POPULARITY
49 episodes with Femoral
6 episodes with Femoral
8 episodes with Femoral
6 episodes with Femoral
6 episodes with Femoral
8 episodes with Femoral
8 episodes with Femoral
6 episodes with Femoral
4 episodes with Femoral
Contributor: Aaron Lessen, MD Educational Pearls: Point-of-care ultrasound (POCUS) is used to assess cardiac activity during cardiac arrest and can identify potential reversible causes such as pericardial tamponade Ultrasound could be beneficial in another way during cardiac arrest as well: pulse checks Manual palpation for detecting pulses is imperfect, with false positives and negatives Doppler ultrasound can be used as an adjunct or replacement to manual palpation for improved accuracy Options for Doppler ultrasound of carotid or femoral pulses during cardiac arrest: Visualize arterial pulsation Use color doppler Numerically quantify the flow and correlate this to a BP reading - slightly more complex Doppler ultrasound is much faster than manual palpation for pulse check Can provide information almost instantaneously without waiting the full 10 seconds for a manual pulse check The main priority during cardiac arrest resuscitation is to maintain quality compressions If pulses are unable to be obtained through Doppler within the 10-second window, resume compressions and try again during the next pulse check References Cohen AL, Li T, Becker LB, Owens C, Singh N, Gold A, Nelson MJ, Jafari D, Haddad G, Nello AV, Rolston DM; Northwell Health Biostatistics Unit. Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest. Resuscitation. 2022 Apr;173:156-165. doi: 10.1016/j.resuscitation.2022.01.030. Epub 2022 Feb 4. PMID: 35131404. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/
Welcome to Season 2 of the Orthobullets Podcast.Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature Dr. Arun Mullaji and is titled Preop Planning & Templating for Femoral Deformity.Follow Orthobullets on Social Media:FacebookInstagram TwitterLinkedInYouTube
Ankle and hindfoot fusion in the presence of large bony defects represents a challenging problem. The purpose of this study was to evaluate outcomes of patients who underwent ankle-hindfoot fusions with impaction bone grafting (IBG) with morselized femoral head allograft to fill large bony void defects. In conclusion, impaction of morselized femoral head allograft can fill large bony voids around the ankle or hindfoot during fusion, with rapid graft incorporation and no graft collapse despite early loading. This technique offers satisfactory and comparable union outcomes without limb shortening or expensive custom 3D-printed metal cages. Click here to read the article.
Welcome to Season 2 of the Orthobullets Podcast.Today's show is Foundations, where we review foundational knowledge for frontline MSK providers such as junior orthopaedic residents, ER physicians, and primary care providers.This episode will cover the topic of Femoral Shaft Fractures, from our Trauma section at Orthobullets.com.FollowOrthobullets on Social Media:FacebookInstagram TwitterLinkedInYouTube
Welcome to Season 2 of the Orthobullets Podcast.Today's show is Foundations, where we review foundational knowledge for frontline MSK providers such as junior orthopaedic residents, ER physicians, and primary care providers.This episode will cover the topic of Slipped Capital Femoral Epiphysis (SCFE), from our Pediatrics section at Orthobullets.com.FollowOrthobullets on Social Media:FacebookInstagram TwitterLinkedInYouTube
Welcome to Season 2 of the Orthobullets Podcast. Today's show is Coinflips, where expert speakers discuss grey zone decisions in orthopedic surgery. This episode will feature doctors Charles Moon, Alexandra Schwartz, Shaun Patel & Julius Bishop. They will discuss the case titled "Femoral Neck Fracture in 53M." Today's episode will be sponsored by the 2025 California Orthopaedic Association Annual Meeting, taking place May 1st - 4th, 2025 in Universal City, CA. Follow Orthobullets on Social Media: Facebook Instagram Twitter Link
Welcome to Season 2 of the Orthobullets Podcast. Today's show is Foundations, where we review foundational knowledge for frontline MSK providers such as junior orthopaedic residents, ER physicians, and primary care providers. This episode will cover the topic of Femoral Neck Fractures, from our Trauma section at Orthobullets.com. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube
I read from femoral to fender. The word of the episode is "fence-sitting". Use my special link https://zen.ai/thedictionary to save 30% off your first month of any Zencastr paid plan. Create your podcast today! #madeonzencastr Theme music from Jonah Kraut https://jonahkraut.bandcamp.com/ Merchandising! https://www.teepublic.com/user/spejampar "The Dictionary - Letter A" on YouTube "The Dictionary - Letter B" on YouTube "The Dictionary - Letter C" on YouTube "The Dictionary - Letter D" on YouTube "The Dictionary - Letter E" on YouTube "The Dictionary - Letter F" on YouTube Featured in a Top 10 Dictionary Podcasts list! https://blog.feedspot.com/dictionary_podcasts/ Backwards Talking on YouTube: https://www.youtube.com/playlist?list=PLmIujMwEDbgZUexyR90jaTEEVmAYcCzuq https://linktr.ee/spejampar dictionarypod@gmail.com https://www.facebook.com/thedictionarypod/ https://www.threads.net/@dictionarypod https://twitter.com/dictionarypod https://www.instagram.com/dictionarypod/ https://www.patreon.com/spejampar https://www.tiktok.com/@spejampar 917-727-5757
Welcome to another informative episode of “Proctology and Laparoscopic Surgery”. I am your host, Dr. Manas Tripathy, Proctologist in Koramangala, Bangalore with you. And today we're shedding light on a hidden threat in women: Femoral Hernias. Keep listening till the end!! For more information visit: https://www.drmanastripathy.com or call us at +91 8150000200
In this episode, we review the high-yield topic of Femoral Nerve from the Anatomy section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets
In this episode, we discuss the procedural anatomy of the femoral vein including surface
What exactly is an abdominal hernia? - It's where an internal part of body pushes through weak part of your abdominal wall muscle, creating a lump that often you can feel. - It's very common, more common in men but can occur in any age from babies to the elderly. - There's several different types: - Inguinal: occurs in the groin and can sometimes cause lump in the scrotum. - Femoral: occurs where abdomen joins leg. - Umbilical: the front of the stomach often around the tummy button. - Hiatus: where stomach pushes up into the chest. - Incisional: over a surgery scar What causes hernias? - Lots of different things: being overweight, coughing or sneezing, constipation, pregnancy. - Some people have weaker abdominal walls, and hernias can occur more easily. - Occasionally caused by injury from lifting – in which case can be covered by ACC What should you look out for and are they serious? - Most people notice a bulging lump in their stomach or groin. - You may occasionally notice discomfort when bending over or lifting things. - Generally they are small, and if they pop out they can be easily pushed back in. - Over time they can become bigger and cause more discomfort and pain. - Occasionally the bowel can twist and not be able to be pushed back in and become strangulated. This is serious and requires urgent medical help. What do about them? - Your GP will take a history and examine you to diagnose a hernia, they may order a U/S if unsure. - If it's minor and not causing problems, just watch and wait. - However, if it's causing pain and discomfort, they may recommend surgery. - An operation to fix the abdominal wall with stitches or what is called mesh, it's often a keyhole surgery. - You can try to avoid them by eating food with fibre so you don't become constipated, not putting on weight, and careful lifting with your knees instead of your back. LISTEN ABOVE See omnystudio.com/listener for privacy information.
