A soft brace, sometimes called soft support or a bandage, belong to the field of orthoses and are supposed to protect the joints from excessive loads.
Soft braces are also classified according to regions of the body. In sport, bandages are used to protect bones and joints, and prevent and protect injuries. [ 66 ]  Bandages should also allow  proprioception . They mostly consist of textiles, some of which have supportive elements. The supporting functions are low compared to paralysis and relief orthoses, though they are sometimes used  prophylactically  or to optimize performance in sport. [ 67 ]  At present, the scientific literature does not provide sufficient high quality research to allow for strong conclusions on their effectiveness and cost-effectiveness. [ 68 ]


Upper-limb (or upper extremity) orthoses are mechanical or electromechanical devices applied externally to the arm, or segments of it, in order to restore or improve function or structural characteristics of the arm segments enclosed in the device. In general, musculoskeletal problems that may be alleviated by the use of upper limb orthoses include those resulting from trauma [ 69 ]  or disease (arthritis for example). They may also benefit individuals who have a neurological impairment from a stroke, spinal cord injury, or peripheral neuropathy. [ citation needed ]


Scoliosis , a condition describing an abnormal curvature of the spine, may in certain cases be treated with spinal orthoses, [ 70 ]  such as the  Milwaukee brace ,  Boston brace ,  Charleston bending brace , or  Providence brace . As scoliosis most commonly develops in adolescent females who are undergoing their  adolescent growth spurt , compliance is hampered by patient concerns about appearance and movement restrictions caused by the brace. [ citation needed ]


Spinal orthoses may also be used in the treatment of spinal fractures. A Jewett brace, for instance, may be used to aid healing of an anterior  wedge fracture  involving the T10 to L3 vertebrae, and a body jacket may be used to stabilize more involved fractures of the spine. There are several types of orthoses for managing cervical spine pathology. [ 71 ]  The halo brace is the most restrictive cervical thoracic orthosis in use; it is used to immobilize the cervical spine, usually following fracture, and was developed by Vernon L. Nickel at  Rancho Los Amigos National Rehabilitation Center  in 1955. [ 72 ]


Helmets  such as a cranial molding orthoses is an example of orthoses for the head. [ 73 ]  These devices are often suggested for infants with  positional plagiocephaly . [ 74 ] [ 75 ]


An  orthotist  is a healthcare professional who specializes in the provision of  orthoses . An orthotist has an overall responsibly of  orthotics  treatment, who can supervise and mentor the practice of other personnel. [ 1 ]  They are clinicians trained to assess the needs of the user, prescribe treatment, determine the precise technical specifications of orthotic devices, take measurements and image of body segments, prepare model of the evaluation, fit devices and evaluate treatment outcome. [ 1 ]  In the United States, orthotists work by prescription from a licensed healthcare provider. Physical therapists are not legally authorized to prescribe orthoses in the U.S. In the U.K., orthotists will often accept open referrals for orthotic assessment without a specific prescription from doctors or other healthcare professionals. [ 2 ]


The scope of an orthotist includes the design and application of  orthoses  (braces or  orthotic devices ). The definition of an orthosis is an “externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system”. [ 3 ]


In Canada, a Certified Orthotist CO(c) provides clinical assessment, treatment plan development, patient management, technical design, and fabrication of custom orthoses to maximize patient outcomes. To become CBCPO certified through Orthotics Prosthetics Canada (OPC) an applicant must successfully meet the following requirements:


Upon successful completion of the national certification exams, candidates are conferred the designation of Canadian Certified Orthotist CO(c). [ 4 ]


In the UK orthotists assess patients, and where appropriate design and fit orthoses for any part of the body. Registration is with the  Health and Care Professions Council  and BAPO - the British Association of Prosthetists and Orthotists. The training is a B.Sc.(Hons) in Prosthetics and Orthotics at either the  University of Salford  or  University of Strathclyde . New graduates are therefore eligible to work as an orthotist and/or  prosthetist .


Podiatrists are the other profession involved with foot orthotic provision. [ 5 ]  They are also registered with the  Health and Care Professions Council  . Podiatrists assess gait to provide orthotics to improve foot function and alignment or may use orthoses to redistribute stress on pressure areas for those with diabetes or rheumatoid arthritis.


A licensed orthotist is an orthotist who is recognized by the particular state in which they are licensed to have met basic standards of proficiency, as determined by examination and experience to adequately and safely contribute to the health of the residents of that state. An American Board of Certification certified orthotist has met certain standards; these include a degree in orthotics, completion of a one-year residency at an approved clinical site, and passing a rigorous three-part exam. [ 6 ]  A certified orthotist (CO) is an orthotist who has passed the certification standards of the American Board of Certification in Orthotics, Prosthetics and Pedorthics. Other credentialing bodies who are involved in orthotics include the Board for Orthotic Certification, the pharmaceutical industry, the Pedorthic Footcare Association, and various of the professional associations who work with athletic trainers, physical and occupational therapists, and orthopedic technologists/cast technicians.


Four universities including the  Iran University of Medical Science ,  Isfahan University of Medical Science ,  University of Social Welfare and Rehabilitation Sciences  and Iran Red Crescent University confer bachelor of science in the Prosthetics and Orthotics. Three universities including Isfahan University of Medical Science, the Iran University of Medical Science and University of Social Welfare and Rehabilitation Science also confer  M.Sc.  and  Ph.D . New bachelor graduates are eligible to work as an orthotist and  prosthetist  after registration in the  Medical Council of Iran . [ citation needed ]


Lars Peterson  (born 1936 in  Vansbro ,  Sweden ) is an  orthopedist , known as "the father of autologous cell implantation". [ 1 ]


Beginning in 1987, Peterson co-pioneered, with colleague  Mats Brittberg  and others,  autologous chondrocyte implantation , a method of repairing  cartilage  using a patient's own cartilage cells. [ 2 ]  He was honored for his work at  Genzyme  in 2009. [ 3 ]


He is also a professor and sports physician, and has been a Swedish national league football and ice hockey player, active in both  Örgryte IS  and  Frölunda HC .


Peterson's sports career started early in most sports, ending up playing in the Swedish National League in both soccer and hockey with Örgryte IS, ending on fourth place and  Västra Frölunda IF , ending first place, respectively. Along with playing soccer and football, he studied medicine at the  University of Gothenburg  and graduated in 1966.
He served his Residency in General Surgery in Kungälvs Hospital, his orthopaedic residency in  Sahlgrenska University Hospital  from 1967 to 1974, and became specialist in General Surgery 1972 and in Orthopaedic Surgery 1974. In 1974, Peterson defended his doctoral thesis: Fracture of the Neck of the Talus, An Experimental and Clinical Study.


In 1980, Peterson was approved associate professor of Orthopaedic Surgery at the University of Gothenburg and in 2000, appointed professor of Orthopaedic Surgery. Peterson had a long and broad experience in treating athletes in his University practice and as team physician in soccer and ice hockey and since 1987 in his clinic, Gothenburg Medical Center. He has served as head physician of the Swedish National Team in ice hockey and in soccer


For over 25 years, Peterson has been a member of the Sports Medical Committee of  FIFA , The International Football Federation and a founding member of F-Marc (FIFA Medical Assessment and Research Center). He has served as a Medical Officer at six World Cups in Football.
Peterson has been President of the  Swedish Society of Sports Medicine  and is an honorary member. He was president and one of the founding members of the  International Society of Cartilage Repair  (ICRS). He has served as Godfather for ICRS Traveling Fellows in 2001. He also has served as Goodfather in the Herodicus Society.


In 2010, Peterson received “The Duke of Edinburgh Prize“ for “Outstanding contribution to international education in Sports Medicine”. In 2010 awarded “Doctor Honoris Causa” at the  University of Helsinki , Finland. In 2011, he was awarded “Doctor Honoris Causa” at  Universidad Católica San Antonio de Murcia , Spain.


Peterson has lectured extensively, nationally and internationally and served as visiting professor several times. His publication list includes more than 200 originals, reviews books, book chapters in the fields of Orthopaedic Surgery, Sports Traumatology and Sports Medicine, Biomechanics, and Rehabilitation.


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Prosthetic joint infection  (PJI), also known as  peri-prosthetic joint infection , is an acute, sub-acute or chronic infection of a  prosthetic joint . It may occur in the period after the joint replacement or many years later. It usually presents as joint pain,  erythema  (redness of the joint or adjacent area),  joint swelling  and sometimes formation of a  sinus tract  ( a tract connecting the joint space to the outer environment). PJI is estimated to occur in approximately 2% of hip and knee replacements, and up to 4% of revision hip or knee replacements. Other estimates indicate that 1.4-2.5% of all joint replacements worldwide are complicated by PJIs. [ 1 ]  The incidence is expected to rise significantly in the future as  hip replacements  and  knee replacements  become more common. It is usually caused by  aerobic   gram positive  bacteria, such as  Staph epidermidis  or  Staphylococcus aureus  but  enterococcus  species,  gram negative  organisms and  Cutibacterium  are also known causes with  fungal  infections being a rare culprit. The definitive diagnosis is isolation of the causative organism from the  synovial fluid  (joint fluid), but signs of inflammation in the joint fluid and imaging may also aid in the diagnosis. The treatment is a combination of systemic  antibiotics ,  debridement  of infectious and  necrotic  tissue and local antibiotics applied to the joint space. The bacteria that usually cause prosthetic joint infections commonly form a  biofilm , or a thick slime that is adherent to the artificial joint surface, thus making treatment challenging.


