Showing posts with label Orthopaedic Surgery. Show all posts
Showing posts with label Orthopaedic Surgery. Show all posts

Radial nerve injury. Unlar nerve injury. Median nerve inury

The radial, ulnar, and median nerves Injury:

Radial Nerve Injury, Ulnar Nerve Injury, and Median Nerve Injury
The radial, ulnar, and median nerves are all major nerves in the arm and hand that control different muscles and provide sensation to different areas. Injuries to these nerves can cause significant functional impairment and require medical attention.

Radial Nerve Injury:

- Cause:

Injuries to the radial nerve can occur from fractures, lacerations, dislocations, compression, or even sleeping in an awkward position.

- Symptoms:

Weakness or paralysis of the triceps muscle (responsible for straightening the elbow), wrist drop (inability to extend the wrist), loss of sensation on the back of the hand and thumb.

- Treatment:

Treatment depends on the severity of the injury and may include splinting, physical therapy, surgery, or nerve stimulation.

Ulnar Nerve Injury:

- Cause:

Ulnar nerve injuries can occur from fractures, lacerations, repetitive stress (like playing guitar), or leaning on your elbow for extended periods.

- Symptoms:

Weakness or paralysis of the hand muscles responsible for gripping and pinching, clawing of the fingers, numbness and tingling in the little finger and half of the ring finger.

- Treatment:

Treatment depends on the severity of the injury and may include splinting, physical therapy, surgery, or nerve stimulation.
 

Median Nerve Injury:

- Cause:

Median nerve injuries can occur from carpal tunnel syndrome, fractures, lacerations, or even sleeping in an awkward position.

- Symptoms:

Weakness or paralysis of the muscles responsible for flexing the thumb and fingers, loss of sensation in the thumb, index finger, middle finger, and half of the ring finger.

- Treatment:

Treatment depends on the severity of the injury and may include splinting, physical therapy, surgery, or nerve stimulation.

Important Note:

This information is for general educational purposes only and does not constitute medical advice. If you suspect you have injured a nerve, it is important to seek medical attention immediately for proper diagnosis and treatment.

newborn with bilateral talipes equino varus the treatment should started.. immediatily

newborn with bilateral talipes equino varus the treatment should started:

  • A. immediatily.
  • B. after 6 months.
  • C. after one year.
  • D. after 2 years.

In the case of a newborn with bilateral talipes equino varus (clubfoot), the most appropriate answer is: A. Immediately.


There's strong evidence advocating for early intervention in treating clubfoot, ideally within the first 1-2 weeks of life. Delaying treatment can lead to more complex deformities and potentially require more prolonged and invasive interventions later.
Here's why immediate treatment is important:

- Newborn cartilage is more malleable:

The bones in a newborn's foot are mostly cartilage, making them much easier to manipulate and reshape compared to later in life. This allows for gentler and more effective non-surgical correction in early infancy.

- Reduces complexity of treatment:

Early intervention often involves simple techniques like serial casting with the Ponseti method, which has a high success rate and minimal risks. Delaying treatment might necessitate more complex procedures like surgery.

- Improves long-term prognosis:

Early treatment promotes normal foot development and functionality, significantly increasing the chances of achieving a good cosmetic and functional outcome for the child.

Therefore, in cases of bilateral talipes equino varus, seeking immediate medical attention and initiating treatment within the first few weeks of life is crucial for ensuring the best possible outcome for the newborn.

Additional Points:

Here are some additional points to note:
  • Treatment is typically non-surgical and involves serial casting with the Ponseti method.
  • Regular follow-up appointments are essential to monitor progress and adjust the casts as needed.
  • Bracing may be required after casting to maintain the corrected position.
If you have any further questions or concerns about clubfoot treatment, please consult a qualified healthcare professional like a pediatric orthopedist.

adult patient with fracture shaft ulna 6 months ago and treated with closed reduction and cast now there is sill pain in the fracture site and x-ray show hypertrophic nonunion treated

adult patient with fracture shaft ulna 6 months ago and treated with closed reduction and cast now there is sill pain in the fracture site and x-ray show hypertrophic nonunion treated by:

  • a. continue on the cast
  • b. fixation by plate without bone graft
  • c. fixation with plate and iliac crest bone graft
  • d. closed reduction and interlocking nail.

