KUZGUNSPOR

Monteggia Fracture

2011-11-11T12:49:00.000+08:00

Monteggia fractures are displaced fractures of the proximal one-third of the ulnar shaft combined with a radial head dislocation. It is a fracture of the proximal third of the ulna with the dislocation of the head of radius.

It is named after Giovanni Battista Monteggia (1762–1815) who was an Italian surgeon. Monteggia first described about fractures between the proximal third of the ulna and the base of the olecranon combined with an anterior dislocation of the proximal radio-ulnar joint in 1814.

Bado coined the term “Monteggia Fracture” in 1967 and described four different patterns of the Monteggia lesion. Bado extended Monteggia's original description to include any fracture of the ulnar with an associated dislocation of the proximal radio-ulnar joint.He divided Monteggia lesions into 4 types with the classification depending on the direction of the radial head.

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Galeazzi Fractures

2011-02-27T12:40:00.002+08:00

Galeazzi or Piedmont fracture refers to a fracture of the radial diaphysis at the junction of the middle and distal thirds with associated disruption of the distal radioulnar joint. This lesion is approximately three times as common as Monteggia fractures.

Fracture can occur anywhere along the radius or associated with fractures of both radius and ulna with distal radioulnar joint disruption. Galeazzi fractures may result from direct trauma to the wrist, typically on the dorsolateral aspect, or a fall onto an outstretched hand with forearm pronation.

Pain, swelling, and point tenderness over the fracture site are typically present. Galeazzi fractures typically present with wrist pain or midline forearm pain that is exacerbated by stressing of the distal radioulnar joint in addition to the radial shaft fracture.Neurovascular injury is rare.

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De Quervain’s disease

2011-02-20T12:26:00.002+08:00

Refers to stenosing tenosynovitis of the first dorsal wrist compartment (Abductor pollicis longus [APL] and Extensor pollicis brevis [EPB]).

De Quervain’s disease in most cases is caused by overuse. The condition is typically seen in those activities that use the thumb and wrist a great deal such as washing, wringing wet clothes, screwing and unscrewing etc. Also occurs typically in raquets sports or in golfers. With these activities there is often repetitive ulnar deviation of the wrist while the thumbs are fixed as in strong gripping. The condition is much commoner in women (8 to 1).

In between two separate but interrelated pathological processes there is often seen a mixture of tenosynovitis and tendovaginitis with features of both types. This changing pattern is important because in early stages with tenosynovitis the treatment is conservative whereas in the later stages where there is tendovaginitis the fibrous sheath becomes so thickened and constricted that there is a mechanical problem and surgery is required. Apley describes this situation in his text—‘a small lump is visible on the radial side three-quarters of an inch above the wrist. The lump feels bony hard so that it is frequently mistaken for an exostosis (but the X-ray appearance is always normal)

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COMPARTEMENT SYNDROM OF THE ARM, FOREARM AND HAND

2011-02-13T12:13:00.001+08:00

Compartment syndrome is a condition characterized by raised pressure within a closed space with a potential to cause irreversible damage to its contents.

Acute An acute compartment syndrome results when intramuscular pressure (IMP) exceeds capillary blood pressure for a prolonged period of time. In this circumstance, immediate decompression is required to prevent muscle necrosis. Chronic or Exertional, This condition occurs when exercise increases IMP enough to cause ischemia, pain, and in some instances, diminished sensibility or neurological dysfunction.

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KNEE ARTHRODESIS

2011-02-08T12:08:00.000+08:00

Indication

Painful ankylosis after infection, tuberculosis, or trauma
Severe deformity in paralytic conditions; neuropathic arthropathy; and malignant or potentially malignant lesions around the knee.
Salvage of a failed total knee arthroplasty.

Techniques
Compression Arthrodesis with External Fixation
Advantages : the application of good, stable compression across the fusion site and the placement of fixation proximal and distal to an infected or neuropathic joint. Disadvantages : external pin track problems, poor patient compliance, and the frequent need for early removal and cast immobilization.

Arthrodesis with Intramedullary Rod Fixation
The advantages of intramedullary nailing are immediate weight bearing, easier rehabilitation, absence of pin track complications, and high fusion rate. Disadvantages of intramedullary nail fixation are significant blood loss, more frequent major complications, and difficulty in obtaining correct alignment.

