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By O. Taklar. California State University, Fullerton. 2018.

Flamme C generic celebrex 200mg overnight delivery, Wirth CJ buy cheap celebrex 200mg line, Stukenborg-Colsmann C (2001) Charakteristik der Lernkurve bei der Hüfttotalendoprothese am Beispiel der Bicontact-Prothese. Int Orthop 27(suppl 1):2–6 Twenty Years of Experience with the Bernese Periacetabular Osteotomy for Residual Acetabular Dysplasia 1 2 Reinhold Ganz and Michael Leunig Summary. Residual acetabular dysplasia is known as the most frequent cause of early osteoarthritis of the hip. The degeneration starts with overload of the rim, leading to a variety of pathologies. This change may cause the femoral head to migrate further out of the socket, resulting in a loss of congruity and generating even higher pressure point loading, which finally leads to rapid destruction of the joint. It is well accepted today that the surgical increase of the load transmission area can slow down this process of destruction and postpone total hip replacement (THR) substantially. Among the different techniques available, reorientation procedures allow for the most physiological correction of the joint mechanics. Our proposition is a reorientation procedure, which was first executed in 1984. Under the name of the Bernese periacetabular osteotomy, the technique has gained popularity, especially in North America. Our 20 years’ expe- rience performing this osteotomy through a modified Smith-Peterson approach without dissection of the abductors has clearly shown that confound appreciation of joint mechanics is the key to a successful result. Addressing acetabular retroversion and an insufficient femoral head/neck offset has helped to avoid postosteotomy impingement and significantly improved our results. Today, in our armentarium of surgical techniques to preserve the natural hip joint, the periacetabular osteotomy leads to the most predictable results. Hip, Young adults, Dysplasia, Joint preservation, Periacetabular osteotomy Introduction Residual acetabular dysplasia is known as the most frequent cause of osteoarthritis of the hip, leading to joint destruction in 25% to 50% of cases by the age of 50 years. In the classic pathomorphology, the degeneration starts early with overload of 1Department of Orthopaedic Surgery, Balgrist University Hospital, Forchstr. Leunig the anterolateral joint, visible by the increased subchondral sclerosis on standard anteroposterior (AP) X-rays. It is well accepted today that surgical increase of the local transmission area and a more even load transmission can slow the process of destruction and postpone total hip replacement substantially. Among the different techniques available, reori- entation procedures allow for the most physiological correction of the joint mechan- ics. Based on limitations with several of the former techniques (Table 1), we defined in 1983 the aspects to be achieved with a new technique as follows: optimal correction including version and medialization of the acetabular fragment; a single approach to avoid repositioning of the patient during the procedure; easy fixation of the fragment allowing for early ambulation; and unlimited access to the joint to treat intracapsular pathologies without the potential risk of avascular necrosis of the acetabular fragment. Finally, the new technique should allow major bilateral correction without narrowing of the birth canal because most of the patients are females of reproductive age. The new technique, which was tested on 25 cadavers and performed for the first time in March 1984 (Fig. Characteristics of reorientation procedures Author(s) Type of Incisions Possible Relationship Perfusion of osteotomy intracapsular to acetabulum fragment surgery Salter Single 1 — Distant + +(+) Sutherland Double 2 — Distant + +(+) Hopf Double 1(2) — Distal (+) intraarticular LeCoeur Triple 3 — Juxtaarticular + +(+) Steel Triple 3 — Distant + +(+) Tonnis Triple 3 — Juxtaarticular + + + Carlioz Triple 3(2) — Juxtaarticular + + + Nishio Spherical 1 +) Close +(−) Ninomiya Spherical 1 +) Close +(−) Eppright Spherical 1 +) Close + Wagner Spherical 1 +) Close + Kuznenko Translation? Ganz Periacetabular 1 + + Juxtaarticular + + + Periacetabular Osteotomy in Treatment of Hip Dysplasia 149 incomplete cut of the ischium followed by the complete osteotomy of the pubis. For the supra- and retroacetabular chevron-type osteotomy, we abandoned early the detachment of the abductor muscles from the ilium for a complete intrapelvic execution. For the execution, a set of special retractors and osteotomes is needed. Intraoperative fluoroscopy is not necessary, although it is used by most surgeons. Although the execution of the osteotomies becomes easy with time, the precise special orientation of the frag- ment remains challenging (Fig. Postoperative treatment consists of toe-touch weight-bearing for 6 to 8 weeks. Ninety percent of the hips are consoli- dated by then for full weight-bearing. Over the following years, several vascular studies have been performed to confirm the intact perfusion of the acetabular fragment [5–8]. The technique and our own results have been published on several occasions [5,9–11]. The procedure has gained popularity, especially in North America [12–19]. Our own experience is based on more than 1500 operated hips over the years.

