Dr. Ebraheim’s educational animated video describes the subtrochanteric fractures, the etiology, signs and symptoms, diagnosis, and treatment options. Subtrochanteric Femur Fractures are difficult fractures to manage and heal. The deforming forces and high stresses area across the fracture could lead to implant failure before union of the fracture. The subtrochanter area is defined as an area from the lesser trochanter to 5 cm distally. Subtrochanteric fractures occur within this area. May have intertrochanteric extension and is called a peritrochanteric fracture. It usually indicates a high energy trauma in young patient. it can occur in elderly from low energy trauma. Mortality rate of the elderly is about 25% within the first year. Try to exclude pathological fracture. Isolated fracture of the lesser trochanter may indicate a metastatic tumor. Try to exclude fracture caused by bisphosphonate alendronate. Bisphosphonate related fractures: •Lateral cortical thickening •Transverse fracture orientation •Medial spike •Lack of comminution. Patient will complain of symptoms before the fracture occurs. Stop the bisphosphonate and give the patient anabolics that may prevent the fracture. If the patient is on bisphosphonate for 4 or more years and has pain get an x-ray. If you see cortical thickening get an MRI to rule out a stress fracture. Also check the vitamin D and calcium levels. Unique aspects of the fracture Transition from cancellous to cortical bone. The cortical bone vascularity and fracture surface area is less. There will also be high compressive forces medially and tensile forces laterally. The fracture may go to varus with fixation. Lateral plate acts as a tension band and is subject to bending load. Perfect reduction and medial cortex reconstitution in plating is very critical. Bone to bone transfer is important to avoid varus. Failure of the lateral plate is certain if early weight bearing is allowed. As little as 2 mm of separation of the medial cortex will lead to medial collapse and lateral plate bending failure. Strong muscle deforming forces in the proximal fragment. The distal fragment is also adducted and shortened by the adductor magnus muscle. Classification Usually divided into two types 1-No extension of the fracture into the piriformis fossa. 2-Extension into the greater trochanter with involvement of the piriformis fossa: elderly patients are more of this type. Why is it important? The classification helps the surgeon to choose an appropriate device for fixation. Need to restore the medial buttress (bone to bone transfer) before the implant fails. How to restore the medial buttress? By exact reduction of the medial fragment or by bone graft if there is a gap in the medial part of the fracture. The bone graft will consolidate and allow bone to bone transfer. The bone graft is usually used if there is an open fracture reduction and fixation technique or by chest tube if a closed technique is used. Bone healing by callus: weight bearing is used when there is x-ray evidence of healing. How to treat Subtrochanteric Fractures? The Russel Taylor Classification is based on involvement of the lesser trochanter and the piriformis fossa. It provides guidance to the treatment of fractures with a nail, when nailing should be avoided and what type should be used such as a standard cephalomeduallry nail. Most Subtrochanteric Fractures are treated with IM rod especially if the fracture does not extend to the piriformis fossa or the greater trochanter. Why choose a rod? Closed IM rod fixation is minimally invasive. IM rod preserves some vascularity. Stronger construct and load sharing. Positive effect on reaming that will give us bone graft. Insertion of the rod will not reduce the fracture, a small incision to reduce the fracture before reaming and inserting the rod is done if the fracture is not reduced. Piriformis fossa entry point is the gold standard and has the advantage of collinear trajectory with long access to the femoral shaft. It will avoid varus deformity. IM nail may be used in the elderly with a trochanteric entry point. Greater torchnateric entry may disrupt the abductor muscles. Treatment: •Intramedullary nail •Proximal locking technique •Proximal plate fixation with fixed angle device •Nonunion of the Subtrochanter Fracture revision of the internal fixation selected bone graft. •Some still use the compression hip screw. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Background music provided as a free download from YouTube Audio Library. Song Title: Every Step
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Osteoporosis causes bone loss over time, leading to stress fractures, says orthopedic surgeon Faisal Mirza, MD, of Good Samaritan Hospital. Find out more, including how they affect female athletes, in this video.