The most common symptom of periprosthetic joint infections is  joint pain . [ 2 ]  Other local symptoms are also present, including  erythema  (redness of the joint),  joint swelling , warmth of the joint, and loosening of the prosthetic joint. [ 2 ]  A  sinus tract , or a tract connecting the joint space to the external environment, is more common in chronic PJI, and is definitively diagnostic of PJI. [ 3 ]  Fever may be present in PJI, but is uncommon. [ 2 ]


Prosthetic joint infections can occur any time after a joint replacement. Early infections (occurring within 4 weeks of a joint replacement) are usually due to Staph aureus,  streptococci  or  enterococci . [ 4 ]  Whereas late infections (occurring 3 months or later after the joint replacement) are usually due to coagulase negative staphylococcus or  cutibacterium . [ 4 ]  The highest risk of PJI is in the immediate post-operative period, when direct inoculation of bacteria into the joint space may occur during surgery. [ 4 ]  The risk of PJI is highest in this early period; within 2 years of the joint replacement. [ 1 ]   Hematogenous spread , or infection of a prosthetic joint via direct seeding from a bloodstream infection, may occur at any time after a joint replacement, with the risk being as high as 34% in staph aureus  bacteremia . [ 4 ]  An additional possible cause of PJI is from direct spread to the joint from a nearby skin or soft tissue infection, a bone infection ( osteomyelitis ), or from more distal spread to the joint from a respiratory tract infection,  gastroenteritis ,or  urinary tract infection . [ 4 ]  Dental procedures may cause a transient bacteremia which can lead to inoculation of the artificial joint and PJI, with  strep viridans  being the most common causative organism. [ 4 ]


The most common causes of PJIs are aerobic, gram positive bacteria, including staph aureus and coagulase negative staphylococcus (such as  staph epidermidis ), which make up greater than 50% of all causes of hip and knee PJIs. [ 3 ]  With regards to acute PJIs, the most common causative organism is staph aureus (comprising 38% of acute infections) followed by aerobic gram negative bacilli (making up 24% of acute infections). [ 3 ]  70% of PJIs are monomicrobial (with a single causative organism identified), whereas 25% of cases are polymicrobial (with multiple causative organisms identified). [ 2 ]  3% of PJIs are due to fungal organisms. [ 2 ]   Propionibacterium acnes  is the most common cause of shoulder PJIs. [ 3 ]


Risk factors for PJI include  diabetes ,  immunosuppression ,  smoking ,  obesity ,  chronic kidney disease , the presence of a soft tissue infection, or an infection in another part of the body or increased fat tissue around the replaced joint. [ 1 ]  Surgical factors that may lead to an increased risk of PJIs include  wound dehiscence  (unplanned opening of the surgical wound after the surgery) and  hematoma  (collection of blood) formation. [ 1 ]


The presence of multiple artificial joints,  MRSA  PJIs,  rheumatoid arthritis  or bacteremia place people at risk for multiple PJIs (either concurrent or subsequent infections). [ 2 ]


Prolonged operative times, in which the joint is left open to the external environment, determined as greater than 90 minutes in a single study, also increases the risk for PJIs. [ 2 ]


Prosthetic joint infections are generally difficult to treat as most causative organisms form a biofilm, or a thickly adherent membrane, against the artificial joint surface. The bacteria secrete  adhesion proteins  which help them attach to each other and to the joint surface. [ 1 ]  The bacteria then secrete  autoinducer  proteins that act as bacterial signals which facilitate the secretion of an intricate extracellular matrix, the biofilm. [ 1 ]  Biofilms greatly decrease antibiotic penetrance thereby shielding bacteria from the  bacteriocidal  effects of antibiotics. [ 2 ] [ 1 ]  Biofilms usually take 4 weeks to fully mature. [ 4 ]   Granulocytes  have decreased  phagocytic  activity encountering the biofilm, also allowing the bacteria to persist. [ 2 ]


The presence of a PJI is confirmed when one of the proposed major diagnostic criteria are met: [ 4 ]


Polymerase chain reaction  testing of the joint fluid or sonification fluid may aid in the diagnosis. [ 4 ]


Skin swabs, sinus tract swabs, swabbing of the artificial joint surface during surgery is not recommended due to the high risk of contaminants and low diagnostic yield (including the risk of contaminants rather than the pathologic organism being cultured). [ 4 ] [ 2 ]


Blood cultures are positive in approximately 25% of cases of PJIs, especially in acute PJI, however, the organism isolated from blood culture does not always correlate to the organisms isolated from the joint fluid, and therefore blood cultures are not diagnostic of PJIs. [ 2 ]


Routine blood work attempting to identify infection including elevated white blood cells on a  complete blood count , elevated inflammatory markers ( erythrocyte sedimentation rate  and  C-reactive protein ) or  procalcitonin  are not sensitive nor specific in diagnosis PJIs. [ 4 ]


Plain radiography  (X-ray) has a low sensitivity and specificity for diagnosing PJI but it may show radiolucent lines around the prosthetic joint, bone breakdown, loosening or migration of the prosthetic joint. [ 2 ] [ 4 ]   Functional imaging  tests such as white blood cell  Scintigraphy  or  PET scan  may help to identify hypermetabolic areas consistent with infection and aid with the diagnosis. [ 4 ]


Magnetic resonance imaging  is specific to soft tissue infections, with metal artifact reduction sequence (MARS) MRIs having great utility to aid in the diagnosis of PJIs. [ 4 ]


Antibiotic treatment alone, without surgical debridement, usually results in treatment failure. [ 2 ]  Acute infections (in which the biofilm is thought to be immature) are usually treated using the DAIR technique;  debridement , systemic and local antibiotics, and implant retention (the implant is not removed). [ 4 ] [ 2 ]  However, the mobile, easily interchangeable components of the implant are often replaced in the DAIR approach. [ 4 ]  DAIR is contraindicated if there is a sinus tract, loosening of the prosthesis, or the surgical wound cannot be closed. [ 2 ]  The microbial cure rate of DAIR is 74%, 49% and 44% in early, sub-acute and late infections respectively. [ 2 ]


Antibiotic loaded  polymethylmethacrylate  (PMMA) which are placed in the joint are helpful, however these non-resorbable beads may themselves be colonized by bacteria with an associated  biofilm , therefore bio-absorbable local antibiotic carriers (calcium sulfate beads, resorbable  gentamicin  sponges) are preferred. [ 4 ]


Chronic PJIs may be treated using 1 stage revisions, where the artificial joint is replaced with a new one during the same surgical procedure, or with a 2-stage revision; in which the infected joint is removed and an antibiotic spacer is placed, this is followed by a second surgery in which a new artificial joint is placed. [ 4 ]  Two step revisions are associated with increased morbidity, longer hospital stays, longer immobilization time, worse functional outcomes and higher costs. [ 4 ]  Therefore, for intact, or mostly intact bone and soft tissue, and without a history of joint replacement revisions; a 1 step exchange is the treatment of choice. [ 4 ]  In the case of hip PJIs both kinds of surgery are equally effective but one-stage surgery results in faster recovery. [ 5 ] [ 6 ] [ 7 ]


Negative pressure wound therapy  is not recommended as the sponges used are often themselves colonized by the biofilm or by new organisms from the environment (including  multi-drug resistant organisms ). [ 4 ]


An extended course of antibiotics is required in PJIs, usually 6–12 weeks of antibiotic therapy. [ 2 ] [ 4 ]  Intravenous antibiotics are initially used and then transitioned to oral antibiotics. A strategy of surgical debridement to decrease the bacterial load prior to starting systemic antibiotics is sometimes employed. [ 4 ]  Common practice involves switching to oral antibiotics after 14 days. [ 4 ]  Intravenous  ampicillin-sulbactam  or  amoxicillin with clavulanic acid  with  vancomycin  added in cases of MRSA is a commonly employed empiric antibiotic treatment strategy. [ 4 ]


If surgery fails or the PJI persists despite optimal antibiotic therapy, resection arthroplasty of the hip with a pseudarthrosis ( Femoral head ostectomy ) is sometimes done. [ 2 ]  Or in cases of knee PJIs failing treatment; an  arthrodesis  (artificial induction of ossification of the knee joint) is done. [ 2 ]  These are considered last line therapies due to significant disability. [ 2 ]


Antibiotic prophylaxis , or giving small doses of antibiotics as a preventative measure, during the perioperative period (usually less than 60 minutes prior to the start of joint replacements)(usually using second generation  cephalosporins ) is believed to reduce the risk of acute PJIs. [ 2 ] [ 1 ]


Screening for and eradication of MRSA carriage and  chlorhexidine  wipes or soap and water skin cleansing prior to surgery may possibly decrease the risk of PJIs. [ 2 ]


According to the  American Dental Association : in patients with prosthetic joint implants, prophylactic antibiotics prior to routine dental procedures are generally not recommended in the prevention of PJI. However specific circumstances placing patients at higher risk, as determined by the dentist or other physicians, may warrant antibiotic prophylaxis. [ 8 ]


The 5-year mortality after hip PJIs is 21%, which is 4 times that of age adjusted controls. [ 2 ]  And the 10 year mortality after hip PJIs was 45%, as compared to 29% in people with non-infected hip replacements. [ 2 ]  25% of people with PJIs have an unplanned re-operation within 1 year of PJI treatment. [ 2 ]  Hospital stays are longer in those with knee and hip PJIs as compared to un-infected knee and hip replacement controls; at 5.3 vs 3 days (knee) and 7.6 vs 3.3 days (hip). [ 2 ]


PJIs are the most common cause of knee replacement failures, and the third most common cause of hip replacement failures. [ 1 ]  As of 2017, 2.1% of hip and 2.3% of knee replacements will at some time develop a PJI. [ 2 ]  The incidence of PJIs have more than tripled in the last 20 years, with the incidence expected to further increase in the future. This increase is believed to be due to the much greater number of hip and knee arthroplasties being performed presently. [ 2 ]


Shoulder reduction  is the process of returning the shoulder to its normal position following a  shoulder dislocation . Normally, closed reduction, in which the relationship of bone and  joint  is manipulated externally without surgical intervention, is used. A variety of techniques exist, but some are preferred due to fewer  complications  or easier execution. [ 1 ]  In cases where closed reduction is not  successful , open (surgical) reduction may be needed. [ 2 ]   X-rays  are often used to confirm success and absence of associated  fractures . The arm should be kept in a sling or immobilizer for several days, prior to supervised recovery of motion and strength.


Various non-operative reduction techniques are employed. They have certain principles in common, including gentle in-line traction, reduction or abolition of muscle spasm, and gentle external rotation. They all strive to avoid inadvertent injury. Two of them, the Milch and Stimson techniques, have been compared in a randomized trial. [ 3 ]  Pain can be managed during the procedures either by  procedural sedation and analgesia  or by injecting  lidocaine  into the shoulder joint. [ 4 ]


The person's arm is brought against their side. [ 2 ]  The elbow is then bent to 90 degrees and the forearm is slowly and gently externally rotated. [ 2 ]  Any discomfort or spasm interrupts the process until the person is able to relax. Reduction usually takes place by the time full external rotation has been achieved. [ 5 ]


This is an extension of the external rotation technique. The externally rotated arm is gently abducted (brought away from the body into an overhead position) while external rotation is maintained. Gentle in-line traction is applied to the arm while some pressure is applied to the humeral head via the operator's thumb in the armpit to keep the head from moving inferiorly. [ 2 ] [ 6 ]


In the Stimson technique, also known as prone technique, the person lies on their stomach on a bed or bench and the arm hangs off the side, being allowed to drop toward the ground. A 5–10 kg weight is suspended from the wrist to overcome spasm and to permit reduction by the force of gravity; [ 3 ]


The person is on their back and gentle upward traction is applied to the extremity coupled with external rotation. [ 2 ]


The  Cunningham technique  was originally published in 2003 and is an anatomically based method of shoulder reduction that utilizes positioning (analgesic position), voluntary scapular retraction, and bicipital massage. [ 7 ]  If performed correctly most patients do not require analgesia for the performance of this technique. Inappropriate use of traction will result in pain for the patient with subsequent spasm and failure to reduce. If the patient is unable to adduct the humerus or unable to cooperate with positioning the technique should not be attempted. The patient may require analgesia or sedation if they are in pain or unable to relax spasming muscles.


