#c: trochanter

[mechaffeinated-drawings]

Assorted Trochanter/Howitzer moments + meme redraws, because they make me sillyyyyy

Trochanter my failguy favorite belongs to @minminambus 💛

[ntls-24722]

Comets!

I made her antennae-tips different because for their functions of smelling and hearing, they weren't very good at it before.

Her arms have little caps on the elbows where the muscles can attach to, but she also has trochanters now.

I updated her usual dress to be more muted because as much as she WOULD wear something like her old letterjacket, it was wayy overdetailed and I kept forgetting how it even looked like, though I might keep it as what she wore during her time in the Plex. That and... canonically she makes her own clothing because Comet doesn't make moneyyyy. She and Fritz literally live in an abandoned factory that they had to renovate - I don't think she has the RESOURCES to make something that colorful. The brown is dyed with pigment derived from abundant tree bark, but the yellows and blues are small accents derived from the cornflowers and goldenrods nearby, and there's more of a focus on providing warmth rather than fashionable-ness.

It's not actually that bristley but i felt the need to illustrate it

Bonus: her and fritz being newly proud parents c:

[americanphysco]

My Melissa

A Poem by T. C. Tolbert

whose trans body is a house without a hacksaw, a nap inside

a needle, a glass vase ¾ full of smooth stones;

whose trans aorta is a mesquite tree careening through power lines, a Cooper’s Hawk

lit by lightning; whose trans lungs are two jars full

of  bumblebees singing on the uncovered back porch. Even our name is a match

tossed into the fire it started, an edgeless invocation. Melissa, a wind

made by swinging; grass cutting through concrete; bubble-wrap being danced on,

albeit slowly, as if that alone could quiet the tiny explosions down the hall. Whose

trans articular cartilage is string light threaded through the rafters; whose trans

tunica media is a sliver of decorated cardboard doubling as a protest

sign inside the window, which only serves to emphasize the window’s 
inefficacy

against the sun; whose trans epiglottis is an apron

on a hook; whose trans trapezius are cups in the sink filled

with inconsistently directed knives and spoons; whose trans metatarsals are

green beans boiling on the stove; whose trans subclavian artery is organ

pipe cactus under cloud cover; whose trans left ventricle is a black-capped goldfinch hanging

upside down to eat; whose trans lesser trochanter is a hen’s claw growing around a rope;

whose trans great saphenous veins are technologies of prediction—tarot, storm-

tracker, political polls; whose trans dead space is the undeniable pollution

of light; whose trans thyroid cartilage is commissioned

graffiti; whose trans facial hair is the gentrifier yelling

gentrification; whose trans erythrocytes are dapples of daylight

drug across a concrete block wall; whose trans stroke volume is a live-

streamed filibuster; whose trans plasma is the intimacy

of strangers immediate in an emergency; whose trans plasma proteins are women

filling a courtroom—one by one approaching the judge—performing

all the mental and physical labor of obtaining a divorce; whose trans 
integumentary system

is the myth of meritocracy; whose trans rectum is a local philanthropic institution;

whose trans bile is the taste of a slap echoing in your mother’s open palm;

whose trans femoral vein is a cat’s claw’s crafted search for the sun;

whose trans pharynx is an empty building brimming with trampolines; whose trans ovaries

are interrobangs used unironically; whose trans ureter is

a stop sign stuffed with bullet holes near a ditch filled with sunflowers near a wasp’s

nest near a farm. Sometimes I’m afraid I am afraid

of me, my trans sympathetic nervous

system, my trans fatigue

cracks, my trans 1st Corinthians 3:16 training

the god right out of my trans temple,

all trans dove, no savior; a trans baptism, holy

to be a fire (trans) trembling in the tear of the trans (daughter, trans) tongue. How I love you

now, my trans vagina, my trans manubrium, my trans Melissa, in every iteration TC

Melissa Dawn Tolbert who was even once

a Harrison, a wife to a husband; it is possible she loved

me then too. Hiding can she hear me

say thank you. To my trans uterus, my trans pectoralis major, my trans penis: the highest point

on earth is in the ocean. Sea stars, our body’s becoming. A trans prayer. An infinite, inexhaustible

rhizome of the heart. You,

whose tragus is trans, whose kidneys, whose medulla oblongata, whose

adrenal glands, whose cochlea, whose pleural space; whose trans sacrum is simultaneous,

the site of the storm and the keel of a storm-scored boat.

Whose trans arrector pili muscle is the fact that no matter when this 
sentence is read, it will be true

that someone somewhere is trying to survive a sexual assault; whose trans inferior

vena cava is a clock that has not yet been hung on the wall.

I love you time, how trans you are.

Your trans boredom, ribbon-sharp and meadow-bold. You, whose bark is

trans; whose recovery, whose lumen, whose partial pressure

(trans), in order to live, must continue to respond to changes in the lungs.

[irispublishersmedicaljournals]

Iris Publishers - Current Trends in Clinical & Medical Sciences (CTCMS)

External Cortical Femoral Implant in A THP A Long Term Follow Up of a Clinical Case

Authored by Yves Cirotteau

Everyone, in his practice, had patients with more or less severe brain dysfunction, one is hemiplegia [1]. What could happen for the patient from an orthopedic point of view, on the lower limb when such a disease happens? The reduced use of the limb reduces the pressure on the bearing bone and, from a physiological point of view, a reduction of the mineralization. The bone becomes osteoporotic [2]. The physical phenomenon is reversible when the pressure conditions are restored. Here are two examples. This patient had a right haemorrhagic stroke few years ago. He had a left hemiplegia and spent a long time in physiotherapy due to the difficulty to walk. Note the thin both femoral cortical due to the bad utilization of the left lower limb (Figure a). Few years later, he recovered a best walk. Note the very good thickening due to the best support of his body weight by the limb (Figure b). Adversingly, despite the severe coxarthrosis note the good thickness of the femoral cortex before surgery (Figure a, b). Few years later the patient had a hemiplegia. Note the increasing diameter of the femoral medullary canal (Figure c). What would have happened if an intramedullary implant was settle in it?

Scientific Reasons of this New Concept

The choice of this implant’s design was done in the aim of a more physiological respect of the bone structures [3-5].

a) The joint elasticity is mainly due to the cancellous bone of a joint. Most of the intra-medullary canal implants destroy it. In this case the cancellous bone is in the upper femoral metaphyseal neck, more or less in totality (Figure a, b).

b) The bone marrow has one of the most important roles in bone physiology: vascularization, cells of bone remodeling, blood cells, proteins and minerals are the major actors of the normal bone life.

c) The periosteum is acting all lifelong (even after 100 years) and covers all foreign bodies which are fixed on the shaft, keeping a fixation stronger and stronger by time (Figure c, d).

d) The pressure on the calcar is necessary to increase and maintain it thickness. A large crown on the upper part of the implant rests firmly there so that there is no resorption [8-9].

Technical procedure

A cemented Charnley’s cup in polyethylene was cemented in the acetabulum. An external stem implant in titanium was fixed on the lateral cortex of the femoral shaft, below the periosteum. A 22,2 mm diameter of the head was used on the right side. Four years later, a non-cemented metal back acetabulum with a 22,2 diameter of the head was placed on the left side. Insert in polyethylene. A lateral femoral Implant in titanium was screwed. Screws of 5 mm of diameter for the femoral shaft, 6 mm of diameter to fix the greater trochanter.

Clinical story and examination

Me T… Françoise is Born the 04 12 1938 - Her Height is 1.59m, her Weight is 59kg. This 80-year-old patient had a bilateral coxarthrosis. When she was 51 years old, in 1989, she was operated on the left side. Four years later, a THP as placed on the right side in 1993. She was seen in clinic office in May 2019. Follow up: 30 years on the right side Follow up: 26 years on the left side She has no pain. She can climb stairs up and down without difficulty. Over three floors, she uses the ramp stairs. She walks without help as long as she wants. One hour without stop She walks without limping.

Functional scores

Postel-Merle d’Aubigné (PMA) Pain, Mobility, Walk 4 grades: 18 excellent. Harris hip score: Douleur, function, mobilité, absence de déformation Score jusquà 100: 90-100: excellent. Oxford hip score: Activities of the daily Life. Auto-administrated survey with12 items giving a score: 42-48: excellent.

Discussion

The first planning was to start with a well-considered definition of the goal expected. It was to secure the femoral implant on its support so that it would stay all day long, as long as patient’s life, without physical activity limitation. The second question was followed by the development of an effective strategy. Once establishing the goal and the strategy, do we have worked backwards to identify the next steps? Have we reach the goal expected? Can we be sure that the fémoral implant will be aware of complications in 100%.

In fact, the purpose is to answer to three questions:

a. Does bone physiology have been respected? The answer is yes concerning the cancellous bone, the femoral cortices, the role of the periosteum. There was no calcar resorption.

b. Do we have had any mechanical complications such as: broken screws or broken plates. Yes, in a very small cases, some screws fixing the greater trochanter broke. If the osteotomy of this apophysis is consolidated, nothing will happen. In some case the lateral part of the broken screws must be removed when painful. Since we have changed the design of the screws, (6 mm of diameter) no one broke. Have we reach the goal? In this experience, the answer is yes [4]. Not any femoral plate was removed. All patients are either too old now or are in a very high place in the sky where nobody can reach them or are still living with their implants.

Conclusion

The lateral femoral implant is, according to this cohorte, one of the good solutions for a long implant’s life, as long as the patient’s life, whatever his age [5-7]. But we should stress the difficulty of its fixation on the upper femoral metaphysis. The greater trochanteric osteotomy must be perfect. The screws must be of a good size and length. The consolidation delay of this bone section must be respected. The patient must walk with two crutches during this time with only a contact support. Surgeon must keep in mind that he is not at all a simple machine to operate. He must practice with his heart and must explain to his patient what he will do and why he will do for it in order to reach the target [9]. In this way, the surgeon does not destroy the intra-medullary bone marrow. He keeps as much as possible the cervical cancellous bone (Figure a, b). The implant applies a constant pressure on the femoral calcar [8], and the periosteum osteogenic power covers by time the implant plate, connecting strongly mechanically both bone and metal. This patient is

in good health, has a normal activity for her age. Both femoral implants remain stable and will stay so until the end of the story.

