The precipitating factors of rupture TendoAchilles is due to Aging process, DM, Tendinitis, Tendinosis, Local steroid injection, History of repetitive micro trauma. There are different methods of reconstructing the ruptured TendoAchilles. Maximum of these procedure are described in this presentation. All information are taken from the text books of orthopedics. Majority of the information taken from Campbell's operative orthopedics Thirteen Edition.
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Rotator cuff tear is a very common orthopedic condition, which causes shoulder pain and stiffness. The slides are on rotator cuff tears and its management by open repair, mini open repair & by arthroscopy
Basics of patellofemoral instability for postgraduates. Gives brief introduction about patellofemoral joint anatomy, causes, examintaion and treatment for patellofemoral instability
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Rotator cuff tear is a very common orthopedic condition, which causes shoulder pain and stiffness. The slides are on rotator cuff tears and its management by open repair, mini open repair & by arthroscopy
Basics of patellofemoral instability for postgraduates. Gives brief introduction about patellofemoral joint anatomy, causes, examintaion and treatment for patellofemoral instability
Bone fractures are a very common orthopedic injury resulting from trauma and sudden loads or stresses applied to bones or a result from bones being weakened by certain diseases. More than 250,000 femur fracture patients are seen per year in the U.S. on average. Bone fractures are either a complete or partial break in a bone and in some cases a simple cast to immobilize the injury site is not enough to completely heal the fracture.
Immobilization from casts may not be enough to completely heal the fracture if a malunion (when both ends of the fractured bone misalign) occurs and/or if a non-union (when the fracture gap is too large and the fractured ends cannot re-attach to one another) occurs. In the case of a malunion or non-union, a possible solution to the problem is by surgically inserting an intramedullary rod into the center canal (diaphysial) region of the injured bone and fixating it into place with screws.
Hallux rigidus:
A condition characterized by loss of motion of first MTP joint in adults due to degenerative arthritis
second most common condition affecting the big toe after hallux valgus
most common arthritic condition in the foot.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
Arthroscopic ACL Reconstruction By Dr Shekhar ShrivastavDelhiArthroscopy
Arthroscopic Acl Reconstruction By Dr Shekhar Shrivastav.
HOW NORMAL KNEE WORKS ?
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone(femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
WHAT IS THE ROLE OF ACL ?
ACL along with other ligaments of the knee joint and meniscus provides stability to the knee joint.
WHAT IS LIGAMENT RECONSTRUCTION ( ACL ) ?
Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee and fixing the graft in place with screws. This procedure is performed with the use of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures. The torn ligament is excised arthroscopically and new ligament is prepared by ligament grafts taken from your own body. Bony tunnels are prepared in femur and tibia using specialized instruments through which the new ligament is passed and fixed with special screws. This procedure requires relative rest or leave from your work or studies for about 2-3 weeks after which you will be allowed normal day to day activities.
WHEN CAN THE PATIENT BE AMBULATED AFTER SURGERY ?
The patient can walk from the same evening of the surgery. Initially the patient is advised to walk with a brace and a walking cane. Strengthening and range of motion exercises for the knee are started from the next day. The patient is discharged from the hospital 2nd or 3rd day after surgery. The patient can walk without support by 10-14 days depending on muscle strengthening. Slow Jogging and other strenuous activities are permitted after 3 months and the patient can return to active sports only 8-9 months after surgery.
Torn ACL Reconstructed ACL
For Further Queries contact your Orthopedic Surgeon at
+ 91 9971192233
Bone fractures are a very common orthopedic injury resulting from trauma and sudden loads or stresses applied to bones or a result from bones being weakened by certain diseases. More than 250,000 femur fracture patients are seen per year in the U.S. on average. Bone fractures are either a complete or partial break in a bone and in some cases a simple cast to immobilize the injury site is not enough to completely heal the fracture.
Immobilization from casts may not be enough to completely heal the fracture if a malunion (when both ends of the fractured bone misalign) occurs and/or if a non-union (when the fracture gap is too large and the fractured ends cannot re-attach to one another) occurs. In the case of a malunion or non-union, a possible solution to the problem is by surgically inserting an intramedullary rod into the center canal (diaphysial) region of the injured bone and fixating it into place with screws.
Hallux rigidus:
A condition characterized by loss of motion of first MTP joint in adults due to degenerative arthritis
second most common condition affecting the big toe after hallux valgus
most common arthritic condition in the foot.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
Arthroscopic ACL Reconstruction By Dr Shekhar ShrivastavDelhiArthroscopy
Arthroscopic Acl Reconstruction By Dr Shekhar Shrivastav.
HOW NORMAL KNEE WORKS ?
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone(femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
WHAT IS THE ROLE OF ACL ?
ACL along with other ligaments of the knee joint and meniscus provides stability to the knee joint.
WHAT IS LIGAMENT RECONSTRUCTION ( ACL ) ?
Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee and fixing the graft in place with screws. This procedure is performed with the use of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures. The torn ligament is excised arthroscopically and new ligament is prepared by ligament grafts taken from your own body. Bony tunnels are prepared in femur and tibia using specialized instruments through which the new ligament is passed and fixed with special screws. This procedure requires relative rest or leave from your work or studies for about 2-3 weeks after which you will be allowed normal day to day activities.
WHEN CAN THE PATIENT BE AMBULATED AFTER SURGERY ?
The patient can walk from the same evening of the surgery. Initially the patient is advised to walk with a brace and a walking cane. Strengthening and range of motion exercises for the knee are started from the next day. The patient is discharged from the hospital 2nd or 3rd day after surgery. The patient can walk without support by 10-14 days depending on muscle strengthening. Slow Jogging and other strenuous activities are permitted after 3 months and the patient can return to active sports only 8-9 months after surgery.