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Insider Exclusive interviews Miami personal injury lawyers, Stewart Greenberg and Mark Stone with Greenberg and Stone, P.A., about their case against the Advanced Dermatology and Cosmetic Surgery clinic in Orlando, FL. The suit is on behalf of a 25 year old athlete and father who had visited the clinic to treat a skin rash. Shortly after treatment, he was experiencing unusual pain. It was discovered by another doctor that the clinic had injected him with an excessive dosage of corticosteroids such as Prednisone, Kenalog, and Depo-Medrol. The end result of that unnecessary treatment is a lifelong struggle with Osteonecrosis and future hip replacements. If you would like to schedule a Free Consultation with Miami personal injury attorneys, Stewart Greenberg and Mark Stone you can contact us at: Greenberg & Stone, P.A. 11440 N. Kendall Drive Suite 400 Miami, FL 33176 (888) 499-9700 http://www.sgglaw.com/
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Dr. Ebraheim’s educational animated video describes the reverse oblique fractures. A reverse oblique fracture is an unstable fracture that really is not a classic intertrochanteric fracture. It is not a true classic hip fracture. You should think of it as a subtrochanteric fracture with all its difficulties and complications. The fracture is almost parallel to the inferior neck. The fracture starts form medial proximal to lateral distal and extends to include the lateral cortex distally. Treatment: •Intramedullary nail (long or short). •Fixed angle device: fixed angle device such as dynamic condylar screw and blade pate (rarely used). Proximal locking plate- easy application but has a high failure rate. Used if the piriformis fossa is disrupted. •Dynamic hip screw is a bad choice of implant. It will lead to medial displacement of the shaft secondary to the pull from the hip adductor muscles. It can also lead to shortening, nonunion and failure of implant. This fracture is unstable. Dynamic hip screw may not compress the fracture, in fact, it may displace and distract the fracture. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Background music provided as a free download from YouTube Audio Library. Song Title: Every Step
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More than 10 million people in the United States have osteoporosis, a skeletal disorder that causes bones to become weak and fragile as a result of low bone mass. The condition makes people more susceptible to fractures, which can impair their ability to live independently and even threaten their lives. The social and economic burden of osteoporotic fractures is substantial. Reducing osteoporosis prevalence and hip fracture incidence are among the major objectives of Healthy People 2020, the U.S. Department of Health & Human Services’ national health promotion and disease prevention initiative. Lifestyle changes—including getting adequate nutrition and regular exercise, quitting tobacco use, limiting alcohol use, and preventing falls—can help reduce a person’s risk of osteoporotic fractures. However, medications may be prescribed to prevent fractures if a person has very low bone mineral density or has experienced a prior fragility fracture. The U.S. Food and Drug Administration has approved several types of drugs to prevent osteoporotic fractures. Clinical guidelines by various medical organizations recommend bisphosphonates (BPs) as a first line of treatment for most people who have osteoporosis. BPs are effective for short-term use (up to 3–5 years) by people who are at high risk of fracture. However, the benefits and risks of longer-term treatment are less clear. Reports of rare but serious adverse events such as atypical femoral fractures and osteonecrosis (death of cells) of the jaw have raised questions about the safety of osteoporosis drug use, especially in people who use the drugs for more than 3–5 years or who had a low risk of fracture when they began treatment. Research Challenges There is a gap in scientific data about the appropriate long-term use of many osteoporosis drugs. There are uncertainties about which people will benefit or may be harmed if they take the drugs long-term. Public concern about these and other unanswered questions has coincided with a significant decrease in use of osteoporosis drugs and a leveling off in what had been a promising decline in the incidence of osteoporotic fractures. These changes have raised concerns within medical and professional communities that many people who might need the drugs are not being prescribed them, and those who are prescribed them are not taking them. In addition, evidence is limited regarding the initiation and length of “drug holidays” (a medical practice in which a patient stops taking medications for a period of time and then resumes treatment again, if the patient or their doctor believes it could be in their best interests), whether stopping treatment reduces the risk of serious adverse events while maintaining fracture prevention benefit, and which individuals should change treatments instead of simply taking a drug holiday from their current medication. Innovative research strategies are needed to address these knowledge gaps and to help better inform individuals and physicians in their decision-making about osteoporosis treatment. Workshop Goals This P2P workshop will assess the available scientific evidence to better understand the appropriate use of drugs for osteoporotic fracture prevention, specifically addressing the following questions: What are the benefits and risks (including major adverse events) of osteoporotic drugs with short-term use (from first-use up to 3–5 years of treatment)? What factors influence outcomes? What are the benefits and risks of osteoporotic drugs over the longer term (for treatment periods longer than 3–5 years)? What factors influence outcomes? Do drug holidays improve outcomes? What patient and clinician factors impact the use of and adherence to osteoporotic drugs? Workshop Sponsors National Institute on Aging National Institute of Arthritis and Musculoskeletal and Skin Diseases NIH Office of Disease Prevention
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Whether you're a sports fan or not, you've likely heard stories or seen footage of injuries sustained during competition. Most recently, people are talking about broken bones. Dr. Scott Lynch, director of orthopedic sports medicine, and Dr. Matt Silvis, director of primary care sports medicine, discuss two different types of bone fractures and how they can be treated.
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This webinar focuses on the skeletal impact of spinal cord injury as well as bone health after injury.
