pediagenosis: Musculoskeletal
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Showing posts with label Musculoskeletal. Show all posts
Showing posts with label Musculoskeletal. Show all posts

Tuesday, February 16, 2021

TOTAL HIP REPLACEMENT: INFECTION

TOTAL HIP REPLACEMENT: INFECTION

TOTAL HIP REPLACEMENT: INFECTION

Subfascial (deep) infection, whether acute or latent, is a serious complication in joint replacement surgery. It is important to identify the type of infection because prognosis and treatment differ. Also, because any implant can become a focus for infection, patients with a hip prosthesis should be given preventive antibiotics when undergoing dental, urinary, or gastrointestinal procedures.

TOTAL HIP REPLACEMENT: COMPLICATIONS

TOTAL HIP REPLACEMENT: COMPLICATIONS

TOTAL HIP REPLACEMENT: COMPLICATIONS

Although many complications may follow total hip replacement, their incidence is fortunately low. The most common postoperative complications are deep venous thrombosis, neurologic complications, loosening of prosthetic component, dislocation, fracture, and infection.

DYSPLASTIC ACETABULUM AND PROTRUSIO ACETABULI

DYSPLASTIC ACETABULUM AND PROTRUSIO ACETABULI

DYSPLASTIC ACETABULUM AND PROTRUSIO ACETABULI

Reconstruction of the dysplastic or deficient acetabulum presents a particularly difficult surgical challenge, because the anatomic landmarks commonly used as reference points may not be in their normal positions. Portions of the bony circumference of the acetabulum may be deficient as a result of old fractures or congenital dysplasia. For example, in a long-standing posterior fracture dislocation of the hip, the posterior wall of the acetabulum is usually severely deficient; in congenital dislocation of the hip, the acetabulum is shallow and poorly developed. If the femoral head has been dislocated for many years, it articulates with the iliac wing in a pseudoacetabulum. The true acetabulum is stunted, small, and shallow, but its anatomic configuration is usually preserved and identifiable once the contracted overlying inferior capsule is reflected.

TOTAL HIP REPLACEMENT: TECHNIQUE

TOTAL HIP REPLACEMENT: TECHNIQUE

TOTAL HIP REPLACEMENT: TECHNIQUE

The procedure for total hip replacement begins with preoperative planning, which includes a complete medical workup of the patient to identify any existing health problems. A rheumatologist or internist often works with the orthopedic surgeon in planning the appropriate medical therapy. The rehabilitation program should also be thoroughly discussed with the patient.

TOTAL HIP REPLACEMENT: PROSTHESES

TOTAL HIP REPLACEMENT: PROSTHESES

TOTAL HIP REPLACEMENT: PROSTHESES

Arthroplasty, or surgical reconstruction of the joints, has revolutionized the treatment of crippling diseases such as osteoarthritis and rheumatoid arthritis, which destroy the joint’s smooth cartilage surfaces and lead to painful, decreased motion. Relief of pain and improved hip function are dramatic advantages of reconstruction procedures. Hip arthroplasty not only benefits the older patient, but total hip replacement and other procedures using prostheses also now permit young and middle-aged patients with congenital, developmental, arthritic, traumatic, malignant, or metabolic hip disorders to lead active and productive lives.

LEGG-CALVÉ-PERTHES DISEASE

LEGG-CALVÉ-PERTHES DISEASE

LEGG-CALVÉ-PERTHES DISEASE

Legg-Calvé-Perthes disease is defined as idiopathic avascular necrosis of the epiphysis of the femoral head (capital femoral epiphysis) and its associated complications in a growing child. It is a common, but poorly understood hip disorder.

Tuesday, February 9, 2021

HIP JOINT INVOLVEMENT IN OSTEOARTHRITIS

HIP JOINT INVOLVEMENT IN OSTEOARTHRITIS

HIP JOINT INVOLVEMENT IN OSTEOARTHRITIS

Osteoarthritis (OA) of the hip is a common problem in the United States and worldwide. As many as 1 in 4 Americans may suffer from OA in their lifetime. With the continued growth of the elderly population in the United States, and the desire for these patients to continue an active lifestyle, OA is a growing medical and economic concern. Appropriate management of OA, both medically and surgically, requires the physician to be able to accurately diagnose the condition.

SLIPPED CAPITAL FEMORAL EPIPHYSIS

SLIPPED CAPITAL FEMORAL EPIPHYSIS

SLIPPED CAPITAL FEMORAL EPIPHYSIS

Slipped capital femoral epiphysis refers to the displacement of the epiphysis of the femoral head. It occurs most commonly in boys 10 to 17 years of age (average age at onset is 12 years). The initial examination reveals bilateral involvement in about one third of patients, but patients with unilateral involvement have little risk of a subsequent slip on the contralateral side.

DEVELOPMENTAL DISLOCATION OF THE HIP

DEVELOPMENTAL DISLOCATION OF THE HIP

DEVELOPMENTAL DISLOCATION OF THE HIP

Methods for the early detection of developmental dislocation of the hip (DDH) have been reported for nearly 100 years. The first screening program in the United States was described and initiated in the 1930s. After World War II, extensive screening programs in the United States, Sweden, and England resulted in the early identification and, ultimately, the simple, effective, and safe treatment protocols.

