Hillcrest Case 7 Operative Essay

PROCEDURE: While under a spinal anesthetic the patient's knee was examined. She had a small effusion in her knee. Physical exam of her left knee showed her skin intact. Her collateral ligaments were intact. The Lachman's test was negative as was the pivot shift. McMurray's test was negative. She has a range of motion 0 to at least 125 degrees flexion. Her left knee was then prepped with Betadine and draped in a sterile fashion.

Department of Orthopedic Surgery, The First Affiliated Hospital, 3Department of Pharmacy, Dalian Medical University, and 2Institute of Reconstructive Surgery, Dalian University, Dalian, China

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

The patient arrived at SDS at 0811 for the admission process and brought the registration form confirming the procedure and surgical site: Biopsy of left leg. The pre-operative nurse verified the patient identification: name and date of birth which were confirmed as correct by the patient via a telephone interpreter.

The patient was admitted into the hospital. In the morning after admission was taken to the operating room where she under went open reduction internal fixation of her right ankle fracture. She had an uncomplicated post operative course and gradually returned to assisted ambulation, she was then discharged in good condition.

As with any invasive surgical procedure, there is a certain amount of associated risk and complication. Some important complications surrounding any operative procedures utilizing general anesthesia include bleeding, respiratory decompensation, infection, and relapse. Outcome and prognosis of Lefort procedures depend on many factors before, during, and after surgery. Major anatomical complications reported with Lefort I osteotomy include nasal septum deviation, ophthalmic and lacrimal duct injury, malocclusion or mal-union of the maxilla, and injury to stenson’s duct. A reciprocating saw is generally utilized to perform the osteotomy with sufficient cooling methods to reduce heat damage to the underlying bone. Overheating puts bony structures at risk of osteonecrosis. Separation of the nasal septum is crucial and care should be taken to avoid the nasotracheal tube on the side of nasal intubation. Sectioning the tube would compromise the patient’s airway and cause significant risk to the procedure. Separation of the pterygoid plate from the maxillary tuberosity is another technique sensitive step during final completion of the osteotomy in the region of the infratemporal fossa (Patel).

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 onlay patch was then trimmed, laid over the repair and secured around the cord using 2-0 Vicryl suture. The wound was copiously irrigated with saline solution. Hemostasis was felt to be adequate. External oblique was then closed using running 2-0 Vicryl. Scarpa's fascia closed using 3-0 Vicryl. Skin was closed with running 4-0 Vicryl subcuticular suture. Attention was then drawn to the left where a curvilinear incision was made superior and lateral to the os pubis and carried it down through skin and subcutaneous tissue. Hemostasis was obtained with electrocautery. External oblique was opened in the direction of its fibers and an extremely large hernia sac was identified. Ultimately, the spermatic cord was identified and elevated using a Penrose drain. Cremasteric fibers were opened and it was inspected, no evidence of any indirect inguinal hernia was seen. The attenuated transversalis fascia was incised and then this direct left inguinal hernia was then reduced. Once this was done, an extra large mesh plug was introduced in the preperitoneal space and secured in the usual fashion using two sutures of 2-0 Vicryl to the conjoined tendon, shelving portion of Poupart's

Duraplasty was not performed. Bone bridge formation is demonstrated between the occiput and the C2 spinous process.

and Knahr, K. (2004) Chevron Osteotomy in Hallux Valgus. Ten-Year Results of 112 Cases. The Journal of Bone & Joint Surgery (Br), 86, 1016-1020 http://dx.doi.org/10.1302/0301-620X.86B7.15108 [13] Yamamoto, K., Imakiire, A., Katori, Y. and Koizumi, R. (2005) Clinical Results of Modified Mitchell’s Osteotomy for Hallux Valgus Augmented with Oblique Lesser Metatarsal Osteotomy. Journal of Orthopaedic Surgery (Hong Kong), 13, 245-252. [14] Valles-Figueroa, J.F., Rodríguez-Reséndiz, F., Caleti-del Mazo, E., Malacara-Becerra, M. and Suárez-Ahedo, C.E. (2010) Percutaneous Distal Metatarsal Osteotomy for the Correction of Hallux Valgus. Acta Ortopédica Mexicana, 24, 385-389. [15] Bösch, P., Markowski, H. and Rannicher, V. (1990) Technique and Initial Results of Subcutaneous Distal Metatarsal Osteotomy. Orthopädische Praxis, 26, 51-56. [16] Magnan, B., Pezzè, L., Rossi, N. and Bartolozzi, P. (2005) Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus. The Journal of Bone & Joint Surgery (Am), 87, 1191-1199. http://dx.doi.org/10.2106/jbjs.d.02280 [17] Kadakia, A.R. Smerek, J.P. and Myerson, M.S. (2007) Radiographic Results after Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus Deformity. Foot & Ankle International, 28, 355-360. http://dx.doi.org/10.3113/FAI.2007.0355 [18] Díaz-Fernández, R. (2015) Treatment of Moderate and Severe Hallux Valgus by Performing Percutaneous Double Osteotomy of the

Treatment: Following the diagnosis the patient was scheduled and underwent an open reduction, internal fixation surgery where the orthopedic surgeon used a Stryker dorsal Lisfranc plate and a 4.0 mm cannulated screw to successfully reduce and stabilize the dislocation. The patient remained non-weight bearing in a walking boot until six weeks post

This case report is about total knee arthroplasty in a Rheumatoid patient with both valgus deformity and flexion contracture. Rheumatoid patients still have deformity occurring despite new treatment, hence the need for surgery such as total knee arthroplasty. In this case report we will discuss more about the different techniques in the management of bone defect during surgery and use of the screw and cement method for defect correction. This method has been through several debates about its efficacy and failure and a global consensus has not still been

HISTORY: Kristi Abolt was asked to be seen in neurological consultation for further evaluation of a left foot drop. This occurred after an automobile accident on June 10, 2015. She states that she may have fallen asleep at the wheel or lost consciousness and then ran into a couple of other cars. She does not think she actually struck anything with the left knee in the accident. She states that she could lift her foot after the accident. The main difficulty after the accident was with two of her lower teeth protruding through the skin of her lower chin region. She was taken to Methodist Hospital in Indianapolis, Indiana for repair of the teeth. She states that after this procedure, she noticed that she could not dorsiflex the ankle

Infection can gradually wear away the connection to the point where the bone is no longer in contact with the stapes bone. This is called ossicular discontinuity. Reconstruction of this type of ossicular discontinuity can be performed at the time of tympanoplasty surgery through several options. If the gap is small, it can be bridged by inserting a small piece of bone or cartilage taken from the patient at another site (septum cartilage)4. If there is a larger gap, then the incus bone is removed and modelled into a tooth-like prosthesis, using the operating microscope. This is then reinserted between the stapes and the malleus in order to re-establish continuity of the ossicular