Science topic

Orthopedic Surgery - Science topic

Orthopedic Surgery is a surgical and nonsurgical means treatments of musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
Questions related to Orthopedic Surgery
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How many of us think that an academic society or organisation helps us, like AOTrauma helps us in professional growth, academic growth and helps us move up the ladder in our career. Does it really remove the obstacles. If yes please mention the name of such organization ( like Indian Orthopaedic association, AOTrauma, OTA, BOA, Arthroplasty, Arthroscopic or trauma societies of different countries states etc) which really help you. Please write your thoughts if you have a different point of view.
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These help if the association offers various fellowship program or award paper sessions in the society conferences as membership is usually required. May also be helpful in professional networking purpose..
And if one wishes to climb the leadership roles within an association, long term loyalty and association with the concerned association helps.
These are major helpful issues regarding membership of an association... Waiting for other opinions....
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There are contradictory recommendations in this regard. Any authentic guidelines please?
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No role for rapping with aluminuum foil in getting pain relieve.
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Hello there!
I am performing a systematic review regarding the effect of a specific surgical procedure on a common orthopaedic condition. All identified studies are case-series with no control group.
For these studies the outcome is pre- vs post-surgery change in Visual Analogue Scale (VAS).
Is it possible to perform a meta-analysis of pre- vs post-surgery change in VAS given there is no control group?
Any thoughts would be greatly appreciated!
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In my practice, I’ve been able to perform meta-analysis of pre/post op PROM scores in two manners:
1. Performing a pairwise meta-analysis of the continuous data, taking the preop score as one “arm” and the postop scores as the other “arm”.
2. Using the formulae for subtracting means and standard deviations listed in the cochrane handbook to caluclate the difference in pre/postop scores and performing a single-arm meta-analysis of the change value.
Method 1 would be preferrable if you are unable to access software such as RStudio or STATA, as it can be done on Revman.
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Accidents involving motorcycles are responsible for over 50% of open fractures of the tibia and can be associated with other lesions and the victims, in the vast majority, are youth and young adult (Brazil epidemiological data). What preventive measures could be taken to reduce this type of accident?
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Dear Dr. Nelson Elias ,
I suggest you to have a look at the following, interesting reference:
- Motorcycle Safety
My best regards, Amir Beketov.
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As there are greater advances in the field of orthopaedics, how important a role has commercialisation to play ? Are the implant companies and big organisations influencing clinical practice ? What are the pros and cons on this route the modern orthopaedics is on?
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Currently working burden on health care is due to corrupt commercial guidelines in terms of policymakers.
Fancy investigation are priorities over base line labs since 1990 causing a anarchy in 2020 .
High resolution CT scan virology PCR and MRI are top trend examples which are ordered even before CBC ESR and Urine RE.
We have almost forgot to check Urine as routine examination in any clinic.
Health is social physical and mental well-being and merely not an absence of disease or infirmaty
Thought of the day
 American Urological Association estimates that 150 million UTIs occur yearly worldwide, accounting for $6 billion in medical expenditures
Interesting to know first whole world 🌎 is socially affected by lock downs
Mentally harassment by propaganda
Mean while
Promote market of sanitizer and face masks 😷
Which was declared not enough
Then it was testing labs and kits business
Then it came to vaccine
Now all the things are not enough
Where is planning and science or any medical science in management
Interestingly nothing is enough if u have it in ur mind
Walk and Run connect socially physicaly have hopes
Eat healthy food have plenty of warm fluids
Neuroendocrine responses to any insult or stress can cause immune suppression which can lead to acute  or subacute clinical infections mostly asymptomatic.
No of UTI in life time are far more than any other infections
Proceessed food lead to Malnutrition which can lead to malfunction of immune system Incidence of autoimmune diseases is increasing so as Incidence of vit D deficiency
Cold acids (Sour) and Asymptomatic urinary tract infections as top trigger of immune system. Micro or macro nutritional deficiencies can lead to repeated low grade infections and can result in other imune malfunction. Life style modification and muscles Strengthening is key in treatment of Imune diseases. Immune Modulation rather than immune suppression.
Any non neoplastic Atraumatic primarily aseptic myalgia or arthralgia is predominantly reactive phenomena due to asymptomatic urinary tract infections of exposure to allergens like cold and ingestion of sour (acids)Its about stressess
Malnutrition
Low grade infections mostly urinary tract infections
And resulting in immune diseases
Our protocol is IV Alfacalcidol inj
.5microgram once a day 4 days for osteomalcia
IV Zoledronic acid for osteoporosis
Antibiotics according to urine culture in non Traumatic aseptic non neoplastic arthralgia or myalgia
Hydroxychloroquine for immune Modulation
Avoidance of allergens like exposure to cold and sour
Have a look when convenient
My life time project immune component of musculoskeletal diseases have ur input on this will be grateful
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For my dissertation I'm validating the method of sonication culture for prosthetic joint Infections and orthopaedic implant infection. Hopefully this method can be used in our lab since this has been repeatedly proved to be more specific than tissue culture. I want to investigate if this sonication method will also be beneficial for detecting osteomyelitis. In the literature there is not much to find on this subject, maybe researchers here can help me with the question if this is possible or maybe there are labs who already use this method?
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Jana van Wijngaarden Welcome! The sonication of bone fragments is not a valid technique. The implants provide a massive amount of biofilm, the best way to survive in a hostile environment. The other manner to evade the immune system is surviving into the osteoblasts, as Staphylococcus aureus does. It reduces osteoblast activity and may cause osteoblast necrosis. Therefore, sonicating bone fragments could not be helpful; this method can not release S. aureus from osteoblasts. Finally, vortexing (a stage of sonication method) cells can lead to mechanical shearing of the DNA. On the other hand, low-intensity pulsed ultrasound (< 5MHz) is helpful for fracture healing - the frequency for implant-related infection diagnosis purposes is 40±2 kHz.
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Respected Fellows,
First and foremost, wish you all, all the very best for the year 2021!.
I was formerly a faculty member in Canada (2006-2011, Assistant Prof.), then came back to my mother-land. What I've seen in the past 10 yrs, in regard to publishing our papers, was that politics was GREATLY involved in numerous journals' decision on our manuscripts.
My question for you is as follows:
Do you agree that politics is involved in science these days?, and if so, should we, researchers, be indifferent with respect to unfair behavior of some of our fellows with respect to some others who are working in some countries, like my mother-land?.
Most recently, a manuscript from my research team, which was submitted to a Japanese journal, and it was 100% theoretical work, with no experiments involved at all, was rejected since one of the reviewers has criticized our work and mentioned why different steps of the experiment done in our work were not clearly explained (?!!!!!!). We immediately prepared a rebuttal and appealed their decision, but EIC has responded and mentioned we only accept about 10% of the manuscripts we receive (!!!!).
Thanks for your thoughts in advance,
PS1: I am working on Biomechanics related projects, mostly on Orthopaedic and Dental Implants Biomechanics, so no threat to other nations (?!)- please correct me if I am wrong.
PS2: I am Iranian-Canadian, but now am living in Iran, and working from here. If there is anything wrong with this, please educate me.
