The document discusses bone tumors and knee replacement surgery. It begins by defining different types of bone tumors, including benign cysts and malignant sarcomas like osteosarcoma. The indications for knee replacement surgery are then outlined, such as osteosarcoma, rheumatoid arthritis, and trauma. The document proceeds to describe the surgical procedure, including physical examination, prosthesis components, nursing considerations, the surgical instruments used, and postoperative recovery.
Orthodontics provides the ability to move every tooth in all three planes of space(comparable to complete-mouth restoration or a complete denture setup)
that the discrepancy between the seated and unseated condylar position must be identified and eliminated when the occlusion is to be reorganized, which is required:
The seated condylar position is a three-dimensional entity that must be assessed with a three-dimensional measuring device.(CPI condylar position indicator)
What is fixation?
Fixation in orthopedics is the process by which an injury is rendered immobile. This may be accomplished by internal fixation, or by external fixation.
What is internal fixation?
Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone
What is osteosynthesis?
Osteosynthesis is the reduction and internal fixation of a bone fracture with implantable devices that are usually made of metal. It is a surgical procedure with an open or per cutaneous approach to the fractured bone. Osteosynthesis aims to bring the fractured bone ends together and immobilize the fracture site while healing takes place. In a fracture that is rigidly immobilized the fracture heals by the process of intramembranous ossification
INDICATIONS for internal fixation
History of Fracture Treatment and Development Of Modern Osteosynthesis
In the Preantibiotic era, closed reduction of fractures was understandably the rule for most fractures. However, when closed reduction was insufficient, external fixation appliances served to maintain skeletal units in position, frequently without the need for MMF (Maxillo-mandibular fixation) .Following the development of antibiotics, the open treatment of fractures began to be used on a more frequent basis.
Rigid internal fixation (RIF) is “Any form of fixation applied directly to the bones which is strong enough to permit active use of the skeletal structure during the healing phase and also helps in healing”.
Bone fractures have been treated with various conservative techniques for centuries and it was not until the eighteenth century that internal fixation was first documented.
Icart, a French surgeon in Castres, performed ligature fixation with brass wire on a young man with a humeral fracture.
1886, when Hansmann of Hamburg published a technique using retrievable metal bone plates with transcutaneous screws.
Soon after, a Belgian surgeon, Albin Lambotte, improved these techniques and coined the term internal fixation.
Lambotte developed and manufactured a variety of bone plates and screws and much of his armamentarim remained in use until the 1950s.
In the twentieth century, Sherman improved on Lambotte’s designs and created parallel, threaded, finepitched, self-tapping screws. This hardware was made of corrosion-resistant vanadium steel, which was a strength improvement over silver and ivory fixation materials.
BIOLOGY OF BONE AND BONE HEALING
Bone is a complex and ever-evolving connective tissue and serves multiple purposes. Besides being the main constituent of the human skeletal system, bone is highly metabolically active and essential for the regulation of serum electrolytes—namely, calcium and phosphate.
Marrow cavities are filled with hematopoietic elements necessary to manufacture and maintain blood components and regulate the immune system. Bone is comprised
Orthodontics provides the ability to move every tooth in all three planes of space(comparable to complete-mouth restoration or a complete denture setup)
that the discrepancy between the seated and unseated condylar position must be identified and eliminated when the occlusion is to be reorganized, which is required:
The seated condylar position is a three-dimensional entity that must be assessed with a three-dimensional measuring device.(CPI condylar position indicator)
What is fixation?
Fixation in orthopedics is the process by which an injury is rendered immobile. This may be accomplished by internal fixation, or by external fixation.
What is internal fixation?
Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone
What is osteosynthesis?
Osteosynthesis is the reduction and internal fixation of a bone fracture with implantable devices that are usually made of metal. It is a surgical procedure with an open or per cutaneous approach to the fractured bone. Osteosynthesis aims to bring the fractured bone ends together and immobilize the fracture site while healing takes place. In a fracture that is rigidly immobilized the fracture heals by the process of intramembranous ossification
INDICATIONS for internal fixation
History of Fracture Treatment and Development Of Modern Osteosynthesis
In the Preantibiotic era, closed reduction of fractures was understandably the rule for most fractures. However, when closed reduction was insufficient, external fixation appliances served to maintain skeletal units in position, frequently without the need for MMF (Maxillo-mandibular fixation) .Following the development of antibiotics, the open treatment of fractures began to be used on a more frequent basis.
Rigid internal fixation (RIF) is “Any form of fixation applied directly to the bones which is strong enough to permit active use of the skeletal structure during the healing phase and also helps in healing”.
