scholarly journals Patella Dislocation with Vertical Axis Rotation: The “Dorsal Fin” Patella

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
David Gamble ◽  
Quentin Otto ◽  
Andrew D. Carrothers ◽  
Vikas Khanduja
Keyword(s):  
Closed Reduction ◽  
Soft Tissues ◽  
Muscle Relaxation ◽  
Vertical Axis ◽  
Clinical Situation ◽  
Patella Dislocation ◽  
General Anaesthetic ◽  
Minor Trauma ◽  
Femoral Trochlea ◽  
Dorsal Fin

A 44-year-old woman presented following minor trauma to her right knee. While dancing she externally rotated around a planted foot and felt sudden pain in her right knee. She presented with her knee locked in extension with a “dorsal fin” appearance of the soft tissues tented over the patella. This was diagnosed as a rare case of an intraarticular patella dislocation, which was rotated 90 degrees about the vertical axis. Closed reduction in the emergency room was unsuccessful but was achieved in theatre under general anaesthetic with muscle relaxation. Postreduction arthroscopy demonstrated that no osteochondral or soft tissue damage to the knee had been sustained. In patients presenting with a knee locked in extension with tenting of skin over the patella (the “dorsal fin” appearance), intra-articular patella dislocation should be suspected. Attempts to reduce vertical patella dislocations under sedation with excessive force or repeatedly without success should be avoided to prevent unnecessary damage to the patellofemoral joint. In this clinical situation we recommend closed reduction under general anaesthetic followed by immediate knee arthroscopy under the same anaesthetic to ensure that there is no chondral damage to the patella or femoral trochlea and to rule out an osteochondral fracture.

scholarly journals Inferior Patella Dislocation due to Impaction in the Femoral Trochlea

2021 ◽  
pp. 89-92
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory
Keyword(s):  
Closed Reduction ◽  
Early Mobilization ◽  
Patella Dislocation ◽  
Type Ii ◽  
Rare Presentation ◽  
Femoral Trochlea ◽  
Inferior Pole ◽  
Locked Knee ◽  
Inferior Dislocation ◽  
Superior Pole

Acute inferior dislocation of the patella is a rare presentation in trauma and orthopaedics. Type II is caused by direct upward force on the inferior pole of the patella when the knee is flexed impacting the superior pole osteophyte into the intercondylar notch. Impaction in the femoral trochlea is rarely reported. A 92-year-old lady presented with locked knee held in 85° of flexion with an abnormal knee contour. Radiographs demonstrated that the upper pole of the patella was impacted in the femoral trochlea with a fracture of a superior pole osteophyte. The extensor mechanism was intact. Closed reduction is achieved under strong opioid pain relief. The patient returned to her baseline knee function within 6 weeks. Closed reduction of an inferior patellar dislocation in elderly patients is aided by superior pole osteophyte fracture and facilitates early mobilization, and avoidance of general anaesthesia.

“COMPARATIVE STUDY OF DISTAL END RADIUS FRACTURE TREATED BY PERCUTANEOUS 5 PIN TECHNIQUE V/S CLOSED REDUCTION AND CASTING METHOD”.

2021 ◽  
pp. 29-31
Author(s):  
Vibhor Khandal ◽  
Ashwani Kumar Mathur ◽  
Mohit Kumar ◽  
Rajkumar Bairwa
Keyword(s):  
Distal Radius ◽  
Closed Reduction ◽  
Soft Tissues ◽  
Hand Function ◽  
Early Mobilization ◽  
Fracture Site ◽  
Distal Radius Fractures ◽  
Point System ◽  
Casting Method ◽  
Radius Fractures