Welcome to Episode 38 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 38 of “The 2 View” – Retinal Artery Occlusion, Femoral Artery, and a guest appearance by Carl Lange, PA. Segment 1 Yaghoubi G.H., Heidari B. and B. Heidari. Case report: Central retinal artery occlusion in a 28-year-old man after 10 days of smoking cessation. World Health Organization - Regional Office for the Eastern Mediterranean. Accessed September 20, 2024. https://www.emro.who.int/emhj-volume-14-2008/volume-14-issue-5/case-report-central-retinal-artery-occlusion-in-a-28-year-old-man-after-10-days-of-smoking-cessation.html Segment 2 Howden W. Femoral artery. Radiopaedia.org. Revised March 24, 2023. Accessed September 20, 2024. https://radiopaedia.org/articles/femoral-artery?lang=us Ultrasound – Doppler Pseudoaneurysm Evaluation. UT southwestern department of radiology. Utsouthwestern.edu. Revised October 2, 2018. Accessed September 20, 2024. https://www.utsouthwestern.edu/education/medical-school/departments/radiology/protocols/assets/US%20Pseudoaneurysm.pdf Webb S, Madia C. Postcatheterization Femoral Pseudoaneurysms. American College of Cardiology. Published June 4, 2019. Accessed September 20, 2024. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2019/06/04/10/26/Postcatheterization-Femoral-Pseudoaneurysms Zeman J, Kompella R, Lee J, Kim AS. Case report: Non-thrombotic iliac vein lesion: an unusual cause of unilateral leg swelling in a patient with endometrial carcinoma. Front Cardiovasc Med. PMC PubMed Central. Published online May 2, 2023. Accessed September 20, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10185828/ Segment 3 California Board of Registered Nursing. Recruiting Expert Practice Consultants. Rn.ca.gov. Accessed September 20, 2024. https://www.rn.ca.gov/enforcement/expwit.shtml The Academy of Physician Associates in Legal Medicine. APALM. Published March 5, 2024. Updated June 7, 2024. Accessed September 20, 2024. https://www.apalm.net/ Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share! Don't miss our upcoming EM Boot Camp this December in Las Vegas: https://courses.ccme.org/course/embootcamp/about
Dr. Ian Al'Khafaji joins us as we explore the different types of dysplasia, their impact on hip health, and the latest diagnostic techniques. We also discuss the various management strategies, including surgical interventions like periacetabular osteotomy (PAO) and hip arthroscopy. Click here for show notes Dr. Ian Al'Khafaji is an Orthopedic Surgeon and Researcher in complex Hip/Knee Preservation. He is also a Doctor for Surfing Athletes. He received his medical degree from University of South Florida Morsani College of Medicine and has been in practice between 11-20 years. Dr. Ian Al'Khafaji has expertise in treating knee arthroscopy, rotator cuff injury, arthritis, among other conditions. Goal of episode: To develop a baseline knowledge of hip preservation. In this episode, we discuss: Acetabular dysplasia Femoral deformity Femoral anteversion role Classification Managing hip dysplasia and many more.
In this episode, Dr. Sameh Sayfo discusses advanced techniques in radial to peripheral (R2P) interventions, the importance of having multiple techniques, the role of different devices, troubleshooting tips, and the evolving landscape of R2P interventions. Dr. Sayfo is an interventional cardiologist at the Baylor Heart Hospital, and serves as program director for the endovascular fellowship and pulmonary embolism response team (PERT) program. --- CHECK OUT OUR SPONSOR AngioDynamics Auryon System https://www.auryon-system.com/ --- SYNPOSIS Dr. Sayfo shares his experience and insights on using various devices, such as the new Auryon laser, for treating peripheral arterial disease (PAD).Additionally, the doctors address the benefits of radial access over traditional femoral approaches, patient selection, and procedural planning. Listeners are encouraged to adopt a flexible approach and learn from each other's experiences to improve patient outcomes. --- TIMESTAMPS 00:00 - Introduction 05:24 - Incorporating Radial into Peripheral Practice 11:19 - Right vs. Left Radial Access 20:01 - Room Setup and Procedure Planning 25:13 - Radial vs. Femoral Access 33:01 - Advancements in Laser Atherectomy 41:33 - Laser Atherectomy Tips 45:52 - Advantages of Radial Access in Specific Cases 51:33 - Post-Op Care and Best Practices --- RESOURCES BackTable VI Podcast Episode #30 - Transradial Access Basic to Advanced with Dr. Aaron Fischman: https://www.backtable.com/shows/vi/podcasts/30/transradial-access-basic-to-advanced BackTable VI Podcast Episode #148 - Radial vs. Femoral for Prostate Artery Embolization with Dr. Blake Parsons: https://www.backtable.com/shows/vi/podcasts/148/radial-vs-femoral-for-prostate-artery-embolization BackTable VI Podcast Episode #342 - Radial Access for PAD with Dr. Rami Tadros: https://www.backtable.com/shows/vi/podcasts/342/radial-access-for-pad BackTable VI Podcast Episode #395 - Radial to Peripheral Tools & Technique with Dr. Sameh Sayfo: https://www.backtable.com/shows/vi/podcasts/395/radial-to-peripheral-tools-technique BackTable VI Podcast Episode #443 - Innovative Approaches in Radial to Peripheral Interventions with Dr. Amit Srivastava: https://www.backtable.com/shows/vi/podcasts/443/innovative-approaches-in-radial-to-peripheral-interventions BackTable VI Podcast Episode #390 - Laser Atherectomy: An Overview of the Pathfinder Registry with Dr. Tony Das: https://www.backtable.com/shows/vi/podcasts/390/laser-atherectomy-an-overview-of-the-pathfinder-registry BackTable VI Podcast Episode #408 - Laser BTK Study Insights: Navigating Complex Lesions with Dr. Nicolas Shammas: https://www.backtable.com/shows/vi/podcasts/408/laser-btk-study-insights-navigating-complex-lesions Safety and efficacy of radial artery access for peripheral vascular intervention: a single center experience: https://www.ajconline.org/article/S0002-9149(24)00461-2/abstract Comparative Outcomes of Interventions for Femoropopliteal Chronic Total Occlusion Versus Non-Chronic Total Occlusion Lesions From the Multicenter XLPAD Registry: https://pubmed.ncbi.nlm.nih.gov/37318023/ Prospective, Multi-center, Single-Arm Study of the Auryon Laser System for Treatment of Below-the-Knee Arteries in Patients With Chronic Limb-Threatening Ischemia: 30-Day Results of the Auryon BTK: https://pubmed.ncbi.nlm.nih.gov/38458581/ Prospective, Multicenter Registry to Assess Safety and Efficacy of Radial Access for Peripheral Artery Interventions: https://www.jscai.org/article/S2772-9303(23)00813-X/fulltext Solid state, pulsed-wave 355 nm UV laser atherectomy debulking in the treatment of infrainguinal peripheral arterial disease: The Pathfinder Registry: https://pubmed.ncbi.nlm.nih.gov/38566525/ SCAI Expert Consensus Statement Update on Best Practices for Transradial Angiography and Intervention: https://scai.org/publications/clinical-documents/scai-expert-consensus-statement-update-best-practices-transradial
In this episode, we review the high-yield topic of Pelvic Ring Fractures from the Trauma section. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
In this episode, we review the high-yield topic of Femoral Shaft Fractures from the Trauma section. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
