the principle of tension band wiring and plating is beutifully illustrated through this presentation by dr mohamed ashraf,govt TD medical college,alleppey,kerala,india.how it works in certain fracture geometry,how it fails if the principle is not followed strictly through examples
There is no question that given the current state of the art in dentistry, that dental implants are pretty much the best way to replace teeth; they are stand alone tooth replacement systems that look and function just like natural teeth. They do not attach to adjacent teeth like a fixed bridge and don't have to be taken in and out like removable partial dentures.
A dental implant is a tooth root replacement made of titanium, which has the unique property of being osteophilic (osteo-bone, philic-loving) and actually fuses to bone. A crown, the part of the tooth that you see in your mouth, is attached to the implant. And the great thing about implants is they are not susceptible to decay or periodontal (gum) disease in the same way that teeth are.
Now here are a few important pointers, which hold for implants generally and are especially important in your case when replacing a front tooth for an imminent event . Dr Harshavardhan Patwal
There is no question that given the current state of the art in dentistry, that dental implants are pretty much the best way to replace teeth; they are stand alone tooth replacement systems that look and function just like natural teeth. They do not attach to adjacent teeth like a fixed bridge and don't have to be taken in and out like removable partial dentures.
A dental implant is a tooth root replacement made of titanium, which has the unique property of being osteophilic (osteo-bone, philic-loving) and actually fuses to bone. A crown, the part of the tooth that you see in your mouth, is attached to the implant. And the great thing about implants is they are not susceptible to decay or periodontal (gum) disease in the same way that teeth are.
Now here are a few important pointers, which hold for implants generally and are especially important in your case when replacing a front tooth for an imminent event . Dr Harshavardhan Patwal
Experimental Muscle Mechanics in Aging and DiseaseInsideScientific
The focus of this webinar is on the mechanisms underlying muscle impairment associated with aging and age-related diseases. This research evaluates the regulation of muscle contraction at the motor protein, single muscle fiber, and whole muscle levels using in vitro, in situ and in vivo methods in experimental and clinical settings. Specifically, Dr. Qaisar is interested in the contribution(s) of muscle SR stress and calcium dysregulation to loss of muscle mass and strength. Reduced calcium uptake by muscle SR plays a pivotal role in muscle impairment in aging while boosting SR calcium uptake with pharmacological activators can partially restore muscle mass and strength. Matt shares a technical overview of the experimental equipment used in this research. He discusses the design, component functionality, and the applications that can be explored with this system. He also shares some valuable insights into the parameters that can be measured and the data that can be produced with various experimental designs.
Key Learning Objectives
- Contractile dysfunction in sarcopenia involves alterations at motor protein, single fibers and whole muscle levels in rodent models of aging and elderly humans
- Loss of calcium regulation by muscle SR plays a pivotal role in muscle atrophy and weakness associated with sarcopenia
- Age-associated comorbidities such as COPD and Parkinson’s disease accelerated the sarcopenia phenotype in humans
- Circulating biomarkers such as CAF22 can be useful predictors of muscle mass and strength in accelerated sarcopenia
Can read freely here
https://sethiortho.blogspot.com/
Challenges and Solutions in
Management of Distal Humerus Fractures
Epidemiology
Anatomy
Classification
Controversies and Recent studies
Approach
Implants selection
Plate configuration
Ulnar nerve transposition
Role of total elbow arthroplasty in DHF
Role of hemiarthroplasty in DHF
Metaphyseal comminution –
Anatomic complexity of the distal humerus
Positioning of the plates
TBW –
Skin closure
Osteoporotic nature of the bone –
Less BMD/Thin metaphysis
Screw Pullout strength is low
DHF account for 2% of all adult fractures
The common pattern of fracture
Intraarticular and involves both columns
Bimodal distribution
Peak incidence in young male and in older female patients
Young male – High-velocity injury
Older female - Osteoporosis
The distal humerus is flattened and expanded bony structure
It is composed of lateral and medial columns with the trochlea situated between these columns.
