By David Ip
The scope of orthopedic wisdom has increased to this sort of measure that it has develop into more and more tricky to keep up a basic grab of the necessary wisdom base. this is often compounded by the point constraints on grownup studying, with the coed or practitioner confronted with ever-increasing calls for on their time. this article is a far wanted source of orthopedic wisdom, with the intention to end up valuable not just to those in education but additionally to these confronted by means of the ever-increasing calls for of certification and recertification examinations. good illustrated and arranged into 8 chapters extending fro. Read more...
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Extra resources for Orthopedic principles--a resident's guide
8 Appendix 1 Role of Vitamin D in Calcium and Phosphate Metabolism n UV light converts dietary pro-vitamin D2 and D3 to cholecalciferol n Then undergoes 25- and 1-hydroxylation at the liver and kidney re- n n n n spectively (in cases with high calcium, mainly 24,25-dihydroxy vitamin D will be made in the kidney) Acts on targets by diffusion through cytoplasmic membrane; bound to cellular protein and transported to the nucleus In bone, stimulates both osteoblasts and osteoclasts, increases mineralisation and resorption and increases collagen production Kidney: like PTH, vitamin D increases calcium absorption.
Whether bone or other connective tissue, like cartilage/fibrous, form depends on the strain theory put forward by Parren. Bone cannot form if the strain is too high n Intramedullary (IM) nail: healing by mainly external callus formation n Distraction osteogenesis is a special case: bone formation by intramembranous ossification if given adequate rigidity Fig. 2. Cutting cone 16 1 Orthopaedic Basic Science and Commmon Injuries Fig. 3. Natural healing by external calluses [By contrast, natural healing by callus can be strong, although often malaligned.
15 Operative Rn n Arthroscopic drilling and fixation ± Based on the theory that the lesion is regarded as a fracture nonunion, works by penetration of the subchondral bone to initiate inflammatory cascade ± Types: antegrade versus retrograde drilling, an undesirable consequence of antegrade drilling, is the creation of permanent drill holes in the articular surface that fill with fibrocartilage [retrograde drilling with bone graft (BG) sometimes advocated for in situ lesions with intact overlying articular cartilage] ± Fixation of osteochondral lesions increase the likelihood of maintaining joint congruity during healing and potential to allow early range of motion (ROM; by means of K-wires, Herbert, Acutrak) ± important to bury screw head n Abrasion chondroplasty and microfracture ± Again, stimulation of cartilage regeneration by penetration of the subchondral bone to release pluripotential stem cells 36 1 Orthopaedic Basic Science and Commmon Injuries ± Subchondral drilling ± fibrin clot formation ± stem cell migration ± chondrocyte differentiation ± repair the defect ± Histology: fibrous or mixed fibro- and hyaline cartilage.