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The financing and use of science have always been conditioned by politics, it is enough to remember the production and use of penicillin during the Second World War.
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Does the term "contrast bath" imply any random time-temperature combination of hot and cold water or it is a specific combination of repetitive alternate spells of dipping the affected body part in cold water at a specific temperature for a specified duration followed by dipping in hot water at a specific temperature for a specified duration?
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Dear Mr. Shanker Lal, I largely agree with the earlier responders. A contrast bath is the immersion of the extremity under consideration alternatively (for a minute or two) in hot and cold bath for at least 15 min per sitting. Though the literature suggests water in cold container to be between 10-15 degrees C and water in hot container to be between 35-45 degrees C, it may be kept at the tolerance level of the individual.
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After the ORIF surgery of right hand wrist fracture, the fingers are stiffened - the finger segments getting as hard as stones (hardened edema) - making the bending of fingers to close the palm as fist almost impossible as the stone hard lower segment of the finger doesn't allow the finger to be bent downwards. The physiotherapist tries mobiisation applying his full might to bend the fingers downwards causing extreme pain to the patient, still the fingers do not bend beyond 90 degrees from their fully stretched position. Is this physiontherapy (extreme torture to the patient) - extending to 2 / 3 / 4 weeks or even more - the only way to restore the fingure movement or there are some easier / painless patient-friendly ways (such as some medication etc.) of treating the stiffened fingers without subjecting the patient to ubearable tortures?
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There may be various reasons for stiff fingers following wrist surgeries such as lack of occupational therapy and complex regional pain syndrome (reflex sympathetic dystrophy syndrome) . Best option is to start graded occupational therapy combined with wax therapy . If the stiff ness associated with pain ,then always need to suspect CRPS. so treat accordingly with various measures including drugs and therapy. It would be a long course to get normal functional hand.
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What is the course of action in an arthroplasty which is infected clinically but is culture negative? I find this a difficult situation in many orthopaedic infections not only arthroplasty where the clinical features from a weeping wound to local signs cry infection and even the deeper swabs grow nothing. How does one tailor the antibiotics in such situations?
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Negative culture results weren’t really terrible
One-stage revision arthroplasty demonstrated similar outcomes including reinfection, re-revision, and readmission rates for the treatment of chronic culture-negative PJI after TKA and THA compared to two-stage revision (van den Kieboom J, . One-stage revision is as effective as two-stage revision for chronic culture-negative periprosthetic joint infection after total hip and knee arthroplasty. Bone Joint J. 2021 Mar;103-B(3):515-521. )
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What are pros and cons of it vis-a-vis the gold standard two stage revision surgery?
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The selection of one or two-stage exchange in the treatment of periprosthetic joint infection remains a controversial issue,
One-stage exchange appears to be a viable alternative to two-stage exchange, provided there are no contra-indications, producing similar results in terms of eradication rates and functional outcomes, and offering the advantage of a unique surgical procedure, lower morbidity and reduced costs.
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15 y old male normal xrays no other symptoms normal uric acid level bilateral lesions no history of trauma
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As Hartmut Foerstner wrote
most often: Synovialitis of flexor tendons, A1 Pulley affection,
often: infections,
rare: hundreds of diagnoses possible: periarticular crystal arthropathy, some bone tumors (osteoid osteoma) and many many more
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The COVID pandemic has been a blessing for most journals, including our Journal of Clinical Orthopaedics and Trauma. Currently, we are getting around 6 new manuscripts daily and the number of submissions in the last 4 months has risen to 280%, compared to the last year. I do not know when this curve is likely to flatten to come to normalcy.
This trend has over-burdened the editors and their editorial team members, especially as the number of journal staff has not risen but has actually decreased to lockdown and some staff getting sick.
What are the likely reasons for such an exponential rise?
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We all know hospitals have been busy, but many depoartments such as orthopaedics have seen a fall off in major trauma (up to at least a third) in some departments, clinics have been closed or made virtual, some doctors have been redeployed. I think however there has been space for some doctors to write many papers. Certainly from my old department a number of helpful long term patient reported outcome studies (PROMS) have appeared and are in press. Partly this is due to COVID-19.
As a regular reviewer for sugical journals I have seen a surge in paper writing in the last year and often I get about one paper a day to review! Unfortunately the quality of some papers has significantly fallen and there is a lot of replication of very similar studies. I would caution all writers of "new papers" to carefully check the literature on what has already been written, If you don't have a significant new message I'm afraid you won't get published.
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We are currently conducting a study on the influence of collars in metadiaphyseal uncemented stems and I am curious what the orthopedic community at RG thinks about this topic.
Do you think collared stems have advantages or disadvantages? Do you use collared stems in you daily practice?
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In most of my cases I use a non-cemented stem without a collar, but I think that the use of the collar depends on the type of stem, if a wagner-type stem is used, the collar makes more sense than a wedge like the Corail where part of the success is the pressure fit when resting on the impacted spongy bone.
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International Orthopaedics
June 2018, Volume 42, Issue 6, pp 1297–1306| Cite as
Trimorphic extreme clubfoot deformities and their management by triple surgical skin expanders- DOLAR, DOLARZ and DOLARZ-E(evidence based mega-corrections without arthrodesis)
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In my experience outpatient review for orthopaedic patients unless part of a dedicated trial is non standardized and often vague such as pain has improved or back to work and function. Should all patients have a standardized set of reviews recommended by specialist societies to facilitate consistent review, assessment between units and research projects that are multi centre.
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I agree electronic collated data is the way forwards. To record events like complications and a standardized data set. Proms information collected centrally is often not shared with the unit. I felt agreeing between centres a data set would enable the units to keep track over time and a centralized overview.
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Is there any selective advantage to the brachial plexus being a network instead of independent nerves? Same question for the lumbosacral plexus.
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i have found it is difficult to get clear answers to questions about the original design of the body...
why would the taste sense of the anterior part of the tongue run through the middle ear
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I am very interested in scaphoid fracture non-union but have found there is, despite the significant need clinically to improve our understanding, very little interest in the aetiology and histology from the basic science point of view. I would like to find someone or institution who may be interested in this and who I can collaborate with. In preference, this is within the UK because of specimen sharing logistics. Jon Compson. Consultant Orthopaedic Surgeon, Kings College Hospital London, UK
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As we know that arterial supply to the scaphoid is peculiar and main reason behind non union and proximal fragment AVN. So we can study the pattern of arterial supply of scaphoid and look for any variations.
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Whilst we are awaiting evidence of all types, what is the best current evidence for orthopaedic robots?
In the future, there are many possible study designs and outcome measures. Medical device research is confounded by the inability to blind the surgeon and the varied surgical technique. Registry data may give the answer in the long term but is likely to be confounded by experienced surgeons using the robot and fit patients selecting the robot.
Is the best outcome measure 3D CT measured implant position of robotic vs human ?