Dr. Megan Peach // #FitnessAthleteFriday // www.ptonice.com In today's episode of the PT on ICE Daily Show, Endurance Athlete division leader Megan Peach discusses femoral neck bone stress injuries, including referral for diagnosis, potential treatment options, and rehabilitation & return to running. Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our Endurance Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTIONHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PT on ICE Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app slash switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at sign up to receive a one month free grace period on your new Jaina. MEGAN PEACH This is your PT on ICE, the daily show. brought to you by the Institute of Clinical Excellence. My name is Megan Peach. I am one of the lead faculty for Rehabilitation of the Injured Runner online and live. And today I'm gonna talk to you about, no surprises here, bone stress injuries. But specifically I wanna talk to you about femoral neck bone stress injuries and what to do once you expect that your patient has a possibility of even having a femoral neck bone stress injury. because sometimes that decision on what to do might be a little daunting. And so I'm going to present this information in a bit of an algorithm format. And I'm not the biggest fan of algorithms because our patients don't often fit perfectly into the algorithm boxes that we need them to fit in to in order to progress along that algorithm route. But this one I actually think makes a lot of sense and I think it's pretty straightforward so hopefully it will be helpful for you in your clinical decision-making process. So I'm also going to make some assumptions that you have already done your subjective exam, you've already done your objective exam as well, and you are ready to make some decisions and you've decided that your patient has potentially a femoral neck bone stress injury. Now that part is really important because if you are even suspecting a femoral neck bone stress injury, then you need to consider it a femoral neck bone stress injury until it's proven otherwise. And that's important because as physios, we can't tell if that's a high risk or a low risk femoral neck bone stress injury. All we know is that there's potential there and one, they're treated differently, but two, the high risk can progress on to be a more serious injury. And so it's really important that we treat them as femoral neck bone stress injuries until that condition is proven otherwise, or it's proven as a femoral neck bone stress injury, and then we can move on in that treatment algorithm. So once you have made that decision, this person sitting in front of me is potentially a femoral neck bone stress injury or has one. The first thing we're going to do is refer them out to an orthopedist. They need additional imaging. And again, that's because we really need to determine one, if this is a femoral neck bone stress injury, and two, if this is a high risk or low risk, because again, they're treated a little bit differently. And so that referral to the ortho is going to jumpstart that part of the process where they can then get additional imaging. MRI is the gold standard to diagnose bone stress injuries. You could also refer them to their primary care provider. Their primary care provider can certainly refer them for an MRI, but ultimately they're going to go and see an orthopedist. And so it's nice to just take out that middle appointment and you can always communicate this information to their primary care provider, especially if they were the ones that referred them to you in the first place. Okay, so all of the patients are going to start out with their referral to the ortho, and then hopefully go for an MRI. Now the results of the MRI are really important because they're going to dictate at what path in this algorithm they're going to take. So I'm gonna give you three different scenarios based on the results of this initial MRI. The first scenario is that the MRI is positive for only bone marrow edema. It is a femoral neck bone stress injury, but it's only bone marrow edema. There's no fracture line. So this patient is then going to do six weeks of non-weight-bearing. Kind of a bummer, a hard conversation to have, especially if there's no distinct fracture line, but they still need six weeks of non-weight-bearing to prevent further progression of this injury. After the six weeks, whether or not they get a follow-up MRI is really dictated by that orthopedist and their experiences. Typically they don't if it is bone marrow edema only, And so at this point, they would likely begin a weight-bearing progression. And that weight-bearing progression is going to be gradual, likely over the course of a couple of weeks. After they are able to weight-bear normally, they're going to then start into a normal walking program and a formal rehabilitation program. With that being said, during that six-week period of non-weight-bearing, certainly they could do formal physiotherapy, but you could also send them home with exercises they can do on their own to prevent atrophy, to maintain the strength that they do have and the muscle mass that they do have. That, of course, is a conversation between you and the patient and the orthopedist on where they want to spend their time, potentially money, potentially number of visits for physio, because you know they're going to need them once they start that weight-bearing progression. I'm not going to talk a lot about the details of that weight-bearing progression because I want to stick to this clinical decision algorithm, but in that weight-bearing progression, it would then work itself into also a return to sport progression as well, but that's where it starts. Okay, so to summarize that first scenario, you have your patient, You have differentially diagnosed them with a potential femoral neck bone stress injury. You referred them out to an orthopedist. They had an initial MRI, which was positive for bone marrow edema. Then they did six weeks of non-weight bearing, and then they progressed into a loading program to get them to load normally and walk normally, ultimately probably run normally, and get back into the sports and the activities that they want to do. Okay, so the second scenario, we're going back to that first MRI. They come in with their results. Their results say that they now have a stress fracture, okay? And so this is a totally different scenario than the first scenario with bone marrow edema only. Now, the location of a femoral neck stress fracture is really, really important because that's going to determine whether or not this is a high-risk or a low-risk bone stress injury. So if the fracture is on the underside of the femoral neck, it is deemed a compression-type fracture, and it is going to be more low-risk. If the fracture is on the superior aspect of the femoral neck, it is deemed a tension-type injury, and that is going to heal a lot more slowly with a lot more difficulty. It is deemed a high-risk bone stress injury, and it's treated very differently from the low-risk or compression type fracture. So the MRI is going to describe the location of that fracture as well as occasionally the severity. If that person presents with a compression type fracture, so on the underside of that femur, and it is 50% or less of the width of the femoral neck, they are going to then, surprise, do six weeks of non-weight bearing, okay? And so they have a