FARES stands for fast, reliable, and safe. With the person lying on their back, the operator holds the person's hand on the affected side while the arm is at the side and the elbow is fully extended. The forearm is in neutral position. Next, the operator gently applies longitudinal traction and slowly the arm is abducted. At the same time, continuous vertical oscillating movement at a rate of 2–3 "cycles" per second is applied throughout the whole reduction process. [ 8 ] [ 9 ]


Traction countertraction involves pulling the dislocated arm down and outwards while an assistant pulls the body upwards. [ 2 ]


Kocher's method was described in 1870 and has been incorrectly associated with neuromuscular complications and humeral fractures due to the inappropriate addition of traction by later users. It was designed for subcoracoid dislocations.
"This method: Pressing the arm bent at the elbow towards the body, turning outward until resistance is felt, lifting of the outwardly rotated upper arm in the sagittal plane as far as possible, and finally slowly turning it inward." [ 10 ]


A  sling , also known as  arm sling , is a device to limit movement of the shoulder or elbow while it heals. [ 1 ]  A sling can be created from a  triangular bandage . [ 1 ]


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The  Spurling test  is a medical maneuver used to assess nerve root pain (also known as  radicular pain ).


The patient rotates their head to the affected side and extends their neck, while the examiners applies downward pressure to the top of the patient's head.


A positive  Spurling's sign  is when the pain arising in the neck radiates in the direction of the corresponding  dermatome  ipsilaterally. [ 1 ]  It is a type of cervical compression test.


Patients with a positive Spurling's sign can present with a variety of symptoms, including pain, numbness and weakness. In addition to the clinical history, the neurological examination may show signs suggesting a cervical  radiculopathy .


The Spurling test is used during a spinal or neck examination to aid in the diagnosis and assessment of cervical radiculopathy. It should be used to assess patients with radicular symptoms. The results of this test can guide a clinician when considering further imaging and necessary steps needed to make a proper diagnosis.


However, caution should be used when assessing patients with acute cervical injuries, critically ill patients, and those with other neoplastic or infectious processes. Cervical instability is also a reason to avoid performing this medical maneuver.


Spurling's test is somewhat specific when used for individuals with an abnormal  electromyogram study  and is a relatively sensitive physical examination maneuver in diagnosing  cervical spondylosis  or acute cervical radiculopathy. It is not a very sensitive test when used for individuals without classic radicular signs suggestive of cervical radiculopathy. [ citation needed ]   In 2011, one study evaluated 257 patients with clinical cervical radiculopathy and correlated  CT scan  findings with clinical exam findings using the Spurling's test. The Spurling's test was 95% sensitive and 94% specific for diagnosing nerve root pathology. [ 2 ]


In another study done in the late 1900s, 255 patients were examined using a Spurling test and afterwards received an electrodiagnostic examination. The study results showed the Spurling test was 30% sensitive, and 93% specific for finding cervical radiculopathy diagnosed by electrodiagnostic examination. The conclusions drawn from this study demonstrate clinical utility of the Spurling test to confirm cervical radiculopathy rather than for screening purposes. Overall, there continues to be limited data on the specificity and sensitivity of the Spurling test. [ 3 ]


The  sulcus sign  is an  orthopedic  evaluation test for  glenohumeral  instability of the shoulder.  With the arm straight and relaxed to the side of the patient, the elbow is grasped and traction is applied in an  inferior  direction.  With excessive inferior translation, a depression occurs just below the  acromion .  The appearance of this sulcus is a positive sign. [ 1 ]


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Tenodesis grasp and release  is an  orthopedic  observation of a passive  hand grasp  and release mechanism, affected by  wrist extension  or  flexion , respectively.   It is caused by the manner of attachment of the finger tendons to the bones and the passive tension created by two-joint muscles used to produce a functional movement or task (tenodesis). [ 1 ]   Moving the wrist in extension or flexion will cause the fingers to curl or grip when the wrist is extended, and to straighten or release when the wrist is flexed. [ 2 ] [ 3 ]


The tenodesis grip and release mechanism is used in occupational therapy, [ 4 ]  physical therapy [ 5 ] [ 4 ]  and rehabilitation of fine motor impairment, typically various levels of spinal paralysis, [ 6 ] [ 7 ]  and in kinesiology and sports mechanics that are concerned with efficient grasp and release mechanics.  Wrist extension is noted for bat grip in baseball. [ 8 ]    Wrist extension is also noted in the form of grip used in most schools of Japanese swordsmanship or  kenjutsu .


This particular function serves to enhance gripping capabilities for individuals with tetraplegia exhibiting wrist extension against gravity but lacking active finger functionality (C6 Motor Level). The active wrist extension, when initiated, draws the fingers and thumb into a flexed position passively. Acquiring tenodesis function is crucial for enabling task execution, as it allows for the passive holding of objects between the thumb and index finger or within the palm. [ 9 ]  People with tetraplegia devise adaptive approaches to optimize the utility of their hands. Many individuals create alternative techniques to carry out their daily activities. One such strategy involves leveraging the impact of gravity to enhance grasping capabilities. This adjustment is inherent in the tenodesis grasp, where the hand is often opened through wrist flexion assisted by gravity, reflecting a reliance on this natural force. [ 10 ]


The tenodesis grasp entails extending the wrist (specifically the extensor carpi radialis longus and brevis), leading to two distinct types of grips: a passive whole hand grasp attributed to the shortening of finger flexors and a passive lateral grip resulting from the shortening of the flexor pollicis longus. [ 11 ]


There are a number of ways that a patient in a rehabilitation or healthcare setting can optimize their tenodesis Grasp to boost their independence after a spinal cord injury. A physical therapy or occupational therapy professional may guide the patient in the following ways:


The use of an effective tenodesis grasp after a spinal cord injury can have a substantial impact on the activities of daily living for a patient after suffering a spinal cord injury. The majority of individuals with tetraplegia opt against undergoing surgical reconstruction for hand function, relying instead on the inherent passive properties of their musculoskeletal system to carry out functional tasks. [ 10 ]


The following  outline  is provided as an overview of and topical guide to trauma and orthopaedics:


Orthopedic surgery  – branch of  surgery  concerned with conditions involving the  musculoskeletal system .  Orthopedic surgeons  use both surgical and nonsurgical means to treat  musculoskeletal injuries ,  sports injuries , degenerative diseases, infections,  bone tumours , and  congenital limb deformities .   Trauma surgery  and  traumatology  is a sub-specialty dealing with the operative management of  fractures ,  major trauma  and the multiply-injured patient.


History of trauma and orthopaedics


Pet orthotics  refers to the use of  orthotics  for  pets .  Orthotics  is an allied health care field concerned with the design, development, fitting, and manufacture of orthoses. Orthoses, sometimes called braces or splints, are devices that support or correct musculoskeletal deformities and/or abnormalities of the body.


Animals that might benefit from the use of an orthosis commonly have an injury to a lower limb or paw, such as a fracture, torn  meniscus , ruptured  Achilles tendon , or injured  cruciate ligament  (ACL or CCL). They may also have an orthopedic condition due to arthritis, spinal cord injury, or a  congenital abnormality . Animals that have used orthoses and  prostheses  (artificial limbs) include dogs, cats, horses, llamas, and an orangutan. Each animal's situation is unique and should be evaluated by a  veterinarian . [ 1 ]


Orthoses can decrease pain and increase stability in an  unstable joint , as well as prevent potential progression or development of a deformity or contracture. An orthosis will prevent, control or even assist the motion of a joint, depending upon how it is made. An orthosis can be made for short-term use during a post-operative healing period, for example, or for long-term chronic use. [ 2 ]  They can provide a good quality of life for an animal that might otherwise have to be euthanized. [ 3 ]


With a few exceptions, orthoses for animals are custom-made from a  cast . They are typically formed from lightweight plastic or carbon fiber material with a comfort liner inside and velcro to hold them in place. They may have solid joints or hinged joints. [ 4 ]


An orthotic differs from a prosthetic in that a prosthetic completely replaces a missing limb or body part, whereas an orthotic is an external device that is meant to help support or protect a limb or body part.


The most common orthotic, especially for dogs, are  booties . They have a wide range of uses for the dog, including traction while getting up or walking on slippery surfaces such as hardwood or tile flooring. They can especially help dogs with hip issues and dogs with neurological conditions who are less aware of their self-movement ( proprioception ). [ 5 ]


Another form of orthotic is a leg brace that can improve stabilization for issues caused by age, worn-out bones in the foot, or  ectrodactyly . This is the deficiency of one or more central digits of the foot, causing the animal's foot to become deformed. Proper support is necessary or more serious health issues can arise in the future. [ 6 ]


Malpositions should be corrected as early as possible. The sooner the problem is resolved, and the younger the animal, the easier and faster a correction using dog  braces  or other methods is possible since the bones are still remodeled due to the growth. The misaligned teeth are often congenital, i.e., the causes are genetic. They are already visible in the young dog, e.g., excess teeth,  deciduous teeth  that have not failed, or jaw malformations. As with humans, there are also braces or other appliances for orthodontic treatment in dogs. With the help of these methods, teeth in the jaw, for example, can be realigned and thus integrated into the healthy row of teeth. There are different systems of dog braces. [ 7 ]


When looking at purchasing or constructing an orthotic for a pet, several factors must be taken into consideration to ensure the animal's health and wellness. These include how the orthotic sits on the body, the material being used, and the functionality of the product. The fit is also important for prosthetics for the area of attachment so it is comfortable and does not cause irritation to the skin. Material is also a consideration: if the skin is irritated or damaged, it can have a greater impact on the animal than if it were not wearing the orthotic at all, in some cases. The functionality of the orthotic affects both owner and pet. An orthotic or a prosthetic needs to be monitored regularly. Orthotics need to be removed several times daily to check the condition of the skin. For this reason, it is better if they are easier to take on and off, both in terms of ease and in avoiding irritation to the skin by removing or putting on the orthotic in a cumbersome way. It also helps the pet to stay calm if it is not such a laborious task. For functionality, the product itself and how it will serve the pet are important considerations. An orthotic that interferes with the pet's daily life and  range of motion  is problematic. Even if the pet wears it while standing, it might not function well enough when trying to get up from lying down. The orthotic must also be kept clean, both from dirt from everyday activities and sweat build-up, and if the pet gets dirty. [ 8 ] [ 9 ]


Depending on the orthotic, they can be expensive.  3D printing  can be a cost-effective alternative. 3D printing is an additive manufacturing process where filament is layered on top of itself to create a three-dimensional object. This differs from more traditional subtractive manufacturing processes, like drilling, where the material is taken away to form a whole. Free online versions of different orthotics are available to print if a more general model is suitable; they can also be adapted to fit the owner and pet's needs. Libraries may be a source of complimentary or donation-based printing for the public. Custom orthotics can also be designed in  3D modeling  software. [ 10 ]


Frykman classification  is a system of categorizing  Colles' fractures . In the Frykman classification system there are four types of  fractures . [ 1 ]


Though the Frykman classification system has traditionally been used, there is little value in its use because it does not help direct treatment. The classification is as follows: [ 2 ]


Gartland & Werley classification  is a system of categorizing  Colles' fractures . In the Gartland & Werley classification system there are three types of  fractures . The classification system is based on  metaphysical comminution , intra-articular extension and displacement, and was first published in 1951. [ 1 ] [ 2 ]


The  Gartland classification  is a system of categorizing  supracondylar humerus fractures , clinically useful as it predicts the likelihood of associated neurovascular injury, such as  anterior interosseous nerve   neurapraxia  or  brachial artery  disruption.


