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Acetabulum fracture surgical approaches - Ilioinguinal (OTA lecture series III v05b)
 
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Narrated, annotated lecture 2 of 3 on acetabulum fracture surgical approaches (ilioinguinal) from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com.
Views: 19371 OrthoClips
Hip Dislocations - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Educational video describing hip dislocations and their treatment. Hip dislocation cab be either a simple dislocation or it can be a fracture dislocation which involves the posterior wall of the acetabulum or the femoral head. Dislocation of the hip can be two types: 1.Posterior dislocation (most common type) 2.Anterior dislocation (rare) Position of the hip during the impact decides the injury. In posterior dislocation of the hip, which is the most common type, the lower limb will be flexed, adducted and internally rotated. Hip fractures are different than hip dislocations. Notice that the affected extremity is shortened and externally rotated with a hip fracture. Hip dislocation of any type is an emergency. It must be reduced in less than 6 hours of injury. After reduction of the hip, get a CT scan. A CT scan clearly outlines the bony injury. Check the CT scan for congruous reduction, for the absence of fracture and absence of marginal impaction in the acetabulum. Marginal impaction is more common in posterior acetabular wall fractures and could lead to instability. Displaced or comminuted posterior wall fracture could lead to arthritis. Make sure that you have a congruous reduction with no loose bodies or important fractures present. Check for fractures of the acetabulum and the size of the fragment. The size of the posterior wall fracture has an effect on the stability of the hip joint. If congruous reduction of the hip is not obtained, perform open reduction urgently. Open reduction can be done through an anterior approach or a posterior approach. Hip dislocation with or without associated fracture can cause complications.The risk of avascular necrosis depends on the interval between the injury and reduction of the dislocation. Urgent reduction of hip dislocation is mandatory to avoid AVN and interruption of the blood supply which leads to collapse of the femoral head. Closed reduction should be done in less than 6 hours. When injury occurs to the sciatic nerve due to posterior hip dislocation, the common peroneal nerve is usually affected, causing weakness in dorsiflexion of the ankle and loss of toe extension. Injury to the sciatic nerve usually occurs from the dislocation and not from the reduction of the hip. The longer the wait for the reduction of the dislocation, the more the patient is predisposed to sciatic nerve injury. The length of time a hip remains dislocated influences the incidence and the severity of a major sciatic nerve injury. Neurological examination at the time of injury is usually difficult, however it is extremely necessary. Check for sensation on the top of the foot. In posterior dislocation of the hip, always look for injuries in the knee such as dashboard injury. The force of the injury is usually transmitted from the knee to the hip. In cases of high energy trauma, always look at the chest. There might be a tear of the aorta. Check for widening of the mediastinum on chest x-rays. There is concern of deceleration injury involving the aorta. Hip joint dislocation may be associated with acetabular fracture or fracture of the femoral head (Pipkin fracture). With Pipkin fracture, as the femoral head dislocated, it hits the posterior wall of the acetabulum and the femoral head fractures. This may be different from an anterior hip dislocation. Anterior hip dislocation will cause impaction of the femoral head or indentation fractures. Classically, Pipkin fracture is a posterior fracture dislocation of the hip and fracture of the femoral head. Treatment of hip dislocation •Emergency closed reduction of the hip within 6 hours. •Closed reduction is done to avoid AVN of the hip. •Reduction of the hip joint and mobilization of the patient with protected weight-bearing crutches for 4-6 weeks. •After closed reduction, when the patient has an associated fracture, assess the ip stability •The hip is usually stable if the fragment size of the acetabulum is less than 20% •More than 40 %, the hip is unstable. •Between 20-40% fragment size, the hip stability is undetermined. When there is an associated acetabular fracture, the best method to assess the stability of the hip is by examination of the patient under general anesthesia utilizing fluoroscopy. Assess the posterior wall stability with the obturator oblique view. Hip will be in flexion, adduction and add axial load. Check the medial clear space for opening. Irreducible isolated posterior dislocation •Do emergency surgical treatment to reduce the hip. Treatment of posterior hip dislocation with posterior acetabular wall fracture •Must assess the stability of the hip joint by examination under anesthesia after closed reduction. •After closed reduction, if the dislocation is not congruent, do open reduction and fixation urgently. Treatment of Pipkin femoral head fractures •Headless screw fixation.
Views: 133200 nabil ebraheim
Acetabular Fractures - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Dr. Ebraheim’s educational animated video describes fracture types of the Acetabulum. The hip joint is a ball and socket joint where the femoral head is contained within the acetabulum. The acetabulum is round in shape and covered with cartilage which forms the articular surface of the hip joint. Labrum is a ring of shock absorbing cartilage that surrounds the acetabulum. The sciatic nerve is close to the acetabulum and it can be injured. Acetabular fractures commonly occur due to high velocity trauma. Types of acetabular fractures •Anterior wall fracture •Anterior column fracture •Posterior wall fracture •Posterior column fracture •Transverse fracture •T-shape fracture •Both column fracture Posterior wall fractures are the most common acetabular fractures. The posterior wall fracture may be a simple fracture or associated with dislocation of the femoral head. The obturator view radiograph will clearly show the posterior wall fracture. CT scan is the study of choice. In case of fracture dislocation, reduce the hip immediately and fix the fracture later. Always check sciatic nerve function (dorsiflexion of ankle & toes). Peroneal division could be affected. Posterior wall fracture with marginal impaction: •Reduce the fracture •Lift cartilage and apply bone graft. •Posterior plate fixation. Complications of acetabular fractures •Arthritis (post-traumatic) •Degenerative joint disease •Avascular necrosis: death of bone due to interruption of the blood supply. •Myositis ossificans: ossification occurs at the site of injury leading to restriction of motion.
Views: 71683 nabil ebraheim
Capitellum Fracture Classification - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Dr. Ebraheim’s educational animated video describes the classifications of the Capitellum Fractures. The Capitellum is located at the distal humerus. Fractures to the capitellum are rare. Capitellum fractures usually occur in the coronal plane. May be difficult to diagnose. Elbow effusion or displacement of the fat pad after a trauma could suggest a nondisplaced fracture of the radial head or the capitellum. Bryan and Morrey Classification: - Type I: Hann – Steinthal fragment. • Constitutes a large fragment of bone and articular cartilage, sometimes with trochlear involvement. • Treatment: open reduction. • Fixation Herbert screws. - Type II: Kocher – Lorenz fragment. • Characterized by a small shell of bone and articular cartilage. • Treatment: excision - Type III: Comminuted fracture of the capitellum. • Treatment: exision. - Type IV: Mckee Modification. • Fracture extends medially to include the capitellum and trochlea. • See double bubble on lateral x-rays. • Treatment: open reduction and fixation with Herbert screws. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 14742 nabil ebraheim
Lunate or Perilunate Dislocation?
 