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I attended a demonstration of Stryker's arthroplasty robot (Mako), which is currently being introduced in the UK via private healthcare companies (BMI). I discussed theatre aspects of this approach and whilst the surgery duration has not changed between standard or robotic approach, the incisions are small and patients that were available to talk to on the day had reported a shorter length of stay and improved outcomes. The use of CT imaging as a guide during surgery I found particularly interesting as Surgeons are able to take templating one step further and account for all types of structural differences and by using the robot this can be precision cutting. Kayani (2018 - Bone & J Journal) has produced some research on knee arthroplasty and there is a systematic review by Chen (2018) that might be of use?
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Thanks for the answers...
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Hi,
What I understood is that an upper-knee amputation post infection + life threatening medical assistance + multiple sequential amputations caused a fat embolism.
I meant that in post-infected ans scared tissues with possible weak veins, it is hazardous to restrict the embolism entry to the shaft marrow since is seems there was no material pushed inside in the bone shaft; such insertions may cause fat embolism.
For upper knee amputation, by definition, we loose a lot of weight, which is changing the remaining thigh balance in the side coronal plane, since the femoral offset is not changed. Too much correction has consequences for sure.
Soft tissues tend to "melt" very quickly. Then we tend not to strip muscles (they will turn into fat) and fat regarding the bevel bone cut. And in fragile tissues, it is important not to have too tight tractions one the skin causes by the stitches. It may cause succion troubles in the prosthesis but it is another problem.
Talking about shoes, a bare foot has a lot of fat pad regarding metatarsian heads and ever stronger shell at the heel (very useful in Syme's amputation).
Cheers, JM.
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I did orthopedic surgery on my mouse yesterday and for surgical prophylaxis, I had 10 mg of intraperitoneal cefazolin injection 30min before surgery, then once every day for 5 days 10mg of cefazolin will be injected intraperitoneally, today when I checked my mouse, I saw sth around the patella that swelled outward, I want to know if it's ok and it's sth normal like inflammation or its sth serious like infection or abscess, and what should I do with that, if it's the inflammation should I use NSAIDs or if it's infection, should I change or add another antibiotics?
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I always give analgesia like buprenorphine just before surgery and than morning/evening for three days post-surgery. That has worked very well in Nude rats. But normal mice even need less analgesia. You are giving antibiotics before and post-surgery. May be you should include some analgesia also. Swelling first day, I will be of some concerned but can not do much and will wait for 2/3 days, hope that will be go down. If any internal suture has not broken, sometime it can happen also. If veterinarian around, you should address this question to him/her. And watch your mouse morning /evening for few days regularly. Mice in general heal faster than other animals like rabbit.
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In today's era of orthopaedics, PSI helps in performing the replacement surgery more accurately with reproducible results. The literature supports the usage of PSI with numerous benefits.
Market has numerous options of PSI - few being MRI based, while others CT based. What is your take on this technology and which one do you prefer, if any?
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There are two main goals from the imaging. The first is to calculate the optimal alignment for the replacement and the second is to produce cutting blocks which are accurate and easy to use intra-operatively. CT is better for quick analysis of bone contours and therefore alignment whilst MRI can give images which facilitate the production of better jigs - as they can incorporate cartilage and soft tissue. You could argue that as both are non weight-bearing, neither can actually measure physiological alignment. S&N Visionaire is likely one of the most popular and uses combined MRI and full leg X-Ray to design cutting blocks specific to that patient.
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In your previous discussions corrosion is mentioned as one reason of failures. Is it possible to detect corrosion or microfractures before mechanical failure of implants
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Any patient complaining of persistent pain at the site of implant surgery is suspect for either implant loosening, failure,infection .
Always they should be kept under close observation till the diagnosis is clear
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This questionnaire was developed in 2001 by Kirsi Johannson and used again in 2016
Eloranta, S., Katajisto, J. and Leino-Kilpi, H., 2016. Orthopaedic patient education practice. International journal of orthopaedic and trauma nursing, 21, pp.39-48.
I have emailed the researchers in Finland but I have had no reply
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Hello
I recomended to look in google academics
Ingrid
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I am in need of your expertise. What does your experience say?
The fracture is fixated with two metal plates and additional screws.
Four weeks post surgery there is still pain (on a scale from 1 to 10 = 7 to 8) in the region of the metal plates and swelling, total numbness in the antebrachium region and sporadic moments of control over the hand. Is this normal?
Is it possible to reach a total recovery? If not, what factors play a role in this?
What does your experience say in regards of removal of metal plates and screws, does this occur in most cases?
If anyone can refer to scientific papers on the matter I would be so grateful.
This is of personal interest. Feel free to answer here or contact me in my inbox.
Thank you so much for your time.
Kind Regards Sabina
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1. The fracture is purely extra-articular, elbow full ROM can be restored
2. The cause of pain is mostly unstable internal fixation
3. You need to sort out the neurological symptoms that you described
4. The ideal surgery should depend on rigid , stable internal fixation with minimal soft tissue damage during surgery
5. Ideal postoperative physiotherapy should be "assisted Acitive ROM excercises", passive excercise may cause tearing of capule and soft tissues. Contractures will follow..
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Tibial fractures are the most common long bone fractures.The aim of treatment for tibial shaft fractures is function with lower complication rates. Several methods have been used for treatment of this fracture, including compression plating, reamed or unreamed intramedullary nailing and external fixation. Among them, intramedullary nail fixation has been shown to be an effective method for treating both open and closed tibial fractures . However, the choice between two alternative intramedullary nailing approaches, reamed or unreamed, is an ongoing controversy. Reamed intramedullary nailing has the advantage of providing optimal biomechanical stability; however, reaming of the medullary canal may also lead to endosteal blood flow damage, bone necrosis, compartment syndrome and infection . In theory, unreamed intramedullary nailing does not have the above-mentioned problems associated with reaming, but the mechanical stability may limit its application. Both of them have strong rationales; which is better?
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Unreamed nails are kmown to sustain fatigue fractures if used at the wrong indication. They are not the panacea.
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The tibia is the most commonly broken major bone in the leg. Displaced distal tibia shaft fractures are effectively treated with standard plates or intramedullary nails. which one is more preferable?
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Please find attached some recent literature opinions
Effect of Locking Plate Fixation vs Intramedullary Nail Fixation on 6-Month Disability Among Adults With Displaced Fracture of the Distal Tibia
The UK FixDT Randomized Clinical Trial
Matthew L. Costa, PhD; Juul Achten, PhD; James Griffin, MSc; Stavros Petrou, PhD; Ian Pallister, MMedSci; Sarah E. Lamb, DPhil; Nick R. Parsons, PhD; for the FixDT Trial Investigators
JAMA. 2017;318(18):1767-1776
A comparison of the cost-effectiveness of intramedullary nail fixation and locking plate fixation in the treatment of adult patients with an extra-articular fracture of the distal tibia. Economic Evaluation Based on the FixDt Trial
M. Maredza, S. Petrou, M. Dritsaki, J. Achten, J. Griffin, S. E. Lamb, N. R. Parsons, M. L. Costa
Bone Joint J 2018;100-B:624–33.
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Intramedullary nailing has revolutionized the treatment of fractures. It is important to be aware of the biological and mechanical effects of reaming and nailing on bone. Intramedullary devices commonly are termed rods or nails.
