Case 21: Complex Tibial Deformity: Acute Correction and IM Nail Fixation

2015 ◽  
pp. 127-130
Author(s):  
Mahmoud A. El-Rosasy
Keyword(s):  
Acute Correction

COMPARATIVE ANALYSIS FOR THREE FIXTURES OF PAUWELLS-II BY THE BIOMECHANICAL FINITE ELEMENT METHOD

2019 ◽  
Vol 20 (01) ◽  
pp. 1950079
Author(s):  
MATTHEW JIAN-QIAO PENG ◽  
HONGWEN XU ◽  
HAI-YAN CHEN ◽  
XIANGYANG JU ◽  
YONG HU ◽  
...  
Keyword(s):  
Finite Element ◽  
Numerical Models ◽  
Femoral Shaft ◽  
3D Models ◽  
Procedure Time ◽  
Stable Fixation ◽  
Secondary Fracture ◽  
Solid Models ◽  
Acute Correction ◽  
Hip Screw

Little is known about why and how biomechanics govern the hypothesis that three-Lag-Screw (3LS) fixation is a preferred therapeutic technique. A series models of surgical internal-fixation for femoral neck fractures of Pauwells-II will be constructed by an innovative approach of finite element so as to determine the most stable fixation by comparison of their biomechanical performance. Seventeen sets of CT scanned femora were imported onto Mimics extracting 3D models; these specimens were transferred to Geomagic Studio for a simulative osteotomy and kyrtograph; then, they underwent UG to fit simulative solid models; three sorts of internal fixators were expressed virtually by Pro-Engineer. Processed by Hypermesh, all compartments were assembled onto three systems actually as “Dynamic hip screw (DHS), 3LS and DHS+LS”. Eventually, numerical models of Finite Elemental Analysis (FEA) were exported to AnSys for solution. Three models for fixtures of Pauwells-II were established, validated and analyzed with the following findings: Femoral-shaft stress for [Formula: see text](3LS) is the least; Internal-fixator stress (MPa) for [Formula: see text]; Integral stress (MPa) for [Formula: see text]; displacement of femoral head (mm) for a[Formula: see text](DHS+LS) = 0.735; displacement of femoral shaft (mm) for [Formula: see text]; and displacement of fixators for [Formula: see text]. Mechanical comparisons for other femoral parks are insignificantly different, and these data can be abstracted as follows: the stress of 3LS-system was checked to be the least, and an interfragmentary displacement of DHS+LS assemblages was assessed to be the least”. A 3LS-system should be recommended to clinically optimize a Pauwells-II facture; if treated by this therapeutic fixation, breakage of fixators or secondary fracture is supposed to occur rarely. The strength of this study is that it was performed by a computer-aided simulation, allowing for design of a preoperative strategy that could provide acute correction and decrease procedure time, without harming to humans or animals.

Effect of chronic metabolic acidosis on net electrolyte transport in rat colon

1989 ◽  
Vol 256 (6) ◽  
pp. G1036-G1040 ◽  
Author(s):  
G. M. Feldman
Keyword(s):  
Metabolic Acidosis ◽  
Distal Colon ◽  
Distal Segment ◽  
Proximal Colon ◽  
Electrolyte Transport ◽  
Rat Colon ◽  
Chronic Metabolic Acidosis ◽  
In Situ Perfusion ◽  
Arterial Blood ◽  
Acute Correction