The  Gustilo open fracture classification  system is the most commonly used classification system for  open fractures .  It was created by Ramón Gustilo and Anderson, and then further expanded by Gustilo, Mendoza, and Williams. [ 1 ] [ 2 ] [ 3 ]


This system uses the amount of energy, the extent of soft-tissue injury and the extent of contamination for determination of fracture severity. Progression from grade 1 to 3C implies a higher degree of energy involved in the injury, higher soft tissue and bone damage and higher potential for complications. It is important to recognize that a Gustilo score of grade 3C implies vascular injury as well as bone and connective-tissue damage. [ 4 ]


There are many discussions regarding the inter-observer reliability of this classification system. Different studies have shown inter-observer reliability of approximately 60% (ranging from 42% to 92%), [ 7 ] [ 8 ]  representing poor-to-moderate agreement of scale grading between health-care professionals. This is due to much of the criteria being at risk of observer errors, and is a known liability of this scaling system. However, this classification is simple and hence easy to use, and is generally able to predict  prognostic  outcomes and guide treatment regimes. Generally, the higher the grading of Gustillo classification, the higher the rate of infection and complications; any Guistilo classification rating should still be interpreted with caution due to observer errors before any definite therapeutic plans are made. [ 5 ]


Although this classification system has a fairly good ability to predict fracture outcomes, it is not perfect. The Gustillo classification does not take into account the viability and death of soft tissues over time which can affect the outcome of the injury. Besides, the number of the underlying medical illnesses of the patient also affects the outcome. Whether the timing of wound debridement, soft tissue coverage, and bone have any benefits on the outcome is also questionable. Besides, different types of bones have different rates of infection because they are covered by different amounts of soft tissues. Gustilo initially does not recommend early wound closure and early fixation for Grade III fractures. However, newer studies have shown that early wound closure and early fixation reduces infection rates, promotes fracture healing and early restoration of function. Therefore, assessment of all open fractures should include the mechanism of injury, the appearance of soft tissues, the likely levels of bacterial contamination and the specific characteristics of the fractures. Accurate assessment of the fracture can only be performed inside an operating theatre. [ 5 ]


For more comprehensive prognosis purposes other classification systems, such as the Sickness Impact Profile (as a health status measure), [ 5 ]  Mangled Extremity Severity Score (MESS) and Limb Salvage Index (LSI) (decision to amputate or salvage a limb), have been devised by Dr  Shanmuganathan Rajasekaran . [ 9 ]


In 1976, Gustilo and Anderson refined the early classification system proposed by Veliskasis in 1959. An early study conducted by Gustilo in 1976 showed that primary closures with prophylactic antibiotics of Type I and type II fractures reduced the risk of infection by 84.4%. Meanwhile, early  internal fixation  and primary closure of the wound in Type III fractures have a greater risk of getting  osteomyelitis . However, Type III fractures occur in 60% of all the open fracture cases. Infection of the Type III fractures is observed in 10% to 50% of the time. Therefore, in 1984, Gustilo subclassified Type III fractures into A, B, and C with the aim of guiding the treatment of open fractures, communication and research, and to predict outcomes. Based on the results of the previous studies, Gustilo initially recommended  therapeutic irrigation  and surgical  debridement  for all fractures with primary closure for Type I and II fractures; secondary closure without internal fixation for Type III fractures. However, soon after that, he recommended internal fixation devices for Type III fractures. [ 5 ]


The  Herbert classification  is a system of categorizing  scaphoid fractures . [ 1 ]


After  hip replacement ,  hip prosthesis zones  are regions in the interface between prosthesis material and the surrounding bone. These are used as reference regions when describing for example complications including  hip prosthesis loosening  on  medical imaging . Postoperative controls after hip replacement surgery is routinely done by  projectional radiography  in anteroposterior and lateral views.


The DeLee and Charnley system applies to the acetabular cup on anteroposterior radiographs. It divides the acetabulum into three equally large zones. [ 1 ]


The  Gruen zones  is a system of dividing the interface between the bone and the stem of the hip prosthesis.


The  Ideberg classification  is a system of categorizing  scapula fractures  involving the  glenoid fossa .


The  Le Fort  (or  LeFort )  fractures  are a pattern of midface fractures originally described by the French surgeon,  René Le Fort , in the early 1900s. [ 1 ]  He described three distinct fracture patterns. Although not always applicable to modern-day facial fractures, the Le Fort type fracture classification is still utilized today by medical providers to aid in describing  facial trauma  for communication, documentation, and  surgical planning . [ 2 ]  Several surgical techniques have been established for facial reconstruction following Le Fort fractures, including  maxillomandibular fixation (MMF)  and  open reduction and internal fixation (ORIF) . The main goal of any surgical intervention is to re-establish  occlusion , or the alignment of upper and lower teeth, to ensure the patient is able to eat. [ 2 ]  Complications following Le Fort fractures rely on the anatomical structures affected by the inciding injury.


When discussing the anatomy of the face, it is often divided into thirds. The lower third extends from the chin to approximately the level of the upper teeth. The middle third continues from the teeth to just below the brow line. Finally, the upper third stretches from the brow to the hairline. [ 3 ]


The middle third of the face, or the midface, is the anatomical location in which Le Fort fractures occur. It comprises the  maxillary bone ,  palatine bones ,  zygomas ,  zygomatic processes (of the temporal bone) ,  ethmoid bone ,  vomer ,  nasal concha ,  nasal bones , and  pterygoid processes (of the sphenoid bone) . [ 2 ] [ 3 ] [ 4 ]


The maxillary bone contains important anatomical structures which are prone to injury during trauma. The  maxillary sinuses  are housed within the maxillary bone, and traumatic injury to these sinuses may cause  sinus infections , and changes in eye placement and movement. [ 4 ]  The  infraorbital nerve  (a terminal branch of  CNV2 ) courses through the maxillary bone and provides sensation to the central face. Additionally, the maxillary bone contains the upper row of teeth (maxillary dentition).  Occlusion , or the alignment of upper and lower teeth, is vital following midface trauma to ensure a patient is able to eat and speak. [ 2 ]


Facial  biomechanics , or the study of forces on the facial bones, plays an important role in midface reconstruction following trauma. Although the biomechanics of the face are not fully understood due to their complex nature, several vertical and horizontal buttresses, or pillars, have been established. These buttresses dissipate the powerful forces the skull endures during biting and chewing. [ 2 ] [ 5 ] [ 6 ]


The Le Fort fractures are a pattern of midface fractures originally described by the French surgeon,  René Le Fort , in the early 1900s. [ 1 ]  Le Fort studied the effect of  facial trauma  by dropping cadavers from various heights and recording the different fracture patterns observed. [ 2 ]  Today, with the evolution of high-speed  motor vehicle accidents  and advancements in  medical imaging  and surgical techniques, the low-speed fracture patterns originally described by Le Fort are not always applicable. [ 7 ]  Modern midface fractures typically do not neatly fit into one of the Le Fort classifications and often occur in combination with other  craniofacial trauma . [ 1 ]  Nevertheless, the Le Fort type fracture classification is still used today as a starting point for describing midface fractures for communication, documentation, and treatment planning. [ 2 ]


Traditionally, Le Fort described three types of fractures. All three fractures involve the  nasal septum  and the  pterygoid plates . [ 2 ]


Every trauma patient presenting to the hospital should first be evaluated according to the  Advanced Trauma Life Support (ATLS) protocol , which follows the ABC's ( airway ,  breathing ,  circulation ) of trauma. This includes ensuring the patient is able to breathe, confirming that the patient is actively  breathing , and identifying and minimizing major bleeding. [ 1 ] [ 2 ] [ 6 ]  Le Fort fractures have the potential to obstruct a patient's  airway  for a variety of reasons, preventing him or her from being able to breathe. [ 1 ] [ 6 ]  Medical providers should be prepared for  emergency airway management  should the patient develop an obstructed airway due to bleeding or swelling. [ 6 ]  Other life-threatening injuries, including those to the  brain ,  spine , or  abdomen , should receive prompt evaluation by the appropriate  medical specialist . [ 6 ]


After the initial evaluation is complete and the patient is  stable , the patient should be evaluated by a surgeon that specializes in facial trauma, such as a  plastic surgeon , an  otolaryngologist  (ear, nose, and throat surgeon), or an  oral and maxillofacial surgeon  (OMFS). The surgeon will perform a thorough facial exam, paying special attention to any new-onset facial asymmetry or distortion. [ 1 ]  Facial swelling and bruising is very common in Le Fort fractures and can make evaluation of facial changes challenging. [ 6 ]  It can be helpful to have a picture of the patient prior to his or her facial trauma as a comparison.


If the surgeon suspects a Le Fort fracture, they may test for abnormal movement of the  maxillary bone  by planting one hand on the patient's forehead and using the other hand to press on the roof of the patient's mouth. [ 1 ]  Movement in the  maxillary bone  either in isolation or with the nose is suggestive of a Le Fort I or II fracture, respectively. [ 1 ]


The  cranial nerves (CNs)  should be  examined  if the patient is awake and able to participate in the exam process. [ 2 ]  The  CN exam  evaluates facial movement and sensation. Special attention should be made to the  fifth CN (CNV)  as one of its branches (the  infraorbital nerve ) courses through the  maxillary bone . [ 2 ]  If this nerve is injured during trauma, it can result in numbness or tingling around the nose or within the mouth. [ 2 ]


The surgeon will also examine the patient's mouth for bleeding, swelling, cuts, foreign objects, changes in bite, and newly lost teeth. Additionally, an eye exam assessing vision and  pupillary response  may be warranted, especially in Le Fort II and III fractures due to the involvement of the  orbit . [ 2 ]  If there is suspicion that the  skull base has been injured , such as during a Le Fort III fracture, the patient should be examined for clear drainage from the ear or nose which may be caused by a  cerebrospinal fluid (CSF) leak . [ 2 ] [ 6 ]  Abnormal findings during these mouth, eye, ear, or nose exams may require further evaluation.


If it was determined that the patient lost a tooth during the inciting trauma, the tooth's location should be identified as it could have become lodged in the airway,  aspirated into the lungs , or swallowed. [ 1 ]  If there is concern for an  aspirated  tooth, an  x-ray  can confirm the tooth's location. [ 1 ] [ 6 ]  If the eye exam reveals abnormalities in either vision or the  pupillary response , prompt evaluation by a  neurosurgeon  and an  ophthalmologist  should occur. [ 2 ]   Skull base injuries  can result in a  cerebrospinal fluid (CSF) leak , which can present as a clear, metallic-tasting liquid draining from the  nose  or the ear. [ 2 ]  If a CSF leak is suspected, the patient should be evaluated by a  neurosurgeon . [ 6 ]


Although diagnosis can be suspected by history and physical exam, imaging is required for an accurate diagnosis. A  computed tomography (CT)  of the face and skull is the imaging of choice for diagnosing Le Fort fractures. [ 5 ] [ 7 ]  CT imaging has greatly replaced the use of  plain x-ray  as CTs are significantly more likely to show when a fracture is present compared to an x-ray. [ 7 ]  Additionally, CT imaging is far more useful in visualizing the skeletal injuries in Le Fort fractures than  magnetic resonance imaging (MRI) . [ 7 ]  However, MRIs may be useful if there is extensive  soft tissue injuries . [ 6 ]


Surgical  treatment of Le Fort fractures is almost always necessary, especially if the fractures are displaced or impact facial functions like eating and speaking. [ 6 ]  Fractures can be repaired through  maxillomandibular fixation (MMF)  and/or  open reduction and internal fixation (ORIF)  after life-threatening injuries have been addressed.