The most appropriate treatment for an adult patient with a hypertrophic nonunion of the ulnar shaft fracture 6 months after closed reduction and casting is: c. Fixation with plate and iliac crest bone graft.

Here's why:

- Hypertrophic nonunion:

This indicates that the bone fragments haven't healed properly, despite the initial treatment. The excessive bone formation around the fracture site is a sign of failed healing.

- 6 months:

This is a sufficient timeframe for a fracture to heal in most cases. After 6 months without proper healing, surgical intervention is usually necessary.

- Closed reduction and cast:

These are not effective treatment options for a nonunion. They were already used in the initial treatment and failed to achieve proper healing.

- Fixation with plate:

This provides stability and helps to realign the bone fragments. However, in cases of nonunion, bone grafting is often necessary to stimulate bone growth and bridge the gap between the fragments.

- Iliac crest bone graft:

This is a common source of bone graft for fractures. It provides healthy bone tissue to promote healing in the nonunion site.

Therefore, option c addresses the specific challenges of a hypertrophic nonunion and provides the best chance for successful healing.

Sickle cell anemia patient presented with asymptomatic unilateral hip pain, most likely diagnosis is.. Avascular Necrosis

Sickle cell anemia patient presented with asymptomatic unilateral hip pain, most likely diagnosis is:

  • a) Septic arthritis
  • b) Avascular Necrosis
  • c) ?

The correct answer is b.

The most likely diagnosis for a sickle cell anemia patient presenting with asymptomatic unilateral hip pain is avascular necrosis (AVN).

What is Sickle cell anemia?

Sickle cell anemia is a genetic condition that affects the shape of red blood cells. These abnormally shaped cells can get stuck in small blood vessels, causing blockages and preventing blood from reaching different parts of the body. One of the areas that is particularly susceptible to this blockage is the femoral head, the ball-shaped bone at the top of the thigh bone that fits into the hip socket.

When the femoral head does not receive enough blood, it can start to die, a condition known as AVN. AVN can cause pain, stiffness, and eventually, loss of function in the hip joint.

 Hip Painm

Asymptomatic unilateral hip pain in a sickle cell anemia patient is a classic symptom of AVN. The pain is typically described as a dull ache or a sharp pain that worsens with activity. In some cases, there may be no pain at all, especially in the early stages of the disease.

Septic arthritis is another possible diagnosis for a patient with unilateral hip pain. However, it is less likely than AVN in a sickle cell anemia patient. Septic arthritis is an infection of the joint space, and it is typically accompanied by fever, redness, swelling, and pain in the affected joint.

Other possible diagnoses for a patient with unilateral hip pain include:


- Transient synovitis:

Transient synovitis is a temporary inflammation of the joint lining that is common in children. It typically causes pain, swelling, and limping, but these symptoms usually resolve within a few weeks without treatment.

- Perthes disease:

Perthes disease is a condition that affects the blood supply to the femoral head in children. It can cause pain, limping, and a decrease in range of motion in the hip joint.

- Slipped capital femoral epiphysis:

Slipped capital femoral epiphysis is a condition in which the femoral head slips out of place. It is more common in overweight and obese adolescents, and it can cause pain, limping, and a deformity of the hip joint.

If you are concerned about hip pain, it is important to see a doctor for diagnosis and treatment. The doctor will take a medical history, perform a physical examination, and order any necessary tests to determine the cause of your pain. Treatment will depend on the underlying diagnosis.

The best non-medical therapy is proven to be of benefit for osteoarthritis is.. Muscle strength exercise

The best non-medical therapy is proven to be of benefit for osteoarthritis is:

  • a) Muscle strength exercise
  • b) Give NSAID
  • c) Back slap
  • d) ?

The correct answer is a.

The best non-medical therapy proven to be of benefit for osteoarthritis is a) Muscle strength exercise.
Muscle strength exercise has been shown to effectively reduce pain and improve function in people with osteoarthritis. It is thought to work by strengthening the muscles around the joints, which helps to support the joints and reduce stress on them.

Other non-medical therapies that have been shown to be of some benefit for osteoarthritis include:


- Weight loss:

Losing weight can help to reduce stress on the joints and improve symptoms.
Heat and cold therapy: Applying heat or cold to affected joints can help to reduce pain and inflammation.

- Massage:

Massage can help to relax muscles and improve joint mobility.

