Literary meaning of isthmus a narrow strip of land connecting two larger land areas, In anatomy isthmus indicates a narrow anatomical part or passage connecting two larger structures or cavities.

In bone, isthmus refers to the narrowest part of the bony canal.

The location of isthmus varies with the bone.

In femur, for example, it is located approximately at upper third and middle third junction.

Related posts:

1. Innnominate Bone
2. Sesamoid Bone
3. Sympathetic Ganglia

Jackson operating table has  no central table support like in float top tables [ Tables with central base support on which table rests, see video below to see supposrts on both ends of table in case of Jackson table to keep the central area free],  it is really easy to navigate the C arm under the table.

Another peculiarity of the table is being able to place the patient supine position and then flip the patient on the table  to make him/her prone.  This protects the patient from any neurological damage by keeping the spine stable during the turn.

The Jackson table for prone positioning allows the abdomen to hang entirely free of any pressure. This reduces blood loss and pressure related issues, especially in patients with a large belly.

It also allows rotation  to enable spinal fusions without the need for patient repositioning. When anterior fusion is complete, patient can be rotated 180 degress for surgical access to posterior spine.

Here is a video from a commercial maker that would give an idea about the table.

Click here to view the embedded video.

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Palmar TIlt of Distal Radius

It is also called Volar Angle or Radial Tilt.

The normal palmar tilt averages 11° and has a range of 2°-20°.

It is an important parameter in treatment of distal radius fractures.

Image Credit
http://www.radiologyassistant.nl/en/476a23436683b

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1. Injuries of Distal Radius and Ulna Other Than Distal Radius Fracture
2. Treatment Goals In Fractures of Distal Radius
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Multiple Organ Dysfunction Syndrome is altered organ function in an acutely ill patient requiring medical intervention to achieve homeostasis.

It usually involves two or more organ systems.

The condition can result following infection, injury, hypoperfusion and hypermetabolism.

The syndrome occurs when the primary cause triggers an uncontrolled inflammatory response. In one-third of the patients no primary focus can be found.

Pathophysiology

A definite explanation has not been found. Local and systemic responses are initiated by tissue damage. Respiratory failure is common in the first 72 hours after the original insult. Following this one might see hepatic failure, gastrointestinal bleeding, and renal failure.

Treatment and Prognosis

At present there is no agent that can reverse the established organ failure. Therapy therefore is limited to supportive care. Maintaining adequate tissue oxygenation is a principal target. Starting enteral nutrition within 36 hours of admission to an Intensive care unit has reduced infectious complications.

Human recombinant activated protein C has been recently found to reduce the immediate mortality.

Mortality has been reported in 30% to 100% of the cases.

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3. Severe Combined Immunodeficiency Syndrome

With opposite innominate bone and sacrum, the hip bone comprises the skeletal component of the pelvis.

It consists of three parts, the ilium, ischium, and pubis.

Each of these part is separate in childhood but fuse in adulthood by 25 years of age.

The ilium is the superior broad and expanded portion which extends upward from the acetabulum.

The ischium is the lowest and strongest portion of the bone; it proceeds downward from the acetabulum, expands into a large tuberosity, and then, curving forward, forms, with the pubis, a large aperture, the obturator foramen.

The pubis extends medially and inferiorly from the acetabulum and articulates in the midsagittal plane at the pubic symphysis, with the bone of the opposite side: it forms the front of the pelvis and supports the external organs of reproduction.

Related posts:

1. What Is Isthmus Of The Bone
2. Sesamoid Bone
3. Stress Shielding

An adult with Scheuermann's disease resulting in kyphosis

Kyphosis leads to a hunchback or slouching posture.

Image Credit: Wikipedia

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The procedure involves  placement of one or more screws across a fracture site so that fractured fragments are apposed and compressed to each other, called interfragmentary compression ( See image below). The interfragmentary screw can also be used for fixation after osteotomies.

Interfragmentary screw is put in a direction perpendicular to the fracture. Therefore in case of a spiral fracture, the screw direction may vary as the fracture plane changes.

Interfragmentary screw fixation of a spiral fracture

Image Credit:Muller ME, Allgower M. Schneider RW, 30. et al: Manual of Internal Fixation. New York. Springer- Verlag, 1979.

Technique

• Fracture is reduced and held temporarily with reduction forceps and or Kwires-
• A hole is drilled in the near cortex called gliding hole. This drill bit needs to be oversized (equal ot outer diameter of screw) than the drill in far cortex so that screw just glides and compresses two surfaces of fracture. Far cortex should not be drilled with this drill bit.

[The bone is like  a hollow cylinder.The shell of the cyllinder is cortex and empty hollow is medulla. When drilling one would encounter  bone [or near cortex)followed by relatively empty feeling of medulla followed by striking the bony surface from within on the other side {far cortex} in the path of the drilling.

• Insert  a drill sleeve into the overdrilled cortex. Use appropriately sized drill bit to drill the far cortex
• Tap the bone using appropriately sized tapper.
• Use a screw length so as to allow screw to protrude 2 mm beyond far cortex a

Lag screw fixation of an oblique or spiral fracture requires neutralization by a plate if sufficient stability is to be achieved to allow immediate rehabilitation without external protection.

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1. What Is Herbert Screw?
2. Fracture Humerus Fixed Plates and Screws With Radiological Signs of Implant Loosening
3. Osteosynthesis

This method is used in reduction of fractures near the joints.The sustained traction is held most commonly by external instrumentation.

This is called indirect reduction of the fracture [When compared with direct technique of holding and reducing the fractured fragments]

Principle

When you apply traction to the ligament it causes the attached bone fragments to reduce. The technique works only if the ligamnets are intact. It is of no use when ligaments are broken too.

Fractures of distal end of radius and tibia are commonly reduced by this principle.

In posterior instrumentation of spine, ligamntotaxis is used for indirect reduction of the  retropulsed fragments

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1. What Is Interfragmentary Screw or Lag Screw
2. What Is Herbert Screw?
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Image Credit: mattle.ch/upload/Minerva.jpg

The Minerva brace is a cervical and upper thoracic orthosis. It provides good orthotic control of the neck. There are many instances where Minerva brce can be used. For example severe whiplash injury or fracture of the vertebra or lower cervical fusion.

The Minerva orthosis has a rigid plastic posterior section that goes from the base of the skull down to the midtrunk. There is a solid chest piece in the front that is attached to the back along the sides with Velcro straps that can be adjusted.

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1. Sternal Occipital Mandibular Immobilization Brace
2. Cervical Thoracic Lumbar Sacral Orthosis
3. Atlantodens Interval

A lumbar puncture is procedure that is performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological analysis.

Very rarely it is also done as treatment to relieve increased intracranial pressure.

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