tag:blogger.com,1999:blog-84650978362079299402024-03-12T21:13:14.666-07:00Sports MedicineThis is the blog where i write my thoughts on all issues related to sports medicineDr Sanjib kumar Beherahttp://www.blogger.com/profile/16228885482003673646noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-8465097836207929940.post-40236436935511855462011-11-03T23:28:00.000-07:002011-11-03T23:55:57.920-07:00Treatment of Tibial Shaft Fracture - MIPOTibial fracture look very simple to treat, but it posses a bigger exigent problem when it comes to choose a suitable implants and method to fix the Simple , Segmental or Comminuted tibial shaft fracture.<br /><br />In the past a large incision was used in exposing the bone to achive reduction and plate fixation. Soft tissue like skin, muscle and vascularityof the will be damaged and jeopardized because of the large incision and extensive dissection.<br />The insertion of Implant through a small incision will reduce the damage to the muscle, surrounding soft tissue and will preserve the blood supply to the bone.<br />As tibia is eccentrically placed in the circumference of the leg ,and due to its triangular shape, which is beautifully flat to accommodate a flat plate on it surface without any hitch. I therefore decide to put plate subcutaneously through a small hole in a uncomplicated tiia fracture.<br /><br />The peculiarity of the study, we used 4.5.narrow / broad DCP for fixation of fracture with MIPO. technique and under the image intensifier guidance.<br />There are difficult in reduction of tibia fracture when it is spiral and long spiral fracture. In the transvse fracture a simple technique is applied with a small periostal elevated a small hole lift the posterior displaced fragment while levearging on the anteriorly displaced fracture fragment. Long spiral fracture posses difficultly in reduction because of soft tissue and periostal interposition. In this situation Interfragmentary screw screw through the plate or direct IF screw is used to achivenear complete reduction. Technique of MIPO with DCP in the initial was difficult and more time consuming and radiation exposure time nearly 2-4 minutes.<br /><br /><br />We did not use this in impending compartment syndrome or very much swollen limb. In the swollen limb waiting period of 2-3 days with limb elevation till the swelling subside.<br /><br />In all cases we achieved 99% accurate bone contact and alignment in non comminuted fracture. Very acceptable accuracy in severely comminuted fracture. Average union time 10 weeks – 14 weeks. Longer in severely comminuted fractures. Delayed union in 16 cases but no surgery required for achievement of union and 8 were non union. Where bone grafting and change of implant was required. No skin or soft tissue break down observed. Superficial soft tissue infection in 5 cases and deep bone infection in 2 cases. Infected Non union tibia case and refixed locking plate used as locking plate. Non union is seen and implant fracture plate removed and fixed with locking plate and Bone gravity.<br /><br />Percutaneouse plating is minimally invasive and uses indirect reduction technique to achieve a biological stable fixation. In addition to better fixation it gives a better cosmetic value, functional rehabilitation and lees soft tissue complication are encouraging and so it prompt the usage of this technique more commonly. The graph of time started coming time with increase numbers of Patient. It is difficult to put a screw in DCP hole as there is no way to hold the plate in position with reduction is maintained. Spiral fracture easier to plate but complete reductions are not achieved all the time because of soft tissue interposition. Comminuted facture with large fragment is difficult to plate than the small fragment communatio<br /><br />To conclude it was technically difficult in the initial stage but gradually the graph of time consumption of surgery started falling with increasing number.<br />Comparison with Locking plate time consumption with this technology, it is 60% - 70%. less<br />Advantage is less exposure to x-ray radiation and very good results with low cost and the same logistic. The union rate with the plate and screw through MIPO is highly commendable.<br /><br />MIPO featuring small incision, limited periostal strippering and indirect reduction technique has biological advantage compare to standard plating method. Although technically challenging, acceptable reduction and stable fixation was achieved in all the patients.