Introduction: Distal end radius fractures crush the mechanical foundation of most useful tool, the hand. No other fracture has a such potential to devastate hand function, and no other metaphysis of bone is embraced by more soft tissues. Closed reduction and percutaneous pinning is one of the standard treatments for management of distal radius fractures, and its modication 'The percutaneous 5 pin technique improves the reliability of xation thus combining the benets of non-invasiveness as in casting and stability achieved is comparable to open reduction and plating. Material and method: This prospective study was done between December 2018 to December 2020 in department of orthopedics, including 60 patients with fracture of distal radius Among them 30 patients subsequently underwent ve pin xation and 30 patients were treated with closed reduction and casting method. Result: Radiological analysis of the data was done using Sarmiento's Modication of Lidstrom Criteria. Activities of daily life (ADL) were examined by using the demerit point system of Gartland and Wereley based on objective and subjective criteria, residual deformity and complications. Radiological parameters were assessed for at the end of 6months. There was signicant difference in all the three parameters i.e, Volar tilt, Radial length, Radial inclination between both groups at the end of 6 months. Closed reduction with ve pinning technique group had shown not only better but also statistically signicant anatomical reduction compared to other groups. Functional outcome was better in patients treated with percutaneous 5 pinning technique. Conclusion: The ve pin technique carries the advantage of early mobilization, DRUJ stability. Radio Ulnar pins and the pins across the fracture site provide enough stability to permit early mobilization leading to less post operative stiffness in joint. Although the study series is small and further research is essential to provide directions for treatment, it is safe to conclude that the ve pin technique is a technically less demanding, lessinvasive and an effective way of treating displaced distal radius fractures without severe articular or metaphyseal comminution

scholarly journals Clinical Performance of a New Biomimetic Double Network Material

2013 ◽  
Vol 7 (1) ◽  
pp. 118-122 ◽  
Author(s):  
Christine Dirxen ◽  
Uwe Blunck ◽  
Saskia Preissner
Keyword(s):  
Soft Tissues ◽  
Clinical Performance ◽  
Young Patients ◽  
Tooth Wear ◽  
Clinical Situation ◽  
Dental Erosion ◽  
Thin Layers ◽  
Invasive Treatment ◽  
Tooth Structure ◽  
Non Invasive

Background:The development of ceramics during the last years was overwhelming. However, the focus was laid on the hardness and the strength of the restorative materials, resulting in high antagonistic tooth wear. This is critical for patients with bruxism.Objectives:The purpose of this study was to evaluate the clinical performance of the new double hybrid material for non-invasive treatment approaches.Material and Methods:The new approach of the material tested, was to modify ceramics to create a biomimetic material that has similar physical properties like dentin and enamel and is still as strong as conventional ceramics.Results:The produced crowns had a thickness ranging from 0.5 to 1.5 mm. To evaluate the clinical performance and durability of the crowns, the patient was examined half a year later. The crowns were still intact and soft tissues appeared healthy and this was achieved without any loss of tooth structure.Conclusions:The material can be milled to thin layers, but is still strong enough to prevent cracks which are stopped by the interpenetrating polymer within the network. Depending on the clinical situation, minimally- up to non-invasive restorations can be milled.Clinical Relevance:Dentistry aims in preservation of tooth structure. Patients suffering from loss of tooth structure (dental erosion, Amelogenesis imperfecta) or even young patients could benefit from minimally-invasive crowns. Due to a Vickers hardness between dentin and enamel, antagonistic tooth wear is very low. This might be interesting for treating patients with bruxism.

Fibrinolysis After Multiple Trauma In Man. Clinical And Methodological Aspects

1981 ◽  
Author(s):  
A-C Teger-Nilsson ◽  
E Gyzander ◽  
A Medegård ◽  
B Risberq ◽  
B Wiman
Keyword(s):  
Traffic Accidents ◽  
Soft Tissues ◽  
Bone Fractures ◽  
Degradation Products ◽  
Clinical Situation ◽  
Fibrinolytic System ◽  
Phase Reaction ◽  
Chromogenic Substrate ◽  
Immunological Method ◽  
Activity Measurements

Fifteen patients with at least two bone fractures and damages of soft tissues, mainly after traffic accidents, were investigated for changes in the fibrinolytic system. Seventeen healthy students were controls. The patients were conventionally treated in an intensive care unit. Blood samples, in all 140, were taken on the day of admission and then daily for about one week. The blood was analysed for plasminogen with electroimmunoassay and with chromogenic substrate after streptokinase activation, for α 2-antiplasmin with electroimmunoassay and two types of activity measurements (chromogenic substrate), for α 2-antiplasmin - plasmin complexes with RIA technique, and for α 2-macroglobulin with electroimmunoassay and activity measurements. In addition fibrinogen, fibrinogen-fibrin degradation products and fibrinolytic activity on fibrin plates were estimated.Plasminogen was somewhat low the first days after trauma lowest 69 % ± 22 % (M ± SD), day 3]. It then slowly increased towards the end of the investigation (highest 123% ± 21%). The last days of investigation the immunological method also gave higher values than the activity method, α 2 Antiplasmin was low directly after the trauma (lowest 67% ± 18%, day 1 ) and increased gradually (highest 115% ± 19%, day 6 ). The first days after trauma immunological method gave higher values than the activity methods, α 2 Antiplasmin - plasmin complexes varied, but showed occasionally high values in particular the first day. α 2 -Macroglobulin decreased only slightly on day 5-6, when it also showed a difference between the immunological and activity methods.It is concluded that the fibrinolytic system is activated immediately after a trauma. Later there is an increase of plasminogen, α 2 antiplasmin and fibrinogen, probably due to an acute phase reaction. Some reasons for the methodological discrepancies are discussed. Serial analysis of α 2-antiplasmin activity seems to be a relevant method for evaluation of fibrinolysis in a complex clinical situation.