The location of the trochlea is central rather than medial
Formed by Medial SCR + M/Epicondyle
The distal end has 450 angulation with humeral shaft
M/ Epicondyle gives attachment for MCL & Common Flexor Origin
The MCL originates from the undersurface of the medial epicondyle where it is vulnerable to excessive dissection
Ulnar nerve
Formed by Lateral SCR and L/Epicondyle and Capitulum
Distal end has 200 with humeral shaft
L/ epicondyle gives attachment for LCL & common extensor origin
Its posterior surface is non articular and can be used as a site for a plate fixation
The lateral column curves anteriorly
Placement of a straight plate on the posterolateral surface of the humerus risks straightening of distal humerus.
The medial column including the medial epicondyle is in line with the humeral shaft.
It forms the center of the triangle
It has 30 - 80 – external rotation & 250 anterior divergent with the shaft
It forms a 40 - 80 degree valgus direction
X-ray -
Anterior-posterior view
lateral View
Traction View – This can help to define articular fragments and aid in pre-operative classification of the fracture.
NCCT – Elbow
Articular surfaces
Position of the fracture fragments
useful for identifying impacted fracture fragments that make reduction challenging
Olecranon Osteotomy Approach – 52-57%
Triceps sparing VS Olecranon osteotomy approach
The lateral column was often the first to fail as a result of excessive varus forces acting on the elbow during normal activities of daily living. Small anterior-posterior diameter
Smaller diameter of the humerus, permitting only one or two short screws for fixation.
Interruption of blood supply to the lateral column
blood supply to the lateral column is also derived from posterior segmental vessels. Sagittal plane plating has less risk of injuring these structures, which may improve the chances of union
In the elderly osteoporotic fractures although the principles are the same but some special considerations in management of the soft tissues and the bony injuries are considered.
An Introduction, History, Diagnosis, Current Guidelines on Treatment of trochanteric fractures of femur. Presentation also contain an introduction of Dynamic Hip Screw and Surgical Techniques.
low cost antibiotic cement nail for infected non union.pptxdrashraf369
infected non union of long bone is a challenging problem for the trauma surgeons world over.
the enormous disability and loss of working human days add further woes to the issue.
financial burden will be mutiplied manyfold once the fixation gets infected.
there are numerous methods described for managing the situation.
the described technic is a low cost method that can be used successfuly to treat this long drawn problem
author dr Jiju george is well experienced in tackling various complications in trauma surgery.he is working as prefessor at travancore medical college kollam kerala india.
dr mohamed ashraf is the co-author and the head of the dept at travancore medical college and medicity hospitals kollam kerala and former HOD at govt TD medical college alleppey kerala india.
PERFECT BUT PAINFUL TKR -ROLE OF SYNOVECTOMY.pptxdrashraf369
TOTAL KNEE ARTHROPLASTY IS ONE OF THE MOST COMMONLY PERFORMED SURGICAL PROCEDURE PERFORMED FOR ADVANCED OSTEOARTHRITIS KNEE.IT IS PAIN RELIEVING AND A DISABILITY MODIFYING PROCEDURE. BUT A MINORITY OF PATIENTS ARE STILL EXPERIENCING PAIN EVEN AFTER THE PROCEDURE.
AUTHORS ANALYSE VARIOUS FACTORS LEADING TO THE REASON FOR THE PAIN.
THEY ARE EXAMINING THE ROLE OF THE SYNOVIUM AS THE REASON FOR PAIN AND SYSTEMATICALLY ANALYSE ITS ROLE.
DR ABDUL RAHMAN IS WORKING AS ASSISTANT PROFESSOR AND IS AN ARTHROPLASTY SURGEON WITH VAST EXPERIENCE.
DR MOHAMED ASHRAF IS THE HEAD OF THE DEPARTMENT AND IS EXPERIENCED IN KNEE.HIP, SHOULDER AND ELBOW ARTHROPLASTY. DR MOHAMED ASHRAF WAS THE FORMER HOD ORTHOPAEDICS GOVT TD MEDICAL COLLEGE ALLEPPEY KERALA INDIA
PRESENTATION IS FROM TRAVANCORE MEDICAL COLLEGE AND MEDICITY HOSPITALS KOLLAM KERALA INDIA
syndesmotic injuries are serious injuries around ankle but often neglected or under treated.
this may lead to short term and longterm disabilities including early arthritis .
treatment of late case and neglected cases often result in suboptimal outcome.
in this presentation very experienced senior orthopaedic surgeons present the importance technics and outcome of anatomical repaie of syndesmotic injuries.
the presentation is from TRAVANCORE MEDICAL COLLEGE AND MEDICITY HOSPITALS KOLLAM [QUILON] KERALA INDIA.