To read more about this article: https://irispublishers.com/ctcms/fulltext/external-cortical-femoral-implant-in-a-thp-a-long-term-follow-up-of-a-clinical-case.ID.000510.php

Indexing List of Iris Publishers: https://medium.com/@irispublishers/what-is-the-indexing-list-of-iris-publishers-4ace353e4eee

Iris publishers google scholar citations: https://scholar.google.co.in/scholar?hl=en&as_sdt=0%2C5&q=irispublishers&btnG=

[valgasnewsthings]

Tapping in diarrhea.

 Diarrhoea is abundant peristaltic bowel, and peristaltic provoking of abundant irritation bowel s wall.  That irritation for wall a bowel are toxins, abundant meal, dysfunction vegetative nerve system, which regulating a peristaltic. And we can prevent diarrhoea just on last cases,as regulating meal, and calming nerve system. And a most serious pathologies are not by us curing, but a put hand on the heart, 50 precents  digestions destroys are tied with neurotization,  thus let s begin to help:

1.Tapping three sec with connected are middle with direction fingers a projection for oblong brain on external level/ picture 42 a/, which managing are reflections for nerve system, repeat this method for three times.

2. After with this method on 3 sec affecting on the points,finding on both shoulder blades and points for  interscapular zone/picture 42 a/.This method helps create a healthy loading in muscles of shoulder blade zone, which affecting for strengthening stomach and bowel.

3. Tapping with four fingers are points for waist and sacrum regions/picture 42 b.

4. Clapping with an opening palm   for hips zones/picture 42 c/.Using points,finding a higher on big trochanter for hip bone .These are base points for calmking bowel membrane, and stopping diarrhea, doing are 5 pressings on every point for 3 sec.

5. Direction with and middle fingers wit force to knock is on the point between are 1 and 2 finger a leg. And you can affect on a same time on both feet one min /picture 42  d/.

6. With a palm slowly and tighter press as not to hit  on the belly low/any zone/ and on the zone over descending colon/picture 42 e/.

Pictures 42 are points in diarrhoea /ab,b,c,d,e/.

via Blogger https://ift.tt/3FYEbtj

[thelifeofavettech]

Bone Anatomy Tips & Tricks

Here are some little tricks I’ve learned or come up with along the way to help me with learning locations of (animal) bones and parts of bones:

Tubercle vs Trochanter - tubercles are on the front limb because tubes are by your boobs

Olecranon vs Calcaneus - O is on your elbow

Horses walk on their third metacarpal because they’re always flipping you off

similarly, they walk on their third phalanx (P3)

The ulna looks like a can opener

the anconeal process is located here (think [c]anconeal)

In some species, the axis kind of resembles a dragon head

If you see a groove, it’s probably called a trochlea

The styloid process looks like a stylus

The tibia is shaped like a T

Femur vs Humerus - the femur has a more distinct head

The atlas holds the head, just like Atlas from Greek mythology holds the weight of the globe

Lumbar = Lower back

All mammals have 7 cervical vertebrae

The sacrum looks like an elephant head

The frontal bone is at the front of your skull

The temporal bones are by your temples (sides of skull)

Mandible vs Maxilla - think maximum, so higher than everything else

Nasal concha - located in the nose, so pretend you’re going to shove a conch shell up your nose

Feel free to add any others

[meditativeyoga]

7 Myths About Yoga Alignment

If you jump around in between yoga instructors or family trees, confusion about asana positioning is reasonable. Below, Yoga exercise Medicine educator Dana Diament unmasks some common myths with sensible anatomy.

One of my preferred aspects of yoga exercise is the range of yoga exercise methods and lineages to choose from. However with all those choices, you may be left sensation puzzled about positioning. The proliferation of yoga asana pictures in recent times just makes issues trickier as an increasing number of pupils aim to recreate the poses specifically as they see them. Several instructors are additionally taught to advise presents to textbook requirements, which were not necessarily developed for Western or female bodies. This dogmatic approach to positioning establishes the scene for sure myths to hold in our yoga exercise areas concerning the "ideal" way to do a present. To shed light on a few of these misconceptions, allow's take a more detailed check out a few of the crucial anatomical ideas behind some usual yoga poses.

Myth 1: In Chaturanga, the elbows should be curved to a 90-degree angle.

Many yoga exercise practitioners are fixated on accomplishing that 90-degree bend at the arm joint in Chaturanga. The trouble with this usual hint is that when your shoulders go to or listed below elbow elevation, you have actually shed a great deal of your toughness in the stabilizing layers of the shoulder joint. Here, the propensity is to assail the shoulder joint and round the shoulders. This setting usually leads to loss of support from the core and legs along with the effectiveness of the triceps muscles. It likewise enhances stress on the biceps tendon, the potter's wheel cuff muscles, as well as the much deeper frameworks of the joint like the labrum and also joint capsule.

Instead, the key is to flex your arm joints just to the point where you can maintain stamina in your arms, shoulders, legs, and core. This can extremely well suggest that the angle in your arm joints will certainly be above 90 levels. Check it out by doing a strength test in your Chaturanga: After you bend your elbows, you ought to really feel strong and also supported. If you fail the examination, don't misery. Simply drop your knees as well as lower down just to the factor where you could keep your strength.

Myth 2: In Chaturanga, the upper body ought to aim towards the ground.

Opening up the upper body is a vital part for the entire shoulder to collaborate in Chaturanga. It is very important to find out ways to discharge the muscular tissues in harmony, instead compared to excessive using any kind of one muscle mass or part of the shoulder each time. Because lots of people tend to be stronger in the pec muscles than the back of the shoulder, we usually round the shoulders ahead. We want to maintain the head of the humerus focused in the joint by balancing the strength in the front and also back of the shoulder. Transforming the breast bone ahead to open up the breast helps in involving the muscular tissues of the posterior shoulder. The rhomboids along with serratus former kind a band result to support the shoulder blade, which likewise aids the muscular tissues that maintain the arm bone centered in the shoulder outlet. The secret to this is to extend the upper body open prior to bending your arm joints and also keep your core engaged. The core is important here to prevent going down the hips and also sagging in the low back. With your core involved, as you open the chest the spinal column will curve a little bit, which prepares you to going right into Upward-Facing Dog as you have actually already started to launch a backbend.

Myth 3: To prepare for Wheel Posture, you should stop briefly on the top of your head as well as hug your arm joints in towards the center.

Pausing at the top of your head as you come right into Urdhva Dhanurasana is a terrific concept to aid you establish up the upper body in order to develop a fuller curve to your backbend. You might, however, locate it much more valuable to removal your elbow joints away from the midline instead of hugging them in. To comprehend this, it's useful to consider the all-natural flexibility of the spinal column. When we enter into Wheel Posture, a lot of the bend occurs in the lower back, or back spinal column, while the amount we could bend in the upper back, or thoracic spinal column, is restricted. Due to the alignment of the facet joints of the vertebrae as well as the attachment of the ribs into the thoracic back, this component of the spine normally has less movement. This is a great point as our ribs residence important essential body organs like our heart and lungs. Nonetheless, due to this restricted flexibility in our thoracic back, it is really the opening of the chest that offers an extra "C"- curved form to our backbend. In order to open the chest, what we need to do is move the shoulder blades out of the way by withdrawing them (pulling them in toward each other). Taking the elbows better apart makes that activity much more obtainable, particularly if there is restricted adaptability around the shoulder. Once you have the ability to draw the shoulder blades with each other, you can bring your arm joints towards each other as you start to align your arms to raise your head off the ground.

Myth 4: In Tree Posture, your raised knee ought to aim straight to the side.

In Tree Posture, the common propensity is to transform the knee to the side and for brevity's sake that could be an easier means to cue the posture. The anatomical reality is that due to the fact that the acetabulum (the part of the pelvis that the thigh bone inserts into) faces slightly ahead, it's difficult even with biggest hip adaptability to transform your knee to the side without relocating your pelvis, which likewise rotates the back. Rather in Tree Posture, try keeping the pelvis settled ahead as well as removaling the knee as far sideways as you could without letting the hips change. That will certainly maintain the spinal column, the hip, and also the standing leg settled forward too.

Myth 5: In Warrior I, your feet need to remain in "heel-to-heel" alignment.

Setting up Warrior I with the feet bigger apart than heel-to-heel placement could be far more desirable for the health and wellness as well as comfort of your hips as well as spinal column. Warrior I is a forward-facing pose and having the heels on one line, as if standing on a limited rope, makes turning the hips ahead rather tough. By having range between the legs, you develop space in your hip sockets to help you discover the rotation in the pelvis for this position without twisting the spinal column, over-arching the lower back, or causing undesirable compression in the SI Joint (sacroilliac joint).

How much to tip your feet apart depends on the proportions of your pelvis. Positioning your feet as large as the outer bony prominence on your thighbone (the better trochanter) produces a durable base for this pose. To keep it simple, an excellent policy of thumb is to separate your feet concerning 3-4 feet apart.

Myth 6: In Revolved Crescent Lunge, your triceps or armpit must touch the outer component of the front knee.

This placement in your Rotated Crescent Lunge will certainly take you right into an extremely deep spin. If your hips as well as spinal column are not flexible sufficient for this deep version of the posture, you'll need to utilize your arms to get right into it, which typically triggers the spinal column to round. This turning as well as included flexion of the spinal column raises the stress on the intervertebral discs. Among the advantages of twisting is to moisten the discs to keep them healthy and balanced. You do not need this deep of a twist to do that.

