Ankle Fractures: a Guide to Recovery
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Medical Policy Ultrasound Accelerated Fracture Healing Device
Medical Policy Ultrasound Accelerated Fracture Healing Device Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information Policy History Policy Number: 497 BCBSA Reference Number: 1.01.05 Related Policies Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures, #498 Electrical Bone Growth Stimulation of the Appendicular Skeleton, #499 Bone Morphogenetic Protein, #097 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Members Low-intensity ultrasound treatment may be MEDICALLY NECESSARY when used as an adjunct to conventional management (i.e., closed reduction and cast immobilization) for the treatment of fresh, closed fractures in skeletally mature individuals. Candidates for ultrasound treatment are those at high risk for delayed fracture healing or nonunion. These risk factors may include either locations of fractures or patient comorbidities and include the following: Patient comorbidities: Diabetes, Steroid therapy, Osteoporosis, History of alcoholism, History of smoking. Fracture locations: Jones fracture, Fracture of navicular bone in the wrist (also called the scaphoid), Fracture of metatarsal, Fractures associated with extensive soft tissue or vascular damage. Low-intensity ultrasound treatment may be MEDICALLY NECESSARY as a treatment of delayed union of bones, including delayed union** of previously surgically-treated fractures, and excluding the skull and vertebra. 1 Low-intensity ultrasound treatment may be MEDICALLY NECESSARY as a treatment of fracture nonunions of bones, including nonunion*** of previously surgically-treated fractures, and excluding the skull and vertebra. Other applications of low-intensity ultrasound treatment are INVESTIGATIONAL, including, but not limited to, treatment of congenital pseudarthroses, open fractures, fresh* surgically-treated closed fractures, stress fractures, arthrodesis or failed arthrodesis. -
Ideal Medial Malleolar Screw Length Based on the Tibial Epiphyseal Scar Location in Weight Bearing CT’S Collin G
Ideal Medial Malleolar Screw Length Based on the Tibial Epiphyseal Scar Location in Weight Bearing CT’s Collin G. Messerly DPM, Keegan A. Duelfer DPM, Troy J. Boffeli DPM, FACFAS, Tyler K. Sorensen, DPM Regions Hospital / HealthPartners Institute for Education and Research - Saint Paul, MN Figure 1. Zone of Dense Bone in Medial Malleolar ORIF Figure 4. Measuring Distal – Most 5% to Medial Malleolus Table 2. Distance Between Epiphyseal Scar & Distal – Most 5% of RESULTS STATEMENT OF PURPOSE The epiphyseal scar is located in the distal The medial malleolus to distal – most 5% mark Tibia 97 WB ankle CT scans evaluated in uninjured ankles Medial malleolar fractures are one of the most common fracture types metaphysis of the tibia, and can oftentimes be was measured on the coronal WB CT slice with Measurement of interest Male: Mean ± SD Female: Mean ± SD (mm) In males < 60 years old there was a 12.75 mm zone of increased bone the widest medial malleolus. Screw threads observed in the ankle joint and have been long fixated with two screws; easily visualized on X-ray and CT scan (red line). (mm) density, as compared to 13.66 mm in those ≥ 60 which was not statistically The distal – most 5% of the tibia (distal to the beyond this point will purchase less dense bone however, the bone density of the distal tibia has potential for poor screw significant. purchase due to compromised bone density. This is especially true in elderly black line) contains dense bone with marked in the medullary canal with potential to not have Epiphyseal Scar to Medial Malleolus 12.75 ± 2.91 9.39 ± 2.38 In females < 60 years old there was 9.39 mm zone of increased bone populations with osteoporotic bone. -
PTA019: Anatomy & Physiology Manual
Anatomy & Physiology Full content for both the Level 2 Certificate in Fitness Instructing & Level 3 Certificate in Personal Training LEARN - INSPIRE - SUCCEED Contents Anatomy & Physiology for Exercise ………………………………………. Page 3 • The Musculoskeletal System ………………………………………. Page 3 • Energy Systems ………………………………………. Page 76 • The Cardiorespiratory System ………………………………………. Page 86 • The Neuroendocrine System ………………………………………. Page 105 Performance Training Academy 2 Chapter Two: Anatomy and Physiology Introduction This chapter is to be broken down into many sub-chapters, giving you a great reference point for your study as well as when needed once you are actively working as a Fitness Professional. It is of upmost importance that you continue to recap and learn further about the bio-mechanics and workings of the human body. A great fitness professional won’t just know how to programme for an individual, but will know how to help improve weaknesses and imbalances within the body, knowledge of Anatomy and Physiology is key to be able to do this. The Musculoskeletal System Unit Objectives Our first objective is to understand the biomechanics of the human body. We can do this by learning about the skeletal system, and then how the muscles are layered upon the skeleton. By the end of this unit we want you to have a good subject knowledge of the following: • The main bones of the skeleton • Joint types and joint actions • How exercise can create a strong and healthy skeletal system • The main muscles of the body • Muscle contractions and fibre types We will start by going through the skeletal system before bringing the muscles into the equation. This will allow you to build up your knowledge of bones and terminology before recapping them again by layering the muscles across specific joints. -