The primary goal of any intervention is to ensure that a patient is able to eat and speak. This is done by re-establishing  occlusion  (alignment of upper and lower teeth) and stabilizing  facial biomechanics  (via the vertical and horizontal facial buttresses discussed previously) to support chewing. [ 1 ]  Other goals of intervention include restoring cosmetic deformities from the trauma, but this should never be prioritized over re-establishing occlusion. [ 1 ]


Maxillomandibular fixation (MMF) , also known as intermaxiallary fixation (IMF), is a surgical procedure to re-establish  occlusion  by fixating the upper and lower teeth in their correct position. It can be used in isolation or in combination with  open reduction and internal fixation (ORIF)  in treating Le Fort fractures. [ 6 ]  Several surgical techniques exist for establishing MMF, with selection relying on the individual patient injury and surgeon preference. [ 1 ] [ 2 ]  MMF involves fixation of the upper and lower teeth for 6-8 weeks, which limits a patient's ability to speak, eat, breathe through their mouth, and maintain adequate  oral hygiene . [ 1 ]  MMF patients should be provided with wire cutters or scissors for emergency situations. [ 1 ]  A patient in MMF will be placed on a liquid-only diet during the entirety of their treatment, which may result in weight changes. [ 1 ] [ 8 ]  MMF has some effect on a patient's ability to breathe through their mouth while in place, so patients with a history of  pulmonary disease  who rely on mouth breathing may not qualify for MMF. [ 8 ]   Additionally, patients with psychological or seizure disorders may not be good MMF candidates. [ 1 ]


Open reduction and internal fixation (ORIF)  is a surgical term that refers to open surgical repair of broken bones. It is required for correction of complex Le Fort fractures affecting facial function or involving neurological complications (visual changes,  CSF leak ). [ 6 ]  ORIF is especially important for repairing unstable facial buttresses in order to allow the patient to tolerate chewing. Plates and screws are often permanently fixated to facial bones to stabilize the lateral and medial vertical buttresses bilaterally. [ 2 ]  Bone grafts may also be required to stabilize the buttresses. [ 2 ]  ORIF can be used in isolation or in combination with  maxillomandibular fixation (MMF)  in treating Le Fort fractures. [ 6 ]  Following surgery, patients may require up to six weeks of rest before they are able to return to the demands of their daily life. [ 6 ]  As all patients heal slightly differently, ORIF may result in a less-than-ideal correction of facial bones, resulting in poor  occlusion  or facial asymmetries. Furthermore, as with any surgery, ORIF comes with risk of scarring, nerve injury, and infection. [ 2 ]


The role of  antibiotics  in midface trauma is a complex and highly patient-dependent topic. Facial trauma patients with  lacerations  (or wounds) to the inner lining ( mucosa ) of the  mouth  or the  nose  traditionally have been started on antibiotics as soon as they enter the hospital and have remained on antibiotics for a minimum of 24 hours after surgery. [ 2 ]  However, some preliminary studies on  preoperative  antibiotic use suggest that they may not be necessary to prevent  bacterial infections , though these are based on small patient populations and are not strong enough studies to set specific recommendations regarding preoperative antibiotic use. [ 9 ]  Therefore, patients are still often placed on antibiotics before surgery, especially if they are at an increased risk of developing infection (including, but not limited to, patients that are elderly,  tobacco users ,  diabetic , and/or  immunocompromised ). [ 9 ] [ 10 ]  If a patient is begun on antibiotics, it is difficult to determine how long they should remain on antibiotics  postoperatively . [ 10 ]  Although multiple studies have been performed examining postoperative antibiotic use, they have come to contradicting conclusions. [ 11 ]  The more recent studies have suggested that antibiotics may not have any advantage in preventing postoperative bacterial infections. [ 10 ] [ 11 ]  However, these studies acknowledge that their results are based predominantly on the young, healthy, male patients with non-specific  facial trauma  that make up the majority of the studies' participants and may not be applicable to the everyone experiencing midface trauma. [ 10 ]  With limited studies specifically on midface trauma, no standards for postoperative antibiotic use has been determined. The use of postoperative antibiotics relies on the surgeon's clinical recommendations and individual patient risk factors. [ 10 ]


Longterm outcomes of Le Fort fractures depend on the severity and location of the fracture. The most common complication of Le Fort fractures include imperfect fracture reduction resulting in poor  dental occlusion . [ 2 ]  Other longterm effects of Le Fort fractures include various nerve injuries, either from the inciting injury or from surgical correction, resulting in facial movement and sensory deficits. [ 2 ]  If one or both of the  maxillary sinuses  are injured during the trauma, it can result in  chronic sinus infections  or injuries to the eye which may require further surgical correction. [ 2 ]  Le Fort III fractures that injure the  optic nerve  or the  extraocular muscles  that move the eye may result in visual defects. [ 2 ]


Lidström classification  is a system of categorizing  fractures of the distal radius , one of the two bones of the  forearm . In the Lidström classification system there are six types of  fractures . The classification system is based on fracture line, direction and degree of displacement, extent of articular involvement and involvement of the  distal radioulnar joint , and was first published in 1959. [ 1 ]


The  Mayfield classification  is a system of categorizing perilunate dislocations.


The  Milch classification  is a system of categorizing single column ( AO  type B) distal  humerus fractures  based on the pattern of  epicondyle  involvement.  It is distinct from the  Jupiter classification  which is used for bicolumnar distal humerus fractures.


The  Müller AO Classification of fractures  is a system for classifying bone fractures initially published in 1987 [ 1 ]  by the  AO Foundation  as a method of categorizing injuries according to therognosis of the patient's anatomical and functional outcome. "AO" is an initialism for the German "Arbeitsgemeinschaft für Osteosynthesefragen", the predecessor of the AO Foundation.


It is one of the few complete fracture classification systems to remain in use today after validation. [ 2 ]


The English language version of the system [ 3 ]  allows consistent in detail description of a fracture in defined terminology by creating a 5-element alphanumeric code:


First, each fracture is given 2 numbers to describe which bone it affects, and where in the bone:


Each fracture is next given a letter (A, B or C) to describe the joint involvement of the fracture:


The exceptions to this step include:


Finally, the fracture is given 2 further numbers to denote the fracture pattern and geometry.


For segment 2 (diaphyseal) fractures:


For segment 1 and 3 (epiphyseal and metaphyseal) fractures:


Subgroups are then used to describe the fractures in terms of displacement (versus apposition, which is the degree to which the parts are in contact with each other), rotation, angulation and shortening.


A pediatric version of the long-bone classification was published in 2006 [ 4 ]  to further classify fractures of immature bone and so the effects on future growth:


The Orthopaedic Trauma Association Committee for Coding and Classification initially published their classification system covering the whole skeleton in 1996. [ 5 ]   In 2006 [ 6 ]  they published a revision, unifying the Muller/AO and OTA systems into a single alphanumeric classification, which has been further updated in 2018: [ 7 ]


Nissen-Lie classification  is a system of categorizing  Colles' fractures . In the Nissen-Lie classification system there are seven types of  fractures . The classification system was first published in 1939.


Older's classification  is a system of categorizing  Colles' fractures , proposed in 1965. [ 1 ]  In the Older's classification system there are four types of  fractures . [ 2 ]


A  Salter–Harris fracture  is a fracture that involves the  epiphyseal plate  (growth plate) of a bone, specifically the zone of provisional  calcification . [ 2 ]  It is thus a form of  child bone fracture . It is a common injury found in children, occurring in 15% of childhood long bone fractures. [ 3 ]  This type of fracture and its classification system is named for  Robert B. Salter  and  William H. Harris  who created and published this classification system in the  Journal of Bone and Joint Surgery  in 1963. [ 4 ]


There are nine types of Salter–Harris fractures; types I to V as described by Robert B. Salter and William H. Harris in 1963, [ 3 ]  and the rarer types VI to IX which have been added subsequently: [ 5 ]


The mnemonic "SALTER" can be used to help remember the first five types. [ 14 ] > [ 15 ]


N.B. : This mnemonic requires the reader to imagine the bones as long bones, with the epiphyses at the base.


Alternatively, SALTER can be used for the first 6 types, as above but adding Type V — 'E' for 'Everything' or 'Epiphysis' and Type VI — 'R' for 'Ring'.


Fractures in children generally heal relatively fast but may take several weeks to heal. [ 1 ]  Most growth plate fractures heal without any lasting effects. [ 1 ]  Rarely, bridging bone may form across the fracture, causing stunted growth and/or curving. [ 1 ]  In such cases, the bridging bone may need to be surgically removed. [ 1 ]  A growth plate fracture may also stimulate growth, causing a longer bone than the corresponding bone on the other side. [ 1 ]  Therefore, the  American Academy of Orthopaedic Surgeons  recommends regular follow-up for at least a year after a growth plate fracture. [ 1 ]


In  orthopedic medicine , the  Sanders classification  is a system of categorizing intra-articular  calcaneal fractures  based on the number of articular fragments seen on the  coronal   CT  image at the widest point of the posterior facet.


The  Schenck classification  is a system of categorizing  knee   dislocations  based on the pattern of multiligamentous  injury .  It is limited clinically by not describing the risk of neurovascular involvement.


Teisen classification  is a system of categorizing  fractures  of the  lunate bone , which is located in the hand. [ 1 ]


The  Tscherne classification  is a system of categorization of  soft tissue   injuries . [ 1 ]


The intraobserver (observations at two different times by the same person) agreement for Tscherne classification is 85%; while for inter-observer agreement is 65%. [ 2 ]


This classification system was developed by Harald Tscherne and Hans-Jörg Oestern in 1982 at the Hannover Medical School (Hanover, Germany) to classify both open and closed fractures. This classification system is based on the physiological concept that the higher the kinetic energy imparted on the bone, the higher the kinetic energy imparted on the soft tissue. It also serves as a tool to guide management and to predict clinical outcomes. It also serves as a communication tool in research and in clinical presentations. [ 2 ]


The  Vancouver classification  is a grading system used in  orthopaedics  to determine management of post-operative  periprosthetic   femoral   fractures  following a  hip arthroplasty .  It is named for the city  Vancouver , home to the  University of British Columbia  where the authors of the 1995 paper worked.