<br /><br /><br />Dr.Sanjib Kumar Behera<br />Consultant Orthopaedic Surgeon<br />Yashoda Hospital, Secunderabad<br />Ph - 9440180980Dr Sanjib kumar Beherahttp://www.blogger.com/profile/16228885482003673646noreply@blogger.com0tag:blogger.com,1999:blog-8465097836207929940.post-57803849115643853222011-10-19T09:41:00.000-07:002011-10-19T10:09:41.516-07:00Shoulder Arthoscopy for Rotator Cuff Tear<p style="language:en-US;margin-top:5.76pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span" ><span style="font-family: Calibri; color: rgb(204, 51, 0); font-weight: bold; ">Sanjib Kumar Behera</span><span style="font-family: Calibri; color: rgb(204, 51, 0); font-weight: bold; "> </span></span></p> <p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span style="font-family: Calibri; color: rgb(31, 73, 125); "><b><span class="Apple-style-span" >MS(Ortho),DNB(Rehab),ISAKOS Fellow(France)</span></b></span></p> <p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><b><span class="Apple-style-span" ><span style="font-family: Calibri; color: rgb(31, 73, 125); ">Member of International Society of </span><span style="font-family: Calibri; color: rgb(31, 73, 125); ">Arthoscopy,Knee</span><span style="font-family: Calibri; color: rgb(31, 73, 125); "> surgery and Sport Medicine</span></span></b></p> <p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span style="font-family: Calibri; color: rgb(31, 73, 125); "><b><span class="Apple-style-span" >Member SICOT</span></b></span></p> <p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span" ><span style="font-family: Calibri; font-weight: bold; ">Yashoda</span><span style="font-family: Calibri; font-weight: bold; "> Hospital</span></span></p> <p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span" ><span style="font-family: Calibri; font-weight: bold; ">Secunderabad</span><span style="font-family: Calibri; font-weight: bold; "> </span></span></p><p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span" ><b>Shoulder Pain can be devastating and very disabling. Improper diagnosis can be more worst than any damage control.</b></span><span class="Apple-style-span" style="font-family: Calibri; font-size: small; "><b>A small lesion in the rotator cuff (like impingement syndrome,Partial tear of supraspinatus) can turn into full tear and powerless abduction.</b></span></p><p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span" ><b>Many atimes this is improperly diagnosed as Frozen shoulder by many surgeon, Doctor, Physiotherapist and unacceptable treatmemt (Excercise , Shoulder mobilisation,TENS, Manupution underAnaesthsia, Intra-articular steroid Injection) being advocated to this problem which results in Rotator cuff Tear. Most acceptable treatment for this is Arthoscopy assisted Rotator cuff repair. But this is a very skilled jobs and this is carried out by few surgeon in India who vast experince in orthopeadic. Many Surgeon claim themselves to be a shoulder surgeon but this is true.</b></span></p><p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span" ><b><br /></b></span></p>Dr Sanjib kumar Beherahttp://www.blogger.com/profile/16228885482003673646noreply@blogger.com0tag:blogger.com,1999:blog-8465097836207929940.post-56728439566121568772011-10-18T07:31:00.000-07:002011-10-18T07:59:16.700-07:00Total Knee Replacement<p style="language:en-US;margin-top:5.76pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span"><span style="font-family: Calibri; color: rgb(204, 51, 0); font-weight: bold; ">S.K.Behera</span><span style="font-family: Calibri; color: rgb(204, 51, 0); font-weight: bold; "> </span></span></p> <p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span style="font-family: Calibri; color: rgb(31, 73, 125); font-weight: bold; "><span class="Apple-style-span">MS(Ortho),DNB(Rehab),ISAKOS Fellow(France),D .P.M.R.,</span></span></p> <p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span"><span style="font-family: Calibri; color: rgb(31, 73, 125); font-weight: bold; ">Member of International Society of </span><span style="font-family: Calibri; color: rgb(31, 73, 125); font-weight: bold; ">Arthoscopy,Knee</span><span style="font-family: Calibri; color: rgb(31, 73, 125); font-weight: bold; "> surgery and Sport Medicine</span></span></p> <p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span style="font-family: Calibri; color: rgb(31, 73, 125); font-weight: bold; "><span class="Apple-style-span">Member SICOT</span></span></p> <p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span"><span style="font-family: Calibri; color: rgb(137, 137, 137); font-weight: bold; ">Yashoda</span><span style="font-family: Calibri; color: rgb(137, 137, 137); font-weight: bold; "> Hospital</span></span></p> <p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span"><span style="font-family: Calibri; color: rgb(137, 137, 137); font-weight: bold; ">Secunderabad</span><span style="font-family: Calibri; color: rgb(137, 137, 137); font-weight: bold; "> </span></span></p><p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span" style="font-family: Calibri; "><span class="Apple-style-span"><b>Objective of Prosthesis replacement</b></span></span></p><p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span" style="font-family: Calibri; "><span class="Apple-style-span"><span style="font-family: Calibri; color: black; ">Distribute contact Stresses across the artificial Joint as symmetrically as possible, even if this implies deviation from the normal in general and individual anatomy in particular</span></span></span></p><p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span class="Apple-style-span"><span style="font-family: Calibri; color: black; ">Number of joint replacement surgery is increasing because of awareness spread through sensible </span><span style="font-family: Calibri; color: black; ">communication</span><span style="font-family: Calibri; color: black; ">, availability and affordability.