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Osteonecrosis has become a subject of interest amongst orthopaedic surgeons predominantly during the last four to five decades.
There are several etiological factors of osteonecrosis of femoral head. They may be traumatic (after femoral neck fractures or dislocations of hip joint), idiopathic, corticosteroid induced, alcohol abuse, following infection, haemoglobinopathy, post¬irradiation, Caisson's disease, Gaucher's disease and associated with gout. Commonly, the patients belong to third to fifth decades of life. Since the etiopathogenesis is different, the pathomechanics vary from case to case. Though the ultimate fate of the necrotic femoral head is the same, the results of treatment may vary with the etiology.
Diagnosis of osteonecrosis of femoral head is done clinically by pain around the hip, gradual limitation of motions, radiographic criteria and staging of Ficat and Arlet. Radionuclide Scintigraphy (99 mTc Di-phosphonate ) can be done especially for diagnosis in the early stages of osteonecrosis, CT to detect the early details of bone changes, MRI to record very early marrow necrosis not detectable by CT and tests for haemodynamic functions (intramedullary pressure measurements and venography) for vascular stasis.
Patients may present with pain in hip which is due to subarticular increased intravenous pressure in early stages of osteonecrosis marrow oedema, necrosis and also due to increased intracystic pressure associated with degenerative changes of hip in advanced stages of necrosis. In advanced stages, there may be collapse of femoral head, cheilus formation with adhesions around the periphery of femoral head and associated contracture of articular capsule which causes pain due to its stretching effect over t...
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...ure of choice based on surgeon's expertise.
A femoral head preserving operation having satisfactory results in long term follow up should be the treatment of choice in younger individuals and THR in elderly where femoral head is badly damaged and in younger patients with multisystem diseases and poor general health. Considering the life style of people of our country who needs squatting habit, decompression of femoral head and TFL muscle pedicle bone grafting is a good option both in early and even in advanced stages of the disease unless the femoral head is badly deformed or collapsed more than 5mm. Considering its technical simplicity compared to the use of other vascularised bone grafts like vascularised fibular or vascular pedicle iliac crest graft, the above method can be recommended in patients of developing countries like ours where osteonecrosis is common.
Norvell, J. G. (2013, June 11). Tibia and Fibula Fracture Clinical Presentation. Retrieved from http://emedicine.medscape.com/article/826304-clinical
Recent research has been focused on distinguishing the most successful augmentation surgery for restoring deficient bone (4, 16-18). Surgical techniques and survival of the bone graft has been vastly highlighted in the literature. ,However, the importance of recipient site on success rate of augmentation procedure has been less issued (16).
Rheumatoid arthritis is a chronic inflammatory and an autoimmune disease that occurs when the immune system mistakenly attacks the body’s tissue (Rheumatoid arthritis, 2017). This disease affects the entire body, which is called a systemic (means entire body) disease. Arthritis is derived from the word part arthr-, which means “joint,” and -itis, which means “inflammation,” so altogether it means “inflammation of the joints.” It creates inflammation that causes the tissue that lines the inside of joints (synovium) to thicken. About 1.5 million people in the U.S. are affected. It affects all races, but it affects three times as many women than men (What is Rheumatoid Arthritis, n.d.). Overtime, rheumatoid arthritis causes painful swelling that can potentially result in bone erosion or joint deformity, which leads up to physical disabilities. RA can affect more than just your joints, but can spread to body systems, skin, eyes, lungs, heart, blood vessels, e.t.c (Rheumatoid arthritis, 2017).
My most defining experience with osteopathic medicine was shadowing a family physician, Dr. Truong. I was impressed by his holistic, patient-centered care and his hands-on manipulative skills. Not only did he provide the medical treatment to his patients, but he cared for them mentally and spiritually. For example, he asked his patients about their life goals at their initial visit, and he reminded and encouraged them to work towards their goals during their future visits. He also promoted healthy lifestyle, such as eating low sugar, high vegetable diet and doing exercises regularly. As a result, one of his patients lost 20 pounds by following his advice. Additionally, Dr. Truong used OMT and acupuncture to help his patients relieve their pain. One of his patients had serious knee pain that could not be treated by others. He found a spot on her thigh and performed OMT, and the pain never came back again. He also taught me the four tenets of osteopathic medicine. With my knowledge of traditional Chinese medicine, which shares some similarities with osteopathic medicine, I quickly comprehended its philosophy.
Patel S, Pearson D, Hosking DJ. Quantitative bone scintigraphy in the management of monostotic Paget’s disease of bone. Arthritis Rheum. 1995; 38: 1506-12.