Neurosurgical management of symptomatic thoracic spinal ossification in a patient with fibrodysplasia ossificans progressiva

2012 ◽  
Vol 16 (3) ◽  
pp. 285-288 ◽  
Author(s):  
Bartosz T. Grobelny ◽  
David Rubin ◽  
Peter Fleischut ◽  
Elayna Rubens ◽  
Patricia Fogarty Mack ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Genetic Disorder ◽  
Fibrodysplasia Ossificans Progressiva ◽  
Anesthetic Technique ◽  
Minor Trauma ◽  
Thoracic Insufficiency Syndrome ◽  
Canal Stenosis ◽  
Thoracic Spinal ◽  
Muscle Tissues ◽  
Insufficiency Syndrome

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder characterized by heterotopic ossification of soft connective and muscle tissues, often as the result of minor trauma. The sequelae include joint fusion, accumulation of calcified foci within soft tissues, thoracic insufficiency syndrome, and progressive immobility. The authors report on a patient with FOP who developed severe spinal canal stenosis in the thoracic spine causing substantial myelopathy. He underwent a thoracic laminectomy and resection of a large posterior osteophyte. Unique considerations are required in treating patients with FOP, including steroid administration to prevent ossification and anesthetic technique. The nuances of neurosurgical and medical management as they pertain to this disease are discussed.

scholarly journals Neglected Locked Patellar Dislocation in an Adult Female: Report of a Rare Case

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Sumedh D Chaudhary ◽  
Pratik R Gandhi ◽  
Maruti R Koichade ◽  
Suchit P Chavan ◽  
Shreyas H Ghuguskar
Keyword(s):  
Open Reduction ◽  
Patellar Dislocation ◽  
Soft Tissues ◽  
Vertical Axis ◽  
Successful Outcome ◽  
Trochlear Groove ◽  
Osteochondral Fracture ◽  
Chondral Injury ◽  
Wound Healing Problems

Introduction: Dislocation of patella is a very common injury which usually reduces spontaneously or can be reduced easily using gentle manipulation. Irreducible patellar dislocations are rare and usually result due to either rotation of patella along the horizontal or vertical axis or due to bony impaction. Neglected locked patellar dislocations are extremely rare injuries presenting additional challenges. Case Report: We are reporting a case of a 24-year female who presented to us 4 months after suffering a knee injury for which she received native treatment initially. On presentation, patient was able to walk with a limp and some discomfort but was unable to squat or sit cross-legged. Clinical examination revealed a patellar dislocation which was irreducible. On open reduction, the patella was found to be locked in the lateral gutter with rotation along its vertical axis and with an osteochondral fracture of its medial margin. There were a lot of fibrotic adhesions which required extensive release, following which the patella could be derotated and reduced into the trochlear groove. The medial retinaculum was repaired using transosseous sutures. Postoperatively, the patient developed wound edge necrosis which was managed with debridement and secondary suturing. At 1-year follow-up patient had almost full knee range of motion without any signs of patellar pain or instability and was able to squat and sit cross-legged. Conclusion: Unlike acute irreducible patellar dislocations which can be managed easily with open reduction, a neglected dislocation necessitates wider surgical exposure and a lot of soft tissue releases, which may jeopardize vascularity of the soft tissues leading to wound healing problems. Release of all adhesions while taking care to prevent further chondral injury, adequate lateral retinacular release, derotation of patella to relocate it into trochlear groove, and meticulous medial retinacular repair is essential for a successful outcome. Keywords

scholarly journals Isometry of Potential Attachment Sites for the Iliotrochanteric Suture in Dogs: an ex vivo Study