More is not always far better. If your purpose is to moisten the discs and also strengthen the supporting muscles of the spine, decide to maintain the size in the spinal column and not bent as deeply. To do this, try bringing just your joint to your knee and also maintaining your hands in petition placement. If you cannot do that variant maintaining your back right, you can modify further by either dropping your back knee or placing your bottom hand on the ground straight under the shoulder. You could also reconsider other standing benting positions, such as Revolved Chair Position or Revolved Triangle if your main purpose is the healthy activity of the spinal discs.

Myth 7: In Triangle Posture, your bottom hand should get the big toe of your front foot.

Triangle is among the poses where virtually every institution of yoga exercise has something different to provide in concerns to positioning, such as this classical Ashtanga variant. If you do not have the flexibility to get your large toe while maintaining both sides of your back parallel to the flooring, you might want to reassess your strategy to this position to optimize the advantages to your spine. One of these benefits is that Triangle posture can raise the side-to-side adaptability of the torso as well as strengthen certain muscles that are critical to maintaining the spine. To attain this, the secret is stay anchored in your back leg as you reach your front arm ahead to extend the spine out of the hips. When you can't reach your arm forward anymore, simply relax your hand anywhere it comfortably come down on your leg. Focus below to your tendency to reach the hand additionally down your leg.

[rheumatologyarthritisresearch]

Iris Publishers-Open Access Journal of Rheumatology & Arthritis Research

Authored by Vianney Hope JM*

Introduction

Total hip arthroplasty (THA) has become one of the most successful interventions in reconstructive orthopedic surgery. However, dislocation remains the well-recognized challenging complication for the surgeon and the cause for pain and dissatisfaction for patients. According to the registers, dislocation occurs after 0.3% to 10% of primary total hip arthroplasties and after up to 28% of revision total hip arthroplasties [1- 4]. Component malpositioning and abductor insufficiency are two of the most important recognized causes of dislocation [5-7]. Dislocation after THA is easily recognized immediately after its occurrence and reduced immediately or few days later. Therefore, chronic dislocation is exceptionally unusual. Only less than ten cases of unilateral chronic dislocation following THA have been reported to date [1-8]. We report the first case of chronic THA dislocation with bilateral involvement caused by a malpositioned acetabular component in a 59-year-old patient. We aimed to present clinical and radiological features, treatment, and outcome of spontaneous chronic asymptomatic bilateral dislocation of 11-year duration after cemented total hip arthroplasty.

Case Report

A 59-year-old man presented to the surgical clinic eleven years after single stage bilateral cemented primary THA following bilateral hip osteoarthritis. He was operated at another institution (abroad) and had never returned for follow up due to financial constraints. He remained pain-free, had 2 cm of true right leg length shortening with a good range of movement. Since the operation, he was unable to walk without orthopedic aids. However, he was able to walk unlimited distances with a rolling walker. Due to the dissatisfaction caused by long-standing limping associated with a leg-length discrepancy after THA, he decided to consult to our clinic. The patient denied any fall injury or accident. On general physical examination, he was healthy appearing; walking with bilateral axillary crutches; alert and oriented; responds appropriately; in no acute distress. His general status was conserved. Blood pressure measurement revealed a pressure of 155/85 mmHg, his pulse rate was 78 beats/minute, his respiratory rate was 19 cycles/ minute and his body mass index (BMI) was 27.8. There was right lower limb length discrepancy of 2 cm compared to the left side. A posterolateral operative scar, indicative of Austin Moore approach, was seen bilaterally.

Musculoskeletal examination of the right hip showed that he could elevate the hell from the horizontal plane of the examination table; the muscle power of gluteal medius was at 3/5, adductor muscles at 4/5, hamstring muscles at 0/5 and quadriceps at 2/5. The hip flexion was at 110° and extension at -10°. On the left side, hell elevation from the horizontal plane of the bed was possible, muscle power of gluteus medius at 2/5, adductor muscles at 3 /5, hamstring muscles at 0/5 and quadriceps at 3/5. The hip flexion was at 110° and extension at 0°. Full range of motion (ROM) of both hips are presented in table 1. Postel Merle d’Aubigné (PMA) score was 10/18 and Harris Hip Score (HHS) 30/100 bilaterally. Neurovascular examination was unremarkable.

Conventional anteroposterior (AP) radiography of the pelvis showed bilateral postero-superior cemented total hip prostheses dislocation with excessive inclination of acetabular shell at 65° on the left hip and at 85° on the right side. The dislocated femoral components had formed a neoacetabulum within the ilium, in which they were freely articulating (Figure 1). Reconstructed axial and sagittal computed Tomography (CT) scans of both hips confirmed postero-superior total hip prostheses dislocation; muscle wastage with fat degeneration, aseptic loosening of both femoral and acetabular components with excessive inclination of acetabular components (Figure 2). The patient was put on bilateral trans-condylar skeletal traction using Boppe splint (Figure 3). Initial weight of 2 kilograms (Kg) was indicated with daily increase of 1 Kg and daily radiographic control to monitor the descent of the prosthetic heads. At day 5 post traction with traction-weight of 7 Kg, the heads were at the level of the tip of the acetabular shell. At day 9 post traction with traction-weight of 11 Kg, the heads were within the acetabular shell (Figure 4). The patient consented for a 2-month-interval bilateral total hip revision. Preoperative blood examination revealed WBC 8090/μl, Hb 11.4 g/dl, C-Reactive Protein 0.25 mg/dl, platelet 372000/μl, creatinine 10mg/l, uric acid 117mg/l and calcemia 87mg/l.

The right hip was first revised. In the left lateral decubitus position and under general anesthesia, the skin incision was made to the previous operative scar and hip was exposed through a standard posterolateral Austin Moore approach. Intraoperatively, a posterior and superior hip instability was identified as resulting from the combined movements of external rotation and adduction. We found that the prosthetic head has created a pseudoacetabulum and a neocapsule around it which was filled with citric fluids and rice body formations. The prosthetic head was found in the gluteus major muscle and both acetabular and femoral components were loosened with excessive inclination of acetabular component (Figure 5). We removed the implants along with the cement; and prepared for new implantation. Both acetabular and femoral components were revised using cemented modular shell and acetabular reconstruction with Kerboul reinforcement crossplate (acetabular lip). The femoral stem was cemented. The closure of the articular space and a good repair of the neocapsule and remaining short external rotators were performed. Intraoperatively satisfactory stability of the prosthesis movements in all directions was confirmed. The duration of the operation was 5 hours and the blood loss was 700 cc. The patient was transfused 2 units of whole blood. Postoperatively, the wound healed well by primary intention in 3 weeks. Two months later, the left hip was revised in the same way as the right one. Leg discrepancy was corrected. The second operation lasted 4 hours with blood loss of 600 cc. He was again transfused of two units of whole blood. The wound healed in 3 weeks.

He was thereafter scheduled for rehabilitation and monthly follow up. He made an uneventful recovery and returned to fulltime employment 8-month post left hip revision. At 7-year-follow up, he was satisfied and pain-free. The ROM of both hips were satisfactory (Table 1). The PMA score was 17/18 whereas the HHS was 99/100. Control AP pelvis radiography show well maintained total hip prostheses. Femoral and acetabular components are well positioned and fixed. No signs of loosening or impingement were detected (Figure 6).

Discussion

Dislocation following total hip arthroplasty (THA) is a complication which alarms both patient and surgeon. There have been numerous reports instancing the frequency of dislocation, with an overall incidence ranging from 0.3% to almost 10% after primary THA, with the highest risk believed to be within the first three months after surgery [1-5]. The incidence can be as high as 28% after revision surgery [9-15]. The definition of THA dislocation is complete loss of contact between the femoral head and acetabular component. This usually requires intervention to reduce the prosthetic head into the acetabular component. Dislocation may occur early or late and be single or recurrent. Early dislocation occurs in first 3 months postoperatively, and more than two dislocations are defined as recurrent [14]. The term chronicity refers to the time between the occurrence of dislocation and its reduction; thus, we have defined chronic dislocation as dislocation which is unreduced at least 3 weeks (21 days) after its occurrence. Very little has been written about chronic dislocation after THA, and less than ten cases of chronic dislocation following THA have been reported in the English literature. All these reported cases are unilateral [1-8]. We attribute the rarity of this lesion to the factor that hip dislocation is severely painful and patients with THA have a regular medical follow up. Thus, the dislocation is early diagnosed and immediately managed accordingly. At our center, the incidence of dislocation after THA is 0. 6%. For, this reported case of 11-year chronic asymptomatic bilateral dislocation, the primary THA was done in another institution and the patient failed to respect follow up program. Furthermore, the good range of movement and the absence of pain may explain the longstanding nature.

It may happen that an early postoperative total hip prosthesis dislocation is not diagnosed for few days in patients without weight-bearing, but this condition is extremely rare [16-17]. Often, THA dislocation is evident to both the patient and his neighborhood by the position of the dislocated limb and pain. The flexionadduction- external rotation and extension-abduction-internal motion positions are signs of posterior and anterior dislocation, respectively. Furthermore, in active patient’s total hip prosthesis dislocation may occur after a traumatic event (secondary or late dislocations). In our case, there is no possible link to traumatic events, and we think the dislocation is either spontaneous or positional.

