Assessment, Management and Decision Making in the Treatment Of
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
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. -
Skier Tibia (Leg) Fractures
Skier Tibia (Leg) Fractures In years past, the prototypical ski fracture was sustained at the lower part of the outside of the leg in the region of the ankle. However, in the past 10 years, with the advent of the modern ski boots and improvements in binding, the most commonly seen lower leg skier fracture is the tibia (or shinbone) fracture. 10% of these fractures are associated with a collision. Thus, 90 % are associated with an isolated fall or noncontact type of injury, which is generally the result of binding malfunctions and inappropriate release. The most common mechanism leading to a tibia (leg) fracture is a forward fall. Risk factors for sustaining a skier tibia fracture include: beginners or novice skiers, less than 20 years of age, higher outdoor temperatures, and increased snow depth. Non-risk factors include ski lengths, icy conditions, and male versus female sex. The modern ski boot very closely resembles an extremely well padded short leg cast in the treatment of many orthopaedic lower extremity fractures. It of course goes to a much higher level than the former shorter boot top-level varieties. The binding release and designs have been based on the fracture strength of the adult tibia (shin) bone at the top of the modern ski boot. The treatment of most skier leg fractures includes a closed reduction and cast application for variable periods of time, with or without weight bearing allowed. However, severe misalignments of the bones can lead to later bony prominences that may be incompatible with snug, rigid, high fitting ski boots. -
Medial Lateral Malleolus
Acutrak 2® Headless Compression Screw System 4.7 mm and 5.5 mm Screws Supplemental Use Guide—Medial & Lateral Malleolus Acumed® is a global leader of innovative orthopaedic and medical solutions. We are dedicated to developing products, service methods, and approaches that improve patient care. Acumed® Acutrak 2® Headless Compression Screw System—4.7 mm and 5.5 mm This guide is intended for supplemental use only and is not intended to be used as a stand-alone surgical technique. Reference the Acumed Acutrak 2 Headless Compression Screw System Surgical Technique (SPF00-02) for more information. Definition Indicates critical information about a potential serious outcome to the Warning patient or the user. Indicates instructions that must be followed in order to ensure the proper Caution use of the device. Note Indicates information requiring special attention. Acumed® Acutrak 2® Headless Compression System—Supplemental Use Guide—Medial & Lateral Malleolus Table of Contents System Features ...........................................2 Surgical Techniques ........................................ 4 Fibula Fracture (Weber A and B Fractures) Surgical Technique: Acutrak 2®—5.5 .......................4 Medial Malleolus Surgical Technique: Acutrak 2®—4.7 ......................10 Ordering Information ......................................16 Acumed® Acutrak 2® Headless Compression System—Supplemental Use Guide—Medial & Lateral Malleolus System Features Headless screw design is intended to minimize soft tissue irritation D Acutrak 2 Screws Diameter -
Free Vascularized Fibula Graft with Femoral Allograft Sleeve for Lumbar Spine Defects After Spondylectomy of Malignant Tumors Acasereport
1 COPYRIGHT Ó 2020 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED Free Vascularized Fibula Graft with Femoral Allograft Sleeve for Lumbar Spine Defects After Spondylectomy of Malignant Tumors ACaseReport Michiel E.R. Bongers, MD, John H. Shin, MD, Sunita D. Srivastava, MD, Christopher R. Morse, MD, Sang-Gil Lee, MD, and Joseph H. Schwab, MD, MS Investigation performed at Massachusetts General Hospital, Boston, Massachusetts Abstract Case: We present a 65-year-old man with an L4 conventional chordoma. Total en bloc spondylectomy (TES) of the involved vertebral bodies and surrounding soft tissues with reconstruction of the spine using a free vascularized fibula autograft (FVFG) is a proven technique, limiting complications and recurrence. However, graft fracture has occurred only in the lumbar spine in our institutional cases. We used a technique in our patient to ensure extra stability and support, with the addition of a femoral allograft sleeve encasing the FVFG. Conclusions: Our technique for the reconstruction of the lumbar spine after TES of primary malignant spinal disease using a femoral allograft sleeve encasing the FVFG is viable to consider. he treatment of primary malignant neoplasms of the spine mended a magnetic resonance imaging (MRI), but the request currently mainly relies on surgery, often in conjunction with was denied by the insurance company, and the patient T 1-3 radiotherapy .Totalen bloc spondylectomy (TES) is a widely underwent a course of physical therapy with no benefitand accepted surgical technique and has lower reported recurrence rates progression of back pain and radiculopathy. Four months compared with patients who undergo intralesional surgery3,4. -