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Biomechanics and Biomaterials

2011-02-02T11:45:00.008+08:00

Biomechanics
Biomechanics is science of the action of forces, internal or external, on the living body. Statics is study of the action of forces on rigid bodies that are equilibrium. Dynamics is study of the bodies that accelerating and relateted forces, which is divided in two, kinematics and kinetics.

Newton's Law

1. Inertia is if the net external force acting on a body is zero, the body will remain at rest or move with a constant velocity (ΣF = 0)
Accelaration (F = m . a)
If there any action, it should be any reaction (action = reaction)

Biomaterials
Biomaterials is posses certain unique characteristics, including viscoelasticity, creep, and stress relaxation.
Strength of materials is branch of mechanics thet deals with relation between externally applied loads and resulting internal effects and deformation induced in the body, loads, deformation, elasticity, extensibility

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ACUTE, SUBACUTE AND CHRONIC OSTEOMYELITIS

2011-01-24T23:10:00.000+08:00

Acute pyogenic infections are characterized by the formation of pus or abscess (local effect) a concentrate of defunct leucocytes, dead and dying bacteria and tissue debris. And spread further afield via lymphatics or via the bloodstream (systemic effect) causing lymphangitis and lymphadenopathy, bacteraemia and septicaemia, with systemic reaction such as vatigue, mild pyrexia, severe illness, fever, toxaemia and shock.

Acute osteomyelitis is almost invariably a disease of children. This predilection for the metaphysis has been attributed to the peculiar arrangement of the blood vessels in that area: the non-anastomosing terminal branches of the nutrient artery twist back in hairpin loops before entering the large network of sinusoidal veins; the relative vascular stasis favours bacterial colonization.

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Basic Hand Replantation

2011-01-17T23:02:00.001+08:00

Replantation is reattachment by microsurgical means of a completely severed part (amputated part). In replantation, it is require artery and venous repair. Sometime, interposition vein grafting may be needed, the nerve repair is needed also. Fracture stabilization with skeletal shortening facilitates other neccesary repairs.
Flexor tendon rehabilitation is compromised by fracture protection and concomitant extensor tendon extensor repair. Soft tissue is often reperfused after lengthy periods of ischemia. Skin grafting is often required.

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POST TENDON REPAIR REHABILITATION IN UPPER EXTREMITY

2011-01-08T22:55:00.000+08:00

Early post-repair motion stress

It is shown to increase recovery of tensile strength, decrease adhesions in multiple animal models. There are loads at failure for mobilized tendons twice that for immobilized tendons at 3 wks (Gelberman). Application of early motion in small amounts is felt by most surgeons to biologically alter the process of scar formation and maturation at the repair site such that collagen is laid down parallel to the axial forces (increase strength), and tendon adhesions are stretched (increased tendon glide).

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Mallet and Jersey Finger

2011-01-02T22:45:00.002+08:00

Mallet finger (baseball or basketball finger) is disruption of the extensor digitorum profundus tendon at distal phalanx, caused by forced flexion of an extended DIP joint usually caused by direct blow on extended distal phalanx, as an baseball, volleyball. Clinical presentation of mallet finger are pain, unable to extend finger at DIP joint (carrying at 30 degree angle), flexed position, passive movement is normal.

Jersey finger is disruption of the flexor digitorum profundus tendon at distal phalanx, caused by forced extension/hyperextension of DIP joint, as may occur when grabbing a football jersey. Clinical presentation of this deformity are pain, DIP joint cannot flex, finger is in extended position.

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ACHONDROPLASIA

2010-12-24T23:20:00.000+08:00

ACHONDROPLASIA is an autosomal dominant inheritance, a true dwarfism with failure of longitudinal growth in the cartilage of the epiphyseal plate. The prevalence of achondroplasia is about 1 in 30 000 live births. The patient will come with Stunted growth in childhood and disproportionation between the trunks and the limbs. The main differential diagnosis at birth is spondyloepiphyseal dysplasia congenita (SEDC)

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Deep Vein Thrombosis

2010-11-10T11:44:00.001+08:00

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The presence of a thrombus (usually composed of fibrin, platelets and red blood cells) and inflammatory response that accompanies it is what is known as venous thrombosis or thrombophlebitis. The inflammatory reaction may be minimal or cause edema and loss of endothelium.

