Prosthesis Failure

This was then measured and 85 mm was found to be the appropriate length. The core was cut for the sliding screw without complication using a pre-set reamor set at 85 mm. The tap was then used to tap the way for the proximal screw and an 85 mm sliding screw was inserted across the fracture sight into the head and neck without complication. A four hole 135 degree side plate was then attached. We slid it over the depwheeze sliding screw and attached it to the proximal femur using a lommen turkey claw clamp. With the fixation in place AP and lateral fluoroscopic images throughout the fracture sight and hardware position confirmed good reduction and good placement of the hardware. At this point the side plate was then secured to the proximal femur using the 3-2 drill bit to drill a hole measuring the approximate length with the depth gauge and placing 4-5 cortical screws of the appropriate length without complication. At this point the compression screw was inserted. All traction was left off and the compression screw was tightened impacting the fracture nicely. All screws were then tightened with the screwdriver. The lommen was removed, as was all hardware. Multiple views in the AP and lateral plains of the fracture

This is a 94 years old female resident at Derby health and Rehab. Pt have two problem seen today, impaired tissue integrity and acute pain. What I learned although pain is subjective, if a pt is in acute pain is frequently associated with anxiety and hyperactivity of sympathetic nervous (eg tachycardia, increased respiratory rate and BP, diaphoresis, dilated pupils). Also I learned impaired tissue integrity if untreated can cause risk for infection and the necrosis (dead tissue) can lead to systemic

•Use manipulation or surgery to unite the bones into the correct position; which can depend on where and how serious the injury is and, the patient's age

Surgery is generally indicated for patients who have displaced or unstable fractures and patients who will not tolerate cast immobilization. There is currently an increasing trend for immediate surgical fixation for both displaced and undisplaced fractures, mainly due to the short term benefits,

She was advised 2 operations. In first procedure, biopsy of the femoral lesions was followed by prophylactic nailing of both femora using cephalomedullary rods without bone graft.

Case involves a 60yr old man who underwent an uncemented total hip arthroplasty or a total hip replacement, who was referred to a home PT upon d/c instructing the patient to start home PT & begin ambulation using the ‘toe touch weight bearing’ which was incorrectly mentioned in the d/c summary as ‘weight bearing as tolerated’. For the initial 6 weeks, a patient with uncemented prosthesis should begin with ‘toe touch weight bearing’ and not ‘weight bearing as tolerated’ unlike the cemented prosthesis1. Toe touch weight bearing is instructed to the patient to protect the joint & also give bone the time to grow into the porous coating of the implant2. During the patient’s visit, the PT developed a plan of care from his evaluation & examination and handed-over the case to the PTA to carry out the therapy interventions. PTA (Physical Therapy Assistant) is defined as an educated individual who works under the direction & supervision of a physical therapist3. From the mentioned case, it is clear that the PT has not read the d/c summary and also that he has not mentioned the type of prosthesis used whether a cemented or an uncemented which highlights the PT’s failure of proper documentation. PTA has elected to follow a plan of care that she felt was consistent with that of a cemented prosthesis, highlighting the PTA’s mistake because the PTA is not allowed to make any modifications and follow the plan of care as directed by the supervising PT. PTA is not being periodically

In treatment groups removal of the circular layer of periosteum was followed by omentalfree graft sandwich replacement The femoral head was relocated. The articular capsule and the gluteal muscles were sutured with vicryl 4-0 stitches. The skin was closed with nylon 4-0 stitches. The animals were euthanized by CO 2 inhalation after general anesthesia with ketamine-xylazine at 4, 12, 21, 28, 42 and 52 days after the surgery. Both femoral heads were harvested and the soft tissue was excised. The specimens were fixed in formalin for a week. Following decalcification in formic acid for two weeks, Paraffin blocks of 4 µm were cut, and the sections were stained with hematoxylin and eosin. All the histologic specimans were numbered randomly. The result of present study showed the omental free graft sandwich implantation can improve femoral head repair in experimentally induced

The extensiveness of treatment for an ABC depends on the location, severity, and progression of the disease. Although the treatment spectrum ranges from minimally invasive to more invasive procedures, the standard of therapy is to resect the lesion and prevent it from returning in the future (Dhanasekaraprabu et al., 2013). However, complete resection is not always possible. For instance, it is difficult to completely remove lesion tissue from the proximal region of the metaphysis, and incomplete removal of the tissue leaves the patient susceptible to the development of another lesion at the site (Dormans et al., 2004). Cysts located at the proximal region of the femur are especially at an increased risk of recurrence (Mankin et al. 2005).

Malignant bone tumors have a propensity to spread via the bloodstream to various areas of the body, especially to the lungs and other bones. Annually, approximately 2800 new bone sarcomas are diagnosed in the United States. Unlike soft tissue tumors, malignant bone tumors present most commonly with pain. Therefore, these tumors require serious therapy plans that typically involve some combination of surgery, chemotherapy, and bone reconstruction. Specifically, the treatment of a malignant tumor calls for resection of the main tumor as well as the normal tissue surrounding the cancerous area. Bone sarcomas can come in three types: Osteosarcoma, Ewing sarcoma, and Chondrosarcoma.