Numerous factors influence the rate of dislocation after THA such as greater age, female gender, Musculo ligamentous laxity, previous surgery to the affected hip, revision surgery, infection, concomitant neurological deficiencies and other medical comorbidities, excessive alcohol intake, nonunion of the greater trochanter and cognitive impairment preventing adequate patient education. All cause soft-tissue imbalance and increase the risk of dislocation [9- 17]. Some authors have reported a higher rate of dislocation when using a posterior surgical approach and Kristiansen et al, noted less acetabular version with this approach [16-18]. Hedlundh U, et al. [19], registered twice the number of dislocations for inexperienced surgeons as compared with their more experienced colleagues, a correlation which was also reported by other authors [19]. Fackler CD and Poss R [20] observed a frequent association of dislocation with malposition of the component of which the surgeon was unaware at the time of surgery. This was seen more often among less experienced surgeons. The main reason for the higher rate of dislocation of inexperienced surgeons is malpositioning of the cup [20]. Soft-tissue imbalance and malposition are thought to be the two main causes of dislocation. Nonetheless, several authors have reported that excessive femoral anteversion may lead to dislocation [2]. Prosthetic design and selection can have an important effect on the incidence of dislocation. The most commonly considered implant factor is head diameter. In the author’s opinion, the perception that larger femoral heads would diminish the risk of dislocation [11]. In our case, there was excessive inclination of acetabular shell at 65° on the left hip and at 85° on the right side, and we have concluded that the cause of dislocation was malposition of acetabular components. There was soft tissue imbalance as a posterior dislocation injured the capsulo-muscular elements. Fortunately, the sciatic nerve was preserved. Intraoperatively, there were neocapsule around the prosthetic head which was filled with citric fluids and rice body formations which are the signs of chronicity. The prosthetic heads were found in the gluteus major muscle and both acetabular and femoral components were loosened.

Prevention of dislocation is much easier than treatment. This includes careful pre-operative templating and surgical planning. Proper patient positioning, care of the soft tissues, precise component position, intra-operative assessment of stability, and leg length are compulsory. Treatment of dislocation after THA begins with an assessment of the cause. Component position should be carefully evaluated, and hip offset and leg length should be assessed [2-4,7,11]. Surgical options include exchange of modular components to increase soft-tissue tension, or a switch to a larger head diameter, including bipolar or tripolar arthroplasty, and use of an acetabular lip. Malposition and impingement must be corrected. Soft-tissue or trochanteric advancement, and the use of constrained liners should be a last resort [15, 21-25]. In case of chronic dislocation, Butler et al, have used an Ilizarov apparatus to perform closed reduction of a chronic dislocation following THA (Figure 7). In our case, we started with a skeletal traction with progressive increment of traction-weight to preserve the sciatic nerve injury by elongation and to prevent muscle injuries as muscles were already weakened by fat degeneration. After the prosthetic heads were in the acetabular shells, bilateral total hip revision was carried out with a 2-month-interval. As there were loosening of both femoral and acetabular components, both components were revised. Treatment outcomes were uneventful. At 7-year-follow up, he was pain-free with excellent functional satisfaction.

Conclusion

Chronic dislocation after total hip arthroplasty (THA) refers to unreduced dislocation at least 3 weeks (21 days) after its occurrence. It is believed that several factors contribute to chronic dislocation such as surgical approach, inadequate restoration of soft-tissue tension, prosthetic design, and orientation of the prosthetic components. We have reported an unusual case of a longstanding (11-year duration), but asymptomatic, dislocated bilateral total hip replacement in a 59-year-old man. Our case illustrates that a dislocated total hip replacement may occasionally not cause symptoms that cause significant discomfort or reduction in range of movement. The prosthetic femoral head can form a neoacetabulum allowing a full range of pain-free movement.

Read more: Full Text To know more about Iris Publishers Research: https://unam.academia.edu/irispublishers

[biomedgrid]

Biomed Grid | Femur Open Wedge Corrective Osteotomy and Gradual Deformity Correction

Case Report

A seventeen-year-old boy presented with pain and swelling of his left thigh following a futsal game. He denies any significant trauma during the game besides stomping on his left foot multiple times. He was still able to weight bear with pain after the game. Further history taking reveals that he was involved in a high energy motor vehicle accident on September 2017 and sustained open fracture supracondylar left femur and left tibial plateau. Open reduction and locking plate fixation were done for his femur and tibia at that point of time. He claims to be ambulating well with no pain, shortening or instability following the surgical intervention. He also denies any history of chronic discharge or fever.

Examination reveals a short limb and antalgic gait. Lateral bowing of his left femur along with 2cm shortening of his left femur. Deep tenderness over his distal femur and slight mobility appreciated over his distal femur. Otherwise there was no local signs suggestive of infection, such as increased warmth, erythema or sinus discharge.

White blood cell count and C- reactive protein was not elevated with the reading of 3.8x109/L and 0.5 mg/dL respectively. Erythrocyte sedimentation rate was slightly elevated at 30mm/hr. His lower limb radiograph reveals a broken implant and atrophic non- union of his distal femur with thirty degrees medial angulation (Figure 1). There was no significant antero- posterior angulation or translation (Figure 2). The radiograph was not suggestive of any long-standing infective process or osteomyelitis.

Figure 1: Full length antero- posterior plain radiograph reveals a broken implant, atrophic non- union of left distal femur with thirty degrees medial angulation.

Figure 2:Lateral radiograph reveals no significant anteroposterior angulation or translation.

Figure 3:Left knee antero- posterior plain radiograph at postoperative day one.

Figure 4:Full length antero- posterior plain radiograph at ten weeks post operative shows compete correction of the angular deformity

He underwent removal of implant, corrective osteotomy, left Illizarov external fixation and gradual deformity correction (Figure 3). Intra- operatively there was no local signs of infection to the distal femur and intra- operative cultures came back nil of growth/ organism. At ten weeks post-operative the deformity was corrected (Figure 4).

Discussion

Distal femur fractures show two peaks. It is seen in both young and old patients. In the young, it is usually a sequelae of a high energy road traffic accident and in the elderly from a trivial fall. Precise reduction and fixation of distal femur fractures with adequate stability allowing early mobilization is crucial. Nonunions of distal femur do not commonly occur. However, if it happens it causes significant morbidity and remains a nightmare to treat. The typical diagnostic criteria of non-union are pain and tenderness over the fracture site along with serial radiographic evidence showing no visible progressive signs of healing for three months, six months after the fracture [1]. In this case report, the fracture occurred twenty-six months ago and he still experienced pain and tenderness over the fracture site despite. We do not have a three months serial radiograph on him, however at twenty-six months following the fracture, a clear visible fracture line is still seen, indicating a non-union of his left distal femur.

Non-unions are broadly classified into septic and aseptic non-unions. Aseptic non-union is further divided into atrophic or hypertrophic. Atrophic non- union is avascular, nonviable and avital. It is associated with inadequate or poor vascularity with poor healing. Radiographically, it exhibits minimal callus formation filling the fracture gap surrounded by fibrous tissue. Hypertrophic non- union is said to be hyper vascular, viable and vital and occurs due to inadequate immobilization. The vascularity and healing is adequate. Radiographically, hypertrophic non- union shows increased callus formation in a horseshoe or elephant foot pattern [2]. As evident via clinical history and plain radiographs in this case, there was minimal callus seen around the fracture site indicating an atrophic non- union. The likely cause of this atrophic non- union is due to the high energy trauma he sustained leading to avascular, nonviable and avital tissues around the fracture site. Furthermore, the internal fixation he underwent further disrupt the blood supply over the fracture site contributing to the non-union.

Paul J Harwood et al. categorized the causes of non-union into four main groups, namely due to deficient of bone producing cells, deficient of signaling molecules, deficient of stability and deficient of bone conducting framework [3]. Craig S. Roberts et al. on the other hand categorized the causes of non-union into two main categories, namely the systemic causes and local causes. Systemic causes such as malnutrition, diabetes mellitus, cigarette smoking and nicotine use, osteoperosis and use of nonsteroidal anti- inflammatory drugs have been said to be the cause on non-union. As for the local causes, impaired vascularity, unstable fixation, presence of bone gap, infections, mal- alignment or rotation, lack of stimulation (eg: weight bearing), impact of injury (high- energy versus low- energy) and iatrogenic factors such as aggressive periosteal stripping plus local trauma to soft tissue and bone vascularity during fixation are the causes of non-union [4]. This patient does not have any significant systemic disorder contributing to his non-union. However, he has multiple contributing local causes such as impaired vascularity, high magnitude of injury and iatrogenic disruption to periosteum, bone and soft tissue during fixation.

Edward K. Rodriguez et al. in 2013 conducted a multi- centre, retrospective case control study on the predicting factors for non- union of distal femoral fracture following lateral locking plate fixation. He concluded that the only statically significant contributing factors to non- unions were compound fractures (open fractures), presence of an local infection, the use of a stainless steel implant and being obese with a body mass index of above 30 [5]. In this case, he sustained an compound fracture to his left distal femur

Deformity is defined as any deviation from the normal anatomy [6]. This includes any abnormalities of length, rotation, translation or angulation. This is assessed both clinically and radiographically. Clinically, first assess the frontal plane alignment with the patient standing straight.

Look for pelvic tilt, genu varum/ valgum, foot varus/ valgus/ abducrus/ adducrus/ supinated/ pronated, any obvious diaphyseal deformity and trendelenburg sign. Then assess the rotation alignment by looking at the patellar orientation and foot orientation. For length discrepancy, look for pelvic tilt, knee flexion or equinus stance, and the use of blocks for measurement. Then assess the sagittal plane alignment (standing lateral view) for spine lordorsis/ kyphosis, any hip flexion deformity, knee flexion or recurvatum deformity, ankle equinus or calcaneus, flat foot or cavus foot. Finally, assess the gait, patellar and foot progression angle. All this deformity is then confirmed clinically in sitting, supine and prone position. Radiographically, the normal anatomy is needed for comparison, in order to ascertain that the limb is abnormal and thereby deformed. Perform a long limb standing antero- posterior and lateral radiograph to evaluate the lower limbs. The anatomic axis is a line that bisects the medullary canal of the long bone longitudinally into two equal parts.

The mechanical axis of the lower limb is a point from the centre of the femoral head to the midpoint of the ankle. The normal mechanical axis deviation (MAD) is 1mm to 15mm medial to the center of the knee joint. MAD above 15mm medial to the knee midpoint indicates a varus malalignment and a MAD lateral to the knee midpoint indicates a valgus malalignment. This is known as the mechanical axis deviation test. Secondly run the malalignment test to determine the origin of the frontal plane malalignment. Draw the individual mechanical axis of the femur and tibia then measure the lateral distal femoral angle (LDFA) and medial proximal tibia angle (MPTA); normal value 85- 90 degrees. If there is any discrepancy in the value, the source of deformity if from within that bone. Also look for any intra- articular source of malalignment by drawing two parallel lines across the two opposite articular surface of the joint (knee and ankle joint). The normal value is about two degrees, beyond this value there is intra- articular source of malalignment. The common cause of this malalignment is due to ligament laxity and articular cartilage loss. Lastly, look for malorientation with the malorientation test. Deformities close to the hip or ankle joint may cause minimal or no malalignment or mechanical axis deviation. For the hip, look for the lateral proximal femur angle (LPFA) and medial proximal femoral angle (MPFA).