Torn ACL Reconstructed ACL
For Further Queries contact your Orthopedic Surgeon at
+ 91 9971192233
Dear Readers,
this is my ppt was made from a book of BAGHERI ( Current therapy in oral and maxillofacial surgery)- 2012 PLUS other sources.. hope you find it beneficial.
have a nice day,
hanan
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.
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
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
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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.
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- 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
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. Questions
1. What is the problem?
2. Duration?
3. Any H/O trauma?
4. What were you doing during trauma?
5. Any H/O injection in the ankle?
6. Do you take any medicine regularly?
3. Exposure : Both lower limb upto ankle
On examination:
Look:
1. Any scar mark, skin change, skin change, blackening behind the
ankle.
2. Visible gap in TA.
3. Gait abnormalities.
4. Heel & toe walking.
4. Feel:
1. There is tenderness at the rupture site.
2. A gap felt 5cm above the insertion. This gap is more prominent with
dorsiflexion of ankle joint.
3. Thompson’s squeeze test/Simmond’s test: Positive
4. Matle’s test : Positive
5. O’brien’s test : Positive
8. Move:
1. Ankle movement : Plantar flexion is weak.
Tendoachilles injury can be classified can be classified into 02
categories:
1. Tendoachilles rupture: Due to degenerative cause : Steroid injection,
spontaneous.
2. Tendoachilles tear: Due to trauma : Direct blow. Cut injury,
commode injury.
9. Mechanism
A. Indirect :
• Pushing off with the weight bearing forefoot while extending the
knee.
• Sudden unexpected dorsiflexion of the ankle.
• Violent dorsiflexion of the plantar flexed foot, as in a fall from a
height.
B. Direct:
• Direct blow to the contracted tendon or from a laceration.
10. Site:
• Rupture of TA usually takes place about 2-6cm/5cm from the
insertion (Watershed line).
11. Clinical features
• Most patients are aged over 40 years.
• Feeling is has been stuck just above the heel.
• Unable to tip-toe & push-off.
• A gap can be seen and felt 2 to 5cm above the insertion of the
tendon.
• Simmond’d test/Thompson squeeze test, Mateles test, O’brien’s
needle test : Positive.
• Investigations: X-ray on ankle joint to exclude any fractures
USG
MRI
13. Principle of TA injury treatment
• Cut injury, traumatic injury & degenerative ruptures presented early
can be repaired end to end.
• All neglected ruptures need reconstruction by various techniques.
14. Various techniques of treatment of TA injury
A. Repair of fresh & early cases (Up to 4-6 weeks)
1. Krackow technique :
• Posteromedial incision
• Approximate the ruptured tendon done
with a 2.0 non absorbable suture.
15. 2. Lindholm technique:
• Posterior curvilinear incision
• Debridement of the ragged ends of
the tendon done.
• Approximated by box type of mattress
suture of heavy nonabsorb. Suture
• 02 flaps from the proximal tendon &
gastrocnemius aponeurosis taken &
sutured to the distal stump of the tendon
& to one another to cover the site of
rupture completely.
16. 3. Lynn technique:
• Incision parallel to the medial
border of TA.
• The ends of TA are sewed with 2.0
absorbable sutures.
• Then it is covered with by fanned
Out plantaris tendon.
17. 4. Teuffer technique :
• Postero-lateral longitudinal incision
• Reinforcement of TA is done by
passing the peroneus brevis tendon
through a drill hole in the calcaneal
tuberosity to produce a dynamic loop.
18. 5. Turco & spinella :
• Here the peroneus brevis is passed
through a midcoronal slit in the distal
stump of the TA.
19. 6. Ma & Griffith technique :
• Is a method of percutaneous repair
of TA using a nonabsorbable suture
threaded on a straight needle.
20. B. Reapair of neglected rupture (>4-6 weeks):
1. White & Kraynick modification of Teuffer technique:
• Postero-lateral incision.
• TA is repaired by harvested plantaris
tendon in figure of eight fashion.
• Reinforced by peroneus brevis tendon
by passing it through a drill hole in the
calcaneal tuberosity.
21. 2. Bosworth technique :
• Posterior longitudinal midline incision.
• A strip of tendon 1.5cm wide & 17.5cm
to 22.5cm long.
• Strip of tendon taken from the medial
raphe of the gastrocnemius muscle.
• The strip is passed through the proximal
& distal ends of the tendon in different
direction.
22. 3. Abraham & Pancovich (V-Y tendinous flap):
• A lazy ‘S’ incision.
• An inverted ‘V’ incision made through
the aponeurosis over the gastrocnemius.
• The flap is pulled distally to repair the
ruptured tendon ends & proximal part of
the incision is closed in a Y-configuration.
23. 4. Wapner et al. technique:
• Incision on the medial border of the
foot, the flexor hallucis longus tendon
is separated.
• Then the other incision is given postero-
medial to the TA.
• FHL tendon is passed through the tunnel
made in the calcaneus.
• Thereafter it is weaved from distal to
proximal through Achilles tendon.
24. Priciple of vulpius procedure:
• Equinous deformity due to gastrocnemius contracture is corrected by
this procedure.
• Aponeurotic tendon of the gastrocnemius is divided and its distal part
is allowed to retract distally but is not sutured to the soleus.
25. Post-operative management of ruptured TA
• Long leg full plaster with window or anterior slab with knee in 45°-60°
flexed & ankle in equinous position.
• Stitches are removed after 14 days.
• LLFP is converted to SLFP freeing the knee after 4-6 weeks.
• Plaster discarded after 8-10 weeks & walking with high heel shoe is
allowed.
• Heel heigh is reduced gradually & made planti-grade by next one
month.
• Protection of the tendon from stress is needed for at least 6 months.
