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Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
Bleeding is noted to be emanating from the distal ICA, from a zone III injury. You can't get to it from a standard zone II neck exploration incision (mastoid process to sternoclavicular joint). What are some surgical manoeuvers that you can do to attain more distal control?Incise the anterior digastric muscle.Sublux the mandibular condyle anteriorly at the temporomandibular joint (request ENT assistance) (Figure 11.6).Mandibular osteotomy (Figure 11.7).Ligation of distal ICA may be the only solution if the transected artery has retracted and not amenable to reconstruction.
Musculoskeletal Ultrasound
Published in John McCafferty, James M Forsyth, Point of Care Ultrasound Made Easy, 2020
The knee joint is a synovial joint (lined with synovium and with a joint capsule) with one primary direction of movement (flexion/extension). The femur articulates with the tibia inferiorly and the patella anteriorly. The fibula articulates only with the tibia and is an important attachment site for some of the many stabilising ligaments of the knee. The patella is the largest sesamoid bone in the body, embedded within the quadriceps and patellar tendons which traverse the anterior aspect of the knee joint. Where the femoral condyles articulate with the tibial plateau are two menisci (medial and lateral), providing cushioning for this load-bearing joint and allowing a more even distribution of weight (see Figure 7.4 for the relevant knee anatomy).
Fundamentals
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
Bones have many different landmarks or features at and around the joints. Bony landmarks can be divided into articulating and non-articulating surfaces. Articulating surfaces are smooth cartilage-covered parts of bone that are part of the joints. Non-articulating surfaces are located at various sites on the bone where muscles, tendons, and ligaments attach. A head is an articulating surface that is rounded like a ball. The head of the humerus and the head of the femur are part of ball and socket joints at the shoulder (see shoulder complex – bones) and hip (see hip – bones) respectively. A condyle is a large articulating knob that is part of a compound joint. Examples are the femoral condyles at the knee (see knee – bones). A facet is a flat or shallow articular surface found at a gliding or sliding joint (see joint classification). The facets of the superior and inferior articular processes of the vertebrae are good examples (see vertebral structure).
A novel treatment of pediatric bilateral condylar fractures with lateral dislocation of the temporomandibular joint (TMJ) using transfacial pinning
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Kerry A. Morrison, Roberto L. Flores
The patient was a healthy 3-year-old male, who was an unrestrained passenger in a golf cart accident. Physical examination was notable for panfacial edema with no soft tissue injuries, very limited oral excursion, and an intact facial nerve bilaterally. Computed tomographic (CT) craniomaxillofacial findings revealed a tripartite mandibular fracture, including bilateral condylar fractures with lateral dislocation of the left condyle and a symphyseal fracture (Figure 1). There was a complete right condylar neck fracture with lateral apex angulation as well as medial and inferior dislocation of the right mandibular condyle. The symphyseal fracture was associated with lateral displacement of the mandibular angle, bilaterally. Physical exam included bilateral lateral crossbite, retrognathia and an open bite deformity. The remainder of the patient’s facial architecture was intact, the patient’s cervical spine was cleared both clinically and radiographically, and there were no other physical injuries noted.
Elbow dislocation with lateral condyle and coronoid fractures
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Yousef Fallah, Behnam Baghianimoghadam, Seyed-Aref Daneshi
By a direct lateral incision, the brachialis and brachioradialis muscles are shaved about 3 cm above the lateral condyle from the lateral surface of the humerus. Lateral condyle fracture was reduced and fixed with three full-threaded cortical screws (Figure 2). Considering that the lateral collateral ligament (LCL) was intact and attached to the condylar fragment, we hoped that the joint became stable by fixing the fractured fragment. Then, the surgeon examined the elbow by gravity extension test, but the elbow was unstable in extension more than 50° of flexion. Therefore, the incision extended distally by splitting the extensor digitorum communis (EDC) [2], and the anterior capsule with coronoid was exposed. As the coronoid fracture size was small (type I Regan Morrey), the anterior capsule of the elbow was reattached to the ulna with trans-osseous Ethibond No. 5 thread; hence, the elbow became stable after that.
Influence of tibial bearing curvatures of a customised total knee implant on squatting motion and loads
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
The tibial shape was generated by fitting one longitudinal and two transverse curves to each original femoral condyle (Wang and Wang 2019). A range of longitudinal tibial surface shapes was created from the original fitted curve by multiplying the fitted elliptical long axis radius of the original femoral condyle (a_ellipse) by a coefficient (i = 2,4,6) to give a_ellipse_new (Figure 3(a)). Two transverse quadratic curves on each condyle (medial transverse curve and lateral transverse curve) were then calculated to fit the cross-section curves of each femoral condyle through least squares fitting. A range of transverse shapes was created through multiplying the coefficients of the original fitted quadratic curves by additional coefficients C1 and C2. The medial condyle of the tibial bearing has the two transverse curves Figure 3(c) and defined in Eqs. (1) and (2), while the lateral condyle has Figure 3(c) and Eqs. (3) and (4)). The extra multiplying coefficients, C1 and C2, were assumed to be the same for both condyles. Six different pairs of the transverse coefficients were defined. Thus, in this paper three different longitudinal curves and six different sets of medial and lateral transverse curves were implemented using the coefficients listed in Table 1 to investigate their effect on the tibiofemoral dynamic behaviour during squatting motion.