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Intramedullary nails are ideal for diaphyseal long bone fractures and mostly closed fractures are managed by reamed nails. Reaming is supposed to ensure thicker nails to be introduced that is better and stronger. Reaming also is supposed to provide interosseous bone grafts as reaming byproduct assisting Union of Fracture. However in open fractures reaming is withheld as it increases chances of prolonged surgery and chances if fat embolism syndrome. Intramedullary nail in emergency setting is thus a norm.
Reaming was also thought to interfere with intramedullary blood supply but no proven data is present till now.
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I am trying to start a research basing on free published online dataset. My field of research is Orthopaedics. Thank you for any help!
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Hi Emanuele, I would like to speak with you more on this topic. Please email me
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In today's era of sub specialisation in all surgical Fields specially orthopaedics, hands on surgical training in specialty of choice is a must. Considering the steep learning curve for most technically demanding surgeries, are cadaveric courses helpful for the young trainee ?
Some argue that it's the way forward to hone one's surgical skills while others are of the opinion that it's more of a commercialised driven industry activity.
Do such courses equip a young surgeon enough to operate independently on a real patient ?
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I believe there is some utility to the cadaveric course in as far as exposing trainees to surgical approaches and equipment use is concerned. They , however, can not be stand alone courses and have to ultimately be combined with supervised real live surgery before a surgeon can operate independently
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With increasing dependency on technology in pre op planning and execution of orthopaedic surgeries, how much importance would robotics hold in the future of orthopaedics? Can the skills, experience and judgement of a seasoned senior orthopaedician be replaced by an automated machine programmed to follow commands? What are the risks and would it increase or decrease the surgical complication rate?
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I agree with the comments above made by the esteemed faculty. My personal view is that there is no alternative of a skilled and well trained surgeron. Core skills are required to use ribots and computer aided procedures. COAS is being used and is most helpful in complicated cases where patient specific implants are required so one can have 3D reconstruction of comlex anatomy that will help in manufacturing pre operatively and positioning of the implant during surgery.Robots are useful and are thought to be the future but in my view as an adjunct however but a lot of more work is being done for precision, easy to use and cost effectiveness.
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Is any research points toward female prediction with suggestive pathogenesis for the same.
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Dear Ganesh
This article may be useful for you
Ganglion cysts, which is a tumour or swelling usually on top of a joint, are more common in women than men, says Dr Anju Maharjan, Neuropathy Physician of Spark Health Home Hospital. Often overlooked, these occur most commonly among women, whose works involve sewing, washing, and cooking, Dr Maharjan explains.
“It looks like a sac of liquid or a cyst and located just under the skin,” informs the doctor. Adding that the treatment largely involves resting, Maharjan said the main cause is due to excessive movement and pressure of the limbs.
“Especially women while doing household activities, there’s a lack of fine movement of hands. It is strenuous and helps grow cysts on the hand,” The doctor also observed that it is the highest among women between 20 and 40.
A version of this article appears in print on February 25, 2017 of The Himalayan Times.
Follow The Himalayan Times on Twitter and Facebook
Best regards
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The knowledge of SRD, or Complex Regional Pain Syndrome, is improving over the years, however, evidence-based management of this condition, as well as I know, seems to be lacking in the physiotherapy practice.
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Dear all,
Indeed, the question was asked five years ago but still current.
I refer you to the papers of Karlijn Barnhoorn et al. in preparing her PhD thesis at the Radboud University Medical Centre, Nijmegen, The Netherlands.
  • Barnhoorn KJ, van de Meent H, van Dongen RT, Klomp FP, Groenewoud H, Samwel H, Nijhuis-van der Sanden MW, Frolke JP, Staal JB. Pain exposure physical therapy (PEPT) compared to conventional treatment in complex regional pain syndrome type 1: a randomised controlled trial. BMJ Open. 2015 Dec 1;5(12).
  • Barnhoorn K, Staal JB, van Dongen RT, Frolke JPM, Klomp FP, van de Meent H, Adang E, Nijhuis-van der Sanden MW. Pain Exposure Physical Therapy versus conventional treatment in complex regional pain syndrome type 1-a cost-effectiveness analysis alongside a randomized controlled trial. Clin Rehabil. 1 Februari 2018
The PEPT treatment is a breakthrough in the treatment of patients with CRPS. If you have any questions about this treatment, do not hesitate to contact the first author. Best wishes, Rob Oostendorp.
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Some orthopedic screws are hollow. In some orthopedic surgeries, such screws are used, for example Herbert and
Cannold Why are these screws and their advantages over other screws?
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The cannulated screws are a great teaching tool for residents and inexperienced surgeons to cause less mistakes and redrilling. Whether a screw is cannulated or not you have to clear the tissues so the bone is exposed for the drill and screw insertion. In the hands of an experienced surgeon they can insert a solid screw any place a cannulated screw can be used. Solid screws are stronger and cannulated screws cost 8-10 times their solid counterparts.
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Arthroscopic Partial Meniscectomy (APM) is one of the most popular orthopaedic procedures, but recent publications stated that non-operative treatments have similar results to arthroscopic surgery.
The Meniscus Consensus Project in which more than 80 physicians from 21 european countries have been involved was set up to try to standardize an uniform the treatment algorithm of degenerative meniscus lesions (DML).
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Mechanical symptoms = arthroscopic menisectomy. Otherwise, treat as osteoarthritis.
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Skeletal trauma leads to pain and discomforting positioning often with cumbersome braces/splints/plaster etc. How it affects sleep quality. That might also be contributing to various I'll effects in future.
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Hi Ganesh. Please look at this article
Shulman BS1, Liporace FA, Davidovitch RI, Karia R, Egol KA. Sleep disturbance after fracture is related to emotional well-being rather than functional result.
J Orthop Trauma. 2015 Mar;29(3):e146-50. doi: 10.1097/BOT.0000000000000217.
Kind Regards
Fabian
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Dear collegues 
In our practices we often see patients with neurological complaints. At those moments it is important to test the neurological system as good as possible. And we do so by using the techniques we were taught. When it comes to neurological tests in the upper limb we all know the tests of which Wilhelm Heinrich Erb was the founder. They state that when you test nervus ulnaris, nervus radialis and nervus medianus, the patient is in a supine position and the therapist induces the respective movements to create a maximal tension on the nerve. Now I am wondering: ‘Why is it in a supine position and not in a sitting position?’ Is there a specific reason why the test is developed and taught like this? Because personally I think it is possible to test in a sitting position. Is there any known research on this topic? Or does anyone of you have advice in this area? Are there other approaches, or only variations of the technique above?
Dutton, M. (2012). Dutton's Orthopaedic Examination Evaluation and Intervention. 3rd ed. McGraw-Hill Medical, pp.415-417.
Thanks in advance!
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Yes, Sitting position is the best way.
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This is the conventional view (from MedlinePlus):
"Surgery that involves a cut (incision) in the skin can lead to a wound infection after surgery. Most surgical wound infections show up within the first 30 days after surgery.
Surgical wound infections may have pus draining from them and can be red, painful or hot to touch. You might have a fever and feel sick.