Other information which could be included as an appendix are recruitment leaflets or letters; practical details about each research participant; sample transcripts (if permission has been sought); list of inter- view dates; relevant tables and graphs or charts which are too bulky for the main report discount 200 mg celebrex mastercard. X It is obvious that ideas and sentences have been ta- ken from other sources generic 100mg celebrex. Most academic journals do not pay for ar- ticles they publish, but many professional or trade publi- cations do pay for your contribution, if published. However, competition can be fierce and your article will have to stand out from the crowd if you want to be suc- cessful. The following steps will help you to do this: X Choose a topical, original piece of research. X Do your market research – find out which journal pub- lishes articles in your subject area. X Check on submission guidelines – produce an article in the correct style and format and of the right length. X Read several copies of the journal to get an idea about the preferences of editors. X If you are thinking about writing for a trade publica- tion, approach the editors by letter, asking if they might be interested in an article. X Produce a succinct, clear, interesting and well-written article – ask friends, tutors or colleagues to read it and provide comments. X Make sure there are no mistakes, remembering to check the bibliography. X If it is your first article, gain advice from someone who has had work published. Also you might find it easier to write an article with someone else – some tutors or HOW TO REPORT YOUR FINDINGS/ 141 supervisors will be willing to do this as it helps their publication record if their name appears on another article. You may find that you will do most of the work, but it is very useful to have someone read your article and change sections which do not work or read well. It is also useful to have people comment on your methodology or analysis assumptions which could be criticised by other researchers. ORAL PRESENTATIONS Another method of presenting your research findings is through an oral presentation. This may be at a university or college to other students or tutors, at a conference to other researchers or work colleagues, or in a work place to colleagues, employers or funding bodies. Many re- searchers find that it is better to provide both a written report and an oral presentation as this is the most effective way of enabling a wider audience to find out about the re- search, especially if you also reproduce your written re- port on-line. If you want people to take notice of your results, you need to produce a good presentation. PowerPoint is a useful presentation graphics program which enables you to create slides that can be shared live or on-line. You can enhance your presentation with ani- mation, artwork and diagrams which make it more inter- esting for your audience. Acknowledge that this is your first Everybody gets nervous when they presentation and people will tend to first start giving presentations and help you along. Produce aide memoirs, either on Read straight from a paper you have cards, paper, OHP transparencies or written. Make it clear from the outset Get cross if you are interrupted and whether you are happy to be have not mentioned that you don’t interrupted or whether questions want this to happen. If you have and then do not answer them or invited questions, make sure you patronise the inquirer. Look around the room while you are Look at your notes, never raising speaking – if it’s a small group, make your head. Present interesting visual Produce visual information which information such as graphs, charts people can’t see, either due to its size and tables in a format which can be or print quality. Alter the tone and pitch of your Present in a monotone voice with no voice, length of sentence and facial/ facial/hand gestures.

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A computer presentation is governed by the same principles as those for slides and overheads – clear 200 mg celebrex with amex, legible text and pictures order celebrex 100mg overnight delivery, and use in a room where sufficient lighting can be left on for student note-taking and activities. If you are not confident of the environment in which you are teaching and in case the technology fails, it is still wise to have overhead transparencies or slide backups. Videos, and less often films these days, are best utilised in short segments. Their use requires more careful planning, 32 as it will be necessary to have a technician to set up equipment. However, the effort is well worthwhile for both the impact of the content and the variety it introduces. We use such material to show illustrative examples and practical techniques. They may also be used in attempts to influence attitudes or to explore emotionally charged issues. A short segment (trigger) can be shown illustrating some challenging situation and the class asked to react to this situation. Videos and films for this purpose are commercially available in some disciplines. WHEN THINGS GO WRONG Throughout this book we present the view that things are less likely to go ‘wrong’ if you have carefully prepared yourself for the teaching task. However, unexpected difficulties can and do arise, so strategies to deal with these need to be part of your teaching skills. In our experience problems in teaching large groups are likely to fall into one of the following categories. An equipment failure can be a potential disaster if you have prepared a computer presentation or a series of slides or transparencies for projection. Preventive measures in- clude having a thorough understanding of your equip- ment, back-up equipment on hand, and learning to change blown bulbs or remove jammed slides. If these measures are of no avail, you will have to continue on without the materials and may do so successfully provided that you have taken care to have a clear record in your notes of the content of your material. You may then be able to present some of the information verbally, on a blackboard or whiteboard, or on an overhead transparency if the original problem was with the slide projector. You will not, of course, be able to use this approach with illustrations and you may have to substitute careful description and perhaps blackboard sketches to cover essential material. Whatever you do, do not pass around your materials, which may be damaged and, of course, by the time most of the audience receive them, they are no longer directly relevant to what you are saying! Do not start apologising or communicate your sense of ‘panic’ if this should happen. Instead, pause, calmly evaluate your situation, decide on a course of action, and continue. One lecturer we know invites students to check their notes while she simply cleans the board as she thinks through what to do next! We have deliberately avoided the use of the word ‘problem’ in relation to your interaction with students because the ‘problem’ may be with you (that is, your manner, your preparation or presentation, for example) or it could be more in the form of a genuinely motivated intellectual challenge to what you have been doing or saying. It is essential to be clear as to exactly what the challenge is and why it has occurred before you act. We cannot go into all aspects of classroom management and discipline here, but we can identify a number of principles and refer you to more detailed discussions elsewhere (McKeachie’s Teaching Tips is a useful reference). Disruptive behaviour and talking in class are common challenges and must not be ignored, both for the sake of your own concentration and for the majority of students who are there to learn. Simply stopping talking and waiting patiently for quiet usually overcomes minor disturbances. If this happens more than once the other students will usually make their displeasure known to the offenders. If the disruption is more serious, you will have to speak directly to the students concerned and indicate that you are aware of the offence. But do try initially to treat it with humour or you may alienate the rest of the class. If the problem persists, indicate that you will be unable to tolerate the situation again and that you will have to ask them to leave. Make sure you do just this if the problem re- emerges, Do so firmly and calmly. If the situation leads to confrontation, it is probably best if you leave the room.