Rats fed NH4Cl (5 meq.100 g body wt-1.day-1) for one week developed chronic metabolic acidosis and had an arterial blood pH and plasma HCO3- concentration of 7.27 +2- 0.02 and 16.2 +/- 0.8 meq/l, respectively; control animals had values of 7.36 +/- 0.01 and 22.4 +/- 0.5 meq/l, respectively. Net electrolyte transport was measured in proximal and distal colonic segments by in situ perfusion. In proximal colon, chronic metabolic acidosis increased HCO3- absorption from 3.3 +/- 0.8 to 6.4 +/- 0.6 mu eq.min-1.g-1 but did not alter Na+ absorption. In distal colon, although Na+ transport was unaffected, chronic acidosis reduced HCO3- secretion from -6.9 +/- 0.8 to -4.4 +/- 0.7 mu eq.min-1.g-1 and increased voltage from -18.9 +/- 2.0 to -51.1 +/- 4.2 mV. To evaluate the dependence of these effects on altered arterial pH and HCO3- concentration, NaHCO3 was infused intravenously, raising pH and HCO3- concentration to 7.53 +/- 0.04 and 23.9 +/- 1.7 meq/l, respectively. Although acute correction of chronic metabolic acidosis reduced HCO3- absorption in proximal colon, it did not affect HCO3- secretion or voltage in the distal segment, suggesting that proximal and distal colon respond differently to chronic metabolic acidosis. These results also suggest that chronic metabolic acidosis alters the mechanisms of ion transport in distal colon.

The double-arch modified type-1b external skeletal fixator

2011 ◽  
Vol 24 (05) ◽  
pp. 374-382 ◽  
Author(s):  
C. Nikolaou ◽  
M. Farrell ◽  
K. Perry ◽  
S. Girling ◽  
T. J. Smith ◽  
...  
Keyword(s):  
Degrees Of Freedom ◽  
Sagittal Plane ◽  
Radiographic Evaluation ◽  
Reference Ranges ◽  
Radiographic Images ◽  
Suboptimal Outcome ◽  
Limb Deformities ◽  
Acute Correction ◽  
Plane Joint ◽  
Centre Of Rotation

SummaryObjectives: To describe acute correction of antebrachial angular and rotational limb deformities (ARLD) using a new external skeletal fixator (ESF).Methods: Dogs that were presented with lameness caused by ARLD were treated by radial and ulnar osteotomies and acute realignment. A modified type-1b ESF incorporating double arches (DA-ESF) and a novel connecting configuration facilitated alignment with six degrees of freedom. Bilateral deformities were corrected surgically in the same session. Aseptic preparation of both antebrachii allowed comparison of limb alignment. Radiographic evaluation was performed using centre of rotation of angulation (CORA) methodology.Results: Thirty-five antebrachii (22 dogs) underwent surgery. Postoperative limb function was graded as good (n = 31), fair (n = 2), or poor (n = 2). Persistent medial carpal instability was associated with a suboptimal outcome. Postoperative radiographic images of the frontal and sagittal plane joint angles and elbow-to-carpus translation were compared with values that were reported in previous studies, and were within published reference ranges in most cases. Complications included delayed radial osteotomy union (n = 5), delayed ulnar osteotomy union (n = 2) and implant-associated morbidity (n = 3).Clinical relevance: A practical technique for acute correction of complex antebrachial ARLD is suggested, incorporating a new configuration of ESF. Putative limitations of radio-graphic planning using CORA may be compensated by careful attention to intra-operative visual and palpatory assessment.

scholarly journals Needle aponeurotomy for dupuytren’s contracture.

2019 ◽  
Vol 26 (08) ◽  
pp. 1300-1305
Author(s):  
Muhammad Arif ◽  
Saeed Ahmed Shaikh ◽  
Badaruddin Sahito ◽  
Nadeem Ahmed ◽  
Muhamamd Qasim ◽  
...  
Keyword(s):  
Flexion Contracture ◽  
Proximal Interphalangeal Joint ◽  
Dupuytren’S Contracture ◽  
Prospective Longitudinal Study ◽  
Dupuytren's Contracture ◽  
Number Of Patients ◽  
Acute Correction ◽  
Stage 1 ◽  
Prospective Longitudinal ◽  
Needle Aponeurotomy