Venous thrombosis occurring in the deep venous system are more important than the superficial venous system (SVS), due to the severity of potential complications (pulmonary embolism, post-thrombotic syndrome) (Prodigy, 2006).

Most deep vein thrombosis (DVT) occur below the knee. Usually, the thrombus is lysed in other children who spontaneously dissolve in the bloodstream, producing a reendotelización recanalization of the vein, with the restoration of flow in about 10 days. In the case of large thrombus occurs permanent destruction of venous valves, which appears post-thrombotic syndrome and chronic venous insufficiency.

Thrombi located at the popliteal or more proximal areas most at risk of producing pulmonary embolism (PE): 50% of occluded proximal DVT, compared with 30% of the distal (Love G, 1999, Green L, 1998)

The incidence of DVT in the general population is estimated at 1 / 1000 inhabitants / year, increasing to 1 / 100 inhabitants / year in elderly (Botella G, 2000)

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Arthrodesis of the knee

2010-11-06T11:07:00.000+08:00

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The indications are infectious arthritis and joint injuries in fracturas.La great art has always been the same, to address the knee joint surface dry all planes leaving the condyles over the tibial plateau. Functionally, we must place at 0 º - 15 º flexion, 5 ° -8 ° valgus and 10 ° of external rotation.

Arthrodesis using unilateral external fixator should be adjusted frequently and that bone resorption is lost compression is achieved with an intramedullary nail 100% consolidation.

Although this is a relatively simple and safe there satisfied patients back pain, difficulty sitting and gait disturbance.

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Direct injury of the vascular structures of the knee

2010-11-01T10:48:00.000+08:00

Direct injury of the vascular structures of the knee can be avoided by combining a thorough knowledge of knee anatomy and careful surgical technique. The locations of critical vascular structures can be compared with the points on the face of a clock. In the left knee at the joint line, popliteal vein directly after (to 12), medial tibial nerve to the vein (at 11) and lateral popliteal artery to the vein (to 1) . These three structures are vulnerable to injury, penetrating through the rear portion of the capsule during meniscal resection, removal of the posterior cruciate ligament, or capsular release. Distal to the joint line, popliteal artery divides to form anterior and posterior tibial arteries the 2 o'clock position. The common peroneal nerve is supported by the fibula, distal to the joint line in the 3 o'clock position. Damage to any of these structures between 1 and 3 can occur when you use too long screws in the area for fixing tibial components inserted without cement.

Any suspicion of intraoperative vascular injury should be evaluated after deflating the tourniquet and before implanting the components. The joint and the popliteal region should be carefully inspected and confirmed the recovery of distal arterial pulses. A popliteal mass expansion, further bleeding copiously into the joint, and the abolition of distal pulses are shown in intraoperative arteriography immediate consultation with a vascular surgeon. A small vascular perforation can be treated with simple suture. Transection of a glass can be repaired directly if there is no tension on the anastomosis with the knee in full extension. May be necessary when there is tension vascular graft in the repair site directly or extensive vascular damage.

During the resection of the medial and lateral menisci, there is a risk of penetrating injury of the popliteal vessels. It is therefore useful to perform such surgical resection as possible with the knife blade parallel to the back of the tibia, pulling the meniscus forward during this procedure. Laterally, the popliteal artery is protected by the popliteus muscle belly. The lateral meniscus is more mobile and can usually be easily retracted forward.

When cutting the recess for a prosthesis to replace the Crusader, an extensive resection of the posterior cruciate ligament can result in the entry in the popliteal fossa, where the popliteal vein lies directly behind the capsule in the midline. Leaving a stump behind posterior cruciate reduces the risk of vascular injury in this situation.

The division of the posterior capsule in the joint line during the correction of a flexion contracture requires special care to avoid injury to the popliteal vessels and tibial nerve. A safer approach is to elevate the capsule from the posterior aspect of the tibia and the femur tibial sure the knife or Periosteal remain in contact with the bone.

As noted earlier, the healing is influenced by the blood supply to the area. The preoperative vascular examination should include a complete inspection of the skin of the upper extremity. The localization of traumatic or surgical scars, skin color, temperature variations, capillary refill and the presence of ulcerations should be recorded. The strength of the dorsalis pedis and posterior tibial pulses should be appreciated by palpation or, if necessary, using Doppler ultrasound. The rate of ankle-brachial pressure is a valuable indicator of the extent of peripheral vascular disease. It has been reported that measuring transcutaneous oxygen tension as an objective indicator of the viability of the skin and has been used clinically to select the level of amputation in patients with ischemic heart disease. It was found that normal volunteers had oxygen pressures between forty-five and ninety and three millimeters of mercury (6.00 and 12.40 kilopascals) while patients with peripheral vascular disease had lower levels, depending on the severity of the disease.