Relative to the mechanical axis, a line is drawn from the tip of the greater trochanter to the center of the femoral head; normal value LPFA 85- 95 degrees. Relative to the anatomic axis, the same line is drawn from the tip of the greater to the centre of the femoral head; normal MPFA value is 84 degrees. Also measure the femoral neck shaft angle; normal value 130 degrees. For the ankle, the ankle plafond has the same angular relationship with both the mechanical and anatomic axes of the tibia. Thereby the lateral and medial distal tibial angle is normally 90 degrees.

The concept of osteotomy to treat limb deformity has exist some 2000 years ago. In recent years, pain has been added on as an indication for osteotomy, with the development of high tibial osteotomy to treat knee osteoarthritis [7]. Osteotomy is a surgical procedure to create a surgical discontinuity of the involved bone to aid in the realignment and a consequent shift of weight bearing from an injured area to a relatively normal area of the joint surface. Osteotomy can also be done to correct discrepancy in limb length and to correct any angular deformity [8]. For limb lengthening of the femur, the corticotomy is usually done just distal to the lesser trochanter and for the tibia, corticotomy is carried out at the proximal metaphysis and diaphysis interval, distal to the tibial tuberosity. To correct angular deformitiy on the other hand, one must be familiar with the normal anatomy of the limb. Identify the site of deformity and mid- diaphyseal lines are drawn on the radiograph on either site of the deformity. The intersection where these lines bisect is the centre of rotation and angulation (CORA).

The angle between these lines is the degree of the deformity. Creating an osteotomy at the CORA will allow angular correction to occur without translation. In the event of limb length discrepancy and angular deformity, if the potential of bone healing is good a single osteotomy can be done at the CORA. Another option, a double level osteotomy can be done, one at the CORA for deformity correction and another at the suitable level for lengthening of the bone. The concept of ‘distraction osteogenesis’ is applied to this gradual correction and lengthening process. A distraction rate of 1mm per day, 0.25mm each time for four times a day. Bone will regenerate at the distraction gap. Time interval from the time of osteotomy until the commencement of the lengthening process is known as the latency phase. This is usually seven to ten days. This duration of correction and lengthening is the “distraction phase”. And the duration from the end of distraction phase until bony union is the “consolidation phase”. To optimize the chances of achieving union in an atrophic non-union, the bone ends should be refrashioned to achieve good bleeding over both ends plus good bony contact between them. A study conducted by Kevin D. Tetsworth et al. concluded that this technique of gradual correction via the dynamic external fixation can restore alignment and correct complex deformities with good accuracy. The accuracy of correction increases with surgeons experience [9]. Hiroyuki Tsuchiya et al. also concluded that the illizarov method was very effective to treat deformity combined with shortening [10]. He suggested that monofocal treatment might be better to treat patients with a small amount of lengthening as it reduces surgical incisions. However, bifocal treatment does not affect bone formation and is warranted if a large amount of lengthening is required.

Like every procedure, it has complications. Immediate intraoperative complications include direct trauma to the neurovascular bundle. Early complications include pain, hemorrhage which may in turn cause an compartment syndrome, venous thrombolic events such as deep vein thrombosis and pulmonary embolism, neuropraxia or axonomesis due to stretching of the involved nerve and infections, especially pin site infections. Other serious complications include joint subluxations, contractures and soft tissue contractures. Late complications include recurrent chronic pin site infection, osteomyelitis, premature union over the site of distraction, delayed or non- union, implant failure, reflex sympathetic dystrophy, late bowing and refractures. Majority of these complications however are manageable. Rate of complications decreases with surgeon’s experience. Dror Paley reported all these complications, however in his article he concluded that despite, fifty seven of his sixty subjects achieved the original goal and patient satisfaction was reported to be as high as ninety four percent of forty-six cases [11].

As for patient’s satisfaction on illizarov procedure, Micheal D. McKee reported low SF36 and Nottingham Health Profile score preoperative and during treatment and correction. This however increased postoperatively. He concluded that illizarov reconstruction of deformity not only restores bony configuration, but also helps improve the general health status of patients [12].

In conclusion, this patient suffered from atrophic non- union of his left distal femur following a high energy road traffic accident he sustained twenty- six months ago. The non- union was initially masked by the intact implant and he was able to ambulate as usual. The implant was able to withstand his body weight on ambulation. However, upon exertion during his sports activity the implant eventually gave-way and the underlying non- union manifested itself. The likely cause of his atrophic non- union is due to the high energy trauma he sustained which impaired the vascularity around the fracture site, it was a compound fracture and the internal fixation he undergone lead to iatrogenic disruption to the periosteum, bone and soft tissue. Corrective osteotomy, illizarov external fixation and gradual deformity correction was chosen for him as his fracture and deformity had gradually developed over the past twenty- six months, an acute correction may put his nerve at risk of excessive stretching leading to neuropraxia or worst an axonometsis injury. He also had a shortening deformity. Osteotomy and deformity correction rule one can easily address this shortening. Also, should the correction of shortening with the application of rule one is inadequate, the illizarov extenal fixator can easily be readjusted to allow a proximal femur osteotomy and bone transport to achieve the desired length. In addition, in any case of non- union one should always be very caution of an underlying local infection contributing to the non- union, thereby illizarov external fixation is the safest option in this case for the best outcome as evident in this case.

Conclusion

Open wedge osteotomy and gradual deformity correction with illizarov external fixation remains the treatment of choice for chronic limb deformities especially in cases suspicious of infection. This will successfully address the angular and shortening deformity as well as reduces the risk of neurovascular tractional injury and implant related infection associated with acute deformity correction and internal fixation.

Acknowledgements

None

Conflict of Interest

The authors declare that they have no conflict of interest.

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[romoser-entomologist]

Post #6 - “Large Insectoids" (6-29-2020)

INTRODUCTION. Though there appears to be at least some insectoid diversity on Mars, two types, not necessarily species, seem to dominate the scene in rover photos, the " bee-like" insectoids discussed in the last three blogs, and what I will refer to here simply as “large insectoids” on the basis that they are somewhat bigger than the "bee-like" forms. These large forms will be the subject of this and the next two blogs. In many cases, especially in individuals on the ground and fairly close to the rover cameras, structures can be seen that reveal insect-like features in more detail than those used simply to identify a Martian form as “insect-like” or “insectoid”.

Six images of individuals in the large insectoid category that I judge to be at least somewhat closely related, tasonomically speaking, are presented in Fig. 1. In Fig. 1, individual "A" is standing on the ground, in "B" it is lying on its right side, in "C" - "F" the insectoids appear to be running/gliding with wings spread. In this blog, the anatomical structure of the individual in Fig. 1 A will be presented here in some detail (Figs. 2-7). It would be useful to refer back to Blog #5 (“A Brief Introduction to Generalized Earth Insect Anatomy”) as you study the material in this blog.

In the next blog (#7) with an understanding of the large insectoid anatomy, a putative immature form seen in association with an apparently constructed shelter and/or nesting structure will be examined. The running/gliding phenomenon will then be examined in the subsequent blog (#8).

CHARACTERISTICS OF LARGE INSECTOIDS. Anatomic analysis of a large insectoid is presented in Figs. 2-7. As adults, based on the assumption that wings indicate maturity, as they do in almost all Earth insects, these insectoids are considerably larger that the adult “bee-like" types. Scale will be discussed in a later blog in this series on large insectoids. All labels are somewhat tentative, but hopefully illustrative of similarity between Martian insectoids and Earth (Terran) insects.

The specimen in Figs. 2-7 is clearly insect-like in appearance with three body regions (Fig. 3), head with eyes and antennae, three pairs of legs oriented along the venter of the thorax, and wings, the bases of which articulate between the dorsal and lateral thoracic plates (Fig. 4). So far I have not seen evidence of simple eyes or ocelli that are prominent on the head capsule in Earth insects.

In addition to these general insect-like features, many more detailed anatomical structures can be seen (Figs. 5 & 6). In the thorax, aspects of the nota (dorsal sclerites or hardened plates), the pleura (lateral plates), and the sterna (ventral plates) are somewhat evident, especially the pleura. Sutures and intersegmental lines that delineate the various pleural sclerites (episterna & epimera) are evident (Figs. 5 & 6).

All three pairs of legs are clearly specialized (Fig. 7), with the segments of the fore- and midlegs appearing to be reduced in number. However, the generalized insect leg segments are identifiable in insectoids.

The prothoracic legs appear to have 3 or 4 finger-like pretarsi or tarsal “claws” in this case (Fig. 7A), suggesting a prehensile or grasping function. The mesothoracic legs or midlegs (Fig. 7A) are shorter, robust, and distally widened. It appears that they can be flipped up and held against the thorax, suggesting that this could be their position during walking, running, and gliding/flying, that is when not being used. These too could have a prehensile function, being able to carry something oriented longitudinally along the venter (collectively the underpart of an insect or insectoid). More on this in a later blog.