Needle Aponeurotomy is a negligibly obtrusive method where the cords are debilitated through the manipulation & insertion of a small needle. To determine the frequency of recurrence of flexion contracture after correction by percutaneous needle Aponeurotomy. Study Design: Prospective longitudinal study. Setting: Department of Orthopedics, Jinnah Postgraduate Medical Centre, Karachi. Period: March 2017 to February 2018. Materials and Methods: 65 patients were collected for this study with dupuytren’s contracture from stage I-III belonging to either sex of age 18-50 years presented in outpatient department. Results: Total 65 patients were included in the study. Mean flexion contracture was 35.840 with the standard deviation of 13.070. Most of the patients 44(67.7%) had flexion contracture of >300 while 21(32.3%) patients had flexion contracture of ≤300. Majority of the patients had stage 1 of Dupuytren’s contracture, i.e. 26(40%), 25(38.5%) patients were of stage 2 contracture. Least number of patients i.e. 14 (21.5%) had stage 3 Dupuytren’s contracture. Recurrence of contracture was observed in 46(70.8%) of patients, while 19(29.2%) patients had no recurrence of contracture. Conclusion: The frequency of recurrence of flexion contracture found significant after correction with percutaneous needle aponeurotomy, so should be carried in selective patients with counseling’s that it will recur. But acute correction can be made at metacarpophalangeal and proximal interphalangeal joint with needle aponeurectomy.  

scholarly journals Acute correction of severe complex adolescent late-onset tibia vara by minimally invasive osteotomy and simple circular fixation: a case series with 2-year minimum follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Abo Bakr Zein ◽  
Ahmed S. Elhalawany ◽  
Mohammed Ali ◽  
Gerard R. Cousins
Keyword(s):  
Late Onset ◽  
Limited Resources ◽  
Tibial Osteotomy ◽  
Tibia Vara ◽  
Early Weight Bearing ◽  
Proximal Tibial Osteotomy ◽  
Blount’S Disease ◽  
Acute Correction ◽  
The Mean

Abstract Background Despite multiple published reviews, the optimum method of correction and stabilisation of Blount’s disease remains controversial. The purpose of this study is to evaluate the clinical and radiological outcomes of acute correction of late-onset tibial vara by percutaneous proximal tibial osteotomy with circular external fixation using two simple rings. Weighing up the pros and cons and to establish if this method would be the method of choice in similar severe cases especially in a context of limited resources. Methods This study was conducted between November 2016 and July 2020. We retrospectively reviewed the clinical notes and radiographs of 30 patients (32 tibiae) who had correction of severe late-onset tibia vara by proximal tibial osteotomy and Ilizarov external fixator. The mean age at the time of the operation was 16.6 (± 2.7) years (range 13–22). Results The mean proximal tibial angle was 65.7° (± 7.8) preoperatively and 89.8° (± 1.7) postoperatively (p < 0.001). The mean mechanical axis deviation improved from 56.2 (± 8.3) preoperatively to 2.8 (± 1.6) mm postoperatively (p < 0.001). The mean femoral-tibial shaft angle was changed from –34.3° (± 6.7) preoperatively to 5.7° (± 2.8) after correction, with degree of correction ranging from 25° to 45°. Complications included overcorrection (three cases 9%) and pin tract infection (eight cases 25%). The mean Hospital for Special Surgery knee scoring system (HSS) improved from 51.03 (± 11.24) preoperatively to 94.2 (± 6.8) postoperatively (p < 0.001). The mean length of follow up period 33.22 (± 6.77) months, (rang: 25–46 months). At final follow up, all patients had full knee range of motion and normal function. All cases progressed to union and there were no cases of recurrence of deformity. Conclusion This simple procedure provides secure fixation allowing early weight bearing and early return to function. It can be used in the context of health care systems with limited resources. It has a relatively low complication rate. Our results suggest that acute correction and simple circular frame fixation is an excellent treatment choice for cases of late-onset tibia vara, especially in severe deformities.

scholarly journals Acute correction of hyponatremia secondary to psychogenic polydipsia

2012 ◽  
Vol 13 ◽  
pp. 69-71 ◽  
Author(s):  
Coridon J. Quinn ◽  
Uroghupatei P. Iyegha ◽  
Greg J. Beilman ◽  
Frank B. Cerra
Keyword(s):  
Psychogenic Polydipsia ◽  
Acute Correction
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