Causes
Surgical wounds can become infected by:
  • Germs that are already on your skin that spread to the surgical wound
  • Germs that are inside your body or from the organ on which the surgery was performed
  • Germs that are in the air
  • Infected hands of a caregiver or health care provider
  • Infected surgical instruments"
Some Risk Factors, but no other causes were listed, only germs. However, there is an alternative theory that deserves critical scrutiny, especially with the present antibiotic crisis, namely:
The prime cause is a failure to heal any of the usual fluid leaks that occur with surgery. The prime example of this is in the middle ear where fistulas through bone are hard to seal, resulting in persistent attempts to do so, leading to cholesteatomas. In orthopedic surgery, the most likely causes of persistent fistulae are bone fragments in the wrong place. Germs will only be a secondary problem if pools of fluid form instead of draining away, or if these occur in parts of the body outside the influence of the immune system,
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Another large factor that isn't spoken of often is the skill of the surgeon. Damage to the fine vascular layers, damage that creates edema or hematoma formation post operatively or longer surgical time leavint the tissues open to air longer are all contributing factors
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In leg amputation the remained bone is rasped to make the edges smoother to avoid tissue injuries. but still there is an unusual structure underneath the skin. 
Why don’t we use an implantable structure to avoid abnormal structure like sharp edges and damp the undue pressure and shocks underneath bones, the same way heel fat pad*(HFP) protects the underlying structures in the heel?
From my point of view, using such implants might also ease the use of prosthetic legs and decrease the possible pain in leg- prosthetic interfaces.
Are there any specific reasons not to use such implants during the leg amputation?
*The heel fat pad (HFP) is a highly specialized adipose-based structure that protects the rear foot and the lower extremities from the stress generated during the heel-strike and the initial support phase of locomotion. HFP cushioning efficiency is the result of its structure, shape and thickness.
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Bevelled bone end + adequate thickness of myoplasty should do the trick. Implant on the bone end is not necessary especially if the prosthesis is not designed to receive weight transmission through the end stump. If we worry about bad soft tissue surrounding the bone end, putting an implant on that area will create more problems, such as rapid implant wear, infections. Higher amputation level with good soft tissue should be put into consideration.
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since the drill are made of plastic,it is possible for them to be completely sterilized? and they are packed in bags that are also plastic.
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Many less developed world hospitals use commercial " hardware" drill for orthopaedic surgery; usually wrapped in a sterile drape, although this clearly somewhat compromises sterility. The problem is that dedicated, sterilisable battery or pneumatic drills / saws are prohibitively expensive and "hand drilling" is difficult and takes time. Arbutus medical ( http://arbutusmedical.ca ) now produce sterilisable, reusable drill and saw bags. The drill bag uses a bayonet fitting to a De Walt drill that can be bought at hardware stores for as little as $100. 
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Dear Experts,
Am aware, 400 series of steel possess high strength, high wear and acceptable corrosion resistance. Also, it has been extensively used as Cutting tools for Medical surgeries but why not as an Implant (orthopaedic or stents).
I looked for papers which relates the Bio-response of the cell or platelet adhesion over Martensitic steel ( ex. 420 or 440 ) but i couldn't see any published work explaining the same.
It would be great if someone could help me to understand better or to suggest some more research articles ?
Thank you in advance.
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Actually, austenitic SSs have become less used. A certain % of people react badly to the Ni in grades like 316.  Ti alloys, nitinol and Co-based alloys (hip implants) have become more popular. MSSs have too high a modulus of elasticity, likewise the ASSs. The Ti alloys have a lower modulus of elasticity and weigh less, which is a better balance to bone. They have good corrosion resistance in the body.
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I wonder how much of an effect does ankle biomechanics have on the knee.
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Here is one on research gate:
Effect of Ankle Taping on Knee and Ankle Joint Biomechanics in Sporting Tasks
and another one:
The optimum position of arthrodesis of the ankle. A gait study of the knee and ankle.
Buck, P; Morrey, B F; Chao, E Y
Journal of Bone & Joint Surgery - American Volume: September 1987
Archive: PDF Only
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Hello I am orthopaedic surgeon interested on spinal cord injury cases and studies! I was just wondering if  we can be involved in this study 
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Dear dr Mandari, Thanks for your interest. I am the coordinator of the Dutch participation of this international study. The overall organization is in hands of the Swisci. You can find information concerning this worldwide survey at the website. Here, you can also find contact information. The website is: https://www.insci.network/insci/T1/en/welcome.php
Best Regards, Karin Postma
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Please, what can you say about the precision of 3D-printed patient-specific orthopedic surgical guides?
How is its precision impacted during these processes:
- Imaging of the bone model
- Preoperative planning with the imaging
- Manufacturing of the guides
- During surgical operation
- Other processes
Thank you. 
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This is something I've spent a considerable amount of time investigating. Our team has developed surgical planning software for various procedures and have looked at all of these issues.
- Imaging of the bone model: This is very accurate using CT scanners (and MRI). You can obtain CT scans of a human down to 0.2mm or less voxel spacing (meaning a density sample every 0.2mm in 3D space) on standard medical CT scanners and have error tolerances less then than when compared against actual measurements. The important thing here is to choose a resolution that makes sense for the problem and also minimizing the radiation dosage to the patient. Patient movement and a poor rad technician can also play a role here.
- Preoperative planning with the imaging: there are two main parts to consider here, the software itself and the operator. Most surgical planning software if designed properly will have nearly zero error on top of the error inherent in the data operated upon. This can be validated by comparing measurements on input versus output data from the software. The error in pre-surgical planning comes mainly from the clinical operator of the software. It is important to perform intra- and inter-operator studies to understand the variation among operators due to human variations. This can be very high, several millimeters (or degrees if angles are important), and can also simply be completely wrong due to a major human error. The key here is developing a precise and easy to follow procedure to train and guide operators when using the software. It is also a good idea to perform some sanity check at the end to validate some basic assumptions about the output. For example, if a set of points should have symmetric counter parts, software can be added to automatically evaluate symmetry prior to output -- or a surgical guide could be evaluated to determine if it may interfere with other bone regions.
- Manufacturing of the guides: this is also very accurate. This depends upon the mode used, additive printing or CNC manufacturing for example. CNC is ultimately more accurate I believe, down to 0.001mm or better and some 3D printing technologies are close to that.
- During surgical operation: many factors play a role at this stage. However, the ease of use of the surgical guide can greatly affect error at this stage. The guide itself should be designed such that it only fits in a single position. Consider a guide that sits upon a large flat region versus one that fits into the nooks and crannies of an orbital rim. Bony features are required to constrain the 3D placement of the guide in 3D space, you need to have all three directions locked down by some feature. If you don't the surgeon will have a great deal of trouble aligning the guide. Further, there should be visual cues engraved onto the guide to further eliminate error, such as: patient name, patient ID, manufacture date, LEFT/RIGHT, anatomic directions guiding placement, etc. The surgeon needs to be able to pick the guide up without ever seeing it before and know exactly how it goes into place. There are also issues with how the guide sits upon the surface. For example, there could be cartilage that did not appear in the CT scan that blocks final placement of the guide. The surgeon then needs to scrape this away before placing the guide.