The hindlegs are comparatively long and typical, generalized insect leg segments are identifiable from proximal to distal: coxa, trochanter, femur, tibia, tarsus & pretarsus. The pretarsus is relatively large and appears to composed of elements which collectively present something of a “foot” or large “pad”. This seems likely to be an adaptation that facilitates running through patches of sand, or other soft substrata, which seems to be widely present on the Martian surface. A clearly rendered hindleg pretarsus from another NASA-JPL rover photo illustrates the compound structure of the pretarsus (Fig. 7B). The structure of the hindlegs with large coxae and overall being directed somewhat posteriorly and the apparent prehensile function of the forelegs and midlegs, suggests that these insectoids can walk/run/glide in a bipedal fashion using the hindlegs alone. Of course, it is likely that the other pairs of legs could be involved in walking/running if necessary. This idea of bipedality is bourne out by observations of running individuals (Fig. 1 C-F) and will be discussed in Blog #8

As with the material presented in blogs 2-4, the evidence provided in this blog supports the extant part my working hypothesis #1: “There are fossile and extant higher life forms (metazoans; multicellular organisms composed of eukaryotic cells) on Mars.”

_________________________________________________________________

Figure 1: Six images of individuals interpreted as the same type of large insectoid.This larger insect-like type is estimated to be nearly a meter in length with a more than 2 meter wingspan. (A) Individual standing on ground (the wing track spots are probably associated with a passing insectoid (“beelike”?). (B) Individual lieing on its right side with head to the left. (C) - (F) Large insectoids running/gliding with wings spread. Scale will be discussed in a later blog in this series on large insectoids.

Figure 2: An isolated specimen of the larger insect-like form. (A) This individual is standing on the ground and the whole area has been somewhat obfuscated, making it confusing. However, the form, the circled form (B) can be teased out with eraser software and recognised as a bonefide insectoid (C). Scale bar in C, approximately 20 cm.

Figure 3: A Large Insectoid. Body Regions labelled.

Figure 4: A Large Insectoid. Appendages & Eyes labelled. Ocelli have not been seen on Martian insectoids, but could be present.

Figure 5. A Large Insectoid. Thoracic sutures and intersegmental lines are labelled.

Figure 6. A Large Insectoid. Thoracic sclerites labelled.

Figure 7. A Large Insectoid. Thoracic sclerites labelled.

[mechaffeinated-drawings]

My most classical state of being is "annoying the grouchiest character in the ensemble" 👍

[chromoscience]

Additional Structures Associated with Synovial Joints

Source: OpenStax Anatomy and Physiology OpenStax Anatomy and Physiology A few synovial joints of the body have a fibrocartilage structure located between the articulating bones. This is called an articular disc, which is generally small and oval-shaped, or a meniscus, which is larger and C-shaped. These structures can serve several functions, depending on the specific joint. In some places, an articular disc may act to strongly unite the bones of the joint to each other. Examples of this include the articular discs found at the sternoclavicular joint or between the distal ends of the radius and ulna bones. At other synovial joints, the disc can provide shock absorption and cushioning between the bones, which is the function of each meniscus within the knee joint. Finally, an articular disc can serve to smooth the movements between the articulating bones, as seen at the temporomandibular joint. Some synovial joints also have a fat pad, which can serve as a cushion between the bones. Additional structures located outside of a synovial joint serve to prevent friction between the bones of the joint and the overlying muscle tendons or skin. A bursa (plural = bursae) is a thin connective tissue sac filled with lubricating liquid. They are located in regions where skin, ligaments, muscles, or muscle tendons can rub against each other, usually near a body joint. Bursae reduce friction by separating the adjacent structures, preventing them from rubbing directly against each other. Bursae are classified by their location. A subcutaneous bursa is located between the skin and an underlying bone. It allows skin to move smoothly over the bone. Examples include the prepatellar bursa located over the kneecap and the olecranon bursa at the tip of the elbow. A submuscular bursa is found between a muscle and an underlying bone, or between adjacent muscles. These prevent rubbing of the muscle during movements. A large submuscular bursa, the trochanteric bursa, is found at the lateral hip, between the greater trochanter of the femur and the overlying gluteus maximus muscle. A subtendinous bursa is found between a tendon and a bone. Examples include the subacromial bursa that protects the tendon of shoulder muscle as it passes under the acromion of the scapula, and the suprapatellar bursa that separates the tendon of the large anterior thigh muscle from the distal femur just above the knee. A tendon sheath is similar in structure to a bursa, but smaller. It is a connective tissue sac that surrounds a muscle tendon at places where the tendon crosses a joint. It contains a lubricating fluid that allows for smooth motions of the tendon during muscle contraction and joint movements. Source: Read the full article

[siva3155]

300+ TOP ORTHOPAEDICS Objective Questions and Answers

ORTHOPAEDICS Multiple Choice Questions :-

1.Which is not a principle of compound fracture treatment? a) No tendon repair b) Aggressive Antibiotic cover c) Wound debridement d) Immediate Wound closure Ans:d 2.Medial meniscus is more vulnerable to injury because of? a) Its fixity to tibial collateral ligament b) its semicircular shape c) action of adductor magnus d) its attachment to fibrous capsule Ans:a 3.Injury to the popliteal artery in fracture lower end of femur is often due to? a) Distal fragment pressing the artery b) Proximal fragment pressing the artery c) Tight plaster d) Hematoma Ans:a 4.In transverse fracture of the patella, the treatment is a) Excision of small fragment b) Wire fixation c) Plaster cylinder d) Patellectomy Ans:b 5.monster type of dislocation of the hip is a) Anterior b) Posterior c) Central d) Dislocation with fracture of the shaft Ans:b 6. March fracture affects a) Neck of 2nd metatarsal c) Neck of 1 st metatarsal b) Body of 2nd Metatarsal c) Neck of 1 st metatarsal d) Fracture of lower end of tibia Ans:a 7.Commonest complication of extracapsular fracture of neck of femur is a) Non Union b) iscnemic necrosis c) Maiunion d) aTPuTmonary complications Ans:c 9.Blood coagulation profile in pregnancy is a) Increase in fibrinogen level of 10-25 % b) Decrease in factor X, XI, XII c) Decrease in plasminogen activity d) Increase in platelet count Ans:a 10.In classical caesarean section more chances of rupture of uterus is in a) upper uterine segment b) lower uterine segment c) utero cervical junction d) posterior uterine segment. Ans:a

