By L. Tom. North Greenville University. 2017.

Patients with DDH mainly present anatomical challenges (shallow acetabu- lum discount 10mg accupril visa, greater femoral anteversion and neck–shaft angle buy generic accupril 5 mg online, lower offset, and leg length inequalities). Our experience with resurfacing is limited to Crowe class I and II DDH, 200 H. A Anteroposterior radiograph of a 47-year-old man with posttraumatic osteonecrosis consecutive to a bicycling accident. The femoral neck fracture was pinned, and the tracks are visible both on the radiograph and in the intraoperative photograph (insert). The additional area for fixation due to the pin tracks may have enhanced the initial fixation. B Nine years after metal-on-metal resurfacing, the patient has resumed a very active lifestyle (including ski racing), and his UCLA hip scores are 10 for pain, walking, and function, and 9 for activity and the results for this etiology were characterized by perfect acetabular initial and enduring component stability, despite incomplete lateral acetabular coverage of the socket (up to 10%–20%), without the need for a special component with adjunct side bar and screw fixation. The rough surface with small porous beads (75–150μm) pro- vides excellent initial stability when a 1-mm-interference anteroposterior fit is obtained between the anterior and posterior columns. Femoral component durability has been more of a challenge because of failure to provide intimate fixation with good-quality bone, but this problem now appears to be solved with the second- generation surgical technique and cementing of the stem in patients with risk factors. The technical difficulty of resurfacing patients with LCP disease or SCFE is also related to the anatomical characteristics of these hips. The femoral head is generally flattened, the neck–shaft angle is lower than average, the neck is wide and short, and range of motion is consequently reduced (Fig. Notching of the thicker medial cortex of the femoral neck was sometimes necessary to fit the femoral component when the head–neck ratio approached 1 and the standard-thickness sockets were utilized. However, no femoral neck fractures have been recorded in our series with Metal-on-Metal Resurfacing 201 A B Fig. A Anteroposterior radiograph of a 32-year-old man with osteoarthritis (OA) of the left hip secondary to Legg–Calve–Perthes (LCP) disease. Inserts show the Johnson lateral radio- graph and the femoral head (above) after preparation.

Urbaniak JR generic accupril 10mg on-line, Coogan PG buy accupril 10mg with amex, Gunneson EB, Nunley JA (1995) Treatment of osteonecrosis of the femoral head with free vascularized fibular grafting: a long-term follow-up study of one hundred and three hips. Wagner H, Zeiler G (1980) Idiopathic avascular necrosis of the femoral head. Results of intertrochanteric osteotomy and resurfacing (author’s transl). Maistrelli G, Fusco U, Avai A, Bombelli R (1988) Osteonecrosis of the hip treated by intertrochanteric osteotomy: a four to 15 year follow-up. Ganz R, Buechler U (1983) Overview of attempts to revitalize the dead head in aseptic necrosis of the femoral head: osteotomy and revascularization. Dean MT, Cabenela ME (1993) Transtrochanteric anterior rotational osteotomy for avascular necrosis of the femoral head. J Bone Joint Surg 75B:597–602 Vascularized Iliac Bone Graft Using Deep Circumflex Iliac Vessels for Idiopathic Osteonecrosis of the Femoral Head Kunihiko Tokunaga, Muroto Sofue, Youichirou Dohmae, Kenji Watanabe, Masaki Ishizaka, Yutaka Ohkawa, Toshio Iga, and Naoto Endo Summary. This study aimed to analyze the clinical and radiologic findings of 59 hips from 46 patients who underwent vascularized iliac bone graft (VIBG) using the deep circumflex iliac artery and vein for idiopathic osteonecrosis of the femoral head (ION). More than half of the femoral heads collapsed even though they did not show preoperative collapse. In males, preoperative collapse of the femoral head, bone graft with total curettage of the osteonecrotic lesion, and bilateral VIBG reduced JOA scores. For patients over 30 years old, preoperative collapse, bone graft with total curettage of the osteonecrotic lesion, and abuse of alcohol reduced survival rate after VIBG when the endpoint was set as collapse of the femoral head. These data suggest that young patients suffering from early-stage ION without collapse of the femoral head should be indicated to undergo VIBG. However, VIBG is only a time-saving surgery to postpone performing total arthroplasty or hemiarthroplasty for patients with early-stage ION because VIBG cannot always improve hip function and femoral head deformity. Idiopathic osteonecrosis, Femoral head, Vascularized iliac bone graft, Collapse, Time-saving surgery Introduction Since 1982, vascularized iliac bone graft (VIBG) has been performed using the deep circumflex iliac vessels in patients suffering from idiopathic osteonecrosis of the femoral head (ION) [1,2]. The concepts of our VIBG method are based on the aim to Division of Orthopedic Surgery, Department of Regenerative Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan 125 126 K.