We investigated 28 hips in 26 patients with slipped capital femoral epiphy- sis who were treated by the Imhäuser intertrochanteric osteotomy purchase 200 mg celebrex, with subsequent removal of implants cheap celebrex 200mg online. The mean age at operation was 13 years, and the mean age at the time of the final follow-up was 19 years. PTA became restored to within the allowable range of up to 30° in all patients. The limitation of range of motion completely resolved in all patients, and none had necrosis of the femoral head postoperatively. Four patients had a fracture due to bone fragility from long- term traction and bed rest. Chondrolysis developed in only 1 male classified as an unstable case with an unstable classified as unstable. The Imhäuser treatment system for mild to severe cases may be said to be reasonable in that the physeal stability is rendered stable by traction and then the PTA is reduced to 30° or less by osteotomy to lessen the severity to mild. So, satisfactory results were obtained both clinically and roentgenographically in short- or midterm outcome. Slipped capital femoral epiphysis, Intertrochanteric osteotomy, In situ pinning, Posterior tilting angle, Physeal stability Introduction Since 1977, we have been treating slipped capital femoral epiphysis at our hospital using the Imhäuser treatment system. In patients incapable of walking or suffering from hip joint pain on exertion, traction is undertaken until irritant pain in the hip joint disappears. This treatment is not intended for reduction of slipped epiphysis but is aimed at attaining fibrous or osseous stabilization of the slippage site. Therefore, the Imhäuser treatment system may be characterized by these two surgical procedures used according to disease Department of Orthopaedic Surgery, Okayama University Hospital,2-5-1Shikata-cho, Okayama 700-8558, Japan 39 40 S. Imhäuser’s treatment system for slipped capital femoral epiphysis (SCFE). PTA, poste- rior tilt angle severity and preoperative attainment of stabilization of the slippage site. Imhäuser has documented that gratifying treatment results were obtained from a follow-up investigation in patients with slipped capital femoral epiphysis conducted over 11 to 22 years, showing that arthrotic changes had been seen in as few as 2 of 68 hip joints treated. To date, we also have had favorable results using this treatment system, as previously reported. However, because several complications have been noted and because some other investigators demonstrated, even in severe cases, that better treatment results were obtained with the in situ pinning technique than with osteot- omy, we considered it necessary to reexamine this treatment system. The present study was performed to evaluate the treatment system for its usefulness and for any problems involved by reviewing retrospectively patients with slipped capital femoral epiphysis showing a PTA of 30° or greater that was treated by intertrochanteric osteotomy. Patients We investigated 28 hips in 26 patients, which were treated by the Imhäuser intertro- chanteric osteotomy, with subsequent removal of implants. Of the 28 affected hip joints studied, 22 were unilateral in unilater- ally affected cases, 2 were unilateral in bilaterally affected cases, and 4 were in 2 Corrective Imhäuser Intertrochanteric Osteotomy for SCFE 41 bilaterally affected cases. The age at onset of the disorder, estimated from the medical history taken at clinic interview, ranged from 8 years and 6 months to 22 years and 9 months (mean, 12 years and 4 months), and the age at which surgical treatment was performed was between 8 years and 10 months and 23 years and 2 months (mean, 13 years and 2 months). Age at the time of the final follow-up was between 13 years and 8 months and 28 years and 3 months (mean, 18 years and 9 months). The postopera- tive follow-up duration ranged from 2 to 11 years (mean, 5 years and 7 months). According to the classification defined by Campbell Operative Orthopaedics, the type of onset was chronic for 11 hips, acute on chronic for 15, and acute for 2. In situ pinning on unaffected hips for epiphyseodesis was performed on 20 hips. Methods Pertinent data were reviewed as to duration of preoperative traction and intraopera- tive correction angle by osteotomy and such clinical parameters as range of motion of the hip joint, any pain, and, in unilaterally affected cases, difference in leg length. Roentgenographically, the apparent neck–shaft angle was measured in the anteropos- terior (AP) view and the pre- and postoperative PTA in the lateral view. Results Duration of Traction The duration of preoperative traction ranged from 2 to 114 days (mean, 45 days).

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