ORTHOPAEDICS MCQs 11.Only indication for Internal version nowadays is a) Brow presentation b) Face presentation c) Second fetus of twins d) Breech Ans:c 12.Internal fixation is done in all fracture Except a) Compound b) Multiple c) Elderly person Ans:a 13.Myositis ossificans is commonly seen at tlie joint d) Hip a) Knee b) Elbow c) Shoulder d) Hip Ans:b 14.The most important factor in fracture healing is a) Good alignment b) Organization of blood clot c) Accurate reduction and 100% apposition of fractured fragments d) Immobilization e) Adequate calcium intake Ans:d 15.The most preferred treatment of fracture of neck of femur in a young person is a) Hemiarthroplasty b) Total hip treatment c) conservative treatment d) closed reduction & internal fixation Ans:d 16.Lisfranc dislocation is a) Tarsometatarsal dislocation b) Lunate dislocation c) Scaphoid dislocation d) Posterior dislocation of elbow Ans:a 17.Position of immobilization in fracture both bones of forearm in an adult male will be a) Prone b) Mid prone c) Supine d) 10° Supine Ans:c 18.Carpal bone which fractures commonly a) Scaphoid b) Lunate C) Hamate d) Pisiform Ans: a 19.True about clavicular fracture is a) Most common at medial 1/3 & 2/3 b) comminuted fracture common c) malunion occurs d) usually due to fall on elbow Ans:c 20.Commonest site of fracture scaphoid a) Waist b) Proximal third c) Distal third d) Tuberculosis Ans:a 21.Excision of fractured fragment is practised in all fractures except a) Patella b) Olecranon c) head of radius d) lateral condyle humerus Ans:b 22.The complication not common in colle's fracture is a) malunion b) non union c) sudeck's atrophy d) stiffness of wrist Ans:b 23.In 65 year old male with history of fracture neck of femur 6 weeks old, treatment of choice a) SP nailing b) Mc Murray's osteotomy c) hemiarthroplasty d) none. Ans:c 24.In Colles fracture not seen in a) Proximal impaction b) lateral rotation c) dorsal angulation d) medial rotation Ans:d 25.In fracture medial epicondyle of humerus,which of the following can be affected a) Flexion of fingers b) Adduction of fingers c) Abduction of fingers d) Flexion of thumb Ans:a 26.Most common cause of pathological fracture in a child is a) malignancy b) bone cyst c) fibrous dysplasia d) paget's disease Ans:b 27.A lady presents with a history of fracture radius, which was put on plaster of paris casts for 4 weeks. After that she developed swelling of hands with shiny skin. What is the most likely diagnosis. a) Rupture of extensor pollicis longus tendon b) Myositis ossificans c) Reflex sympathetic dystrophy d) Malunion. Ans:c 28.AH are components of Rotator cuff except a) Supraspinatus b) Infraspinatus c) Subscapularis d) Teres major Ans:d 29.Complication of fracture scaphoid is a) Injury to radial artery b) avascular necrosis of proximal part c) avascular necrosis of distal part d) injury to radial nerve Ans:b 30.Which fracture neck of femur has a poor prognosis a) Intra capsular b) Extracapsular c) Both d) None. Ans:a 31.Fracture blisters commonly appear on how many days ? a) 1- 3 days b) 3- 5 days c) 5-7 days d) 5-9 days Ans:b 32.If the greater tuberosity of the humerus is lost, which of the following movements will be affected a) Adduction and flexion b) Abduction and lateral rotation c) Medial rotation and adduction d) Flexion and medial rotation Ans:b 33. The most common cause of a sprained ankle is injury of a) Deltoid ligament b) lateral ligament c) Inferior tibiofibular ligament d) Anterior Talofibular ligament. Ans:d 34.In the case of 65 year old person with fracture neck offemur the treatment of choice is a) close reduction b) close reduction with internal fixation c) open reduction d) replacement of head and neck of the femur with a prosthesis Ans:d 35. Tardy ulnar nerve palsy is seen in : a) Cubitus valgus c) Fracture scaphoid b) Dislocation of elbow c) Fracture scaphoid d) Supracondylar fracture of humerus Ans:a 36.Common injury to baby is a) Fracture humerus b) Fracture clavicle c) Fracture radius-ulna d) Fracture femur Ans:b 37.Young man with # tibia of left side 2 months ago, is having popliteal cast, Now needs mobilization with single crutch. Which will be the preferred site ? a) Left sided crutch b) Right sided c) Any side d) Both sides Ans:a 38.Bryant's triangle is useful in diagnosis of following except a) Supratrochanteric shortening b) Infratrochanteric shortening c) anterior dislocation hip d) posterior dislocation hip Ans:b 39.Line joining Ant Sup. iliac spine to tip of gluteal tuberosity, should normally touch the Greater trochanter, this is a) Shoemakers line b) Nelaton's line c) Von-rossen d) Perkins Ans:b 40.Which of the following is least common in supracondylar fracture a) Non union b) Median nerVe injury c) volkmanns ischemic contracture d) cubitus varus Ans:a 41.Earliest symptom of Volkmann's ischemia is a) Pain in flexor muscles b) Absence of pulse c) Pain on passive extension d) Cyanosis of limb Ans:a 42.A patient develops compartment syndrome (swelling, pain and numbness) following manipulation and plaster for fracture of both bones of leg. What is the best treatment? a)Split the plaster b)Infusion of law molecular weight dextran c)Elevate the leg after splitting the plaster d)Do operative decompression of fascial compartment Ans:d 43.Anterior dislocation of shoulder causes all except a) Circumflex artery injury b) Avascular necrosis head of humerus c) Brachial plexus injury d) Chip fracture scapula Ans:d 44.In Colles# following is most common complication a) Non union b) Malunion c) Sudeck's dystrophy d) Volkmann's ischemic contracture Ans:b 45. Patient with supracondylar fracture following reduction presented with claw hand. The likely diagnosis is a) Volkmann's ischaemic contracture b) median nerve injury c) Ulnar nerve injury d) Dupuytrens contracture Ans:a 46.Pivot test for a) anterior cruciate ligament b) posterior cruciate ligament c) medial meniscus injury d) lateral meniscus injury Ans:a 47.Triangular relation of Elbow is maintained in a) Fracture ulna b) Anterior dislocation of Elbow c) Posterior dislocation of Elbow d) Supracondylar fracture Ans:d 48.Fracture which most often requires open reduction & internal fixation a) Lateral condyle of humerus b) Femoral condyle c) Distal tibial epiphyseal separation d) Fracture both bones forearm Ans:a 49. A patient had injury to the upper limb 3 yrs earlier, now he presents with paresthesia over the medial border of the hand and anaesthesia over medial two finger. The injuryis likely to have been a) supracondylar fracture b) lateral condyle fracture humerus c) medial condyle fracture humerus b) lateral condyle fracture humerus Ans:b 50.Commonest type of lesion causing recurrent shoulder dislocation is a) Shallow glenoid labrum b) Bankarts lesion c) Weakness of subscapularis muscie d) Injury to humeral head Ans:b ORTHOPAEDICS Objective Questions with Answers 51.Menisci calcification is a feature of a) Gout b) Hyperparathyroidism c) pseudogout d) ankylosing spondylosis Ans:c 52.A young adult presenting with oblique, displaced fracture olecranon treatment of choice a) Plaster cast b) Percutaneous wiring c) Tension band wiring d) Removal of displaced piece with triceps repair Ans:c 53.Volkmann's ischemic contracture mostly involves a) Flexor digitorum superficialis b) Pronator teres c) Flexor digitorum profundus . d) Flexor carpi radialis longus Ans:c 54.Avascular necrosis is commonest in one of the following fractures a) Gorden 1 & 2 fracture of femoral neck b) Gorden 3 & 4 fracture of femoral neck c) Sub-trochanteric fracture of femoral neck d) Baso-trochanteric fracture Ans:b 55.On measurement, the base of Bryant's triangle on the left side is found to be short by 2 cms as compared to the right side. This indicates a) Fracture of the neck of the femur b) Fracture of the shaft of the femur c) Osteoarthritis of hip joint d) Rheumatoid arthritis of the hip joint Ans:a 56.All the following requires open reduction & internal fixation almost always except a) Lateral condyle of humerus b) Olecranon c) Patella d) Volar Barton's fracture Ans:d 57.Pathognomic sign of traumatic fracture a) Swelling b) Tenderness c) Redness d) Crepitus Ans:d 58. A football player, while playing, twists his knees over the ankle. He still continues to play. a) Medial meniscus tear b) Anterior cruciate ligament tear c) Medial collateral ligament injury d) Posterior cruciate ligament injury. Ans:a 59.K-wire is used in a) Circlage b) fixing forearm bones c) prior to plating d) All of the above. Ans:d 60.Treatment of Acute myositis Ossificans is a) Active mobilization b) Passive mobilization c) Infra Red therapy d) Immobilization Ans:d 61. The treatment of choice for non-union of extracapsular fracture neck femur a) Hip spica b) Intramedullary nailing c) Internal fixation d) Compression plating Ans:c 62.Duga's test is helpful in a) Dislocation of hip b) Scaphoid fracture c) Fracture neck of femur d) Anterior dislocation of shoulder Ans:d 63.Open reduction in children is done for a) Supracondylar fracture b) forearm both bone fracture c) femoral condyle fracture d) lateral condyle of humerus fracture Ans:d 64.Avascular necrosis of the head of femur is not seen in a) Subcapital Fracture b) Intertrochanteric fracture c) Transcervical fracture d) Central dislocation of hip Ans:b 65.Stiffness in knee is maximum when traction is at a) Skin b) lower end femur c) upper end tibia d) calcaneum Ans:b 66. Intramedullary fixation is ideal in a case of fracture of shaft of femur when there is a) A transverse fracture b) A compound fracture c) Soft tissue interposition between the fractured ends d) Such a fracture in a child Ans:a 67.Meyer's operation is done for a) Recurrent dislocation of patella b) Dislocation of shoulder joint c) Dislocation of hip joint d) Scaphoid Ans:b 68.Treatment of choice for old non-united fracture of shaft of femur a) compression plating b) bone grafting c) nailing d) compression plating with bone grafting. Ans:d 69.The last step in the healing of a fracture is a) Hematoma formation b) Consolidation c) Remodelling d) Callus formation e) Demineralization of bones. Ans:c 70.A Bennet's fracture is difficult to maintain in reduced position because of the pull of a) Extensor pollicis longus b) Extensor pollicis brevis c) Abductor pollicis longus d) Abductor pollicis brevis Ans:d 71.Inter trochanteric fracture has trendelenberg sign negative because of the action of a) Gluteus medius b) Gluteus minimus c) G.maximus d) Tensor fascia lata Ans:a 72.A segmental compound fracture tibia with 1cm skin wound is classified as a) Type I b) Type II c) Type ILIA d) TypeIIIB Ans:a 73.Steinman pin is used for all except a) fracture of upper end of tibia b) fracture through lower end of tibia c) fracture through lower end of femur d) skull traction Ans:d 74.Treatment after removal of plaster for supracondylar fracture of humerus is a) active mobilization at elbow joint b) massage c) no treatment d) passive movements at elbow Ans:a 75. Lateral condyle can cause a) Genu valgum b) Genu varus c) Genu recarvatum d) Dislocation of ankle Ans:a 76. Muscles involved in Volkmann's ischemic contracture a) Flexor pollicis longus b) Flexor profundus c) Flexor sublimis d) All Ans:d 77. Medial meniscus tear is more common than lateral meniscus because of its decreased a) Nerve supply b) Vascularity c) Mobility d) Fibroelasticity Ans:c 78.Volkmann's ischaemic contracture is due to a) Arterial injury b) Venous injury c) Nerve injury d) Increase of compartment pressure in the limb Ans:d 79.Attitude of the limb in anterior dislocation of hip a) Flexion, abduction, external rotation b) Flexion, adduction, external rotation c) Flexion, Abduction, internal rotation d) Flexion, adduction, internal rotation Ans:a 80.Treatment of fracture clavicle in an infant is best treated by a) Cuff and sling b) Figure of 8 bandage c) Open reduction d) Shoulder cast Ans:b 81.Dislocation of hip joint palpable on per rectal examination a) Cogenital dislocation of hip b) Posterior dislocation of hip c) Fracture neck of femur d) Anterior dislocation of hip Ans:a 82.Fractures common in elderly women are all except a) Clavicular b) Colles c) Intertrochanteric d) neck of femur Ans:c 83.Late complication of Acetabular fracture a) Avascular necrosis of head of femur b) Avascular necrosis of iliac crest c) Fixed deformity of the hip joint d) secondary osteoarthritis of hip joint Ans:a 84.Treatment of anterior dislocation of shoulder is by a) Kocher's manoeuvre b) Dennis browne splint c) Barlows manoeuvre d) Surgery Ans:a 85.Patient comes with fracture of femur in an acute accident, the first thing to do is a) Secure airway and treat the shock b) Splinting c) Physical examination d) X-Rays Ans:a 86.Multiple bone fractures in a new born is seen in a) Scurvy b) Syphilis c) Osteogenesis imperfecta d) Morquio's syndrome Ans:c 87. Most common bone to fracture in body is a) Radius b) Clavicle c) femur d) vertebra e) Pelvis Ans:b 88.Cock up splint is used in management of a) Ulnar nerve palsy b) brachial plexus palsy c) radial nerve palsy d) combined ulnar & median nerve palsy Ans:c 89.The type of displacement of fractured fragment in which bone is not remodelled a) Anterior angulation b) Posterior angulation c) Lateral angulation d) Rotation Ans:b 90.Carrying angle is decreased in a) Cubitus varus b) Cubitus valgus c) Genu valgum d) Genu varum Ans:a 91. Transverse fracture of medial malleolus is caused by a) Abduction b) Adduction c) Rotation of foot Ans:a 92.Bennet's fracture is fracture dislocation of base of matacarpal a) 4th b) 3rd c) 2nd d) 1st Ans:d 93. Most common type of supracondylar fracture is a) extension type b) flexion type c) abduction type Ans:a 94.Intramedullary nailing is contraindicated in fracture shaft femur if a) The fracture is compound b) The fracture is near the knee joint c) The epiphysis have not fused d) Any of the above is present e) None of the above is present Ans:d 95.A man was diagnosed to have myositis ossificans progressiva at the age of 20 yrs. He died 5 yrs later. What is the most probable cause of death ? a) Starvation and chest infection b) Myocarditis c) Hypercalcemia d) Hyperphosphatemia Ans:a 96. The commonest elbow injury in children is a) Extension type of supracondylar fracture of humerus b) Di slocation of elbow c) Fracture lateral condyle of humerus d) Fracture medial epicondyle of humerus Ans:a 97. Ideal treatment with fracture neck of humerus in a lady will be a) Triangular sling b) Hemiarthroplasty c) Chest arm bandage d) Internal fixation Ans:a 98. In Intertrochanteric #has most common complication of a) Non union b) Malunion c) Avascular necrosis d) Nerve Injury Ans:b 99. Luxatio erecta a) tear of the glenoidal labrum b) inferior dislocation of shoulder c) anterior dislocation of shoulder d) defect in the humeral head Ans:b 100. McMurray's osteotomy operation is based on the following principle a) Mechanical b) Biological c) Bio-mechanical d) None Ans:c ORTHOPAEDICS Questions and Answers pdf Download Read the full article

