Dimon Hughston Osteotomy

Dimon and Hughston described technique of trochanteric osteotomy which results in valgus angulation and medial displacement.

The osteotomy is used to improve stability in unstable intertrochanteric fractures.

Types of Carpal Instability

A wrist is considered stable when the modifications brought about by the various forces acting on it are restored when the said forces stop to act.

In contrast, the alteration of one or more of the structures responsible for stability lead to preclusion of the restoration of the order and leads to misalignment and decrease in performance of the organ.

This happens when takes wrist is damaged by trauma, chronic inflammation or anatomical alterations like ulnar variance and and neoplasms.

Carpal instability often depends on capsular integrity and on the interosseous ligaments. It can be

  • Dynamic instability – This occurs in incomplete injury. The wrist maintains normal alignment at rest but will collapse under applied load
  • Static Instability – This occur in complete injury to the structure involved. This kind would show  abnormal intercarpal alignment on static radiographs

Further, carpal instability is said to be of following types. Each link would take you to the details of the particular  instability [Read more...]

What is Colles Cast?

Colles cast is a cast used for treatment of Colles fracture and other wrist fractures like scaphoid fracture. Here is a nice video on application of Colles cast

 

If the video is giving you problems, it can be viewed here also.

http://www.medclip.com/index.php?page=videos&section=view&vid_id=104214

Capitolunate Angle

Capitolunate angle formed by the lines formed by lines in longitudnal axes of the capitate and lunate.

Capitolunate Angle

Capitolunate Angle

The average value is -5°.

The capitolunate angle is affected instability of the wrist in a way similar to radiolunate angle, But this measurement is less accurate than radiolunate angle because of difficulty in determining axis of capitate.

What Is Bier Block?

Bier block is intravenous regional anesthesia which was originally introduced by  August K. G. Bier in 1908 and thus the name.

Bier bock  used in surgery of distal part of upper limb like wrist, hand and distal forearm. It is not useful in surgery around the elbow.

The main advantages of this technique are its simplicity and reliability.

Principle

With tourniquet tied intravenous anaesthetic agent like lignocaine is injected in previously exsanguinated limb. There is a  direct diffusion of the local anesthetic from the vessels into the nearby nerves as the drug is not distributed due to circulation blockage by tourniquet.

Peripheral nerve endings of the extremities are nourished by small blood vessels. Injection of a local anesthetic solution into a venous system results in diffusion of the local anesthetic into the nerve endings with the consequent development of anesthesia. The duration of the anesthesia and analgesia are limited by the duration tourniquet. [Read more...]

C Reactive Protein

C-reactive protein (CRP) is a protein found in the blood which rises in level in response to inflammation.

CRP was first discovered as a substance in the serum of patients with acute inflammation that reacted with the C- (capsular) polysaccharide of pneumococcus and thus the name.

It was discovered by Tillett and Francis in 1930 and is synthesized in liver.

 

A rise in CRP occurs as acute phase response  in a wide range of conditions like infections, inflammatory diseases, malignancy and autoimmune disordres. The levels of CRP rapidly increase within 2 hours of acute insult, reaching a peak at 48 hours. [Read more...]

Distal Radio Ulnar Joint

The distal radioulnar articulation or inferior radioulnar joint is a joint formed between the head of the ulna and the ulnar notch on the distal radius.

The articular surfaces are connected together by the following ligaments:

  • Volar radioulnar ligament
  • Dorsal radioulnar ligament
  •  Articular disk (Triangular fibrocartilage)

Triangular fibrocartilage complex is ulnar continuation of distal radius & presents concave surface for articulation with lunate and triquetrium. [Read more...]

Acute Normovolemic Hemodilution

Acute normovolemic hemodilution, also called s intraoperative hemodilution is a blood conservation process where blood of the patient is removed before or shortly after induction of anesthesia and volume is maintained using crystalloid and/or colloid replacement.

The amount of blood removed varies between one and three units (450 to 500 mL = 1 unit) usually.

The withdrawn blood is anticoagulated and maintained at room temperature, in the operating room, for up to eight hours. It is reinfused into the patient as needed during, or after, the surgical procedure.

Acute normovolemic hemodilution should be considered for patients with good initial hematocrits and who are expected to lose more than two units of blood. [Read more...]

Atlantodens Interval

The atlantodens interval is defined as the distance between the anterior aspect of the dens and the posterior aspect of the anterior ring of the atlas. This distance should be 5 mm or less. In the adult population, the normal ADI is 3 mm.

An atlantodens interval that exceeds 5 mm in lateral flexion and 4 mm in lateral extension indicates instability and is suspicious for ligamentous disruption.

Alkaptonuria

Alkaptonuria is a genetic disorder that results in a defect in the gene that makes the body unable to properly break down certain amino acids tyrosine and phenylalanine.

It is an autosomal recessive disease. It means both the parents should pass a copy of defective genes to the child if the child gets the disorder.

Due to this inefficient breakdown, a substance called homogentisic acid builds up in the skin and other body tissues.

The acid leaves the body through the urine. The urine turns brownish-black when it mixes with air.