The  Wassel classification  is used to categorise radial  polydactyly , based upon the most  proximal  level of skeletal duplication. [ 1 ]


The  Winquist and Hansen classification  is a system of categorizing  femoral shaft   fractures  based upon the degree of  comminution . [ 1 ]


Adnan Al-Bursh  ( Arabic :  عدنان البرش ,  romanized :  ʿAdnān al-Bursh ; 17 September 1974 –  c.  19 April 2024) [ 1 ]  was a  Palestinian   orthopedic surgeon  and the head of orthopedics at the  Gaza Strip 's largest medical facility,  Al-Shifa Hospital . [ 2 ] [ 3 ]  He died after having been reportedly tortured in Israeli prison after four months of detention during the  Israel–Hamas war . [ 4 ] [ 5 ]


During the  Israeli invasion of Gaza , Al-Bursh was arrested by the Israeli military and held at Israel's  Ofer Prison  in the  Israeli-occupied   West Bank . Palestinian authorities and advocacy groups have attributed his death to  torture and mistreatment  in custody, with the  OHCHR  confirming his body showed signs of torture. [ 6 ]  His death has been highlighted as part of the "systematic targeting process against physicians and the health care system in Gaza" by Israel. [ 5 ] [ 2 ] [ 4 ]


Adnan Al-Bursh was born in 1974 in  Jabalia , the  Israeli-occupied   Gaza Strip , and received his early education there before traveling to  Romania  to study medicine. [ 7 ] [ 8 ]  In his career, he was a prominent Palestinian  orthopedic surgeon  who served as the head of orthopedics at  Al-Shifa Hospital , Gaza's largest medical facility. [ 2 ] [ 7 ] [ 8 ] [ 9 ]  Al-Bursh was married and had five children. He served as an adviser to the  Palestine national football team . [ 3 ]


In 2018, a viral photograph showed Al-Bursh in the Al-Shifa operating room covered in blood. [ 10 ]


Shortly after the outbreak of the  Israel–Hamas war  in October 2023, Al-Bursh started living full-time at Al-Shifa, sleeping in the hospital's staff room at night. [ 10 ]  In November 2023, during the  Israeli invasion of Gaza , Al-Bursh was stranded in the  besieged Al-Shifa Hospital  for 10 days with his nephew. Israeli forces later asked them to move south, but Al-Bursh refused to comply and instead moved north to assist at the  Indonesia Hospital . Al-Bursh's wife and six children [ clarification needed ]  also refused to move south and sought refuge at one UNRWA school in the northern area of the strip. [ 11 ]


On 20 November, Al-Bursh was injured when he was at work in the operating room of the Indonesian Hospital when the hospital was surrounded by Israeli tanks. Projectiles fired on the building killed at least 12 people and destroyed the hospitals' front entrance. The IDF denied that it was responsible for the attack. Following a truce, he relocated again in early December to  Al-Awda Hospital , also in northern Gaza. [ 10 ] [ 11 ]


On 5 December 2023, the IDF surrounded  Al-Awda Hospital  in North Gaza where Al-Bursh was temporarily working. The hospital director told him that staff would have to leave the building. According to a doctor who worked with him there, the IDF would destroy the hospital if all the male workers did not exit. [ 10 ]  Israeli forces arrested the 50-year-old doctor alongside 10 other workers. [ 3 ] [ 2 ] [ 9 ] [ 4 ]


According to Israeli security sources, Al-Bursh was detained for national-security reasons;  IDF  sources reported that he was suspected of terrorism. [ 12 ] [ 13 ]  According to Naji Abbas, Physicians for Human Rights Israel's prisoners' department director, medical professionals have been mass arrested and interrogated to 'fish' for information even if they are not suspected of participating in the militant activity. [ 14 ]  An IDF statement to  Sky News  confirmed that Al-Bursh was taken to  Sde Teiman detention camp , which had been processing Palestinian prisoners since the start of the war and is the subject of multiple allegations of prisoner abuse. According to Dr. Khalid Hamoudeh, a former prisoner at Sde Teiman who was used as an assistant by the guards and had been ordered to receive Al-Bursh at the camp's gates, he was heavily beaten, unable to use the toilet without help, and believed that he had broken ribs. [ 10 ]  Hamoudeh also noted that he had breathing difficulties. [ 15 ] [ 16 ] [ 17 ]


According to the IDF, Al-Bursh's processing at Sde Teiman was completed on 20 December, after which he was transferred to the  Israel Prison Service  (IPS). In April 2024, Al-Bursh was transferred to  Ofer Prison  near Jerusalem, where he died shortly after arrival. [ 10 ]  On 19 April 2024, the IPS confirmed Al-Bursh's death in custody at Ofer Prison, without disclosing the cause of his death. [ 5 ] [ 3 ] [ 9 ]


Palestinian authorities and advocacy groups have attributed his death to torture or mistreatment in custody. [ 4 ] [ 15 ] [ 16 ] [ 17 ]  Released prisoners told Al-Bursh's family that he was being subjected to torture, [ 11 ]  and a UN statement on his death confirmed his body showed signs of torture. [ 6 ]  According to a  deposition  provided to  HaMoked , an Israeli human rights organization, by a prisoner who knew Al-Bursh, he was injured upon his arrival at Ofer in mid-April and was "naked in the lower part of his body". The deposition said that guards threw him down in the yard and left him there, unable to stand up, and that he died shortly after being helped to a room by prisoners. [ 10 ]  The IPS denied these events. [ 10 ]


Al-Bursh's body was kept in Israeli custody, and the fate of the other detained medical workers remains uncertain. [ 4 ]  In May 2024, the family of Al-Bursh had a lawyer from  The Hague  look into his death and help facilitate the return of his body. [ 11 ]  On 15 May, Al-Bursh's wife and  Physicians for Human Rights–Israel  submitted a request for an investigation and autopsy to the Jerusalem  Magistrate Court . [ 18 ]  Days later, Israel agreed to perform an autopsy, with a doctor representing the family present. [ 19 ]  As of June, [ needs update ]  Israel had not released Al-Bursh's body to his family. [ 16 ]


The Prisoners' Affairs Authority and the  Palestinian Prisoners Club  labelled Al-Bursh's death an "assassination" and a part of the "systematic targeting process against physicians and the health care system in Gaza". [ 5 ] [ 2 ] [ 4 ] [ 11 ]  The  Palestinian Ministry of Health  wanted the investigation done immediately. [ 11 ]


Francesca Albanese ,  UN Special Rapporteur  for human rights in the  occupied Palestinian territories , expressed her extreme alarm at the news of Al-Bursh's death and called for better protections for Palestinians. [ 11 ]  After additional details about his death were reported in November 2024, [ 10 ]  Albanese tweeted: "A doctor. A stellar surgeon. The embodiment of Palestinian ethics. Likely raped to death." [ 20 ] [ 21 ] [ 22 ]


Tlaleng Mofokeng , UN Special Rapporteur on the Right to Health, described herself as "horrified" by his death, lamenting that Al-Bursh "died for trying to protect the rights to life and health of his patients". She called for an international investigation on the matter. [ 6 ]


His death was highlighted as an example of the ongoing challenges and risks faced by healthcare workers in Gaza, with  hundreds killed , injured or arrested. [ 2 ] [ 4 ]  The Ministry of Health stated that 492 Palestinian doctors had been killed by Israel in the conflict. [ 11 ]  The international community and human rights organizations have repeatedly called for an end to attacks on medical personnel and the protection of Palestinians under Israeli occupation. [ 4 ]


Al-Bursh's nephew, Mohammad Al-Bursh, described him as a "cheerful" and "loved" figure who dedicated his life to his profession, often working nonstop during the height of the conflict in Gaza. [ 3 ]  Colleagues praised him as a "rare individual" and the "safety valve" for orthopedic departments across Gaza's hospitals, often working tirelessly even during the height of conflicts in the region. [ 2 ] [ 7 ]


RCSI ,  Royal College of Surgeons in Ireland , 2011


Chichi Menakaya  (Chinyelu Uchechukwu Anne-Menakaya) is a  Nigerian  Trauma and  Orthopedic Surgeon  based in the  United Kingdom . She is the founder of Annomo Health concierge service, [ 1 ] [ 2 ]  which brings together doctors and hospitals to the awareness of patients. [ 1 ] [ 3 ] [ 4 ]


Menakaya has held honorary lectures at Hull and York Medical Schools in  Yorkshire , United kingdom and works as a surgical medical student tutor for the  University College of London . [ 5 ] [ 3 ]  She is also the Founder of Okwuís_Frocentric, a fashion line with African ideas. [ 6 ]


She was born on June 4, 1980 to Dr.  Tim Menakaya  (Nigeria's former Minister of Health) and Chief Magistrate Ann Menakaya in Nigeria. She hails from  Umunya  in  Anambra State  of Nigeria. [ 3 ] [ 7 ]   She attended the  University of Ibadan  from 1999 to 2006. While there, she served as Director of Finance, Federation of African Medical and Dental Students, and later earned a bachelor's degree in Medicine and Surgery. She then proceeded to the  Imperial College, London  in 2009 and earned a master's degree in Surgical Technology with supplementary module in Medico-legal Diploma from that college in 2011. She attended the Royal College of Surgeons in Ireland (RCSI) in 2011 and she is a member of the  Royal College of Surgeons of England  (MRCS RCSEng). [ 3 ] [ 8 ]


Menakaya founded Annomo in 2013. [ 3 ] [ 4 ] [ 9 ]  In 2020, the group donated boxes of masks to rural areas and hospitals in Nigeria. [ 10 ]  Menakaya served as the development director (Europe) for RISE Global Health Initiative from July 2014 to September 2017. She served as clinical Research Fellow for Hull and East Yorkshire Hospitals from August 2011 to August 2013. She was orthopaedic trauma travelling and research fellow for  Harvard medical school  and  Massachusetts General Hospital  from 2013 to 2016. In 2023, she became a  National Health Service  (NHS) Clinical Entrepreneur Fellow. [ 3 ] [ 8 ]  Menakaya, through a non-profit organization, Okwuí Mask Scheme, based in the United Kingdom and Nigeria, empowers victims of domestic violence. [ 11 ] [ 12 ]


Menakaya served as lce Hockey Doctor for the  Hull Stingrays  lce Hockey Club from September 2009 to August 2013. She is Foundation Board Member,  Chelsea and Westminster Hospital  NHS Foundation Trust from June 2007 to Present. Menakaya was Mail Room and Campaign Volunteer, Society for Protection of Unborn Children from July 2006 to August 2007 and Director, CareConnect Incorporated from September 2015 to Present. She was Academic Honorary Clinical Tutor for  Hull York Medical School  (HYMS) from August 2011 to August 2013. [ 3 ]


Menakaya was awarded the Marcela Uribe Zamudio Award for Women Researchers (Issued by SICOT.  Société Internationale de Chirurgie Orthopédique et de Traumatologie ) Nov 2014; [ 13 ]  Travelling Fellow and Research Collaborator (Issued by  Harvard  Orthopedics Combined Residency Program) Sep 2013.; [ 3 ]  and, Year of the African Child Essay Award for  Eastern Nigeria  (Issued by  UNICEF )  Jun 1997. [ 3 ]


Menakaya is cousin to  Lorenzo Menakaya . The name of her company, Annomo, is taken from the names of her mother, “Ann Okwuchukwu Menakaya Orakwue.”  [ 10 ]


Dr.  Raul Geller  (ראול גלר; born 23 January 1936) [ 1 ]  is a Peruvian-Israeli former professional  footballer , who played as a  forward , and an orthopaedic surgeon. [ 2 ]  In Peru he played for  Deportivo Municipal ,  Porvenir Miraflores , and the  Peru national football team . In Israel, he is the third -leading scorer of all time of  Beitar Jerusalem . His 0.64 goals per game ranks first. He also competed in soccer in the  1969 Maccabiah Games . In 2013, Geller was ranked #161 in the world in 75+ tennis by the  International Tennis Federation .