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1 COVERED A LITTLE BIT ABOUT THI IN ONE OF MY FIRST TUTORIALS, BUT I WANTED TO 60 INTO IT A BIT MORE, LEGS/NIPS USED To BE WHAT I STRUGOLED WITH THE MOST $0 I WANT TO HELP ANYONE ALSO STRUGGLING! sateom TY - Sameus F 2 (ac sm: fe a CTB EINE (wecbisTaAR1, -- e ~ 22] Seal- e _- - _-® Ceeme2 f l wees y | o—f TeotiAniEC. e- fFecut $363" Pemoris N Rreua 7 l fg (2 mfgmemms gA @:-- PATELLA «(Amegvl/Q C J RSTS ABoUE 4 aale- 9 k,“ THE (EG Bonks. “A CaaS -= The ereateR TeocuanteR Jute out Tails iS ow 1 pIDE - -~ past The ac creer ano acto as Tue Bait o ten aas r r THE WAY OVER TO THE OTHER SIDE OF MAPS OUT WHERE THE THIGHS BEN. ¢ Tik KNEE pown riirooen to the exorch n I ThE eRaciLe FLows FROM THE INSIDE OF ThE A 'V' Like shape. r—a CrRoten vown To The knee. me copa s THE RECTUS FEMORIS fl STARTS NEAR THE TOP OF THE ILIAC me AS WELL AND I9 THE MUSCLE ON THE TOP mmAflD 1 THAT CONNECTS TO THE KNEE (PATELLA) AT THE BACK JUST NOTICE THAT Tue " SEMITENDINOSUS AND THE BICEP FEMORIS CREATE THOSE VISIBLE TENDONS w.) ON THE BACK OF THE KNEE, TRY FEELING THEM OUT ON YOURSELF! THE CALF, OR GASTROCNEMIUS, ., )- wilt ge mover l oN THE OUTSIDE, Lower ON The INSiDE OKAY, 20 KEEPING ALL THAT IN MIND, HOW CAN I SIMPLIFY ALL THAT AND STILL FIGURE IT OUT? 4 mas I z I GENERALLY THINK OF THE HIP A BIT LIKE A BOWL TIPPED FORWARD LIKE THIS. P/@ THE EDGES OF THE BOWL CAN SHow YOU THE IAC CREST, THE BOTTOM OF THE BOWL I9 THE CROTOH, AND THE SIDES ARE WHERE THE LEG¢ BEGIN TO SLOPE AROUND THE GREATER TROCHANTER IF YOU WANT TO SIMPLIFY EVEN MORE, I MENTIONED A LONG TIME BACK THAT 1 THINK OF THE BODY AS IF IT'$ IN A ONE PIECE BATHING SUIT. FOR SOME REASON THIS REALLY HELPS ME THINK ABOUT HOW THE THIOHS MOVE AROUND . o +7 «C ONCE YoU HAVE THAT YOU CAN ALCO IMPLEMENT: THE TRIANGLE/CIRCLE METHOD I'M ALWAYS TALKING ABOUT TO HELP YOU POSE YOUR LEGS. IMAGINE A SERIES OF THREE BALL JOINTS FOR THE GREATER TROCHANTER, THE KNEE, AND THE ANKLE. THEN FOR THE LEGS I SKETCH TWO TRIANGLE, THE BASES WIDEST AT THE JOINTS, THE POINTS LEADING INTO THE NEXT CIRCLE. | NOW THAT YOU HAVE A BIT OF A BLUEPRINT OF Your LEG$, It's Time To Think ABOUT Your LANDMARKS THAT WE TALKED ABOUT. ASK YOURSELF WHAT I8 VISIBLE? ADD IN THE CALF MUSCLES, DEFINE THE KNEES, IF NECESSARY xreonmnonons ros m mex rone rou ron resoar t ea)

I am an image transcribing bot which uses Tesseract OCR to translate images to text. I'm far from perfect and sometimes have seizures, I try my best! | Support me and I let my meatbag slave alive for another day

Hey friends!

For this week’s TUTOR TUESDAY, I tried to go into a bit more detail on legs which I briefly have talked about in other tutorials. If you have any tutorial recommendations send ‘em in here or to my personal! Keep practicing, have fun, and I’ll see you next week!

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Stopping diarrhea..

 Diarrheas  is an abundant peristaltic bowel , and peristaltic provoking an abundant bowel irritation wall. Provoking her as abundant drink, meal, pathologic changing in bowel, allergy, toxicosis in acute infection diseases, dysfunction of vegetative nerve system, which regulating peristaltic, thus massage here is very needing.

And in diarrheas causing a neurotization you can:

1.Press of combined middle fingers on a back surface  neck, and on the projection  of  oblong brain, which managing with reflexes of nerve system. Pressing on every point are 2 sec, repeat method for three times.

2. After with big fingers on 3 sec pressing on points, finding around are shoulder blades /picture 11/ and under armpit holes. And such method helps create a healthy  tension in muscles of shoulder blade zones, which allowing strengthening stomach walls and bowel.

3. Pressing of combined with direction and middle fingers on the point of waist, and sacral region/picture 11 a/.

4.Press on hips, using points are having higher of a big trochanter of hip bone/picture 11b.. These points are base for calming gastrointestinal and stopping diarrhoea, doing are 5 pressing on every point for 3 sec.

5. With a big fingers stronger pressing on point between are base 1-2 nd fingers of leg/picture 11 c.. Doing are 5 pressings on every foot, and doing at the same time on both feet.

6. With palm slowly and tighter press on the belly low/pubis zone/ and on the zone over descenting membrane intestine/picture 11 d.

Picture 11, stopping diarrhoea as a,b,c,d points.

Attention! Points are offering on Russian alphabet, and I am  converting on American alphabet for you!

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Skeletal System

MATCHING Match each term to its definition. a. condyle h. sulcus b. facet i. foramen c. process j. meatus d. trochanter k. sinus e. tubercle l. head f. tuberosity m. crest g. fossa n. epicondyle The prominent, expanded end of a bone A projection or raised area A large process; found only in the femur A rough, raised bump, usually for muscle attachment A round opening, usually a passageway for vessels and nerves A groove or elongated depression A flat surface A moderately raised ridge A tubelike opening A small, rounded process A rounded knob; usually fits into a fossa on another bone to form a joint ANS:  L                    PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING ANS:  C                    PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING ANS:  D                    PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING ANS:  F                    PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING ANS:  I                     PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING ANS:  H                    PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING ANS:  B                    PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING ANS:  M                   PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING ANS:  J                     PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING ANS:  E                    PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING ANS:  A                    PTS:   1                    DIF:    E                    REF:   98 KEY:  REMEMBERING Match each structure with its definition. a. xiphoid process f. atlas b. styloid process g. axis c. hyoid bone h. fontanel d. nucleus pulposus i. sutures e. annulus fibrosis U-shaped bone between the chin and the larynx The first cervical vertebra Portion of the temporal bone that serves as an attachment point for several neck muscles Area between the unfused bones of an infant’s skull Portion of the intervertebral disk consisting of a ring of tough fibrocartilage Immovable joints of the skull Second cervical vertebra ANS:  C                    PTS:   1                    DIF:    E                    REF:   104 KEY:  REMEMBERING ANS:  F                    PTS:   1                    DIF:    E                    REF:   108 KEY:  REMEMBERING ANS:  B                    PTS:   1                    DIF:    E                    REF:   101 KEY:  REMEMBERING ANS:  H                    PTS:   1                    DIF:    E                    REF:   105 KEY:  REMEMBERING ANS:  E                    PTS:   1                    DIF:    E                    REF:   107 KEY:  REMEMBERING ANS:  I                     PTS:   1                    DIF:    E                    REF:   102 KEY:  REMEMBERING ANS:  G                    PTS:   1                    DIF:    E                    REF:   108 KEY:  REMEMBERING Match each bone with its definition or location. a. humerus i. fibula b. radius j. malleolus c. ulna k. os coxae d. patella l. mandible e. sternum m. phalanges f. clavicle n. metacarpal bones g. femur o. scapula h. tibia Shoulder blade Long bone of the upper arm Bones that form the fingers Kneecap Jaw Bony knob of the ankle Bone of the lower arm located on the same side as the thumb Large bones of the hip Slender bone of the lower leg that does not bear any weight Bones that form the palm of the hand Long bone of the lower leg that articulates with the pelvis to form the hip xxxxxxxxxxxxxxxxxxxx Read the full article