“Hands Free” Femoral Retraction

“Hands Free” Femoral Retraction

The illustration posted in this example was created for the April 2013 issue of Orthopaedics feature and peer-reviewed article, Technical Trick: Simple, No-Hands Retraction for Lateral Approach to the Proximal Femur.

A simple technique is described that allows the orthopaedic surgeon to perform no-hands retraction during the lateral approach to the proximal femur during fixation of an intertrochanteric fracture with a sliding hip screw. All instruments remain sterile and within 6 inches of the surgical wound. Use of this technique is particularly useful in the event that a surgeon is operating with only one surgical assistant who may not be able to provide adequate assistance with retraction while concurrently preparing surgical instruments.

Modular Taper Junctions

Modular Taper Junctions

Illustration created for the article Evaluation and Treatment of Painful Total Hip Arthroplasties with Modular Metal Taper Junctions by R. Michael Meneghini, MD; Nadim J. Hallab, PhD; Joshua J. Jacobs, MD. Orthopedics May 2012, Volume 35, Number 5.

Modern primary total hip arthroplasty femoral components have emerged to include modular necks. Subsequently, the additional taper junction provides another interface as a potential source for mechanically assisted crevice corrosion, which is a complex process involving fretting and crevice corrosion. Furthermore, it is becoming evident that an adverse local tissue reaction may result in some patients due to the mechanically assisted crevice corrosion. This article details the clinical, radiographic, and laboratory evaluation of patients with these components who present with persistent pain. The relevant surgical strategies and techniques to address this pathology in symptomatic patients are addressed.

Labor Analgesia

Labor Analgesia

This illustration is one of the latest editorial pieces completed for the American Academy of Family Physicians featuring Labor Analgesia.

Depicted are a montage of images illustrating Epidural analgesia, a commonly employed technique which provides pain relief during labor. Epidural analgesia is a form of regional analgesia involving injection of drugs through a catheter placed into the epidural space. The injection can cause both a loss of sensation (anaesthesia) and a loss of pain (analgesia), by blocking the transmission of signals through nerves in or near the spinal cord.

The epidural space is the space inside the bony spinal canal but outside the membrane called the dura mater (sometimes called the “dura”). In contact with the inner surface of the dura is another membrane called the arachnoid mater (“arachnoid”). The arachnoid encompasses the cerebrospinal fluid that surrounds the spinal cord.

 

Biliopancreatic Diversion

Biliopancreatic Diversion

‘Sleeve’ Gastrectomy and Duodenal Switch: Traditionally biliopancreatic diversion with lateral “sleeve” gastrectomy  and biliopancreatic diversion has been performed as a single or staged procedure for  patients categorized as “superobese”. The technical challenges of performing the procedure laparoscopically combined with the associated severe nutritional deficiencies have made this combined procedure less popular in recent years. Initially offered as the first part of the staged procedure prior to weight loss, the Sleeve gastrectomy has become increasingly popular as a stand-alone procedure. Reports of excellent weight reduction have become increasingly common in the literature resulting in the acceptance the procedure by the American Society of Metabolic and Bariatric Surgery as a surgical alternative in select patients. Although considered to be technically less challenging to perform by many minimally invasive surgeons, the risk of leak from the long gastric staple line, gastric dysmotility and treatment failure due to delayed dilation of the stomach should warrant caution among inexperienced bariatric surgeons.

The biliary pancreatic diversion creates a malabsorptive state in which bile and digestive enzymes within a long afferent intestinal limb contacts food within  a  “common channel” measuring only 100 cm. The alimentary limb of the Roux-en-Y measures only 250 cm from its anastomosis with the duodenum to the cecum. The small intestine is normally 600 cm long (with some variation), so in this operation, the total length of the small intestine is shortened to about 40% of normal, but the length of the “common channel,” where digestion of complex fats and proteins occurs is only 1/6 or 16% of normal. When combined with the lateral gastrectomy the procedure accomplishes dramatic weight loss by creating both severe restrictive and malabsorptive conditions.

Failed Total Shoulder Arthroplasty

Failed Total Shoulder Arthroplasty

This illustration was commissioned for Arthroscopically Assisted Conversion of Total Shoulder Arthroplasty to Hemiarthroplasty With Glenoid Bone Grafting by Surena Namdari, MD, MSc; and David Glaser, MD for publication in ORTHOPEDICS October 2011 issue (ORTHOPEDICS November 2011;34(11):862).

Aseptic loosening of the glenoid component after total shoulder arthroplasty presents a considerable treatment challenge in the setting of substantial glenoid bone loss.  Glenoid component explantation and bone grafting of defects has become a common methods of recreating bone stock in hopes of preventing later fractures, maintaining joint kinematics, and allowing for later glenoid reimplantation if necessary.  While this has been traditionally accomplished via open techniques, we describe an arthroscopic-assisted method of glenoid explantation and bone grafting for cases of aseptic glenoid loosening with contained bone defects.

Patellar Instability

Patellar Instability

According to Dr. Hu Xu of the Department of Orthopedics, Xijing Hospital, proximal soft-tissue realignment is the main surgical intervention for recurrent patellar instability. In recent years, all-inside arthroscopic procedures or mini-open surgeries comes to replace traditional operations which have more associated morbidity and poor cosmetic results. In this article (ORTHOPEDICS July 2011;34(7):524), Xu and his colleagues report a very simple and all-inside arthroscopic technique for the operative treatment of recurrent patellar instability. Using two epidural needles in several steps and no accessory portals required, the medial patellar retinaculum is imbricated to the desired tension. The combination of lateral release and medial retinacular placation obviously improves the patellar tracking compared with pre-operation.

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