DR GOKUL DEV IS A WELL KNOWN TRAUMA SURGEON AND DR MOHAMED ASHRAF WAS THE FORMER HOD ORTHOPAEDICS AT GOVT TD MEDICAL COLLEGE ALLEPPEY KERALA WITH MULTIPLE SLIDESHARE UPLOADS
neglected and failed achilled tendon repair is a complex situation.this presentation illustrate how to deal with such complications.
presentor -Dr MOHAMED ASHRAF
PROF AND HEAD.
INSTITUTION -TRAVANCORE MEDICAL COLLEGE AND MEDICITY HOSPITALS.
KOLLAM,KERALA,INDIA
paediatric monteggia fracture dr mohamed ashraf alleppey kerala india.pptxdrashraf369
paediatric monteggia fracture is often missed especially by less experienced orthopaedic surgeon.
once missed ,it can lead to progressive deformity of the elbow,restricted elbow and forearm movements.
subsequent management is often less satisfactory and give inferior results.
a high degree of suspicion is often needed in all pediatric elbow injuries brought to the emergency department.
the presentation is by prof.mohamed ashraf ,head of the department of orthopaedics. govt TD MEDICAL COLLEGE,ALLEPPEY,KERALA, INDIA
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...drashraf369
femoral head fractures are very complex fractures that need immediate and prompt surgical intervention.conventional surgical appproaches to hip may lead to short and long term complications.dr mohamed ashraf ,dr rahul thampi et al are presenting their experience with gantz safe surgical dislocation approach to surgical management of femoral head fractures
Safe surgical dislocation[ssd] for avascular necrosis hip[ avn]drashraf369
presenting a novel technic to treat avascular necrosis of hip.AVN hip is a challenge for any orthopaedic surgeon especially in precollapse stage. here dr mohamed ashraf and dr jyothis george from govt TD medical college alleppey kerala india demonstrate a novel and effective method to arrest the progression of disease to collapse.instead of performing a conventional core decompression they do multiple micro core decompression through safe surgical dislocation of GANTZ .in addition they are supplementing the procedure with intralesional infiltration of zolidronic acid to prevent structural collapse.
DHS or PFN debate..dr mohamed ashraf,head of dept,govt TD medical college,al...drashraf369
new generation hip surgeons choose proximal femoral nail.but many of the experienced surgeons still bet on dynamic hip screw,are they really comparable,which one is superior.this presentation is a debate between the opponents and proponents.very vividly demonstrated by dr mohamed ashraf, HOD, orthopaedics,govt TD medical college hospital,alleppey,kerala, india
Osteoarticular tuberculosis [bone and joint tb] dr mohamed ashraf,hod orthopa...drashraf369
bone and joint tuberculosis is making a comeback due to immunosuppressive drugs and diseases.presentation may be atypical and the diagnosis may be delayed.how this menace is diagnosed and treated.dr mohamed ashraf HOD orthopaedics, govt TD medical college is presenting with his own experienct at his institution
neglected proximal humerus fractures-a surgical challenge, dr mohamed ashraf...drashraf369
neglected proximal humerus fractures are a nightmare for trauma surgeons due to its poor outcome.dr mohamed ashraf enumerate and demonstrate the surgical challeneges and tips and tricks of surgical management of these fractures
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..
Lisfranc injuries -surgical management , dr mohamed ashraf ,HOD orthopaedics,...drashraf369
lisfranc injuries are a group of very complex foot injuries.these injury is notorious for missed and mismanaged due to associated more lethal multisystem trauma.dr mohamed ashraf ,dept of orthopaedics,govt medical college,alleppey,kerala,india is doing the presentation with various examples to show how not to miss these injuries.
Post traumatic and post operative stiff elbow is a surgical challenge for even experienced orthopaedic surgeons.dr mohamed ashraf govt TD medical college alleppey kerala india is presenting systematically how to approach surgically to a case of stiff elbow to get back the functional movements.