- Other issues: the guide is for drilling or cutting, so what comes after that? Placement of a prosthetic or construction of a mandible? There can be additional significant error sources here as well.
We were involved in some cadaver studies that measured the final placement of  total-knee prosthetics using our surgical guides and we obtained less then 0.5mm and 0.5 degrees of variation for the final prosthetic from our intended plan for several cadavers as measured from a post-operative CT -- this is considered significantly better than the current standard or care.
If it's not clear, the main source of error is human. So, study each step and determine where humans are involved and either minimize or eliminate them from the step or provide clear guidance to create a repeatable and robust process.
We provide some software that can be used to perform 3D measurements based upon landmark points. This software, Checkpoint can load DICOM data, render it in 3D, provides tools for landmark placement and measurement of lengths and angles among a variety of other things. This can be used to quantitate error at the various stages.
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65 yo patient, previously healthy.
Medial pain since 1 month ago with no trauma history. 
Physical examination: range of movement complete, no effusion, no meniscal signs, no instability, pain after palpatio of anterior part of medial condyle, slight limping.
MRI with a small cartilage depression, bone marrow edema in medial condyle.
----
Do you have experience with this cases? What treatment would you recommend? 
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I think it is bone marrow edema
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What is right ? To continue with pharmaceutical prophylaxis for fearing DVT or stop (reduce) it to avoid wound complications ?
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  • Wound complications - especially bleeding complications are 'in your face' issues while the DVT is a perceived threat. Not to counter bleeding and persisting with LMWH is counterintuitive is just wrong.
  • DVT prophylaxis can be continued with mechanical means
  • DVT chemical prophylaxis is industry driven and more from fear of legal issues , perhaps that's is obstructing clear thoughts
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Some hospital care standards require pharmacologic DVT prophylaxis for orthopedic operations (even minor surgeries) in pediatric patients. Is it necessary  indeed or this a hypermeasure taken to insure against eventual litigation problems ? 
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Good day! As previously mentioned, its use is only limited to patients with tumoral pathology; In pelvic surgery and hip dysplasia (which we say are the largest surgeries we perform as pediatric orthopedics) are not used and there is little literature on prophylaxis.
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56yo pt needs a unilateral hip replacement due to Osteoarthritis. No significant Past medical history. Pt is active and would like to continue activities such as basketball, snow and waterskiing. What type of replacement will allow hip to continue such activities for as long as possible, with as few revisions as possible. 
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This is a very difficult question аnd not clear enough. Do you mean inflammation of the joint(osteoarthritis) or degeneration of the joint (osteoarthrosis )?               Anyway, the requirements for longevity and activity seem to me to be very high. In fact, every replacement surgeon strives to secure such excellent outcome results on a long-term basis. Based on my practice, I would also recommend cementless total endoprosthesis (highly crosed linked poly and ceramic femoral head with porous coated stem). In average, 92-93% of the implants do well in a 10-year period. Thereafter, the revision rate slowly increases. Just one more issue to be kept in mind:  big loads on the THR may lead to an earlier loosening and exchange.  As far as the implant models recommended are considered, you may have a look at The Swedish Hip Registry which gives  precise and actual data on the prosthesis survivorship almost every year.
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Treatment of osteoarthritis hip is mainly surgical.Attempts to look at treatment options and traditional medication has not been well cited or published.
Do outline treatment options seeked by your patients in dealing with hip osteoarthritic pain and its success rate
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Do you mean "osteoartritis" (inflamation of the joint) or "osteoarthrosis" (degeneration of the joint)? There is a big difference, as far as conseravtive or surgical treatment is also concerned. 
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We would like to get a way to predict the need for glenoid bone-grafting in a reverse shoulder replacement planning
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Orecurso ao TAC 3D permite fazer a avaliação do defeito ósseo pre operatoriamente; existem atualmente implantes "custom made" baseados nessa tecnologia. Mas o uso de enxertos ósseos, após estudo 3D, é comum e com excelentes resultados no longo prazo.
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I have limited experience in nonunion treatment by autogenous bone marrow aspirates (ABMA)
I published 2009 an article on(tretment of  infected nonunion by autogenous Bone marrow aspirates in Yemen) in the egyptian journal of Orthopedic surgery.
there is a research work on bone marrow aspirates for treatment of bone defect.
bone marrow injection for treatment of aneurysmal bone cyst published in 2016.
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For delayed union or non union we have this procedure:
we drill under fluoroscopy control the fracture zone and we inject percutaneous bone marrow aspirated from iliac bone. We had good results in all delayed union cases but in non union we prefer to use also the PRP technique.
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Plano-valgus foot deformity, children, teenage, adults
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Evans procedure was modified 20 years ago by Mosca and we can compare this osteotomy with Salter osteotomy due at the hip joint. After the lengthening of the external ray the coverage of the talus head increase by correcting the abduction of the forefoot.  To be efficient is important to have enough bone that means that exist age limit. I think 9 years old is ok to start this osteotomy if we treat a child with spastic disease. For idiopathic planus valgus is better to use this osteotomy after 12 years old at girls and 13 years old at boys.
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Gives h/o bilateral K-nailing for femoral shaft #s in 1988 (asymptomatic now) and Right patellectomy for comminuted patellar # subsequently in 1997. 
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If computer assistance (CAOS) is available, you can operate both knees without removing the nails. If not, I suggest removing the nails. The screws in the right femur may remain in place. The left knee seems easy, but the right knee is a challenge: Take a true anterior-posterior long hip-knee-ankle x-ray with a calibration object on it. Imagine were you can place the intramedullary rod. Measure the distance from the entry point to the point where the rod will abut on the lateral cortex of the femur. Measure the HKFS-angle (hip-knee-intramedullary rod angle). Then ask your supplier or technician to deliver an intramedullary rod that is not too long. Finally, during the operation, set the distal cut at the HKFS-angle you already measured on the x-ray. The rest should be like a standard procedure.
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I wonder how many of you encountered a discoid meniscus during knee alloplasty? Was it injured, degenerated or connected with greater/lower rate of degeneration of the condyles facing it?
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The discoid meniscus is common in East Asian (10-13%) than in Western World (3-5%). In China, it’s very common and routinely being operated (arthroscopic partial meniscectomy-saucerization). It is not that uncommon to see discoid meniscus during TKA as incidence is high, but exact frequency is not known. Most of the discoid gets injured as patients get older due to the degenerative changes of both the meniscus and the bone, and even simple activities predispose to discoid meniscus injury.
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Tissue valve has a tendency to degenerate early but can be dilated or a valve in valve replacement may be tried by intervention, mechanical valves are durable but needs lifelong anticoagulant therapy with its inherent complications. So, a controversy remains in making a choice.