- Acupuncture:

Acupuncture is a traditional Chinese medicine technique that involves inserting thin needles into the skin at specific points. Some studies have shown that acupuncture may be effective for reducing pain in people with osteoarthritis.

It is important to note that non-medical therapies are not a cure for osteoarthritis, but they can help to manage symptoms and improve quality of life. If you are experiencing symptoms of osteoarthritis, it is important to talk to your doctor about all of your treatment options.

The other options are incorrect:

  • b) Give NSAID is a medical therapy, not a non-medical therapy. NSAIDs (nonsteroidal anti-inflammatory drugs) are a type of medication that can help to reduce pain and inflammation.
  • c) Back slap is not a recognized therapy for osteoarthritis.

Adult patient with # shaft humerus and closed reduction was done and on doing the post reduction x-ray there were 20 degree rotation and 15 degree medial angulation

Adult patient with # shaft humerus and closed reduction was done and on doing the post reduction x-ray there were 20 degree rotation and 15 degree medial angulation and 2.5 cm shortenning we should do:


  • a.repeat the reduction
  • b. continue on the brace
  • c. open reduction and internal fixation
  • d. closed reduction and interlocking nail
(b) ??

after trauma to the knee the patient examined in prone position and there is increased external rotation of the knee in 30 degree and 90 degree flexion thus he has

after trauma to the knee the patient examined in prone position and there is increased external rotation of the knee in 30 degree and 90 degree flexion thus he has:


  • a. PCL injury
  • b. PCL and posterolateral corner injury
  • c. meniscal tear
  • d. ACL injury
(b)

the expected time of internal complete remodeling of bone transplant is

the expected time of internal complete remodeling of bone transplant is:
a- 6 ms
b- 1 year
c- 2 years
d- never.

Bone grafting as part of a dental implant:
Dental implant placement requires a strong bone structure that can integrate the device.
Some people do not have enough bone mass in their jaw for this procedure.
This then greatly increases the risk of rejection of the implant.
In these cases, it is possible to have a bone graft.
The graft can indeed fill the alveolus of a tooth after an extraction with high bone loss.
It can also increase the height and thickness of the alveolar bone, located in the jaw.


The different areas of bone removal:
The different areas of the body from which bone can be taken for a dental transplant are:
- The mandible (the chin), if the quantity to be taken is moderate.
This is a quality bone that can be obtained under local anesthesia.
- Skull. The operation of removal (also called parietal removal) is psychologically heavier and is done under general anesthesia.
It nevertheless allows to obtain a bone of very good quality.
- Hip. The sample is taken under general anesthesia and the patient may limp for 10 to 15 days.
The advantage is the possibility of taking larger amounts of bone, but this bone is also less dense, so of lower quality.

The different types of grafts:
We can distinguish several types of grafts:
- The autogenous graft: it is taken from the patient himself, the graft is then called "autograft" or "apposition", while the others are grafts called "without sampling",
- the allogeneic graft: it comes from another person,
- The xenogeneic graft: it is taken from cattle,
- The alloplastic graft: it is synthetic.

Other bone volume restoration techniques:
The three main techniques for restoring the bone volume that the jaw needs to accommodate an implant are post-extracorporeal bone filling, sinus lift (also known as sinus lift) and bone grafting.

Post-extracorporeal bone filling:
This technique makes it possible to prevent resorption of the bone following a preexisting bone extraction or defect (which may be due to a previous infection or a feline).
Its principle is to plug the hole in the bone, thanks to a biomaterials.

The raised sinus, or sinus lift:
This method involves raising the sinus floor. We then fill the cavity created by a bone substitute.
It is used when the residual height below the sinus is less than 5 mm.
This technique is very common, and its postoperative consequences are limited and not painful.

The price and reimbursement of dental bone grafts:
The dental bone graft is considered an "out-of-class" act. It is therefore entirely the responsibility of the patient.
Some mutuals nevertheless offer to refund all or part of the intervention, under certain conditions.
Its price can vary between 600 and 1300 euros.

After THR surgery by 9 days the patient suffered from severe pain in the thigh and calf muscle ,redness and fever and diffuse edeama in the leg but with normal walking the diagnosis is

After THR surgery by 9 days the patient suffered from severe pain in the thigh and calf muscle ,redness and fever and diffuse edeama in the leg but with normal walking the diagnosis is?
a. infection
b. DVT
c. dislocation  of the joint
d. cellulitis
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