• No shortening
• After surgery- still slight flexion and extention
of the foot on leg , in the two subtalar facets
and talonavicular joint is possible.
62.
63. Surgical Approaches
based on the fracture location and pattern
• Posterior Approach
• Anteromedial Approach
• Anterolateral Approach
• Dual Anteromedial and Anterolateral
Approaches
64. Posterior Approach
• Incision is made between the posterior edge of
the medial malleolus and the medial border of
the Achilles tendon
• Deep interval can be made either anterior or
posterior to the flexor digitorum longus tendon,
depending on the fracture location
65. Anteromedial Approach
• interval between the tibialis anterior and tibialis
posterior tendons with the incision -anterior aspect
of the medial malleolus toward the navicular
• Anterior and medial articular surfaces of the talar
body, middle facet of the subtalar joint are readily
visualized
• oblique medial malleolar osteotomy is performed
after predrilling ( PRESERVING DELTOID BRANCHES)
66.
67.
68. A posteromedial approach to the body of the
talus would destroy its blood supply. Therefore,
if the body has to be exposed, one utilizes an
osteotomy of the medial malleolus
Most of the blood supply to the body is through
the deltoid branches of the posterior tibial
artery.
69. Anterolateral approach
• medial to the peroneus tertius tendon, and is
directed distally, parallel to the fourth metatarsal
• Superficial peroneal nerve
• extensor digitorum brevis is elevated
• osteotomy of the distal part of the fibula may be
indicated to gain access to the posterior portion
• Plantar flexing the foot to improve visualization
70. Dual Anteromedial and Anterolateral
Approaches
• Complicated talar body fractures with coronal
displacement, comminution, or associated talar
neck fractures
• Plantar dissection along the talar
neck is avoided - to protect the tarsal canal
• fibers of the deltoid ligament should also be
preserved
• Dorsal neck vessels are protected
71.
72. Fixation options
• Screws(2-4 mm)( headless preferred()
• AP/PA
• PA : Theoretically better/perpendicular
• Titanium (thordarson et al) for future MRI to
assess AVN
• LAG SCEW in noncommunated #
• Compression scew antero lateral to postero
medial( bone is denser and no varus
malalignment)
73. • Postoperatively,
Nonweight bearing cast x 6 weeks
Ideally ankle in a dorsiflexed position to ensure bony
reduction and minimize anterior scar tissue
formation.
• After 6 weeks, gentle, nonweight bearing ROM
(subtalar and ankle joints)
• Nonweight bearing continued for a full 12 weeks
74.
75. Complications
• skin infection and subsequent necrosis
• AVN
• Malunion
• nonunion
• late osteoarthritis
• ankylosis of subtalar joint.
• Most common reason for secondary surgery=
subtalar arthritis
76. • nonunion after talar neck or body fractures is
rare, occurring in <5%
• malunion in previous reports varies between
0% and 37%
• 65% incidence of posttraumatic tibiotalar
arthritis
• 34% incidence of posttraumatic subtalar
arthritis.
77.
78.
79. talar body involve both the tibiotalar and subtalar
joints, and have the highest incidence of arthritis
among all talus fractures.
80.
81.
82.
83. • nonunion after talar neck or body fractures is
rare, occurring in <5%
• malunion in previous reports varies between
0% and 37%