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as all low pressure circulation valves, the bioprothetic is more desirable, thelike expectancy of tissue valve in the right side is longer and should the valve developed stenosis later on a transcatheter management is feasible and much easier
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On the Czech Republic there are realised about 13500 surgeires with THA, there are in Central Health Statistic to find about 32 types of typical product set THA from cca 28 various producers ....but there are no statistic about median Patient durabilities implanting in years, there are no evidence about risks by "easy safety implanting with minimum preoperational complications - technical, postoperational infects, anesthesy complication, Crashes of sets by implanting, luxation of implanting in durace 5 month since Hall surgery, there sre no computer testing of efficiency locomotion ability of patients in timing - 1, 3 , 6, 12, 24 month after usrgeries"...ther are no advice to buy the best types of sets THA for Hospital in respects to realtion Costs/durability of perfect patient functional years, able to reoperability, etc". There are no summary evidences about State views, about local views for safety implantation in identified Clinics with yearly implanting about 850 cases of prime iámplanting THA....there are no advice to patient agreement with surgery THA - as well informed about patients risks....there ar no internal software controlling "Non of Hall surgeries THA could be legal beginning - without Clinic preliminary Plan of individual surgery"...there are absency to preference the computer supervised processing of implanting set THA by the well educated firm Videorecording with describeing the most important describeing mandatory activites of Orthopaeds, Radiologists ...by the Technician Requirements of Laws and with respecitng the firm implanting instruments, Firm implanting Measurements, Firm processing to respects the firm assembling technical and functional accuracy and ability......There are no "bands of acceptable tolerances of medical processing activites" with guaraces of Technical Quality, sequential processing...excluded absency or false partial Results step by steps...Immediately with immediastely to solve medical mistakes in time with substitutional supervising and certificated reoperational processing....substitutional controlling rescued medical processing, etc. There are most patients with stroke or Heart infarct in surgery hall or in the one week after surgery set THA, etc. The Orthopaeds - which are engaged 25 years on this fields of useres medica Tasks have no identity views on Patients risk with such standard operation....they habe no similar routine to carefully implanting set THA as it is standard by finished Clinics testing of New Medical Devices with respects Technicians so as Medical Aspects with rational balancies by repeated Medical strategic decision making...there are interrupting Interface between Research and Developement on the One side - and with User praxis in Hospital Clinis in daily medical workfllow on the Second side - despite the Implanting Technician Laws are the same....but adequated controlling supervised Technician similar system - NO! I saw the thousands of Statistic Analyses - which all prefered the Physicians, Ecopnomics aspects strongly - and undertaken the respensibilities to Patients risks and Technician Requirements Laws systematically!  
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@Cuc     I agree entirely with Dr. Zafiropoulos. Human body is not a machine and it is a very difficult  task if ever possible to measure the effects of THA  using mathematical methods. That is why we use the so-called Joint Replacement Registries which give an exact picture of results and complications with different endoprostheses over the years. The most popular one is the Swedish Hip Replacement Registry since 1979. It is actualized almost each year. In this registry you may see that there are about 5 types of THA models which have stood the test of time giving prosthesis survival in over 95% of the cases on a long-term. Meanwhile, I believe there is a Czech Hip Registry too ?     Please, see links below:
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What is probable mechanism of such medial malleolar # and the line of management of this 78M.
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I agree that stress #s are common in young athletes, rather than in elderly with OA. severe and long lasting knee deformity seems to be an obvious responsible factor in its causation.
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This means:
- are there generalized surgical procedure specifications (e. g. common steps of a gal bladder resection or knee endoprosthetic - independently of those routines high variety level)
- are there furthermore general terms for the single steps or particular sequences (e.g. in general a total knee replacement is divided into certain steps like (1) incisioin (2) preparation of tibia (3) prep of femur (4) trial bearing (5) original implant (6) closure of  wound/suture)
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There is no international institute or committee that 'regulates'  or ' provide general structured models.... of surgical procedures'.
Most textbooks and academic journals on technique present a logically structured and organised approach to procedures. These are not standardised. There would be variations in technique, justified by authors, for various clinical reasons, as appropriate.
Most surgical procedures have multiple approaches and techniques, as described in journals and textbooks. These vary in different institutions, and geographically.
Also, technology is changing procedures, and a structure appropriate at one point in time, would be inappropriate with a change in this area. This allows for innovation and advancements in surgery.
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40 y.o. female with breast cancer, known metastases in ribs, spine, pelvis and right femur suffered pathological pertrohanteric fracture without severe trauma. She is in generally good condition, obese, treated for breast cancer for 1,5 mths (hormonal treatment), hip pain for about 6mths. As we see in the x-ray there is also a methastasis in the middle of the femur shaft, no visible methastases below this one as well as clear femoral head and acetabulum (based on CT). Would you prefer IM-nailing with/without cement use or hip prosthesis? Any other ideas?
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Good morning,
I note that there is a distal lesion at the bottom of your x-ray.  I have managed these kinds of fractures.  The plate does not need to be very long.  Determine the size of the diaphyseal lesion.  If it is an impending fracture, simply place the and then place a retrograde nail up the femur.  The plate screws can be used to lock the nail.  You most recognize that the primary object is to NOT fracture the bone any further, as doing so would get into a lot of bleeding.  You must have a well-thought-out plan before you start.  Alternatively, you can watch the distal lesion if it does NOT meet the need for prophylactic stabilization.  The key is to use the contralateral hip as a template for the angle and proper placement for the plate on the fractured side.  Please note how thick the cortex is.  A substantial amount of reaming would be required to drop the nail.  Noe of which wold be beneficial to the patient.
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I have made a mini-review about CMI and I want to interact with someone who have knowledge in this area. Be free to contact me; )
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Thank you very much Gustavo! 
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Needed an article which describes ACR criteria in detail?
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You can readily get it with American studies of Rheumatology
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The management done is ideal and done here worth applause. Sir, what would be further protocol by your side like length of immobilisation, time to weight bear, whether complete non weight bearing or toe touch from start...  etc.
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Literature suggest that capsulorrhaphy will take care of it but I have normally seen otherwise in few cases. What may be the evidence for going for bony surgery at this age?
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The main reason of  re-dislocation after OR is inadequate exposure that lead to incomplete release and ....
I`m disagree with 3d cCT for all cases.
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Whats your take on this modality of fixation? Is it rationale or just a fad?
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I have used Synthes (calcaneal) mesh plate for severely comminuted patella fractures (off-label). You can essentially fix each comminuted fragment through a plate hole - preserves the fragments with good fixation. However, the overlying skin is very thin and patients will feel the subcutaneous hardware, which may pose a symptomatic problem.
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What's the name of distal phalanx pseudarthrosis, due to interposition of ungueal matrix?
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Yes, I agree, Seymour's fracture
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Please send me a publication as an evidence for it too.
A few books say that it is 30-35 degree, whereas others say its around 15-20 degree.
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It depends on culture. Biomechanic is one thing, culture is second and preferred posture type in human is third. Every culture has its own posture and thinks it is the major. Every country explains biomechanic in different aproach.
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When should the weight bearing be allowed in these cases with uncemented arthroplasty?
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This is a very demanding procedure.AS is a disease of the whole organism which makes more probable complications, especially when done bilaterally. As far as the local tips are concerned I always prefer lower neck cut and long necks to oppose the effect of ectopic ossifications that are more common in AS patients.