2020 ◽  
Vol 48 ◽  
Author(s):  
Cristiane Alves Cintra ◽  
Luís Gustavo Gosuen Gonçalves Dias ◽  
Fernanda Gosuen Gonçalves Dias ◽  
Danyelle Rayssa Cintra Ferreira ◽  
Lucas De Freitas Pereira ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Surgical Techniques ◽  
Vertical Axis ◽  
Central Point ◽  
Neutral Position ◽  
Joint Movement ◽  
Caudal Portion ◽  
Attachment Sites ◽  
Suture Tension ◽  
Hip Extension

Background: Coxofemoral luxation is the most common traumatic luxation in dogs and the iliotrochanteric suture is one of the surgical treatment options. The orthopedic suture aimed at surgically restoring joint movement should be employed in an isometric manner in order to maintain adequate tension throughout the arc of motion. This study aimed to determine the isometric points for the iliotrochanteric suture in dogs during the joint extension and flexion movements. This evaluation was performed both in the intact hip joint and in the luxation model, establishing the best combination, among the determined points, for the reestablishment of normal joint movement.Materials, Methods & Results: Radiographic analyses of 12 canine cadaveric hips, both intact and in craniodorsal luxation model, were performed in a neutral position, flexion at 50°, and extension at 150°. In the trochanteric segment, two parallel lines were drawn, creating the central vertical axis and the secondary vertical axis. Three points were then determined on each axis, from proximal to distal, corresponding to 25, 50, and 75% of the height of the axis, and were labelled as T1, T2, and T3 and T4, T5, and T6, respectively. In the iliac segment, a line perpendicular to the longitudinal axis of the ilium was drawn, and 25, 50, and 75% of this height corresponded to points I1, I2, and I3, respectively. The lengths between the points were measured, with the objective of evaluating which combination of points presented less variation in the joint positions. The central location of the iliac and trochanteric segments, determined respectively by I2 and T2, provided smaller variations during the maximal movements of hip flexion and extension.Discussion: The surgical techniques of iliotrochanteric suture target to maintain the internal rotation of the femoral head inside the acetabulum and abduction of the femur until the soft tissues have healed. The described techniques for the iliotrochanteric suture present a great anatomical variety in the arrangement of the anchor points of the suture. It is known that if during motion, the attachment sites move closer to one another, the suture will become lax and, if the attachment sites move away from one another, the suture will tighten. Therefore, the implantation in isometric sites assists in reducing the variation of the distance between the points of origin and insertion of the suture during joint movement, keeping the suture tension constant and allowing the functional recovery of the joint. This study demonstrates that there are some locations for the origin and insertion of an iliotrochanteric suture that are associated with less length change than others. I2-T2 combination is the point closest to isometry for the iliotrochanteric suture during hip extension and flexion, so that, T2 is the most central point of the greater trochanter, corresponding to 50% of the height of its central vertical axis, as well as I2, which corresponds to the most central point of the ilium, representing 50% of the height of the most caudal portion of its body. The isometric point found by us details the exact location of perforation in all aspects (height and length), both in the ilium and the trochanter. In addition, it is a personalized point created for each patient from its radiographic examination and taking into consideration its anatomical variations, so that there is no damage to the suture during hip extension and flexion movements.

Dislocations of the hip and femoral head fractures

2011 ◽  
Author(s):  
A. Pohl
Keyword(s):  
Femoral Head ◽  
Surgical Approach ◽  
Early Treatment ◽  
Closed Reduction ◽  
Open Reduction ◽  
Injury Pattern ◽  
General Anaesthetic ◽  
Associated Injuries ◽  
Imaging Studies

♦ Most injuries are high violence, so look for associated injuries♦ Immediate closed reduction usually best under general anaesthetic♦ Do not proceed to open reduction without appropriate imaging studies♦ Surgical approach depends on injury pattern♦ Some long term complications can be minimized/avoided by appropriate early treatment (e.g. avascular necrosis).

scholarly journals Combined Lag Screw and Cerclage Wire Fixation for Calcaneal Tuberosity Avulsion Fractures

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Vincenzo Giordano ◽  
Alexandre Leme Godoy-Santos ◽  
Felipe Serrão de Souza ◽  
Hilton Augusto Koch ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Large Diameter ◽  
Minor Trauma ◽  
Cannulated Screws ◽  
Avulsion Fractures ◽  
Cerclage Wire ◽  
Plantar Aspect ◽  
Calcaneal Tuberosity