Geller was born in  Quillabamba , Peru. [ 1 ]  His father Marcus (Mordechai) played football in Poland, and fled it before  the Holocaust  to Peru. [ 3 ]  Geller as a child was a member of the youth movements  Beitar  and  HaNoar HaTzioni . [ 3 ]  When he was 13, he and his family moved to  Lima, Peru . [ 3 ]


Geller was a  midfielder  in football. [ 1 ]   Geller played football in Peru for  Deportivo Municipal  (1956–59),  Porvenir Miraflores  (1960–64), and the  Peru national football team  (1964) at the 1964  Copa América . [ 4 ] [ 5 ] [ 6 ]


He emigrated to Israel in January 1965. [ 3 ] [ 7 ]  Geller played football in Israel for  Beitar Jerusalem  (1965–70; scoring 41 goals in 1966–67 and helping the club gain promotion to the Israeli top division). [ 8 ] [ 1 ] [ 4 ] [ 5 ] [ 6 ]  In 1971 he returned to the club for half a season. [ 3 ]  He is the third -leading scorer of all time of Beitar Jerusalem. [ 9 ] [ 5 ]  His 0.64 goals per game ranks first. [ 3 ]


Geller competed in the  1969 Maccabiah Games . [ 8 ]  He played  football at the 1969 Maccabiah Games  for Peru, which came in 8th. [ 8 ]


Geller also worked as an  orthopaedic surgeon  at  Hadassah Ein Kerem , specialising in sports injuries. [ 3 ] [ 5 ] [ 10 ] [ 9 ]


In 2013, Geller was ranked #161 in the world in 75+ tennis by the  International Tennis Federation . [ 11 ] [ 6 ]


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Yip Wing-Yuk  is a  Hong Kong   orthopedic surgeon . She is  International Powerlifting Federation  level 1 referee and  International Weightlifting Federation  referee. [ 1 ]  Former president of The Hong Kong, China Weightlifting and Powerlifting Association. [ 2 ]  She is also a clinical associate professor in the Department of Orthopaedics and Traumatology at the School of Clinical Medicine,  The University of Hong Kong . She has studied the Bachelor of Medicine and Bachelor of Surgery (MBBS) and the Master of Surgery (MS) at the University of Hong Kong, and the Diploma in Hand Surgery from the Federation of European Societies for Surgery of the Hand (FESSH). She is a Fellow of the Royal College of Surgeons of Edinburgh, a Fellow of the Hong Kong College of Orthopaedic Surgeons, and a Fellow of the Hong Kong Academy of Medicine (Orthopaedic Surgery). [ 3 ] 。


In March 2024, during her speech at the "Hong Kong Weightlifting Invitation 2024", Ip Wing-yuk described Hong Kong as a "relatively small country", which caused dissatisfaction from the Hong Kong government and  Sports Federation & Olympic Committee of Hong Kong, China  (SF&OC). Later, the SF&OC acknowledged that it was a slip of the tongue and decided not to pursue the matter further. [ 4 ] [ 5 ]


In May 2024, during the opening ceremony speech of the "Asian Equipped Powerlifting Championships cum Asian University Cup", Ip Wing-yuk mistakenly stated that "13 countries are participating in the competition". Since  Taiwan  and Hong Kong were participating in the competition, the  Hong Kong Special Administrative Region (HKSAR) Government  criticized her statement for potentially violating the  One-China principle . [ 2 ]


Yaser Jabbar  is a consultant orthopaedic surgeon. After graduating from  St. George's medical school at the University of London  in 2004, his surgical training and surgical practice has been predominately based in the United Kingdom. As of January 2024, Jabbar no longer has a license to practice in the UK, and has been subject to allegations of surgical malpractice with multiple past and ongoing investigations into his surgical practice and professional conduct. As of September 2024, Jabbar is believed to be working in Dubai in the United Arab Emirates. [ 1 ]


Jabbar gained his primary medical qualification from  St. George's University of London  in 2004. He received provisional registration with the  General Medical Council  (GMC) in July 2004, extended to full registration in August 2005, allowing him to practice medicine in the United Kingdom. [ 2 ]


Jabber trained in orthopaedic surgery at hospitals in  Oxford  and London, with further training at the  University of Cardiff  where he completed an MSc in Orthopaedic Engineering, before working for a year at the  Royal Children's Hospital  in  Melbourne  and  The Children's Hospital  at  Westmead ,  Sydney . [ 3 ]  On returning to the UK, Jabbar worked at the  Chelsea and Westminster Hospital NHS Foundation Trust  and in December 2014, Jabbar received registration on the GMC's Specialist Registrar, as a consultant in trauma and orthopaedic surgery. [ 2 ] [ 3 ]


From 2017 until late 2023, Jabber worked as a consultant paediatric orthopaedic surgeon at the  Great Ormond Street Hospital , whilst also working privately at the  Portland Hospital  in London. [ 2 ] [ 3 ] [ 1 ]


Whilst working with children at the Great Ormond Street Hospital, the hospital placed Jabbar on 11 months of paid sabbatical leave after staff and parents had raised concerns about his conduct and care. These concerns prompted the hospital to ask  Royal College of Surgeons  to conduct a review into Jabbar's surgical practice at the hospital. [ 3 ]  Jabbar resigned from his post at the hospital in September 2023, one month before the  Royal College of Surgeons  produced a confidential report at a result of their investigations. [ 3 ] [ 1 ]  As of January 2024, Jabbar no longer has a license to practice in the UK, with interim tribunal conditions in place and fitness to practice proceedings against him currently ongoing. [ 2 ]


In February 2024 it was reported that limb lengthening devices were used by Jabbar. The use of such devices between 2017 and 2022 would raise concerns about patient safety, medical ethics, and the standards of care provided by the surgeon. The revelation came about after parents raised concerns. [ 4 ] [ 5 ]


In September 2024,  The Times  newspaper, having seen a copy of the Royal College of Surgeons' report published details of the investigation's findings. [ 3 ]  The investigation found Jabbar had exhibited “unacceptable and unprofessional behaviour”. His record-keeping was poor and assessments of children before surgery were unacceptable and he carried out operations for which he had not sought proper consent. It also concluded that children were also subjected to surgery that had no clear benefits or justification. Accusations were made that Jabbar would alter clinical records after surgery and dismissed concerns raised about the post-surgical recovery of children. According to the report, “the review team heard of serious complications … with staff reportedly seeing more amputations in recent times than they ever had within the service” and that some staff working with Jabbar “would not wish for their friends and family to be operated on” by him. The report also concluded that Jabbar "hid his complications and he didn’t learn from them. So they kept happening.” In a review of one child's care, the report concluded surgery by Jabbar was “incorrect and unsuitable”. It said Jabbar “demonstrated a lack of understanding of the principles of deformity correction surgery, in addition to a lack of insight”. [ 3 ]


It was announced [ by whom? ]  in September 2024 that Great Ormond Street Hospital was launching an urgent review into the 721 children who had been treated by him. Patients treated by Mr Jabbar – who has not worked at the Trust since October 2022 – are now to have their medical records independently reviewed to check that the treatment provided was appropriate. As of September 2024, only 39 out of 721 cases had been fully reviewed, but of these 39 cases, 22 children had been harmed, 13 were classified as having suffered "severe harm" as a result of Jabbar's surgical practice, with potentially lifelong injuries as a result. One child harmed was only four months of age during surgery. At least one child had to have a leg amputation following Jabbar's surgery, with another child at risk of amputation if the work of other surgeons cannot save the limb. In other cases, children have been left with a disparity in leg length by as much as 20 centimetres (7.9 in), with children living with chronic pain even years after surgery and other having to be repeatedly operated on due to muscle damage, nerve injuries and permanent deformities after surgery. [ 1 ] [ 3 ]


Beyond Jabbar's behaviour and care, the Royal College of Surgeons report was highly critical of the working environment at the hospital, with staff and patients feeling their concerns weren't listened to, and the report accusing the hospital of being run like a "political organisation". [ 3 ] [ 1 ]  The father of one child said "we tried to raise our concerns repeatedly through the official complaints procedure, and I copied the clinical director into many emails, but heard nothing back." He described the initial investigation as feeling like everything was being "brushed under the carpet," which he found "very upsetting." [ 3 ]


Jamil bey Lambaranski ( Azerbaijani : Cəmil Məşədi Nasir oğlu Lənbəranski; b. 1884, Lambaran,  Shusha Uyezd ,  Elizavetpol Governorate ,  Russian Empire  - d. 1959,  Baku ,  Azerbaijani SSR ) was an Azerbaijani public figure and statesman, a member of the parliament of the Azerbaijan Democratic Republic (1918-1920). He was  Alish Lambaranski 's father. [ 1 ]


Jamil bey Meshedi Nasir oglu Lambaranski was born in 1884 in the village of Lambaran, Shusha district. In 1913, Jamil bey graduated from the medical faculty of Kyiv University. Until 1920, he worked in the Terter hospital, which he himself created. In 1918 he was a participant in the Batumi Conference. On November 20, 1918, the National Council of Azerbaijan adopted the Law on the Formation of the Azerbaijani Parliament. In accordance with the adopted law, Jamil bey Lambaranski was included in the Parliament of the  ADR , was a member of the  Ittihad  faction. [ 2 ] [ 3 ]


After the  Red Army invasion of Azerbaijan , Jamil bey served as head of the medical department of the People's Commissariat of Health of Azerbaijan, head physician of the 1st surgical hospital, head of traumatology departments in oil fields ( Sabunchi ,  Black City ), during the Great Patriotic War - chief surgeon of the garrison hospital and adviser to the evacuation hospitals of the commissariat healthcare. In 1949, Jamil beyLambaranski defended his Ph.D. thesis, headed the Department of Orthopedics and Traumatology of the Azerbaijan Institute for the Improvement of Doctors. In 1957, Jamil bey Lambaranski was awarded the honorary title of Honored Doctor of the Azerbaijan SSR. [ 4 ]


Jamil bey Lambaranski died in 1959 in Baku. [ 5 ]


Hatim Rida Jarrar  ( Arabic :  حاتم رضا جرار ) is an orthopedic surgeon from  Jenin , in the  West Bank . He was elected as Mayor of the city, until he was arrested by the Israel Forces and spent 3 years in jail. After his release, he resigned from the position and went back to practice in his clinic in Jenin city. [ 2 ] [ 1 ]  He is diagnosed with  diabetes .