fracture line, but we're still going to treat them conservatively in this scenario. After the six weeks of non-weight bearing, typically they will have a second MRI or follow-up imaging. Occasionally that can be x-ray if they were able to visualize the fracture line on an initial x-ray. So a follow-up image, and based on the results of the follow-up image, they're going to be filtered into basically three different paths again. And so if that follow-up image says that they are making good progress and healing, so maybe we don't see a line anymore, maybe there's callus, maybe there's less bony edema, then we're going to filter them back into that progressive weight-bearing approach. And so the same thing that we use for scenario one, they're going to do a progressive loading program into full weight-bearing and then walking and then running and then return to sport, et cetera. Okay, that is if they were asymptomatic and they demonstrate healing on that follow-up image. If the follow-up image does not show any progress, it doesn't show any regression, it's just kind of stagnant, or the patient is still symptomatic, they're still having symptoms in that hip. Now, granted, they haven't been weight-bearing for six weeks. they're going to restart that six weeks weight-bearing. It is a tough, tough conversation, and nobody likes it. Not you, not the orthopedist, certainly not the patient. They're going to start that process over again, and they're gonna start back at the top of that six weeks non-weight-bearing, and then they'll likely have a repeat image at the end of that second six weeks of non-weight-bearing. I should mention here that I keep saying six weeks non-weight-bearing It's a start and I think it's important to educate our patients on that. It is just a start very often they will go into Longer durations of time non weight-bearing in order to treat this condition Okay, so the third scenario after the second image the follow-up image is that there is a regression and so this is not based on symptoms it is only based on that second image and this now shows a progression in the injury, maybe the fracture line increased, maybe the edema increased, but there's been some basically like regression in the issue. And so, or progression in the injury, however you want to take it. And so with this situation, unfortunately, they've now become a surgical candidate and they will likely stay under the care of that orthopedist. Okay. So to summarize that second scenario, They have come into your clinic, you suspect a femoral neck bone stress injury, you refer them out to an orthopedist, they come back with a positive MRI for a fracture line, but that fracture line is less than 50% of the width of the femoral neck and it is on the compression side or the underside of that femoral neck. They then do six weeks of non-weight bearing. They get a follow-up image. Based on that follow-up image, they will either continue in a progressive loading program in formal rehabilitation, repeat the six weeks non-weight bearing, and then do another follow-up image, or go on to be a surgical candidate, depending on the results of that second image. Okay, our third scenario. They come back with their first MRI, and the results show, again, a fracture line. This fracture line, though, is one of two scenarios. It is either a fracture line on the superior aspect of that femoral neck, which is a high-risk, tension-tight bone stress injury, or that fracture line is on the compression side, or the underside of that femoral neck, and it is greater than 50% of the width of that femoral neck. Either of these two situations, unfortunately, are going to necessitate, likely, a surgical intervention. So an open reduction, internal fixation, to stabilize that fracture and make sure that it doesn't progress into a more severe injury. The type of that ORIF is obviously very dependent on that surgeon as is the weight-bearing status post-operatively. So some will do non-weight-bearing for an additional six weeks, Some will do partial weight-bearing and then some will do full weight-bearing immediately after surgery. It is obviously just up to that orthopedist. And so that third scenario is quite short compared to the others. Your patient came in, you suspect ephemeral neck bone stress injury, you refer them out to the orthopedist, they come back with the MRI results with a positive for either a fracture line on the underside of that femoral neck on the compression side that is greater than 50% of the width of that femoral neck, or they have a fracture line on the tension side, the superior aspect of that femoral neck. Either of those two situations are then going to necessitate some kind of surgical fixation for that injury. Obviously, that is always a discussion between you and that patient and the orthopedist and whatever team they have around them in terms of if surgery is the appropriate intervention for them. Obviously, this is just a basic algorithm and then to help guide some of these clinical decision-making processes. Okay, so the themes in this algorithm that I want to highlight are regardless of what that initial MRI says, basically all roads lead to six weeks non-weight bearing. It's kind of an unfortunate part of this injury is that we definitely don't want this to progress from a low risk to a high risk bone stress injury. That's the worst case scenario because if we can prevent that in any way, even if it means six weeks non-weight bearing, we have to do that. So any roads, maybe with the exception of that third scenario where it just leads to surgery, all of the other paths essentially lead to that six weeks non-weight-bearing. So just know that that might be in their future. The other thing is, is that any progression that we do formally as informal rehabilitation after they've done their six weeks non-weight-bearing and they've been basically released to physiotherapy or released to progress to walking or weight-bearing, all of the progression has to be asymptomatic. Any progression that is symptomatic, creating symptoms in that hip, it must be backtracked. And so if they are initiating weight bearing and they are symptomatic, they're likely going to have to backtrack into a few weeks of non-weight bearing again. Really hard conversation again, but it's necessary in order to really prevent progression of this injury for obvious reasons. So the two themes, six weeks non-wavering and any progression must be asymptomatic. SUMMARY All right, that is the content I have for you today. Just want to make a couple of mentions of our upcoming Rehab of the Injured on our online course. We are currently in the middle of our, our current cohort is right in the middle of this session and All of the online cohorts this year have been on our new ICE app, which has been fantastic. It is really generating a great online community of therapists that are interested in treating endurance athletes. And so we've had some good discussions on there and it's really just fostering a great community. So if you haven't already taken Rehab of the Injured Runner online, I would definitely encourage you to do so. Our next cohort starts, I believe, in June. We will see you there. I can't wait to see you there. And have a great Friday and a great weekend. OUTRO Hey, thanks for tuning in to the PT on ICE daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.