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Is There Evidence Based Support for the Surgical Treatment Algorythm of Osteonecrosis of the Femoral Head? Presented by Paul Edwards, M.D., University of South Florida, Tampa, at the 2008 Florida Orthopaedic Society Annual Meeting.
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http://www.yourlawyer.com/new-york/car-auto-accident-attorney-lawyer-lawsuit-NY Attorney Jonathan Macri of Parker Waichman talks to you about whether or not your injury qualifies as a "threshold injury" and why that should matter to you. Under personal injury law, you may not be able to seek compensation for your injuries in a car accident unless they qualify as a serious injury. This type is injury is called a "threshold injury." Injuries of this type include those that are permanent or can cause a very long recovery time. Compound fractures, brain or spine injuries, amputation, and permanent disfigurement are some examples of injuries that fall under the threshold category. This law is intended to keep smaller cases from clogging up the court system and allow those who have more qualifying injuries the ability to seek compensation from the party that harmed them. Another way this protects the injured victim is if both your insurance company and that of the other party have paid out your coverage and you're still dealing with more medical bills, lost wages, and other economic losses due to the life altering severity of your injury. Watch this video now to learn more. To learn more about personal injury law, I encourage you to watch the video above and to explore our educational website at http://www.yourlawyer.com/new-york/car-auto-accident-attorney-lawyer-lawsuit-NY. If you have legal questions, I want you to call me at (800) 800-9797. I welcome your call. Jonathan Macri Parker | Waichman LLP 6 Harbor Park Drive Port Washington, NY 11050 (800) 800-9797 http://yourlawyer.com
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Nonenhanced CT: no free fluid GOT: 140
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Dr. Clifford Rosen, director of clinical and translational research and senior scientist at the Maine Medical Center Research Institute, gives a "tour" of the recent history of osteoporosis research and the NIH's and the NIAMS' role in sponsoring much of it. Among the examples Rosen highlights are genetic studies that have improved our understanding of a major cell-signaling pathway in osteoporosis, the wealth of new basic and translational research spawned by that understanding, and the importance of data that continue to come from the NIH-funded Study of Osteoporotic Fractures, now in its twenty-first year.
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The radio show Calling All Cars hired LAPD radio dispacher Jesse Rosenquist to be the voice of the dispatcher. Rosenquist was already famous because home radios could tune into early police radio frequencies. As the first police radio dispatcher presented to the public ear, his was the voice that actors went to when called upon for a radio dispatcher role. The iconic television series Dragnet, with LAPD Detective Joe Friday as the primary character, was the first major media representation of the department. Real LAPD operations inspired Jack Webb to create the series and close cooperation with department officers let him make it as realistic as possible, including authentic police equipment and sound recording on-site at the police station. Due to Dragnet's popularity, LAPD Chief Parker "became, after J. Edgar Hoover, the most well known and respected law enforcement official in the nation". In the 1960s, when the LAPD under Chief Thomas Reddin expanded its community relations division and began efforts to reach out to the African-American community, Dragnet followed suit with more emphasis on internal affairs and community policing than solving crimes, the show's previous mainstay. Several prominent representations of the LAPD and its officers in television and film include Adam-12, Blue Streak, Blue Thunder, Boomtown, The Closer, Colors, Crash, Columbo, Dark Blue, Die Hard, End of Watch, Heat, Hollywood Homicide, Hunter, Internal Affairs, Jackie Brown, L.A. Confidential, Lakeview Terrace, Law & Order: Los Angeles, Life, Numb3rs, The Shield, Southland, Speed, Street Kings, SWAT, Training Day and the Lethal Weapon, Rush Hour and Terminator film series. The LAPD is also featured in the video games Midnight Club II, Midnight Club: Los Angeles, L.A. Noire and Call of Juarez: The Cartel. The LAPD has also been the subject of numerous novels. Elizabeth Linington used the department as her backdrop in three different series written under three different names, perhaps the most popular being those novel featuring Det. Lt. Luis Mendoza, who was introduced in the Edgar-nominated Case Pending. Joseph Wambaugh, the son of a Pittsburgh policeman, spent fourteen years in the department, using his background to write novels with authentic fictional depictions of life in the LAPD. Wambaugh also created the Emmy-winning TV anthology series Police Story. Wambaugh was also a major influence on James Ellroy, who wrote several novels about the Department set during the 1940s and 1950s, the most famous of which are probably The Black Dahlia, fictionalizing the LAPD's most famous "cold case", and L.A. Confidential, which was made into a film of the same name. Both the novel and the film chronicled mass-murder and corruption inside and outside the force during the Parker era. Critic Roger Ebert indicates that the film's characters (from the 1950s) "represent the choices ahead for the LAPD": assisting Hollywood limelight, aggressive policing with relaxed ethics, and a "straight arrow" approach. http://en.wikipedia.org/wiki/LAPD
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