Bone fractures have been treated with various conservative techniques for centuries and it was not until the eighteenth century that internal fixation was first documented.
Icart, a French surgeon in Castres, performed ligature fixation with brass wire on a young man with a humeral fracture.
1886, when Hansmann of Hamburg published a technique using retrievable metal bone plates with transcutaneous screws.
Soon after, a Belgian surgeon, Albin Lambotte, improved these techniques and coined the term internal fixation.
Lambotte developed and manufactured a variety of bone plates and screws and much of his armamentarim remained in use until the 1950s.
In the twentieth century, Sherman improved on Lambotte’s designs and created parallel, threaded, finepitched, self-tapping screws. This hardware was made of corrosion-resistant vanadium steel, which was a strength improvement over silver and ivory fixation materials.
BIOLOGY OF BONE AND BONE HEALING
Bone is a complex and ever-evolving connective tissue and serves multiple purposes. Besides being the main constituent of the human skeletal system, bone is highly metabolically active and essential for the regulation of serum electrolytes—namely, calcium and phosphate.
Marrow cavities are filled with hematopoietic elements necessary to manufacture and maintain blood components and regulate the immune system. Bone is comprised
Acl Reconstruction Surgery In Delhi Dr. Shekhar Srivastav 09971192233DelhiArthroscopy
ACL Reconstruction Surgery in Delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Check Out Details at http://www.delhiarthroscopy.com
Changes on Maxillary Sinus and Pharyngeal Airway Space after orthognathic sur...Turgut Novruzlu
Presentation about impact of Bimaxillary orthognathic surgery on Maxillary Sinuses and PAS. Evaluation with CBCT. Article investigation. 2018 Research, rejected null hypothesis that orthognathic surgeries does not affect dimensions maxillary sinuses and PAS. BSSO. Bilateral Split Sagittal Osteotomy, LeFort1
Fractures after Knee replacement can be challenging. An algorithmic approach would help manage them better. The presentation defines correct approach towards the same.
In this article, we present the general principle of management Periprosthetic fracture after arthroplasty according to the "Unified” or “Comprehensive” classification system. We especially review the current concepts of periprosthetic hip and knee fractures.
مرض السيلان الاسباب ,الاعراض وطرق الوقاية منه والعلاج الفعالashrafmostafahammam
وصف الموضوع
يعد مرض السيلان من الأمراض الخطيرة ، التي تنتقل عبر الأتصال الجنسي المباشر ، وكثيراً ما يزعج هذا المرض أصحابه سواء كانوا رجالاً أو نساءاً ،
ويفزعون بشدة حينما يعلمون بأن لديهم هذا المرض ، ورغم خطورته إلا انني في هذا المقال سأوضح لكم كل ما يخصه ، وسأقدم العلاج المناسب للشفاء من هذا الداء .
رابط الموضوع
http://www.ar-only4men.com/sexual-health/gonorrhea.html
فوائد الزعتر لعلاج الكحة والربو و فوائد اخرى مذهلة
http://www.ar-only4men.com/home-remedy/benefits/zaatar-benefits.html
فوائد البردقوش فى علاج مختلف امراض الجسم
http://www.ar-only4men.com/home-remedy/benefits/benefits-marjoram.html
فوائد البابونج للبشرة والشعر وفوائد مذهلة لزهرة وشاي البابونج وطريقة تحضيرها
http://www.ar-only4men.com/home-remedy/benefits/chamomile.html
الصداع ,انواع الصداع,علاج الصداع والصداع النصفى
http://www.ar-only4men.com/mens-health/%d8%a7%d9%84%d8%b5%d8%af%d8%a7%d8%b9
-%d8%a7%d9%86%d9%88%d8%a7%d8%b9-%d8%a7%d9%84%d8%b5%d8%af%d8%a7%d8%b9%d8%b9%d
9%84%d8%a7%d8%ac-%d8%a7%d9%84%d8%b5%d8%af%d8%a7%d8%b9.html
Acl Reconstruction Surgery In Delhi Dr. Shekhar Srivastav 09971192233DelhiArthroscopy
ACL Reconstruction Surgery in Delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Check Out Details at http://www.delhiarthroscopy.com
Changes on Maxillary Sinus and Pharyngeal Airway Space after orthognathic sur...Turgut Novruzlu
Presentation about impact of Bimaxillary orthognathic surgery on Maxillary Sinuses and PAS. Evaluation with CBCT. Article investigation. 2018 Research, rejected null hypothesis that orthognathic surgeries does not affect dimensions maxillary sinuses and PAS. BSSO. Bilateral Split Sagittal Osteotomy, LeFort1
Fractures after Knee replacement can be challenging. An algorithmic approach would help manage them better. The presentation defines correct approach towards the same.