Listen in as host Michael Blankstein, MD chats with Richard Yoon, MD and Jason Halvorson, MD about the state of dual fixation for distal femur fractures. For additional educational resources visit https://ota.org/
Patello-femoral pain is a common, and at times, debilitating condition of the knee that can impact people across the lifespan. Professor Bill Vicenzino is a world leading expert on this topic and to that end I've enticed him onto the show to give us the ins and outs of this tricky condition. This is truly a must listen episode with a real pioneer of physiotherapy about a very common and important musculoskeletal condition. Key Papers: 1. Rathleff MS, Holden S, Krommes K, Winiarski L, Hölmich P, Salim TJ, Thorborg K. The 45-second anterior knee pain provocation test: A quick test of knee pain and sporting function in 10-14-year-old adolescents with patellofemoral pain. Phys Ther Sport. 2022 Jan;53:28-33. doi: 10.1016/j.ptsp.2021.11.002. Epub 2021 Nov 4. PMID: 34775189. 2. Powers CM, Witvrouw E, Davis IS, Crossley KM. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. Br J Sports Med. 2017 Dec;51(24):1713-1723. doi: 10.1136/bjsports-2017-098717. Epub 2017 Nov 6. PMID: 29109118. 3. Powers CM, Ho KY, Chen YJ, Souza RB, Farrokhi S. Patellofemoral joint stress during weight-bearing and non-weight-bearing quadriceps exercises. J Orthop Sports Phys Ther. 2014 May;44(5):320-7. doi: 10.2519/jospt.2014.4936. Epub 2014 Mar 27. PMID: 24673446. 4. Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, McConnell J, Vicenzino B, Bazett-Jones DM, Esculier JF, Morrissey D, Callaghan MJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016 Jul;50(14):839-43. doi: 10.1136/bjsports-2016-096384. Epub 2016 Jun 24. PMID: 27343241; PMCID: PMC4975817. 5. Nimon G, Murray D, Sandow M, Goodfellow J. Natural history of anterior knee pain: a 14- to 20-year follow-up of nonoperative management. J Pediatr Orthop. 1998 Jan-Feb;18(1):118-22. PMID: 9449112. 6. Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005 Jul;(436):100-10. doi: 10.1097/01.blo.0000172303.74414.7d. PMID: 15995427. 7. Holden S, Matthews M, Rathleff MS, Kasza J; Fohx Group; Vicenzino B. How Do Hip Exercises Improve Pain in Individuals With Patellofemoral Pain? Secondary Mediation Analysis of Strength and Psychological Factors as Mechanisms. J Orthop Sports Phys Ther. 2021 Dec;51(12):602-610. doi: 10.2519/jospt.2021.10674. PMID: 34847699. 8. Robertson CJ, Hurley M, Jones F. People's beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study. Musculoskelet Sci Pract. 2017 Apr;28:59-64. doi: 10.1016/j.msksp.2017.01.012. Epub 2017 Feb 2. PMID: 28171780. The Shoulder Physio Online Course Connect with Jared and guests: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 Bill on Twitter: @Bill_Vicenzino See our Disclaimer here: The Shoulder Physio - Disclaimer
In this episode, we review the high-yield topic of Femoral Neck Fx Nonunion from the Trauma section. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
Is it save to mobilize patients with trans-formal devices such as balloon pumps, impellas, and ECMO? Who was the first person to dare to ask, "Why can't we mobilize patients with trans-femoral balloon pumps?" Stephen Ramsey, PT, DPT, CCS shares with us his journey to developing the Ramsey protocol and revolutionizing mobility in the CVICU. Episode transcript and citations at: www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support
In this episode Dr. Perry talks about the power of massaging the femoral canal and the structures it holds. Femoral nerve, artery, vein, and lymph nodes. Restriction of fluid flow here may cause inflammation and pain anywhere in the body.
In this episode Dr. Perry talks about the power of massaging the femoral canal and the structures it holds. Femoral nerve, artery, vein, and lymph nodes. Restriction of fluid flow here may cause inflammation and pain anywhere in the body. One of the most important and neglected areas of the body for healing, recovery, regeneration, and finding underlying root causes of chronic pain. Don't neglect the groin! Link to our MOJO VIBRATION BALL below MOJO BALL
In this episode, we review the high-yield topic of Femoral Shaft Fracture from the Orthopedics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Distal Femoral Physeal Fractures from the Pediatrics section. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
Host Dr. Joseph Patterson interviews paper author Dr. Cory Collinge. This paper was presented at the 2023 OTA Annual Meeting. To see the abstract, listen in the free ConveyMED app: Apple Store or Google Play For additional educational resources visit https://ota.org/
In this episode, we review the high-yield topic of Femoral Head Fractures from the Trauma section. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
Dr. Wayne Paprosky leads the case discussion Revision THA with Proximal Femoral Revision. Drs. Stephen Murphy and Rafael Sierra present their views in the table discussion followed by comments from attendees. To see the presentation while you listen, download the free ConveyMED App: Apple Store click here Google Play click here
In this episode, we review the high-yield topic of Femoral Shaft Fractures from the Pediatric section. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
In this episode, we review the high-yield topic of Slipped Capital Femoral Epiphysis (SCFE) from the Pediatric section. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
Dr. Daniel Berry leads the discussion Tapered Spline Stems for Femoral Reconstruction. Drs. John Clohisy and Christopher Peters present their views in the table discussion followed by comments from attendees. To see the presentation while you listen, download the free ConveyMED App: Apple Store click here Google Play click here. Attend CCJR 2023 Dec 13-16 in Orlando. Visit CCJR.com for more information.
Dr. Gil Scuderi leads the discussion Dealing with Femoral Bone Loss: How to Assess and Achieve Balance and Stability in Revision TKA. Drs. Adolph Lombardi and Steven Haas present their views in the table discussion followed by comments from attendees. To see the presentation while you listen, download the free ConveyMED App: Apple Store click here Google Play click here Attend CCJR 2023 Dec 13-16 in Orlando. Visit CCJR.com for more information.
Dr. Wayne Paprosky leads the discussion Dealing with Tibial and Femoral Bone Loss: Cones, Short Cemented Stems vs. Press Fit Stems Drs. Adolph Lombardi and Steven Haas present their views in the table discussion followed by comments from attendees. To see the presentation and case information while you listen, download the free ConveyMED App: Apple Store click here Google Play click here Attend CCJR 2023 Dec 13-16 in Orlando. Visit CCJR.com for more information.