Preoperative arteriography should be reserved for patients who may be candidates for a vascular bypass before total knee arthroplasty or will be operated by a severe post-traumatic condition or a tumor.

Vascular absolute contraindications for total knee arthroplasty include vascular claudication with mild activity or at rest, active skin ulcers secondary to arterial insufficiency or venous stasis, and ischemia or frank necrosis of the fingers. If peripheral pulses are not palpable and there is no possibility of a vascular bypass, the PTR should be done without tourniquet use because it can cause thrombosis of the atherosclerotic femoral artery.

FLEXOR TENDON ZONE

2010-10-09T20:25:00.000+08:00

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žZone I
the region distal to the synovial sheath, occupied by the profundus tendon only.
žZone II
extends the length of the fibro-osseous sheath of the digit, where (in the nonthumb digits) FDP and FDS glide within the sheath’s narrow confines
žZone III
extends from the proximal aspect of the digital synovial sheath (approximately the level of the metacarpal neck) to the distal aspect of the transverse carpal ligament.
žZone IV
comprises the carpal tunnel
žZone V
proximal to the carpal tunnel

Club Foot

2010-10-06T11:12:00.000+08:00

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Clubfoot is a congenital abnormality of the foot. It is one of the most common pediatric orthopedic conditions. The heel is inclined inward and downward and the front foot is also turned inward. A patient with untreated clubfoot walk on the outside of the foot, which may cause pain and / or disability. Clubfoot is usually smaller than the unaffected foot (regular foot). The calf is also usually smaller in the leg of clubfoot. One or both feet may be affected.

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Special Examinations of the Knee Joint

2010-09-28T20:46:00.001+08:00

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20% of adults experiencing knee pain, pathology associated with clinically significant disability. Acute symptoms occur more than one million annual visits to the emergency and primary care physician. Knee X-ray revealed fractures in only 6% to 11% of cases of acute pain. Many clinicians have difficulty assessing this type of pain and have doubts about the studies to be performed. The diagnosis of delayed fracture is associated with unfavorable clinical course. Internal derangement of the knee, and meniscus tears and ligament, also cause conflicts diagnoses. In this experience the authors analyzed the literature on the accuracy of history, physical examination and studies and determined whether they are sufficient for the treatment of patients with acute knee pain and when shall the imaging examinations

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Anatomy of The Knee

2010-09-14T20:31:00.000+08:00

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Knee is the argest joint in the body
3 joints; Double condyloid joint (hinge-like) and patellofemoral joint
3 bones ; Distal femur, proximal tibia and patella are involved
3 compartments

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Developmental Dysplasia of the hip

2010-09-06T11:15:00.001+08:00

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Developmental Dysplasia of the hip (DDH) is the anatomical abnormality of the hip joint in newborns, where the femoral head remains out of the acetabulum at birth or is unstable (may dislocate) in the first weeks of life. This causes the femoral head and acetabulum does not develop normally, and deformed, causing premature osteoarthritis. Often the DDH accompany other congenital malformations in this case is known as DDH teratological, which has evolution and treatment than typical DDH.

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Diabetic foot management

2010-08-14T20:12:00.000+08:00

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•Diabetic foot is considered one of the most challenging wound healing problem faced by modern orthopaedic surgeon (Mc Dermott J.E, 1993).

•The prevalence of foot ulceration in the general diabetic population is 4–10%,

•lower (1.5–3.5%) in young and highest (5–10%) in older patients

Risk factors for foot ulceration are as follows.

• History of previous foot ulceration or amputation

• Peripheral neuropathy

• Peripheral vascular disease

• Trauma (poor footwear, walking barefoot, objects inside the shoes)

• Foot deformities (prominent metatarsal heads, claw tow, hammer toe, pes cavus, nail deformities, deformities related to previous trauma and surgery, bony prominences, etc.)

• Callus formation

• Limited joint mobility

• Long duration of diabetes

• Poor diabetes control

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