Use of automated external defibrillators by the AED scheme so that data may be extracted from the a US airline discount accupril 20mg without a prescription. Ensure all supplies are replenished ready for the ● Resuscitation Council (UK) accupril 10mg low cost. The diagram of the algorithm for the use of AEDs is adapted from ● Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman Resuscitation Guidelines 2000, London: Resuscitation Council (UK), RG. PEA was formerly known as electromechanical dissociation but, by international agreement, PEA is now the preferred term. In the community, VF is the commonest mode of cardiac arrest, particularly in patients with coronary disease, as Asystole: baseline drift is present. The ECG is rarely a completely straight line in asystole described in Chapter 2. Asystole is the initial rhythm in about 10% of patients and PEA accounts for an even smaller proportion, probably less than 5%. The situation is different in hospital, where the primary mechanism of cardiac arrest is more often asystole or PEA. These rhythms are much more difficult to treat than VF and carry a much worse prognosis. Asystolic cardiac arrest Suppression of all natural or artificial cardiac pacemakers in asystolic cardiac arrest leads to ventricular standstill. Under normal circumstances an idioventricular rhythm will maintain The onset of ventricular asystole complicating complete heart block cardiac output when either the supraventricular pacemakers fail or atrioventricular conduction is interrupted. Myocardial disease, electrolyte disturbance, anoxia, or drugs may suppress this idioventricular rhythm and cause asystole. Excessive vagal activity may suddenly depress sinus or atrioventicular node function and cause asystole, especially when sympathetic tone is reduced—for example, by blockers. Asystole will also occur as a terminal rhythm when VF is not successfully treated; the amplitude of the fibrillatory waveform declines progressively as myocardial energy and oxygen supplies are exhausted and asystole supervenes.

On social occa- dic Surgeons generic 5mg accupril visa, and an associate member of the sions generic accupril 20mg visa, he loved to be surrounded by the younger French Academy of Orthopedic Surgery. Smith-Petersen died on June 16, 1953 in a Scandinavian manner, and provoking both at the age of 67, after a short illness. After the Second World War, he visited Great Britain in 1947, 1948 and 1952. On the foremost occasion, he was made an Honorary Fellow of the British Orthopedic Association, and also deliv- ered the fourth Moynihan Lecture at the Univer- sity of Leeds. He also took charge of the orthopedic staff conference and operated before a distinguished audience at the London Hospital. At a reception following this occasion, the gift of his characteristic ties will long be remembered by the recipients. It was during this friendly and amusing ceremony that the household dog laid her favorite bone at Dr. Smith-Petersen’s feet, this bone was none other than half the pelvis including the hip joint! After the termination of this visit to England, a Jensen silver bowl was presented to him by the staff of the London Hospital at a simple and moving little ceremony, which brought tears to the eyes of this great and senti- mental man. Smith-Petersen, accompanied by his wife, visited London to be given the Honorary Fellowship of the Royal Society of Medicine, and to attend the meeting of 311 Who’s Who in Orthopedics control. In World War II, he served in the United States Army from 1942 to 1946, first with the Twenty- fifth Evacuation Hospital and then as chief con- sultant in orthopedic surgery to the South Pacific area, the Tenth Army at Okinawa, and the Pacific. He was awarded the Legion of Merit, a Bronze Star, and five battle stars, and achieved the rank of colonel. On returning to civilian life, he became chief surgeon at Shriners Hospital for Crippled Chil- dren in Chicago; he retained that post until 1965, after which he remained a consultant until his death. He succeeded Beveridge Moore, about whom he often spoke and whom he greatly admired. Sofield truly enjoyed caring for the children at Shriners and was well known for his Harold Augustus SOFIELD technique of multiple osteotomies and intramedullary fixation (the shish-kebab opera- 1900–1987 tion) for osteogenesis imperfecta. His attitude of Harold Augustus Sofield was born in Jersey City, open-mindedness, relaxation, good humor, and New Jersey, on March 27, 1900.