PROXIMAL FEMORAL FOCAL DEFICIENCY

PROXIMAL FEMORAL FOCAL DEFICIENCY

PROXIMAL FEMORAL FOCAL DEFICIENCY

Proximal femoral focal deficiency is a randomly occurring congenital abnormality of the proximal femur and hip joint. It is usually unilateral and in 68% of patients is accompanied by fibular hemimelia on the ipsilateral side. About 50% of the patients have skeletal abnormalities of other limbs as well. Based on results of a large radiographic survey, proximal femoral focal deficiency has been classified into four types, according to the type and severity of the femoral and acetabular defects (see Plate 2-22).

PHYSICAL EXAMINATION

PHYSICAL EXAMINATION

PHYSICAL EXAMINATION

Physical examination of the hip is initiated with observation of the patient. Specific note is made of body habitus. Gait is evaluated directly, looking for a Trendelenburg or antalgic gait that favors the affected side. Both gait patterns are associated with intra-articular and extra-articular hip pathologic processes.

Monday, January 11, 2021

BLOOD SUPPLY OF THIGH

BLOOD SUPPLY OF THIGH

BLOOD SUPPLY OF THIGH

ARTERIES

The femoral, obturator, superior gluteal, and inferior gluteal arteries supply the thigh. The former two distribute principally anteriorly; the latter two distribute in the hip region. The femoral artery is the continuation of the external iliac artery. It distributes largely in the femoral triangle and descends through the midregions of the thigh in the adductor canal.

FASCIAE AND MUSCLES OF HIP AND THIGH

FASCIAE AND MUSCLES OF HIP AND THIGH

FASCIAE AND MUSCLES OF HIP AND THIGH

The region of the hip and thigh extends from the iliac crest to the knee. The upper portion is the hip, which is limited generally by the level of the greater trochanter of the femur. The subcutaneous connective tissue contains a considerable amount of fat, especially in the gluteal region. The subcutaneous tissue here is continuous with the similar layer of the lower abdomen, and the membranous layer of the latter region continues beyond the inguinal ligament to become attached to the fascia lata a short distance beyond the ligament. The layer attaches medially to the pubic tubercle and laterally to the iliac crest. It also attaches to the margins of the saphenous opening and fills the opening itself with the cribriform fascia, a subcutaneous connective tissue perforated for the passage of the greater saphenous vein and other blood and lymphatic vessels.

NERVES OF THIGH

NERVES OF THIGH

NERVES OF THIGH

FEMORAL NERVE

The femoral nerve (L2, 3, 4) is the largest branch of the lumbar plexus (see Plate 2-5). It originates from the posterior divisions of the ventral rami of the second, third, and fourth lumbar nerves, passes inferolaterally through the psoas major muscle, and then runs in a groove between this muscle and the iliacus, which it supplies. It enters the thigh behind the inguinal ligament to lie lateral to the femoral vascular sheath in the femoral triangle. Twigs are given off to the hip and knee joints and adjacent vessels, and cutaneous branches are given off to anteromedial aspects of the lower limb.

Thursday, November 5, 2020

LUMBOSACRAL PLEXUS

LUMBOSACRAL PLEXUS

LUMBOSACRAL PLEXUS

NERVE SUPPLY

In describing the lower limb, the lumbosacral plexus may be said to be formed from the ventral rami of the first lumbar to third sacral nerves (L1 to S3), with a common small contribution from the 12th thoracic nerve (T12) (see Plates 2-2 to 2-4). The lumbar portion of the plexus arises from the four upper lumbar nerves and gives rise to the iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous, obturator, accessory obturator, and femoral nerves.

SUPERFICIAL VEINS AND CUTANEOUS NERVES

SUPERFICIAL VEINS AND CUTANEOUS NERVES

SUPERFICIAL VEINS AND CUTANEOUS NERVES

SUPERFICIAL VEINS

Certain prominent veins, unaccompanied by arteries, are found in the subcutaneous tissue of the lower limb (see Plate 2-1). The principal ones are the greater and lesser saphenous veins, which arise in the venous radicles in the feet and toes. Dorsal digital veins lie along the dorsal margins of each digit, uniting at the webs of the toes into short dorsal metatarsal veins that empty into the dorsal venous arch. There are also plantar digital veins, which drain into the dorsal metatarsal veins.

LUMBOSACRAL AGENESIS

LUMBOSACRAL AGENESIS

LUMBOSACRAL AGENESIS

Lumbosacral agenesis is a condition in which the sacrum and some of the lumbar vertebrae, or both, fail to develop. Although the etiology is not certain, it has been noted that 14% to 18% of patients have mothers with diabetes or a strong family history of diabetes.

MYELODYSPLASIA

MYELODYSPLASIA

MYELODYSPLASIA

The number of infants with myelodysplasia who survive infancy has increased dramatically in the past 30 years, and as clinical experience with these patients has increased, new principles and techniques of treatment have emerged.

SPONDYLOLYSIS AND SPONDYLOLISTHESIS

SPONDYLOLYSIS AND SPONDYLOLISTHESIS

SPONDYLOLYSIS AND SPONDYLOLISTHESIS

Spondylolysis may represent a stress fracture of the pars interarticularis of the fifth lumbar vertebra. When the fracture allows L5 to slip forward on S1, it is called isthmic spondylolisthesis. Dysplastic, or congenital, spondylolisthesis, in contrast, is due to anomalous development of the posterior structures of the lumbosacral junction.

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