In this article, we present the general principle of management Periprosthetic fracture after arthroplasty according to the "Unified” or “Comprehensive” classification system. We especially review the current concepts of periprosthetic hip and knee fractures.
مرض السيلان الاسباب ,الاعراض وطرق الوقاية منه والعلاج الفعالashrafmostafahammam
وصف الموضوع
يعد مرض السيلان من الأمراض الخطيرة ، التي تنتقل عبر الأتصال الجنسي المباشر ، وكثيراً ما يزعج هذا المرض أصحابه سواء كانوا رجالاً أو نساءاً ،
ويفزعون بشدة حينما يعلمون بأن لديهم هذا المرض ، ورغم خطورته إلا انني في هذا المقال سأوضح لكم كل ما يخصه ، وسأقدم العلاج المناسب للشفاء من هذا الداء .
رابط الموضوع
http://www.ar-only4men.com/sexual-health/gonorrhea.html
فوائد الزعتر لعلاج الكحة والربو و فوائد اخرى مذهلة
http://www.ar-only4men.com/home-remedy/benefits/zaatar-benefits.html
فوائد البردقوش فى علاج مختلف امراض الجسم
http://www.ar-only4men.com/home-remedy/benefits/benefits-marjoram.html
فوائد البابونج للبشرة والشعر وفوائد مذهلة لزهرة وشاي البابونج وطريقة تحضيرها
http://www.ar-only4men.com/home-remedy/benefits/chamomile.html
الصداع ,انواع الصداع,علاج الصداع والصداع النصفى
http://www.ar-only4men.com/mens-health/%d8%a7%d9%84%d8%b5%d8%af%d8%a7%d8%b9
-%d8%a7%d9%86%d9%88%d8%a7%d8%b9-%d8%a7%d9%84%d8%b5%d8%af%d8%a7%d8%b9%d8%b9%d
9%84%d8%a7%d8%ac-%d8%a7%d9%84%d8%b5%d8%af%d8%a7%d8%b9.html
implant-based prosthetic rehabilitation requires an understanding of associated anatomical structures. The ultimate predictability of an implant site is determined by the existing anatomy as related to dentition and the associated hard and soft tissues. Meticulous clinical assessment helps in determining the suitability of the potential site for implant placement. The purpose of this article is to present the clinical assessment for dental implants' placement to modulate peri-implant tissue characteristics in individual clinical need.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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
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
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.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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.
2. *DEFINE BONE SARCOMA *INDICATION FOR SURGERY. *PHYSICAL EXAMINATION * *TYPE & COMPONENT OF PROSTHESIS *NURSING COMSIDERATION *SURGERY KNEE &HIP PROCEDUREOPARATIVE *TO KNOW SURGIAL INSTURMENT USED IN OBEJECIVE:
3. Its divided into two group: 1.Benign tumors: *Bone cysts, are expanding lesion within bone this present with painful, palpable mass of the long bone (vertebra or flat bone) in children may cause pathological fracture. *Osteochondroma. 2.Malignant tumors: *Sarcoma, its from connective and supportive tissue. *myelomas bone marrow tumor . *(OSTEOSARCOMA)is the most common malignant bone tumors BONE TUMORE
4. BONE TUMORS Ewing’s sarcoma of the distal two-thirds of the femur, Sagittal section of a high-grade osteosarcoma of the distal femur. Biologic behavior of bone and soft-tissue sarcomas
5. Extension of an osteosarcoma of the distal femur to the knee joint along the cruciate ligaments
6. *Rheumatoid arthritis *Osteosarcoma *Trauma *Maintain stability *Relieve pain INDICATION OF SURGERY
7. *Physical examination of orthopedic injuries in the ED is based on a simple four step process *Palpation of the injury for deformity and tenderness *Assess range of motion (both active and passive) of the affected bone, as well as consideration of the joints above and below the injured bone *Inspection (deformity, swelling, discoloration) Neurovascular exam PHYSICAL EXAMINATION
8. Preoperative planning might include physical examination, patient education, radiographic examination, ((((Patients should be educated about what to expect before, during, and after surgery)))), PHYSICAL EXAMINATION
9. Most joint replacement consist metal and high density polyethylene component ,the joint implant may cemented in the prepared bone with polymethy methacrylate (PMMA: a bone bonding agent) which has properties similar to bone which may lead to failure of prosthesis, cementing method of securing prosthetic implant. *Cementless,artificial joint component ,porouse-coated.that allow pt bone to grow accurate fitting and the presence of healthy bone with adequate blood supply are important in using cementless component TYPE &COMPONENT OF PROSTHESIS
12. 1.Pain management(medication). 2.Wound care(keep wound clean and dry sign of infection). 3.Mobility(using assistive device, don’t moving in acute flexion put pillow between knee) 4.Potential problems. dislocation of prosthesis,, pain,,encourge pt to accept help with ADLs. NURSING CONSEDRATION
14. KNEE SURGERYLIMP SALVAGE (A) Anatomic location of malignancy. Adequate resection includes 15–20 cm of the distal femur and proximal tibia and portions of the quadriceps. (B) An intra-articular resection is usually performed.