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Muthana Mithqal Sartawi  is a Kuwaiti  orthopedic surgeon  specialized in  joint replacement  surgery. [ 1 ] [ 2 ] [ 3 ]  He is best known for inventing the  Modified Intervastus Approach  surgical approach used in  total knee replacement surgery. [ 4 ]  He has operated on notable individuals including  Saud bin Fahd Al Saud  and was part of the medical team that performed the knee replacement for  George W. Bush . [ 5 ]


Sartawi completed his medical degree from  Arabian Gulf University  in 2006, [ 6 ]  and went on to conduct his training at the General Surgery Department at  Farwaniya Hospital  in Kuwait. In 2007, he relocated to Canada after receiving a scholarship to train as a neurosurgery resident for three years in the department of neurosurgery at the  University of Alberta, Canada . In 2013, he completed  residency  at the department of orthopedics at  Dalhousie University  in  Halifax, Canada . [ 7 ]


In 2014, Sartawi completed a fellowship in joint replacement surgery at  Rush University Medical Center  in  Chicago, Illinois . [ 8 ]  He joined the faculty of surgery at the  University of Illinois  from 2014 to 2019 and has served as director of the Joint Care Center of Excellence at  Presence Hospital  in Illinois. [ 9 ]  He was appointed head of the orthopedic department at Christie Clinic in  Champaign, Illinois . [ 8 ] [ 10 ]


In 2018, he patented the  Modified Intervastus Approach , a surgical technique in knee replacement surgery where the surrounding ligaments and muscles of the knee are preserved, helping to shorten the recovery period. [ 11 ] [ 12 ] [ 13 ]  This technique was patented by the  United States Patent and Trademark Office . He has received other patents in the field of orthopedics. [ 14 ] [ 15 ]  Sartawi is both American and Canadian  board-certified . [ 16 ]


His achievements were recognized by  Emir of Kuwait   Sabah al-Ahmad al-Jaber al-Sabah  who named Sartawi as a source of pride to Kuwait, [ 17 ] [ 18 ] [ 19 ]  and by  Kuwait Youth Sports Authority . [ 20 ]


Selected publications by Muthana M. Sartawi include the following:


The  Abbreviated Injury Scale  ( AIS ) is an anatomical-based coding system created by the  Association for the Advancement of Automotive Medicine  to classify and describe the severity of  injuries . [ 1 ] [ 2 ] [ 3 ]  It represents the threat to life associated with the injury rather than the comprehensive assessment of the severity of the injury. [ 4 ]   AIS is one of the most common anatomic scales for  traumatic  injuries. [ 5 ]


The first version of the scale was published in 1969 [ 6 ]  with major updates in 1976, 1980, 1985, 1990, 1998, 2005, 2008 [ 7 ]  and 2015. [ 8 ]


The score describes three aspects of the injury using seven numbers written as 12(34)(56).7 [ 4 ]


Each number signifies


Fractures, rupture, laceration, etc.


Abbreviated Injury Score-Code is on a scale of one to six, one being a minor injury and six being maximal (currently untreatable). [ 1 ]  An AIS-Code of 6 is not the arbitrary code for a deceased patient or fatal injury, but the code for injuries specifically assigned an AIS 6 severity. [ 1 ]  An AIS-Code of 9 is used to describe injuries for which not enough information is available for more detailed coding, e.g. crush injury to the  head .


The AIS scale is a measurement tool for single injuries. A universally accepted injury aggregation function has not yet been proposed, though the  injury severity score  and its derivatives are better aggregators for use in clinical settings. [ 1 ] [ 5 ]  In other settings such as automotive design and occupant protection, MAIS is a useful tool for the comparison of specific injuries and their relative severity and the changes in those frequencies that may result from evolving motor vehicle design. [ 1 ]


The  European Union  defined the MAIS3+ as the maximum abbreviated injury scale (MAIS) with a score of 3 or more. The definition was used to harmonize count of serious injuries or serious  road injury  in different member States (see  Killed or Seriously Injured ). Since 2017 Valletta Council conclusions on road safety, States started collecting those numbers. This need use of hospital data rather than police data. [ 9 ]


Patients often have more than one injury. The Maximum Abbreviated Injury Score (MAIS) is the highest AIS score of all injuries of a person. A road casualty with a MAIS score of 3 or more is referred to as MAIS3+


Those data can be computed in three different ways: [ 9 ]


Previously each State had a different definition of a serious injury. [ 11 ]


It has been estimated that 110,000 people were seriously injured in traffic collisions on the roads of European Union member States in 2019, based on MAIS3+ definition. [ 10 ]


The  Harris Hip Score  (HHS) is a common evaluation instrument of the results of various hip disabilities and methods of treatment, especially for the assessment of  hip replacement . [ 1 ]  It was developed by  William H. Harris  in 1969 with 30 patients who had suffered a fracture of the acetabulum or a luxation of the hip. [ 2 ]  The HHS contains 10 questions/ items, which can be divided in 4 categories: pain, function, range of motion and deformity. It scales from 0 to 100 points. Today, in most cases the version of Haddad et al. is used, where the calculation of the result of the category range of motion has been simplified. [ 3 ] [ 4 ]  The HHS differs from other hip scores as it contains objective as well as subjective items. This has been sparked some controversies as results as the range of motion may be biased by the investigator. [ 5 ]  In recent years, (solely subjective) patient reported outcome measurement-tools have been developed such as the  WOMAC -Score or the Forgotten Joint Score (FJS). Another issue with HHS lies in so called ceiling effects, as it does not allow to differentiate between a very good and an excellent result. [ 6 ]  However, the HHS still offers a valid and reproducible tool for the results of hip surgery, [ 7 ]  although comorbidities should be assessed simultaneously, for example with the Charnley-Score. [ 8 ]


The  Kapandji score  is a tool useful for assessing the  opposition of the thumb , based on where on their hand the patient is able to touch with the tip of their thumb. [ 1 ]


The  Kocher criteria  are a tool useful in the differentiation of  septic arthritis  from  transient synovitis  in the child with a painful hip. [ 1 ]   They are named for  Mininder S. Kocher , an  orthopaedic surgeon  at  Boston Children's Hospital  and Professor of Orthopaedic Surgery at  Harvard Medical School .


The original study used retrospective pediatric cases to develop the criteria over multiple years. The score is primarily used in orthopedic cases in which the symptoms experienced in septic arthritis and transient synovitis are similar. [ 2 ]  The criteria can be used on multiple joints — the hip being the most tested given its frequency of diagnosis and importance to the patient's mobility. The knee and the ankle can also experience these symptoms and the criteria can be applied to symptomatic joints such as these. [ 3 ] [ 4 ]  Septic arthritis is an orthopedic emergency, which, if treatment is delayed, can lead to irreversible joint damage. Septic arthritis occurs more often in childhood than at any other time. [ 4 ] [ 5 ]  Kocher criteria are a useful guide to the diagnosis of septic arthritis in children, especially in the hip, one of the most frequently affected joints. However, the attending physician is requested to put these criteria into clinical context. For example, the attending physician has to use his own clinical judgement and experience to rule out the presence of concurrent acute hematogenous osteomyelitis in cases of proven  septic arthritis . Further, children with septic arthritis - of hip - are highly unlikely to  be able to weight bear freely. Contrastingly, children with  transient synovitis  of the hip can occasionally. [ 4 ]


A point is given for each of the four following criteria:


Mirels' score  is a tool useful in the management of  bone tumors , by identifying those patients who would benefit from prophylactic  fixation  if they have a high enough risk of  pathological fracture .


A score of 1 to 3 is given for four criteria and summed together. A score greater than 8 suggests prophylactic internal fixation prior to irradiation.


In  medicine , the  Ottawa ankle rules  are a set of guidelines for clinicians to help decide if a patient with foot or  ankle  pain should be offered  X-rays  to diagnose a possible  bone fracture . Before the introduction of the rules most patients with ankle injuries would have been imaged. However the vast majority of patients with unclear ankle injuries do not have bone fractures. [ 1 ]  As a result, many unnecessary X-rays were taken, which was costly, time-consuming and a slight health risk due to radiation exposure.


Ankle X-ray is only required if:


Additionally, the Ottawa ankle rules indicate whether a foot X-ray series is required. It states that it is indicated if:


Certain groups are excluded [ clarification needed ] , in particular  pregnant  women, and those with diminished ability to follow the test (for example due to  head injury  or  intoxication ). Several studies strongly support the use of the Ottawa Ankle Rules in children over 6 (98.5% sensitivity); [ 2 ]  however, their usefulness in younger children has not yet been thoroughly examined.


The rules have been found to have a very high  sensitivity , moderate  specificity , and therefore a very low rate of  false negatives . Evidence supports the rules as an accurate instrument for excluding fractures of the ankle and mid-foot, reducing the number of unnecessary investigations and length of stay in emergency departments. [ 3 ]


The original study reported that the test was 100% sensitive and reduced the number of ankle X-rays by 36%. [ 4 ]  A second trial with a larger number of patients replicated these findings. [ 5 ]   Subsequently, a multi-centre study explored the feasibility of implementing the rules on a wider scale. [ 6 ]  Teaching the rules to patients does not appear to help reduce presentation to hospital. [ 7 ]


This list of rules was published in 1992 by a team of doctors in the emergency department of the Ottawa Civic Hospital in  Ottawa ,  Canada . [ 4 ]   Since the rules were formulated in Ottawa they were dubbed the  Ottawa ankle rules  by their creators a few years after their development, a title that has stuck. [ 5 ]    In this respect, the naming of the rules is similar to that of the  Bristol stool scale  or the  Glasgow Coma Scale  (GCS), which also take their names from the cities in which they were formulated.


The original rules were developed for ankle and foot injuries only, but similar guidelines have been developed for other injuries such as the  Ottawa knee rules . [ 8 ] [ 9 ] [ 10 ]


The  Ottawa knee rules  are a set of rules used to help physicians determine whether an x-ray of the  knee  is needed. [ 1 ]


They state that an X-ray is required only in patients who have an acute knee injury with one or more of the following:


The Ottawa knee rules were derived to aid in the efficient use of radiography in acute knee injuries and have since been prospectively validated on multiple occasions in different populations and in both children and adults. [ 2 ]  Some studies found the  sensitivity  of the Ottawa knee rules is 98-100% for clinically significant knee fractures, meaning that 98-100% of all patients with a fracture will meet the criteria for X-ray. However,  specificity  for the Ottawa knee rules is typically poor, meaning that a significant proportion of those who meet Ottawa knee criteria will have no knee fracture on X-ray. The  Pittsburgh knee rules  have been found to be more specific in diagnosis. [ 3 ]


Clinical decision guidelines such as these not only avoid  unnecessary health care  and its costs but also help minimize exposure to ionizing radiation. Such radiation is necessary for radiography but may raise risk for cancer, so physicians  try to avoid using it whenever practical .


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