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
Tensor fascia lata[tfl] muscle pedicle grafting for avn hip dr mohamed ashraf...drashraf369
slide presentation of a very promising surgical technic for a very elusive condition called avascular necrosis of femoral head.good clinical and surgical demo by dr mohamed ashraf,HOD, govt TD medical college ,alleppey,kerala, india
Pilon fractures reduction and fixation technics-dr mohamed ashraf-govt TD med...drashraf369
this presentation demonstrates tha various tips and tricks of reduction and fixation of pilon fractures.veru useful technics demonstrated by the author dr mohamed ashraf HOD orthopaedics govt TD medical college alleppey kerala india
presentation about the non TKR options for OA knee.discussed with data and clinical evidence by dr mohamed ashraf HOD govt TD medical college alleppey kerala india
Tuberculosis hip and TB like lesions dr mohamed ashraf -HOD-govt TD medical ...drashraf369
diagnostic dilemma in tuberculosis of hip is presented with variety of illustrations by dr mohamed ashraf HOD orthopaedics govt TD medical college alleppey kerala india
Distal humerus fracture fixation dr mohamed ashraf-HOD-govt TD medical colleg...drashraf369
presentation illustrates various aspects of principles and practical tips of fixation of lower humerus fracture fixation .various options are demonstrated by dr mohamed ashraf HOD govt TD medical college ,alleppey,kerala,india
Intramedullary nailing of fractures.dr mohamed ashraf.HOD.govt TD medical co...drashraf369
presentation of biology,biomechanics and practice of intramedullary nailing of long bone fractures by dr mohamed ashraf,govt TD medical college,alleppey,kerala,india
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.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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.
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
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
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.
- 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
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
Tension band wiring and plating of fractures- dr mohamed ashraf.govt TD medical college,alleppey,kerala,india
1. Dr Mohamed ashraf
Prof and head
Govt TD medical college
Alleppey,kerala,india
drashraf369@gmail.com
TENSION BAND
PRINCIPLE AND PRACTICE
2. Importance of training
and teaching
The back bone of AO method is the careful
documentation of over 30000 operative cases which are
carefully followed up with over 250000 radiographs .
AO is totally able to prove / disprove hypothesis with
facts. A systematic analysis of failures has shown that
most of these were due to disregard for biomechanical
principles. This means that most failures are
preventable
6. PRINCIPLES OF AO METHODS
There are two principal methods of achieving
internal fixation
• Interfragmental compression.
• Splinting.
• Tension band-combines both
Each method has a best way of
achieving it and this is governed in part by
instrumentation.
8. Bone under load
• Central loading [straight bone]
only compressing force
• Eccentric loading[curved bone]
tension force [tension side]
compression force [compression side
10. If cylinder [bone] broken
• No more force force transmitted
• If you band the tension [convex] side
• Then if force transmitted
• Force is converted to compressive force
especially on concave [compression] side
11.
12. Tension band-biomechanics
• The implant alone doesn’t provide stability
• Along with deforming muscles it exerts
compressive force across fracture site
• Parallel K wires serve as rails for guided
compression
14. 1. A PLATE OR WIRE THAT IS ABLE TO
WITHSTAND THE TENSILE FORCES.
2 . BONE WHICH IS ABLE TO WITHSTAND
A COMPRESSIVE FORCE.
3 . AN INTACT BUTTRESS OF THE OPPOSITE
CORTEX.
4.INTACT SOFT TISSUE FOR TRANSMITTING
FORCE
PREREQUISITES OF TENSION
BAND FIXATION
18. Implant strength
• Steel wire patella 1-1.25 mm
• medial malleolus-0.8-1 mm
• lat malleolus-0.8 mm
• K wire patella 1.8-2mm
• malleoli 1.6 mm
• olecranon 1.6mm
23. Surgical applications
• Long bone diaphysis have clear tension
and compression sides
• Patella and metaphyseal regions may not
have clear and defined sides
• Irregular bones calcaneum
35. Tension band is an optimal mechanical
principle
Can be applied to many selected
fracture situations-TBW , TBP
If applied properly ,it is a strong implant
construct
Active and passive mobility must be
ensured for optimal results
36.
37. Dr mohamed ashraf
MBBS [ GMC CALICUT]
DORTHO [GMC TRIVANDRUM]
MS ORTHO [MMC MADRAS]
DNB,MNAMS[ NEW DELHI]
drashraf369@gmail.com