Common Stress Fractures BRENT W
COVER ARTICLE PRACTICAL THERAPEUTICS Common Stress Fractures BRENT W. SANDERLIN, LCDR, MC, USNR, Naval Branch Medical Clinic, Fort Worth, Texas ROBERT F. RASPA, CAPT, MC, USN, Naval Hospital Jacksonville, Jacksonville, Florida Lower extremity stress fractures are common injuries most often associated with partic- ipation in sports involving running, jumping, or repetitive stress. The initial diagnosis can be made by identifying localized bone pain that increases with weight bearing or repet- itive use. Plain film radiographs are frequently unrevealing. Confirmation of a stress frac- ture is best made using triple phase nuclear medicine bone scan or magnetic resonance imaging. Prevention of stress fractures is most effectively accomplished by increasing the level of exercise slowly, adequately warming up and stretching before exercise, and using cushioned insoles and appropriate footwear. Treatment involves rest of the injured bone, followed by a gradual return to the sport once free of pain. Recent evidence sup- ports the use of air splinting to reduce pain and decrease the time until return to full par- ticipation or intensity of exercise. (Am Fam Physician 2003;68:1527-32. Copyright© 2003 American Academy of Family Physicians) tress fractures are among the involving repetitive use of the arms, such most common sports injuries as baseball or tennis. Stress fractures of and are frequently managed the ribs occur in sports such as rowing. by family physicians. A stress Upper extremity and rib stress fractures fracture should be suspected in are far less common than lower extremity Sany patient presenting with localized stress fractures.1 bone or periosteal pain, especially if he or she recently started an exercise program Etiology and Pathophysiology or increased the intensity of exercise. -
Foot and Ankle Systems Coding Reference Guide
Foot and Ankle Systems Coding Reference Guide Physician CPT® Code Description Arthrodesis 27870 Arthrodesis, ankle, open 27871 Arthrodesis, tibiofibular joint, proximal or distal 28705 Arthrodesis; pantalar 28715 Arthrodesis; triple 28725 Arthrodesis; subtalar 28730 Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse 28735 Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; with osteotomy (eg, flatfoot correction) 28737 Arthrodesis, with tendon lengthening and advancement, midtarsal, tarsal navicular-cuneiform (eg, miller type procedure) 28740 Arthrodesis, midtarsal or tarsometatarsal, single joint 28750 Arthrodesis, great toe; metatarsophalangeal joint 28755 Arthrodesis, great toe; interphalangeal joint 28760 Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint (eg, jones type procedure) Bunionectomy 28292 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method 28295 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method 28296 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method 28297 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method 28298 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with -
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 -
Bones Can Tell Us More Compiled By: Nancy Volk
Bones Can Tell Us More Compiled By: Nancy Volk Strong Bones Sometimes only a few bones are found in a location in an archeological dig. VOCABULARY A few bones can tell about the height of a person. This is possible due to the Femur ratios of the bones. It has been determined that there are relationships between the femur, tibia, humerus, and radius and a person’s height. Humerus Radius Here is a little help to identify these four bones and formulas to assist with Tibia determining the height of a person based on bone length. Humerus Femur: Humerus: The thigh is the region of the femur. The arm bone most people call the From the hip bone to the knee bone. upper arm. It is found from the elbow to the shoulder joints. Inside This Packet Radius Strong Bones 1 New York State Standards 1 Activity: Bone Relationships 2 Information for the Teacher 4 Tibia: Radius: The larger and stronger of the two bones The bone found in the forearm that New York State Standards in the leg below the knee bone. extends from the side of the elbow to Middle School In vertebrates It is recognized as the the wrist. Standard 4: Living Environment strongest weight bearing bone in the Idea 1: 1.2a, 1.2b, 1.2e, 1.2f body. Life Sciences - Post Module 3 Middle School Page 1 Activity: Bone Relationships MATERIALS NEEDED Skeleton Formulas: Tape Measure Bone relationship is represented by the following formulas: Directions and formulas P represents the person’s height. The last letter of each formula stands for the Calculator known length of the bone (femur, tibia, humerus, or radius) through measurement. -
Normative Values for Femoral Length, Tibial Length, Andthe Femorotibial