15. SURGICAL PROCEDURE FOR DISTAL FEMUR Surgical approach and incision. The patient is placed supine on the operating table. The entire extremity, including the groin and pelvis, is prepared and Draped The groin should always be included to allow for the rare instance in which exposure of the common femoral vessels is required.
16. (A) Popliteal exploration. Resectability is determined by exploration of the popliteal space and vessels. (B) Superficial femoral artery exploration. The superficial femoral artery is (C) Posterior exploration. The interval between the popliteal vessels and the posterior femur is developed and explored. The popliteal artery is mobilized,
18. Tibial osteotomy and preparation of the femur Preparation of the proximal tibial canal Preparation of distal femur by facing reamer.
19. Trial reduction with templates. The purpose of the trial reduction is to determine the easy of insertion of the femoral and tibial components prior to cementing
23. spacer blocks Resect the distal femur using the chosen resection level. The distal thickness of the Sigma femoral implant is 9 mm (10 mm on size 6). The holes on the block are designated -2, 0 and +2, indicating in millimeters the amount of bone resection each will yield supplemental to that indicated on the calibrated outrigger. Position the oscillating saw blade through the slot or, where applicable, position the blade flush to the top cutting surface of the block. Resect the condyles and check the surface for accuracy.
24. Assemble the upper cutting platform Assemble the upper cutting platform Translate the lower assembly anteroposteriorly to align it parallel to the tibial axis.
26. Cut an entry slot with a narrow oscillating saw into the intercondyle the attachment of the PCL. Position an osteotome to shield the ligament Fixation of plate cutting in the tibia anterior with alignment reevaluation at trial reduction.
47. surgery requires a number of instruments to be available to the surgeon. Surgical instruments are needed to expose the joint, retract and protect soft tissue, and cut and shape the bone. Additionally, trays of instruments are provided with implant systems. These instruments allow for appropriate sizing, shaping, and cutting of the bone SURGICAL INSTRUMENT
48. These general instrument trays should include: • standard surgical instruments: a basic tray that varies from hospital to hospital but should include scissors, hemostats, clamps, retractors, forceps, scalpel handles, needle holders, and other standard instruments • retractors: general retractors that are used on many different orthopedic surgical procedures (e.g., Hofmann, Hibbs, and Richardson retractors); and specific retractors that are used for particular TJA applications (e.g., a Charley retractor for THA or a notch retractor for TKA) • osteotomes: surgical chisels that come in various sizes (usually 0.25 to 1 inch) and are either straight or curved SURGICAL INSTRUMENT
49. • curettes: spoon-shaped cutting tools that come in various sizes (2–5 mm) • rongeurs: plier-like tissue resectors that have slightly sharpened jaws used to grab and/or rip tissue • large oscillating and/or reciprocating saw (depending on surgeon preference) for cutting/shaping bone • reamer: a drill-like device with a high torque-to-speed ratio used to prepare the canal of the femur or humerus
50. acetabular reamer: reamer that has a hemispherical head to prepare the acetabulum for cup replacement • pulsatile lavage system: battery-operated irrigating system that delivers pressurized irrigation • medullary canal preparation kit: brush used to scrub the intramedullary canal after reaming/broaching, suction apparatus, cement restrictor, etc; used to mechanically remove any debris from the canal prior to cementing • post-op drain system (if the surgeon prefers a drain;) • cement gun • vacuum cement mixer: cement mixing bowl used under suction; limits formation of air pockets in the cement and limits staff exposure to methylmethacrylate fumes • electrocautery: instrument whose electrified tip is used to cauterize bleeding tissue