Assessment, Management and Decision Making in the Treatment Of
Pediatric Ankle Fractures Anthony I. Riccio, MD Texas Scottish Rite Hospital for Children Update 07/2016 Pediatric Ankle Fractures The Ankle is the 2nd most Common Site of Physeal Injury in Children 10-25% of all Physeal Injuries Occur About the Ankle Pediatric Ankle Fractures Primary Concerns Are: • Anatomic Restoration of Articular Surface • Restoration of Symmetric Ankle Mortise • Preservation of Physeal Growth • Minimize Iatrogenic Physeal Injury • Avoid Fixation Across Physis in Younger Children Salter Harris Classification Prognosis and Treatment of Pediatric Ankle Fractures is Often Dictated by the Salter Harris Classification of Physeal Fractures Type I and II Fractures: Often Amenable to Closed Tx / Lower Risk of Physeal Arrest Type III and IV: More Likely to Require Operative Tx / Higher Risk of Physeal Arrest Herring JA, ed. Tachdjian’s Pediatric Orthopaedics, 5th Ed. 2014. Elsevier. Philadelphia, PA. ISOLATED DISTAL FIBULA FRACTURES Distal Fibula Fractures • The Physis is Weaker than the Lateral Ankle Ligaments – Children Often Fracture the Distal Fibula but…. – …ligamentous Injuries are Not Uncommon • Mechanism of Injury = Inversion of a Supinated Foot • SH I and II Fractures are Most Common – SH I Fractures: Average Age = 10 Years – SH II Fractures: Average Age = 12 Years Distal Fibula Fractures Lateral Ankle Tenderness SH I Distal Fibula Fracture vs. Lateral Ligamentous Injury (Sprain) Distal Fibula Fractures • Sankar et al (JPO 2008) – 37 Children – All with Open Physes, Lateral Ankle Tenderness + Normal Films – 18%: Periosteal -
Bimalleolar Ankle Fracture Fixation of a 13-Year-Old Patient with Two Activascrew™ LAG Bioabsorbable Screws
Bimalleolar ankle fracture fixation of a 13-year-old patient with two ActivaScrew™ LAG bioabsorbable screws. Pierre Lascombes Professor, M.D., Ph.D. For medical professional use, not public. © 2020 Bioretec Ltd. and Prof. Lascombes. All rights reserved. Table of Contents Summary Table ........................................................................................................... 3 1 Case Description .................................................................................................. 4 2 Implants and operative technique ......................................................................... 5 3 Outcome ............................................................................................................... 7 4 Contact Information Concerning the Case ............................................................ 8 For medical professional use, not public Page 2 / 8 © 2020 Bioretec Ltd., Prof. Lascombes. All rights reserved. Summary Table Demographics Patient number: P01 Patient Initials: NX Smoking: No Sex: Female Use of alcohol: No Age: 13 Years Systemic disease: No Height: 158 cm Cont. Medication: No Weight: 40 kg Case description Diagnosis: Dislocation right ankle - bimalleolar fracture Cause of injury: Gymnastic injury Operation Operator: Lascombes Operation year: 2016 Note: Immediate reduction of the Operation description: Open reduction of medial malleolus and fixation with TWO resorbable screws dislocation at emergenry room - ketamine. Surgical treatment 5 hours Operation time:h57 min Immobilisation -
Geometric Variations in Load-Bearing Joints
University of Alberta Geometric Variations in Load-Bearing Joints by Kamrul Islam A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science in Structural Engineering Department of Civil and Environmental Engineering ©Kamrul Islam Fall 2012 Edmonton, Alberta Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission. Dedication Dedicated to my dad, A.F.M. Shamsul Islam, my mom, Shahina Akhter Chowdhury, and my brother, Nazmul Islam Abstract The purpose of the current study was to investigate the geometric variations in the load-bearing joints among individuals. Two existing concepts in mathematics were introduced and their application in computational biomechanics was completely novel: 1) computing the depth of penetration between contact objects as an indirect measure of stress; and 2) computing the geometric similarity using the cubic root of volumetric ratio as a scaling law. Furthermore, an alternative geometric method to finite element analysis was proposed, which should be considered as a “proof of concept”. -
Back of Leg I