Bonus Cuts back again! Zack and Mike talk with guest Yale Tung-Chen about the POCUS vibe in Spain and his recently reviewed study on using doppler flow as a measure of right ventricular dysfunction in heart failure. https://www.ultrasoundgel.org/152
Pediatrician Dr. Paul Bunch consults Dr. Patrick Whitlock on SCFE (Slipped Capital Femoral Epiphysis). Episode recorded on October 11, 2023. CME & MOC Part 2 We are proud to offer CME and MOC Part 2 from Cincinnati Children's. Credit is free and registration is required. Please click here to claim CME credit via the post-test under "Launch Activity." Resources discussed in this episode: Community Practice Support Tools
Welcome to our eighth Trauma citation classics episode! We talk about the highest cited articles over the last 20 years or so over the topic hip fractures today . Video: https://youtu.be/iOp0QZHa4uk A little more about our Trauma citation classics team! We have Dr. Matthew Brown, a PGY-3 resident at Duke University Medical Center, Nicholas Todd, a 4th year medical student at Edward Via College of Osteopathic Medicine-Virginia, Brie Paradis- Brie is a current 4th year student at University of New England College of Osteopathic Medicine. and Olumide Olotu- Olumide went to St Georges School of Medicine, and is a current orthopaedic surgery intern! Let's talk some neck fractures! This episode is sponsored by Locumstory: Everyone has a story. Different needs, wants, and goals, and how to attain them. Your story determines your solution. Whatever your situation and story, locum tenens should be part of the conversation. How do you find out if locums is a good option for you? Go to an unbiased, informative source like locumstory.com. You'll learn all the ins and outs of locums, details on travel and housing, assignment coordination, tax information, and more. You'll also hear firsthand stories from locums physicians from all walks of life, so you get a bigger picture of the diverse options. About Nailed It Ortho: Get on top of the game, deepen your learning and further your practice with this Orthopaedic Surgery Podcast featuring Orthopaedic Surgery residents as they interview national and international experts to bring you key information and knowledge in the field. Dr. Jamal Fitts and Dr. Wendell Cole are here to light that fire under your feet and get your blood pumping with some good Orthopaedic Knowledge. We stay away from the boring, put you to sleep lectures, and just come with some high quality content and fun. Its a great podcast for attending physicians, residents, and medical students. Topics include high yield trauma, pediatrics, spine, sports, hand, and foot and ankle. There may also be some off brand topics. Connect with Nailed It Ortho: Visit the Nailed It Ortho PODCAST: https://naileditortho.com/category/podcast/ Visit the Nailed it Ortho BLOG:https://naileditortho.com/category/blog/ Follow Nailed It Ortho on TWITTER: www.twitter.com/naileditortho Follow Nailed It Ortho on INSTAGRAM: www.instagram.com/naileditortho Follow Nailed It Ortho on FACEBOOK: www.facebook.com/naileditortho
In this debate, Drs. James Browne and Michael Mont recap their debate presented live at CCJR 2022 on Cemented vs. Uncemented THA Femoral Components in the Elderly. Thank you for listening to our podcasts. As a token of appreciation, The Hip Society and The Knee Society are excited to offer you a 23% discount on CCJR 2023 meeting registration across all registration categories if you register before 11/1/2023. Please visit https://ccjr.com/ccjr-2023/ and apply the following discount code: SHAK23 at checkout.
In this episode, we review the high-yield topic of Femoral Region from the Gastrointestinal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message
In this episode, we cover the following:What is Slipped Capital Femoral Epiphysis (SCFE)?What are some risk factors for developing this?What do we look for in a patient's clinical presentation?How is this identified in imaging?Support the showThe purpose of this podcast is to provide useful, condensed information for exhausted, time-crunched Physical Therapists and Student Physical Therapists who looking to build confidence in their foundational knowledge base and still have time to focus on other important aspects of life. Hit follow to make sure you never miss an episode. Have questions? Want to connect? Contact me at ptsnackspodcast@gmail.com or check out more at ptsnackspodcast.com. On Instagram? Check out the unique content on @dr.kasey.hankins! Need CEUs but low on time and resources? Go to https://www.medbridgeeducation.com/pt-snacks-podcast for over 40% off a year subscription. Use the promo code PTSNACKSPODCAST. This is an affiliate link, but I wouldn't recommend MedBridge if I didn't think they offered value. Willing to support monetarily? Follow the link below to help me continue to create free content. You can also support the show by sharing the word about this show with someone you think would benefit from it.
In this episode, we review the high-yield topic of Femoral Anteversion from the Pediatrics section. Follow Orthobullets on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
Another cutting edge topic! These insatiable investigators propose to use doppler waveforms from the common femoral vein as a marker of right heart dysfunction in heart failure patients. Novel? Certainly. Useful? We shall see! https://www.ultrasoundgel.org/148 https://pubmed.ncbi.nlm.nih.gov/37088380/
Jesse presents with decreased sensation in the left leg and reports difficulty with dorsiflexion and inversion of the foot. Which of the following nerves is MOST likely affected? A. Femoral nerve B. Tibial nerve C. Common peroneal nerve D. Obturator nerve LINKS MENTIONED: Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck. Are you looking for a bundle of Coach K's Top MSK Cheatsheets? Look no further: www.nptecheatsheets.com --- Support this podcast: https://podcasters.spotify.com/pod/show/thepthustle/support
In this episode of Coin Flips & Controversies, we present the case of Femoral Neck Fracture in 53M and feature expert faculty from the upcoming California Orthopaedic Association 2023 Annual Meeting: Drs. Charles Moon, Alexandra Schwartz, Shaun Patel, and Julius Bishop. Important Links: Vote on Case Full Video California Orthopaedic Association 2023 Annual Meeting --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
The Trulyfit Podcast welcomes Rick Olderman to talk about Chronic Pain: Femoral Anteversion & Retroversion._Rick graduated with his Master's degree from The Krannert School of Physical Therapy at the University of Indianapolis in 1996. He is the author of the popular Fixing You® series of books to help people with chronic pain or injuries_Check out his website for more information:https: www.freepaintest.comIG: @fixingyouclinic-----------------------------------------------------------------------------------------------------------The TrulyFit Podcast's mission is to provide insights for those in health & wellness fields to better their understanding of science, patients/clients, business, and trending health tips & technologies.The show interviews experts in various Fitness & Health realms and gives actionable tips for both the general public and the professional.If you're curious about all things fitness & health...you found the right place!LISTEN ONApple Podcast: https://podcasts.apple.com/us/podcast/the-trulyfit-podcast/id1559994164Spotify: https://open.spotify.com/show/27jDzRtFENn03QQRRFCf5wSUBSCRIBE TO OUR CHANNEL: https://www.youtube.com/@trulyfitappFOLLOW USInstagram:@trulyfitapp#fitness #health #personaltrainer #trulyfitapp #fitnesspodast #healthpodcast #coach #stevewashuta #fitpro #podcast #trainer #chronicpain #rickolderman #femoralanteversion #retroversion #therapist #therapy