Avulsion fractures of the calcaneal tuberosity represent a rare injury pattern that is caused by a powerful tension force from the Achilles tendon and is usually seen following minor trauma, especially in elderly patients. The objective of this study is to describe a surgical technique using cerclage wiring through cannulated screws in the treatment of extra- and intra-articular avulsion fractures of the calcaneal tuberosity and to present our results in a small patient’s cohort. Through a 5.0 cm longitudinal skin incision over the posterolateral aspect of the calcaneus, after adequate debridement of the fracture fragments and while keeping the ankle in plantarflexion, the calcaneal tuberosity is anatomically reduced with the help of a periarticular reduction clamp and an accessory plantar longitudinal approach. Provisionally fixation is performed with K-wires. Definitive fixation is achieved with two parallel partially threaded 7.0 cannulated screws, which are positioned from the superior and posterior aspect of the tuberosity to the inferior and anterior aspect of the plantar surface of the calcaneus, and 1.5 mm cerclage wires that are pulled epiperiosteally to the plantar aspect of the calcaneus to avoid damage to local soft tissues. Alternatively, for smaller fracture fragments, two 3.5 mm partially threaded cannulated screws and 1.25 mm cerclage wires can be used. We also report the results of the procedure in a small cohort of four patients. All fractures healed in an anatomic position. There was no failure of fixation, loss of reduction, or need for secondary surgery, including hardware removal. At final follow-up, all patients had regained full plantar flexion range of motion and strength, with no gait or weight-bearing restrictions. In conclusion, the combination of cerclage wire and large diameter cannulated screws represents a promising option in the treatment of avulsion fractures of the calcaneal tuberosity, demonstrating good functional and radiographic results in our cohort of patients.

Anaesthetics

2019 ◽  
Author(s):  
Stevan R. Emmett ◽  
Nicola Hill ◽  
Federico Dajas-Bailador
Keyword(s):  
Diethyl Ether ◽  
Interventional Procedure ◽  
Muscle Relaxation ◽  
Clinical Situation ◽  
Depth Of Anaesthesia ◽  
Drug Induced ◽  
Rapid Induction ◽  
Anaesthetic Agents ◽  
Severe Liver Damage ◽  
Muscular Spasm

Anaesthesia is a state of reversible unconsciousness that comprises some or all of the ‘triad of anaesthesia’— hypnosis, analgesia, and muscle relaxation. Safe and ef­fective anaesthesia requires information of the drug’s potency at effector sites and knowledge of administration concentrations, as well as an understanding of the degree of noxious stimulus and how a patient’s physiology may modulate drug actions. Historically, the first compounds used as anaesthetics were diethyl ether, nitrous oxide, and chloroform. Diethyl ether was demonstrated to the wider medical commu­nity in 1846 by William Morton in the removal of a jaw lump from Gilbert Abbot, and the introduction of chloro­form followed within the year. It was noted by James Simpson, Professor of Obstetrics in Edinburgh in 1847, that chloroform was much more potent, but had a ten­dency to precipitate death in the anxious and could cause severe liver damage. This tendency demonstrates clearly that the depth of anaesthesia is critical. Too much cir­culating drug can lead to respiratory depression, cardiac arrhythmias, and death, while too little permits persistent consciousness, pain, and muscular spasm. This is of particular concern with regards to laryngospasm, which when combined with an unsecured airway can rapidly lead to hypoxia and death. Nowadays, death is incredibly rare, with signs of hypotension, tachy- , or bradycardia detected early and easily reversed by controlling drug dosage. The risk of drug- induced side effects when using anaesthetic drugs means that the depth of anaesthesia must be closely monitored. This is achieved subjectively with experience and training, in combination with ob­jective clinical assessment, such as pulse, BP, and mean alveolar concentration. See Table 8.1 for ideal properties of anaesthetic agents. There are many approaches to the application of gen­eral anaesthesia, and these depend on clinical situation, depth, and length of anaesthesia required, the type of sur­gical or interventional procedure to be undertaken and as­sociated patient risk factors. The stages of anaesthesia (outlined in Table 8.2) was a concept introduced at a time when induction was rou­tinely achieved through the use of inhalational anaes­thetics. More recently the use of IV induction agents has meant that transition between these stages is smoother, resulting in a rapid induction with minimal excitation responses, compared with inhalation agents. Inhalation agents also carry the risk of airway irritation.

Sign in / Sign up

Export Citation Format

Share Document