Back of Leg I Dr. Garima Sehgal Associate Professor “Only those who risk going too far, can possibly find King George’s Medical University out how far one can go.” UP, Lucknow — T.S. Elliot DISCLAIMER Presentation has been made only for educational purpose Images and data used in the presentation have been taken from various textbooks and other online resources Author of the presentation claims no ownership for this material Learning Objectives By the end of this teaching session on Back of leg – I all the MBBS 1st year students must be able to: • Enumerate the contents of superficial fascia of back of leg • Write a short note on small saphenous vein • Describe cutaneous innervation in the back of leg • Write a short note on sural nerve • Enumerate the boundaries of posterior compartment of leg • Enumerate the fascial compartments in back of leg & their contents • Write a short note on flexor retinaculum of leg- its attachments & structures passing underneath • Describe the origin, insertion nerve supply and actions of superficial muscles of the posterior compartment of leg Introduction- Back of Leg / Calf • Powerful superficial antigravity muscles • (gastrocnemius, soleus) • Muscles are large in size • Inserted into the heel • Raise the heel during walking Superficial fascia of Back of leg • Contains superficial veins- • small saphenous vein with its tributaries • part of course of great saphenous vein • Cutaneous nerves in the back of leg- 1. Saphenous nerve 2. Posterior division of medial cutaneous nerve of thigh 3. Posterior cutaneous -
Masaryk University Faculty of Medicine REHABILITATION IN
Masaryk University Faculty of Medicine REHABILITATION IN PATIENTS AFTER TOTAL KNEE ARTHROPLASTY Bachelor´s Thesis Physiotherapy Bachelor’s Thesis Supervisor: Author: Mgr. Veronika Mrkvicová Josh Tilrem Brno, 2018 Name and Surname of the Author: Josh Tilrem Title of Bachelor’s thesis: Rehabilitation in patients after total knee arthroplasty Název bakalářské práce: Rehabilitace u pacientů po totální endoprotéze kolenního kloubu Department: Department of Rehabilitation and Physiotherapy MF MU Supervisor: Mgr. Veronika Mrkvicová Year of the Bachelor’s thesis defence: 2018 Summary: This Bachelor’s thesis is composed of two parts. The first part deals with the subject of total knee arthroplasty. The aim of this part is to describe the indication, surgical procedure and treatment, both in acute and long-term phase. The first part also contains the approach and management of the physical therapist and how to utilize proper rehabilitation. The second part is a case study and the aim is to describe the practical procedure of a specific rehabilitation after total knee arthroplasty. This include examination at admittance, discharge and rehabilitation provided by the author. Souhrn: Tato bakalářská práce je složená ze dvou částí. Prní část pojednává o tématu totální endoprotézy kolenního kloubu. Cílem této části je popsat indikace, chirurgický přístup a léčbu, jak v akutní, tak chronické fázi. První část také zahrnuje fyzioterapetické postupy a provádění léčebné rehabilitace. Druhá část obsahuje kazuistiku a jejím cílem je přiblížit praktické postupy speciální rehabilitace po totální endoprotéze kolenního kloubu. To zahrnuje vstupní a výstupní vyšetření a rehabilitaci prováděnou autorem. Keywords: Total knee arthroplasty, rehabilitation, physiotherapy Klíčová slova: Totální endoprotéza kolenního kloubu, rehabilitace, fyzioterapie I agree that this bachelor thesis will be archived in the Masaryk University of Brno library and will be quoted according to citations norms. -
A Finite Element Model of a Realistic Foot and Ankle for Flatfoot Analysis
A Finite Element Model of a Realistic Foot and Ankle for Flatfoot Analysis Item Type text; Electronic Thesis Authors Williams, Lindsey Leigh Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 27/09/2021 13:32:56 Link to Item http://hdl.handle.net/10150/626145 A FINITE ELEMENT MODEL OF A REALISTIC FOOT AND ANKLE FOR FLATFOOT ANALYSIS by Lindsey Leigh Williams ___________________________ Copyright © Lindsey Leigh Williams 2017 A Thesis Submitted to the Faculty of the DEPARTMENT OF AEROSPACE AND MECHANICAL ENGINEERING In Partial Fulfillment of the Requirements For the Degree of MASTER OF SCIENCE WITH A MAJOR IN MECHANICAL ENGINEERING In the Graduate College THE UNIVERSITY OF ARIZONA 2017 STATEMENT BY AUTHOR The thesis titled A Finite Element Model of a Realistic Foot and Ankle for Flatfoot Analysis prepared by Lindsey Williams has been submitted in partial fulfillment of requirements for a master’s degree at the University of Arizona and is deposited in the University Library to be made available to borrowers under rules of the Library. Brief quotations from this thesis are allowable without special permission, provided that an accurate acknowledgement of the source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in his or her judgment the proposed use of the material is in the interests of scholarship. -
Bimalleolar Fracture of Ankle Joint Managed by Tension Band Wiring Technique: a Prospective Study Dr
Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online) Sch. J. App. Med. Sci., 2014; 2(1D):428-432 ISSN 2347-954X (Print) ©Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources) www.saspublisher.com Research Article Bimalleolar Fracture of Ankle Joint Managed By Tension Band Wiring Technique: A Prospective Study Dr. Maruthi CV*1, Dr.Venugopal N2, Dr. Nanjundappa HC2, Dr. Siddalinga swamy MK2 1Assistant Professor, Department of Orthopaedics, MVJ MC and RH, Hoskote, Bangalore, India 2Professor, Dept of Orthopaedics, MVJ MC and RH, Hoskote, Bangalore, India 3MVJ Medical College & Research Hospital, Hoskote, Bangalore -562 114, India *Corresponding author Dr. Maruthi CV Email: Abstract: Ankle fractures are the most commonly encountered by most of the orthopaedic surgeons. According to the lauge Hansen’s classification five different types can be seen. The surgical treatment of adduction, abduction and supination external rotation type of injuries leading to bimalleolar fractures can be fixed with either tension band technique or cancellous screws. Here we are done a study to evaluate the benefits of tension band wiring technique in the management of bimalleolar fractures of the ankle. In our study, 40 cases of bimalleolar fracture of ankle joint of above mentioned types were admitted in Department of Orthopaedics, between February 2009 and November 2013 was included. We included patients above 20 and below 58 years. We excluded patients with pronation external rotation, vertical compression and trimalleolar fractures, pathological fractures, compound fractures and who are medically unfit and at extremely high anaesthesia risk. All the patients, operated by open reduction and internal fixation using tension band wiring technique. -
Biomechanical Efficacy of Four Different Dual Screws Fixations in Treatment
Fan et al. Journal of Orthopaedic Surgery and Research (2020) 15:45 https://doi.org/10.1186/s13018-020-1560-8 RESEARCH ARTICLE Open Access Biomechanical efficacy of four different dual screws fixations in treatment of talus neck fracture: a three-dimensional finite element analysis Zhengrui Fan1,2†, Jianxiong Ma1,2†, Jian Chen1,2, Baocheng Yang1,2, Ying Wang1,2, Haohao Bai1,2, Lei Sun1,2, Yan Wang1,2, Bin Lu1,2, Ben-chao Dong1,2, Aixian Tian1,2 and Xinlong Ma1,2,3* Abstract Background: Current there are different screws fixation methods used for fixation of the talar neck fracture. However, the best method of screws internal fixation is still controversial. Few relevant studies have focused on this issue, especially by finite element analysis. The purpose of this study was to explore the mechanical stability of dual screws internal fixation methods with different approaches and the best biomechanical environment of the fracture section, so as to provide reliable mechanical evidence for the selection of clinical internal fixation. Methods: The computed tomography (CT) image of the healthy adult male ankle joint was used for three- dimensional reconstruction of the ankle model. Talus neck fracture and screws were constructed by computer-aided design (CAD). Then, 3D model of talar neck fracture which fixed with antero-posterior (AP) parallel dual screws, antero-posterior (AP) cross dual screws, postero-anterior (PA) parallel dual screws, and postero-anterior (PA) cross dual screws were simulated. Finally, under the condition of 2400N vertical load, finite element analysis (FEA) were carried out to compare the outcome of the four different internal fixation methods. -
Anatomy of the Foot and Ankle
Anatomy Of The Foot And Ankle Multimedia Health Education Disclaimer This movie is an educational resource only and should not be used to manage Orthopaedic Health. All decisions about management of the Foot and Ankle must be made in conjunction with your Physician or a licensed healthcare provider. Anatomy Of The Foot And Ankle Multimedia Health Education MULTIMEDIA HEALTH EDUCATION MANUAL TABLE OF CONTENTS SECTION CONTENT 1 . ANATOMY a. Ankle & Foot Anatomy b. Soft Tissue Anatomy 2 . BIOMECHANICS Anatomy Of The Foot And Ankle Multimedia Health Education Unit 1: Anatomy Introduction The foot and ankle in the human body work together to provide balance, stability, movement, and Propulsion. This complex anatomy consists of: 26 bones 33 joints Muscles Tendons Ligaments Blood vessels, nerves, and soft tissue In order to understand conditions that affect the foot and ankle, it is important to understand the normal anatomy of the foot and ankle. Ankle The ankle consists of three bones attached by muscles, tendons, and ligaments that connect the foot to the leg. In the lower leg are two bones called the tibia (shin bone) and the fibula. These bones articulate (connect) to the Talus or ankle bone at the tibiotalar joint (ankle joint) allowing the foot to move up and down. The bony protrusions that we can see and feel on the ankle are: Lateral Malleolus: this is the outer ankle bone formed by the distal end of the fibula. Medial Malleolus: this is the inner ankle bone formed by the distal end of the tibia. Tibia (shin bone) (Refer fig.1) Tibia