Endovascular 101 Authors: Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California Sukgu Han - Associate Professor of Surgery at the University of Southern California. Co-director of Comprehensive Aortic Center at Keck Hospital of USC. Program Director of the Integrated Vascular Surgery Residency and Vascular Fellowship Editor: Yasong Yu Reviewers: Matt Chia and Kirthi Bellamkonda Core Resources: Rutherford's Vascular and Endovascular Therapy 10th Edition Chapter#26-28 Additional Resources: Relevant Audible Bleeding episodes Holding Pressure Case Prep - AKA/BKA Journal Review in Vascular Surgery: Introduction to Endovascular Surgery – A Prime Peter A. Schneider, MD and Endovascular Skills - history, personal techniques and updates in the 4th Edition Closure devices: Angioseal Mynx Proglide Endovascular procedures are minimally invasive techniques used to treat conditions affecting blood vessels, such as aneurysms, stenosis, or occlusions, by accessing the affected vessels through an incision in a peripheral artery and using imaging guidance to navigate catheters and devices through the blood vessels to the treatment site. Endovascular procedures can be broken down into 4 key steps Establishing arterial access Navigating to target treatment zone or vessel Treating the lesion Closure Basic definition of wire, sheaths, and catheters Wires are thin, flexible metal devices used to navigate through blood vessels and to guide other devices, such as catheters or sheaths, to the target location. They are measured in thousands of an inch A 0.018 wire is 0.018 inch in diameter There are two categories of wires: Flexible and support Flexible wires are soft and hydrophilic. They are considered the “workhorses” because they are useful for navigating through vessels. A common type of wire is called the Glidewire which is slippery and useful in traveling across tortuous vascular anatomy. Support wire are generally a lot stiffer and not hydrophilic. For that reason they are used to deliver and deploy devices A common type of support wire is called the Lunderquist which is used for the deployment of stent grafts in endovascular aortic repair Catheters are flexible hollow tubes used in conjunction with wires to navigate vascular anatomy Various characteristics include the degree and shape of the taper, the lengths, and the stiffness. They are inserted inside the sheath Sheaths are hollow tubes of various diameters that are inserted into a blood vessel to provide a pathway for catheters or wires. They have a one way valve to prevent backflow of arterial blood and a side port that permits aspiration and administration of fluids. They also come with a dedicated dilator which is used to fill the lumen of the sheath and allows the surgeon to insert the sheath safely into the vessel. If the wire is the rail and the catheter is the train, the sheath is the ground. Sheaths and catheters sizing Both are measured in French 1 French equals 0.33 mm. French size divided by 3 equals the approximate diameter in millimeters. Another way to think about Fr is roughly the circumference in mm. Divide by 3 instead of 3.14 to get the diameter Sheaths are defined by their inner diameter (ID) Catheters are defined by their outer diameter (OD) This is because catheters go inside the sheath, so the size of a catheter must be smaller or equal to the size of the sheath for it to fit inside.For example, a 5 Fr sheath can accommodate 5 Fr catheter/devices Of note, the hole in the artery will roughly be 2-4Fr larger than the sheath size. This is important when considering the type of closure that will be used at the end of the procedure. Step One: Establishing Arterial Access Preop preparation: During physical exam, make sure there's a palpable femoral pulse to rule out iliofemoral disease Review the CT if available for high femoral bifurcation or presence of vessel disease Patient positioning on the angio table, depends on the access site of choice. Typical position (for retrograde femoral artery access) is supine, arms tucked. Alternative access sites (ie. radial, brachial, carotid) may require arms to be out and prepped. How do you choose arterial access, location? Depends on location of lesion you are trying to treat and complexity of the path from the access site Size of the access vessel and device size must be considered when deciding on the access site The most common is retrograde femoral artery access When would other access points be used? Radial artery, brachial, antegrade femoral access. The goal, target location, and path complexity defines the access point. Arterial puncture Femoral access: Look for pulsatile vessel on the US (vein is medial, artery is lateral; “venous penis”) Usually access at the level of femoral head for common femoral artery Seldinger technique is used to establish access to a vessel or cavity using needle, wire, catheters, and sheath. E.g. using the micropuncture kit: contralateral arterial CFA access with s 21 gauge needle .018” guidewire is passed through the needle Needle is removed and a short 4 or 5 Fr microcatheter with an inner dilator is passed over the guidewire The dilator and guidewire are removed leaving the catheter in place to maintain access Bigger wire is inserted through the catheter, which is then removed over the wire A sheath is inserted over the wire The overall purpose is to start with smaller arterial puncture and exchange to larger size to minimize complication should the access fail Often, percutaneous closure devices are preloaded at this step. We will discuss this later. Step Two: Navigating to treatment zone or vessel With sheath in place, a guidewire is inserted into the vessel under fluoroscopic guidance. Continuous fluoroscopy is taken with the C-arm during key steps to visualize wire movement The C-arm can be portable or built into the room X rays are emitted from the X-ray generator below the patient And the subsequent image is generated from the image intensifier above the patient Radiation safety: wear protective gear which is made of lead. In addition, use the tableside lead shield whenever possible minimize use of continuous fluoroscopy whenever possible limit use of magnification, and digital subtraction angiography keep the image intensifier as close to the patient as possible to minimize scattering The C-arm can rotate around the patient to get optimal viewing of the vessels Frequently used terminology: 30 degrees RAO which stands for right anterior oblique, describing the relationship of image intensifier to the patient Common projections used for lower extremity angiograms Iliacs: 20-30 degrees contralateral anterior oblique Femoralsl: 20-30 degrees ipsilateral anterior oblique Trifurcation and tibials: anatomic anterior-posterior or 20 degrees ipsilateral anterior oblique with feet in neutral supine position Thoracic aorta/distal aortic arch: 30~45 degree LAO Renals: AP maximizing image quality by limiting patient movement and with breath holding and collimating Contrast Two types of contrasts: Iodinated contrast vs carbon dioxide Iodinated contrast has better resolution but patients can have allergic reactions and are at risk of contrast induced renal injury. Therefore, CO2 is preferred for patients with compromised renal function in which an image is created by transiently displacing blood. The downside is that it has lower image resolution than iodinated contrast, and rare but potentially serious complications of air locking. Power injection vs manual injection When using power injection, you have control over pressure, the amount of contrast, timing, and rate or rise of injection. It allows for rapid filling of large arteries at high flow rates. Manual injection is more efficient for small vessels since you can control dilution and volume Types of Wires Characteristics: wire tip, stiffness, diameter, and length Guide wires To assist in