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 Patient of 64 Year old, with Olecranon fracture, Elbow dislocation, and radial head fracture cephalad displaced about 2 cm. 
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Keep the radial head as it is stabilizing the joint and assisting to the ligamentous healing. Even if the head is fractured at the neck junction and occasionally in more than two pieces, something that the majority will  replace, there are surgeons who repair and use the head as spacer and in case of post-operative limitations, (in the long run and after the union of the ulnar fracture) they go back to remove it as elective procedure. These are accepting even fibrous union. Such research is presented in German literature.
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An orthopaedic expert stated in his report  that as regards to an inguinal hernia,  spinal belts are often used as part treatment of hernias. Would any surgeons care to comment on this?
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Appreciate the discussion and it is very true that spinal belts are being used for ventral abdominal wall hernias but not  for inguinal as discussed above.This is probably due to miss iinterpretation.As a matter of fact pure spinal belts are not very satisfactory even for ventral hernias due the design.
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It is mentioned in literature that using patient-specific instruments 3D-printed patient-specific orthopedic surgical guides (e.g MySpine by Medacta and OtisMed by OtisKneeTM) for surgery is expensive. High CT imaging cost is a factor. 
Please, what other factors drive the cost of these surgical instruments?
Thank you.
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There are many variables depending on the type of printer but typically the costs of 3D printing include cost of technician, material used in the printing process, and wear/tear on the machine. The material probably equates to the majority of the costs and can be significantly reduced if a hollow object can be made.
To give a perspective, the in-house cost to print something like a hollow scapula would be around $50-75. This same build could easily be 3-400 if out-sourcing and more if purchasing through second-hand party. 
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We have been practicing the Local Injection of Gentamicin for Prophylaxis Against Infection in Open Fractures and Intravenous Cephalosporins for prophylaxis of Surgical wound infection.
But, Does anyone has the experience/ evidence of using Local injection of Gentamicin for prophylaxis of Surgical wound infection???
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We do not use local antibiotics for prevention of SSI and I agree with the colleagues above. Recently, I read a RCT on gentamycin-containing collagen sponges in THA. No benefit was found. Perhaps, you may extrapolate to have an answer to your question. S. below: 
Effectiveness of gentamicin-containing collagen sponges for prevention of surgical site infection after hip arthroplasty: a multicenter randomized trial
Clin Infect Dis. 2015 Jun 15;60(12):1752-9
Westberg M. et al.
739 patients with a displaced femoral neck fracture to be treated with hemiarthroplasty were randomized into two groups, which received either routine intravenous antibiotic prophylaxis alone or intravenous antibiotic prophylaxis and local application of 2 gentamicin-containing collagen sponges into the hip joint. The purpose of the study was to determine the efficacy of these sponges in reducing surgical site infections (SSIs) within 30 days of surgery, in addition to routine antibiotic prophylaxis. The results indicated that gentamicin-collagen sponges did not provide any added benefit in terms of SSI incidence.
Level of Evidence: 2  (RCT) , Study Type: Therapy
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I need to know what is the taper(conical) angle in pedicle screw of vertebra.
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I have found this angle a bout 3 or 4 degree in different manufacturer companies that have substantiated on attached paper.
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What is the best treatment for the medial meniscus posterior root tear?
To my knowledge, there are several surgical options; pull-out suture, all-inside suture with meniscus fixator (e.g.FasT-Fix) and debridement only.
The pull-out suture technique seems to be the best biomechanical stability. However, difficulty, iatrogenic cartilage injury and relatively long operation time of this procedure make me to hesitate to choose this technique.
I prefer to treat the medial meniscus posterior root tear using meniscus fixator only. One suture in the posterior cruciate ligament and posterior capsule, another suture in the meniscus root. This repair technique does not provide sufficient strength and anatomic reduction of the medial meniscus. Furthermore, pain in the flexed knee after this procedure is frequently found.
If there is varus alignment with the medial meniscus posterior root tear, I do only debride the degenerative portion of the medial meniscus with concomitant high tibial osteotomy and do not repair it. Spontaneous healing of the medial meniscus posterior root lesion was reported in several studies.
I would like to know what the best surgical option for the medial meniscus posterior root tear is. Especially in older patient without deformed knee and osteoarthritis.
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Place one to two sutures in the meniscal root using an arthroscopic suturing instrument.keep the suture ends of each together and separated from the other suture. mark the tails of one suture with a sterile skin marking pen, or cut the tails of one suture a couple of inches shorter than the other suture.
  Identify the intended repair placement position on the tibia, And using a PCL drill guide, place a drill hole at the intended posterior aspect of the selected reatachment position. Leave a shorter pin in the drilled hole. Repeat the drill process placing a second pin at the anterior placement site, and leave a second shorter pin in place.  
  Remove the posterior pin and pass a long suture loop thru the drilled hole. grasp the suture loop thru a portal to create enough seperation to then reach through the loop and grasp one tail of  each suture. As you then pull the looped suture back thru the posterior drill hole, you will pull one tail of each suture thu as well. You will have to "pulley" the meniscal suture tails on each side of the looped suture to prevent them from "binding" in the bone tunnel. The very small Arthrex Suture grasper may be used instead of a looped suture for this step.
 Then repeat the process for the other two suture  tails.
 Seperate the suture tails so the previously marked, or cut ends, match.  Reduce the meniscus and maintain the reduction holding one suture while you tie the other suture over the bone bridge between the two drill holes. Then tie the second suture. probe your repair, and you are done. Good Luck!
  For radial tears near the meniscus root I have placed two fast fix sutures-one under one on top. Trim the inner rim slightly prior to placing the sutures.
  Aftercare for either procedure requires protected weight bearing for 4 weeks, plus low load in flexion also. 
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Sometimes, It is difficult to differentiate between postoperative hematoma and imminent deep infection the first postoperative days after THA. Early debridement is reported to be very effective if it is done after 4-7 days of wound drainage. We need a biomarker to make the exact diagnosis and to act adequately.
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Hello everyone, haven't gone through all the discussions above. I also can't add much to the IL-6 topic, but just wanted to share The Musculoskeletal Infection Society criteria for PJI. I find them somewhat useful. Please excuse me if I am slightly off topic.
One of the following is necessary for diagnosing PJI:
(1) A sinus tract communicating with the prosthesis
(2) A pathogen is isolated by culture from two separate tissue or fluid samples obtained from the affected prosthetic joint
(3) Four of the following six criteria exist:
(a) Elevated ESR and CRP (ESR > 30 mm/hour; CRP > 10 mg/L)
(b) Elevated synovial fluid WBC count (> 3000 cells/μL)
(c) Elevated synovial fluid neutrophil percentage (> 65%)
(d) Presence of purulence in the affected joint
(e) Isolation of a microorganism in one periprosthetic tissue or fluid culture
(f) > 5 neutrophils per highpowered field in 5 highpower fields observed from histologic analysis of periprosthetic tissue at ×400 magnification
Sincerely,
Hristo
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Hi,
Is there anyone involved in stem cell application and research in Pediatric Orthopaedics?
nonunion of fractures, simple bone cyst (SBC), and osteonecrosis, pediatric osteoarticular disorders etc..
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