There are 206 bones in the adult human skeleton; these bones relate to movement, posture, and protect internal organs (American society of Clinical Oncology, 2012).Bones connect to bones with ligaments and are covered and protected by cartilage (American Society of Clinical Oncology, 2012).Cancer of the bone is rare but is caused by normal bone marrow and tissues inside the bone that change and form tumors(American Society of Clinical Oncology, 2012). The tumor happens in the bone and is benign it does not spread (American Society of Clinical Oncology, 2012). The benign tumor can press against surrounding tissues and weaken the bone it it grows big enough (American Society of Clinical Oncology, 2012). Malignant bone tumors break the surrounding tissue and cortex, hard covering of the bone (American Society of Clinical Oncology, 2012). The tumor can then get into the bloodstream and spread all over the body (American Society of Clinical Oncology, 2012). Osteosarcoma and ewing sarcoma are the two most common type of bone cancer (American Society of Clinical Oncology, 2012). Chondrosarcoma is more common in adults and is cancer of the cartilage (American Society of Clinical Oncology, 2012). The last type of bone cancer is chordoma which usually starts in the lower spinal cord (American Society of Clinical Oncology, 2012). Ewing sarcoma is a type of bone cancer that affects the hip, rib, and middle of bone most often (National Cancer Institution, 2015). Ewing

On the less severe side you may just be advised to go to physical therapy and given a list of stretches or “gentle motions”. On the more severe side the doctor will prescribe you a diphosphonate, an anti-inflammatory drug that is nonsteroidal, or you may be ordered to endure local radiation therapy sessions. Surgery is often needed to preserve the integrity of the joint or area and it’s ability to move. A downside to the surgery though is the likeliness of heterotopic ossification to redevelop. This only happens when the surgical resection is done before the lesion has had adequate time to mature. To help prevent the instance of this happening serial quantitative bone scans are conducted and used to determine the time that surgery is most

Background and problem to be addressed: According to the American Association of Orthopedic Surgeon’s (AAOS), chondrosarcomas are the second leading cause of bone cancers, as well as the most difficult to treat (1). Currently, the only effective treatment includes chemotherapy and wide surgical resection of the bone and cartilaginous tissue surrounding the tumor, which is incredibly invasive and painful for the patient (2). Depending on the location of the tumor, however, surgical resection might not always be possible. Also, if the margin is not wide, the tumor can recur. Alternatives to resection include debulking and intralesional surgery, but these are associated with a recurrence rate of up to 93% (3,4). Therefore, developing a less-invasive alternative treatment would be a significant advancement in quality of life for patients with chondrosarcomas.

For symptomatic patients, the initial treatment option available is conservative therapy, and most patients do well with these treatments. However, there are some patients who do not respond to conservative treatment and need an alternative option for pain reduction and increased quality of life. Kyphoplasty and vertebroplasty are the two minimally invasive procedures that are successful options to enhance analgesia, physical functionality, and quality of life. Electing which procedure to have performed proves to be difficult due to the ongoing debate of which procedure is superior. As additional randomized clinical studies become available, it may become clear as to which procedure is more beneficial in regards to reduced procedural complications, reduction of vertebral deformity, and long term pain relief. Just as the vertebroplasty procedure was the blue print for the foundation of the kyphoplasty procedure, there will continue to be advancements and new innovations such as Radiofrequency kyphoplasty or Radiofrequency-Targeted Vertebral Augmentation (R-TVA). For this procedure, there is no use of balloons but a PMMA that is radiofrequency activated to eliminate premature hardening of the bone cement. By utilizing this specific PMMA there is a reduction in the chance of cement

Wide resection was performed in 26 patients and intentional marginal resection in 8 patients with favorable response to chemotherapy to preserve the adjacent joint. In metaphyseal lesions, at least 20 mm of tumor free subchondral bone was essential for joint preservation. The tumor bearing bone was frozen using single cycle liquid nitrogen protocol by freezing in liquid nitrogen for 20 minutes, thawing at room temperature for 15 minutes, and then rinsing with 37∘C distilled water for 10-15minutes. There are two main kinds of freezing procedures. The first one is the “Free Freezing Procedure” (FFP) in which either two osteotomies or hemicortical resection should be done and the tumor bearing bone is totally immersed in liquid nitrogen after

Prolonged survival of Compress prosthesis is due to a biomechanical concept of continuous compressive forces at the bone–implant interface leading to local bone hypertrophy and osseous integration into the implant spindle. Few studies talked about effect of chemotherapy on bone hypertrophy and osseointegration and discussed only the cortical width at the bone-implant interface ignoring the changes in the geometry of the whole segment at the whole compression area. Clinical correlation of increase in bone hypertrophy with patient function and relation to implant failure still unknown. So we asked about the effect of chemotherapy on Compress osseointegration based on radiological changes at the anchor-spindle area and response of bone to compression