Osteosarcoma, characterized as a neoplasm that produces osteoid, is a highly malignant tumor that develops predominantly in the metaphysis of the long bones, often in the distal femur and proximal tibia. More rare osteosarcomas may develop in the soft tissue. Although the malignancy usually arises in the medullary cavity of the metaphysis of a growing tubular long bone, less frequent growth patterns can develop on the surface on the bone. Surface osteosarcomas, as well as being significantly rarer, are also of a low grade, where else medullary osteosarcomas are of an aggressive nature, making it high grade. Osteosarcomas may also be confined to the cortex, and can even originate in an extraskeletal site.
Osteoporosis is a disease in which the bones become so weak and brittle that even a cough can cause enough stress on the bone that it will cause the bone to facture. The most commonly broken bones are the hip, wrist, and the spine. Although it affects men and women of all races, post-menopausal Caucasian and Asian women are more commonly affected than those of other ethnicities and sexes. In fact, thirty percent of all post-menopausal women in the US and Europe will be diagnosed with Osteoporosis and at least 40 percent of those will suffer from a fracture in their lifetime.
Type IV of OI is much rarer, comprising only 5% of cases. The bones may appear normal at the time of the first...
Rheumatoid Arthritis is when the joints are chronically inflamed, which happens because it is an autoimmune disease which means that the immune system attacks the body tissues. Although Rheumatoid Arthritis mainly affects the joints, it can also affect other organs.
Total Hip Replacement (THR) is a surgical procedure that relieves pain from most kinds of hip arthritis, thus helping to improve the quality of life for the majority of the patients that undergo the operation. Arthritis simply means "inflammation of a joint." Arthritis can occur in any joint in the body. The main symptom of arthritis is pain which usually worsens with activity and weight bearing. This pain may be relieved most of the time through rest. There are over 100 types of arthritis but less than a handful account for over than 95 percent of the hip replacements that are performed. Some of these include Osteoarthritis (causes deterioration of the cartilage and the growth of bone spurs), Rheumatoid arthritis and Osteonecrosis of the femoral head. Doctors suggest that before considering hip replacement surgery for arthritis that the patient tries a number of non-operative interventions. Your doctor may have you consider little things such as weight loss (most arthritis is caused due to the weight bearing on a joint), activity modification or even the use of a cane. Patients should consider THR when daily living activities become harder to accomplish due to the pain. These activities would include walking, climbing stairs or other moderate pastimes. Anti-inflammatory medications which will help reduce the inflammation from the arthritis and reduce your pain may also be prescribed by the patient's doctor.
Orthopedic surgeons are responsible for mending and operating on the musculoskeletal system. “Orthopedics is a medical specialty that focuses on the diagnosis, care, and treatment of patients with disorders of the bones, joints, muscles, ligaments, tendons, nerves, and skin” (Career in Orthopaedics). Depending on the damage the patient has sustained determines how the orthopedic surgeon is able to correct the patient’s injury. In many cases there are multiple ways of correcting the patient’s injury such as; using medical, physical, and rehabilitative techniques to using complex surgical methods. “Typically, as much as 50 percent of the orthopedic surgeon’s practice is devoted to no surgical or medical management of injuries or disease and 50 percent to surgical management” (Career in Orthopaedics). The majority of surgeons, including orthopedic surgeons, prefer to choose the least invasive procedures such as; arthroscopy which is a technological advancement allowing orthopedic surgeons to use special cameras in order to diagnose and treat a joint with minimal cutting and trauma to...
This Preusser (2008) case study involves a 75 year old female, S.P., who fell at home and is admitted to the orthopedic ward for an intracapsular fracture of the hip at the femoral neck (p. 183). Assessment data includes her height is 5’3”, weight is 118 lbs, blood pressure...
The musculoskeletal system is comprised of bones, joints, cartilage, tendons, ligaments, fascia and muscles. Together these body parts work to establish a framework that is the musculoskeletal system. This framework is what gives the body its shape, form, and figure. It stabilizes the body as well as supplies the structural support. The musculoskeletal body features not only provide a framework for your body but allows your ability to create movement. These movements are monitored by the musculoskeletal components which then determine your degree of flexibility. Overall the amount of energy your body uses comes almost entirely from these musculoskeletal functions. Which makes sense because it
Osteosarcoma is often diagnosed through several different imaging modalities. Some of with include diagnostic x-ray to show different densities in the bone. CT and MRI scans are useful in the detection of soft tissue extension. A PET scan is also valuable in that this test will show metabolic uptake of the affected area. It is also very important to have such lab test that determine an alkaline phosphate level because it is found that 50% of patients with osteosarcomas demonstrate an elevated level. The most promi...
The Skeletal System, also known as the Skeleton make up a framework that support the body and protect the organs. The Skeleton consists of the bones and joints of the body. In the human body there is 300 bones at birth, these then fuse together to make 206 bones in a fully grown adult. The Skeleton is made up of two divisions: The axial and appendicular Skeleton.