Article Normative Values for Femoral Length, Tibial Length, and the Femorotibial Ratio in Adults Using Standing Full-Length Radiography Stuart A Aitken MaineGeneral Medical Center, 35 Medical Center Parkway, Augusta, ME 04330, USA; [email protected] Abstract: Knowledge of the normal length and skeletal proportions of the lower limb is required as part of the evaluation of limb length discrepancy. When measuring limb length, modern standing full-length digital radiographs confer a level of clinical accuracy interchangeable with that of CT imaging. This study reports a set of normative values for lower limb length using the standing full-length radiographs of 753 patients (61% male). Lower limb length, femoral length, tibial length, and the femorotibial ratio were measured in 1077 limbs. The reliability of the measurement method was tested using the intra-class correlation (ICC) of agreement between three observers. The mean length of 1077 lower limbs was 89.0 cm (range 70.2 to 103.9 cm). Mean femoral length was 50.0 cm (39.3 to 58.4 cm) and tibial length was 39.0 cm (30.8 to 46.5 cm). The median side-to-side difference was 0.4 cm (0.2 to 0.7, max 1.8 cm) between 324 paired limbs. The mean ratio of femoral length to tibial length for the study population was 1.28:1 (range 1.16 to 1.39). A moderately strong inverse linear relationship (r = −0.35, p < 0.001, Pearson’s) was identified between tibial length and the Citation: Aitken, S.A. Normative corresponding femorotibial ratio. -
Tibial De-Rotational Osteotomies for Tibial Torsion
Tibial De-Rotational Osteotomies for Tibial Torsion Why does my child need tibial torsion surgery? What happens during the surgery? A lot of young children walk with their toes pointing in or First, the surgeon cracks the tibia and the smaller fibula bone out instead of straight ahead. The most common reason is next to it, usually just above the ankle. Surgically cracking a tibial torsion, a twist in the tibia bone of the lower leg. This bone is also known as an osteotomy. It is similar to breaking twist brings the knee and ankle out of alignment. The feet a bone, except that it is done on purpose. The surgeon respond by turning in (internal tibia torsion) or out (external weakens the tibia bone first by drilling holes through a small tibia torsion). Most of the time, tibial torsion gets better as a surgical opening. The next step is to rotate, or turn, the bone child exercises the leg muscles by walking and running. into correct alignment. The surgeon then places a pin in the bone just below the knee. The pin will be removed once the But when a child has spasticity, a condition in which muscle bone heals. In the meantime, your child will wear a cast that tone is very strong, tibial torsion can get worse instead starts at the pin and covers the leg and foot. The cast keeps of better as the child grows. Surgery helps children with the leg from moving while new bone grows. spasticity who can stand, but cannot walk or run normally because of tibial torsion. -
NCB® Proximal Tibia System Surgical Technique
NCB® Proximal Tibia System Surgical Technique NCB® Proximal Tibia System– Surgical Technique 3 Surgical Technique Table of Contents NCB Locking Plate Introduction 4 System for Proximal Tibia Plate Design 5 Screw Selection 5 Cable Fixation Options 6 MIS Radiolucent Targeting Device 7 System Features 7 Indications/Contraindications 8 Fracture Classification 8 Sample Cases 9 Preoperative Planning and Patient Positioning 11 Open Technique 12 Incision 12 Fracture Reduction 12 Optional: Bone Spacers 12 Insertion of NCB PT Plate 13 Insertion of NCB Screws 13 MIS Technique* 18 Plate Hole Numbering System 18 Incision and Fracture Reduction 18 Targeting Device Assembly 19 Insertion and Preliminary Fixation of NCB PT Plate 19 Insertion of NCB Screws in the Proximal Area 21 Insertion of NCB Screws in the Shaft 22 Implant Removal 24 Ordering Information 25 Implants 25 Graphic Case 28 Standard Instruments 29 MIS Instruments 30 Cannulated Option (Screws and Instruments) 32 * MIS Minimally Invasive Solutions™ Technique by Zimmer Planning Aid 33 4 NCB® Proximal Tibia System – Surgical Technique Introduction The NCB PT (Non-Contact Bridging for the Proximal Tibia) is an optimal plate solution for the treatment of complex fractures of the proximal tibia. The system allows for polyaxial screw placement (30°) with subsequent screw locking. Before locking, the screws can act as lag screws and be used for fracture reduction; a benefit which is not offered with standard locking systems. Implants are available with 2 or 3 proximal holes, left and right. Plate length In the locked mode, NCB PT Plate late varies from 5 to 9 shaft acts as an internal fixator without holes for the 2-proximal hole contact between the plate and the plate and between 3 and 13 shaft holes for the 3-proxi- bone surface reducing the risk of mal hole plate. -
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