catheter placement, navigate different arteries, cross lesions, and deliver devices. The most common sizes used in vascular surgery Large .035” - generally used for the aorta and iliac. Small .014”/.018” - used for smaller branches like the SFA Length: from 120 to 360cm Based on distance from access site to the lesion Long enough to reach target lesions and beyond (inside pt) and deliver catheters (outside pt) but not too long that it's falling off the table and slowing down exchange Flexible vs stiff/support wires How do you decide which wire to use? Typically, you start with flexible wire inside an angle tip catheter to navigate to the target vessel. Once you reached and crossed the target vessel, the wire is exchanged to a stiff/support wire, which allows you to deliver common brands and models used that every medical student should know and the settings they are used in? Example answer: Glidewire (Tumero): a floppy wire with a hydrophilic coating which is useful for navigating stenosis and tortuous vessels and is used in a variety of different vessels. Lunderquist (Cook): it is very stiff and used for endovascular repairs of AAAs Rosen wire: support wire with a J tip with intermediate stiffness. Less stiff than Lunderquist. Used to catheterize visceral and renal arteries. Bentson: starter wire, that's short in length with a very long floppy tip that prevents vessel trauma. Types of Catheters Main purpose of the catheters Allows to approach the target vessel based on the shape of the catheter Allows wire exchange from flexible to stiff Sizes are based on Fr (4-5) 5 Fr are the most common. Microcatheters are for embolizations (2.5Fr) Nonselective (Angiographic catheter) Common types are omni flush, pigtail, and straight They have multiple side holes along the tip so they can inject high volume of contrast into large blood vessels like the aorta Selective catheters/Guide (shape) catheters Have an end hole only with no side holes so they can cannulate specific branch vessels A variety of lengths and shapes depending on the curvature and tortuosity of the pathway to the target vessel. Catheter with specific shapes can align your vector (the force you are exerting by pushing the wire forward at the access site) to the stenotic lesion. Type of catheter that can be used to cross to the contralateral side at the aortic bifurcation – generally the omni. Types of sheaths Size range: 4-26Fr (larger available for endografts) Size is decided by the device you have to deliver to the target lesion Length is based on the support required from the procedure. The distance from the access site to the target site determines the length of the sheath required. Common lengths range from 5 to 110cm What are some of the common sheaths used and for which procedure? For endovascular aortic repairs, Dryseal sheaths range from 12Fr ~ 26Fr with lengths of 33cm to 65cm. For visceral and renal artery intervention, Ansil or Raabi sheaths range from 5Fr to 9Fr, with lengths of 45cm to 90cm. For lower extermity work, Ansil, Raabi, Balkin sheaths ranging from 4Fr to 7Fr with lengths of 45cm to 110cm. Steerable sheaths can actively articulate the shape of the sheath, allow you to navigate and treat more challenging anatomy. Step Three: Treating the lesion The lesion has to be crossed with wire and catheters before treating the lesion. They may require the need to exchange sheath Stent and balloon sizing is measured by diameter in millimeters x length in centimeters Balloons Generally need to exchange wire to stiff support wire through the catheter, then the catheter is exchanged over the wire with the balloon mounted catheter Balloons have a wide variety of diameters and lengths Nominal vs Burst pressures Nominal: pressure is where the balloon will inflate to the labeled diameter Burst: pressure where 99.9% of tested balloons ruptured Typically you inflate to nominal but can go higher depending on the type of lesion Compliant balloon vs a semi-compliant vs non-compliant balloon Most of the time, we use a compliant balloon, but in certain situations where we need high pressure dilation, we use non-compliant balloon. This has to do with the nature of the lesion and risk of vessel rupture. Additional features Cutting balloons have microblades on the wall. So the idea is to perform control rupture of calcified atherosclerotic lesions, so that the expansion happens more evenly. Drug coated balloons are coated with paclitaxel to reduce the risk of neo-intimal hyperplasia So, it is sometimes used in peripheral cases where the surgeons feel that the lesions are more prone to developing neo-intimal hyperplasia or areas that have restenosed. Stents small mesh-like device made of metal that is used to prop open a blocked or narrow blood vessel. It is inserted through a catheter and deployed at the site of the blockage to improve blood flow and reduce the risk of future blockages. balloon expandable vs self-expanding stents Balloon expandable Better radial force at the time of deployment More accurate deployment Mounted on balloons, so it is more difficult to track them across tight stenosis. May cause damage to the surrounding tissue due to balloon inflation. Self-expanding Usually more flexible in tortuous vessels More resistant to kinking Higher risk of migration or dislodgement during deployment Post-dilation is often needed covered stents vs bare metal stents Covered stents Covered by PTFE, polyurethane, or silicone May be more resistant to in-stent restenosis, compared to bare metal stents. useful in ruptured vessel EVAR/TEVAR/FEVAR devices are essentially fancy covered stents. Step Four: Closure Hole in the artery is outer diameter of the sheath, and is bigger than the sheath size since sheath is measured by inner diameter Manual compression Direct pressure with fingertips Enough pressure without bleeding, but not too much that it cuts off circulation No peeking! Timing depends on sheath size, coagulation status, and vessel health. Closure devices Extravascular plug Angio-seal: sandwiches the arteriotomy with a biodegradable anchor and collagen sponge. https://www.youtube.com/watch?v=XhgAs2SxNjA Mynx: utilized a small balloon to create temporary hemostasis within the artery and covers the outside with a polyethylene glycol sealant. https://www.youtube.com/watch?v=_kcJM1lnQo8 Suture-based Sometimes placed at beginning of the case for large bore access Proglide: https://www.youtube.com/watch?v=Wol22SlEpxE Complications What are the most common complications that you experience and how do you mitigate them? Access site Hematoma, pseudoaneruysm, AV fistula, occlusion, infection Navigation related Dissection, perforation, thromboembolism Systemic Contrast induced AKI —----------------------------------------------------------------------------------------------------------------------- Please share your feedback through our Listener Survey! 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In this episode, we review the high-yield topic of Femoral Neck Fractures from the Trauma section. Follow Orthobullets on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
In this episode, we review the high-yield topic of Femoral Shaft Fractures from the Trauma section. Follow Orthobullets on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://podcasters.spotify.com/pod/show/orthobullets/message
In this episode, we review the high-yield topic of Femoral Neck Stress Fractures from the Knee & Sports section. Follow Orthobullets on Social Media: Facebook: www.facebook.com/orthobullets Instagram: www.instagram.com/orthobulletsofficial Twitter: www.twitter.com/orthobullets LinkedIn: www.linkedin.com/company/27125689 YouTube: www.youtube.com/channel/UCMZSlD9OhkFG2t25oM14FvQ --- Send in a voice message: https://anchor.fm/orthobullets/message
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