</span></span><span class="Apple-style-span" style="font-family: Calibri; font-size: medium; ">.</span></p><p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span style="font-family: Calibri; "></span></p><div style="color: rgb(137, 137, 137); margin-top: 8.64pt; margin-bottom: 0pt; margin-left: 0.38in; text-indent: -0.38in; text-align: left; direction: ltr; unicode-bidi: embed; word-break: normal; "><span style="font-family: Calibri; color: black; "><span class="Apple-style-span"><span class="Apple-tab-span" style="white-space:pre"> </span>Femoral component</span></span><span class="Apple-style-span" style="color: rgb(0, 0, 0); "><span class="Apple-style-span" style="font-family: Calibri; font-size: medium; ">Patellar ,</span><span class="Apple-style-span" style="color: rgb(137, 137, 137); font-family: Calibri; "><span style="font-family: Calibri; color: black; "><span class="Apple-style-span">Base Plate and</span></span></span><span class="Apple-style-span" style="color: rgb(137, 137, 137); font-family: Calibri; "><span class="Apple-style-span"><span style="font-family: Calibri; color: black; ">Tibial</span><span style="font-family: Calibri; color: black; "> Insert The </span></span></span><span class="Apple-style-span" style="color: rgb(137, 137, 137); font-family: Calibri; font-size: medium; "><span style="font-family: Calibri; color: black; ">Tibial</span><span style="font-family: Calibri; color: black; "> component</span></span></span></div><p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span style="font-size: medium; font-family: Calibri; color: black; ">Soft tissue Balancing during the TKA is very important step in </span><span style="font-size: medium; font-family: Calibri; color: black; ">optimsing</span><span style="font-size: medium; font-family: Calibri; color: black; "> the mechanical<span> </span>balance of the knee joint </span><span style="font-size: medium; font-family: Calibri; color: black; ">P</span><span style="font-family: Calibri; color: black; "><span class="Apple-style-span">roper soft tissue balancing during TKA is a paramount to ensure long term success</span></span></p><p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span style="font-family: Calibri; color: black; "><span class="Apple-style-span">This is very important Surgery it should be performed very carefully .</span></span></p><p style="language:en-US;margin-top:4.32pt;margin-bottom:0pt;margin-left:0in; text-indent:0in;text-align:center;direction:ltr;unicode-bidi:embed;mso-line-break-override: none;word-break:normal;punctuation-wrap:hanging"><span style="font-size:18.0pt;font-family:Calibri;mso-ascii-font-family:Calibri; mso-fareast-font-family:+mn-ea;mso-bidi-font-family:+mn-cs;color:#898989; mso-color-index:1;mso-font-kerning:12.0pt;language:en-US;font-weight:bold"><br /></span></p>Dr Sanjib kumar Beherahttp://www.blogger.com/profile/16228885482003673646noreply@blogger.com0tag:blogger.com,1999:blog-8465097836207929940.post-8481997054232778442010-03-10T03:49:00.000-08:002010-03-10T04:20:17.131-08:00Sport person having shoulder problem.Rotator cuff injuries in young adultand Sport Persons populations more complex and controversial matter.Numerous cause have been proposed for these conditions,including outlet impingement, impingement due to glenohumeral instability,abutment of the cuff tendon in the glenoid labrum. The introduction of the Shoulder Arthoscopy in the evalutation and treatment of rotator disease has had a profound impact.<br />It is very high skilled surgery and is done by few surgeons allthrough in India. this procedure are regularly performed by our team in Yashoda Hospital . Secundrabad.Dr Sanjib kumar Beherahttp://www.blogger.com/profile/16228885482003673646noreply@blogger.com0tag:blogger.com,1999:blog-8465097836207929940.post-79416133007136349402010-03-07T08:46:00.000-08:002010-03-07T09:01:49.500-08:00Myth or real Shoulder pain termed as Frozen Shoulder.Term Frozen Shoulder is used discrimnately for any shoulder pain with or without restriction of shoulder by the doctor, surgeon or Physician.<br />This in fact is not true. Commonly Shoulder pain is associated with restriction of movement should be properly examnied and investigated in the required direction. Most of the time if there is no trauma or injury is not involved the suspicion should go in the direction of the Rotator cuff Tear or Impingment syndrome and If this when diagnosed and after giving proper conservative treatment doesn't resolve then the final treatment is Artyhoscopic surgery.<br />85% of the cases it resolved with the Arthoscopic Asisted Surgery give good Result.Dr Sanjib kumar Beherahttp://www.blogger.com/profile/16228885482003673646noreply@blogger.com0