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It's possible to have confusion about the type of carpal dislocation one is seeing in a patient. Is it a lunate or perilunate dislocation? In this video we demonstrate such a patient as well as the reduction and splinting procedures.
Views: 19460 Larry Mellick
Dislocations Of The Talus - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Dr. Ebraheim’s educational animated video describes the Dislocation of the Talus Bone, which can be either Total or Subtalar, Subtalar could be Lateral or Medial. Dislocations of the talus can be a total dislocation or a subtalar dislocation. Types of dislocation Total dislocation of the talus which is not accompanied by a fracture is a very rare injury. Most of the injuries are open. Urgent care is necessary to avoid soft tissue complication. High risk of avascular necrosis of the talus, arthritis and soft tissue infection. Subtalar (the foot is lateral or medial ). Subtalar dislocation of the talus is a rare injury that results from excessive pronation. It involves simultaneous dislocation of the distal articulations of the talus at the talocalcaneal and talonavicular joints. Lateral subtalar dislocation/ tibialis posterior tendon entrapment It is often a result of high energy trauma. Worse long-term prognosis. Irreducible lateral dislocation due to interposed tibialis posterior tendon. Could be unstable and may sublux. May need CT scan to check for fractures. Medial subtalar dislocation 85% of the dislocations are medial and often result from low energy trauma. Irreducible medial dislocation due to interposed extensor digitorum brevis or extensor retinaculum. The direction of subtalar dislocation has important effects with respect to management and outcome. Complications of subtalar dislocation may include stiffness and subtalar arthritis. Treatment •Stable- closed reduction with 3-4 weeks of immobilization followed by physical therapy. •Unstable- after closed reduction internal fixation may be required. The anteromedial incision is used for medial dislocation. Lateral approach is used for lateral dislocation.
Views: 22812 nabil ebraheim
DEPRESSED LATERAL CONDYLE FRACTURE  CC SCREW FIXATION
 
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IN A 80 YEARS OLD YOUNG MAN
Views: 13749 dr kiran kumar nvs
Introduction to Lauge Hansen & Danis Weber Classifications Ankle Fracture
 
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Surgery of the Foot and Ankle: http://astore.amazon.com/nichogiovi-20 Popular Running Shoes: http://astore.amazon.com/nichogiovi-20?_encoding=UTF8&node=2 Lauge-Hansen is perhaps one of the most commonly utilized classifications for ankle fractures. Dr. Lauge-Hansen in 1948, broke down the mechanism of injury into two simplistic terms for a complicated three-dimensional fracture. The first term describes the position of the foot at the time of injury. The second term was originally described as the direction and/or force in which the talus moves relative to the tibia and the fibula. Since, the original classification was based off of a cadaver study the second term has been modified to describe the way the tibia moves relative to the talus, which is what occurs in a weight-bearing individual. Lauge-Hansen's classification is a numerical system which describes a step-wise approach through the injuries progression. One must look at rotational injuries in a clockwise fashion while direct blow injuries must be looked at in a transverse abductory /adductory fashion. Generally pronation injuries will start at the medial aspect of the ankle joint while supination injuries will start at the lateral aspect of the ankle joint. This classification not only allows you to visualize the osseous injury to the tibia & fibula but also incorporates the ligamentous structures that may become damaged within the ankle joint. The Lauge-Hansen system can provide insight into the proper maneuvers required for closed reduction. Another classification that is commonly correlated with the Lauge-Hansen classification system is the Danis Weber classification. Danis Weber is based on the fibular fracture line's relationship to the ankle joint. Danis Weber type A injury starts below the level of the ankle joint and corresponds with a Lauge-Hansen Supination Adduction injury. Danis Weber type B starts at the level of the ankle joint and correspond with Lauge-Hansen Supination External rotation and Pronation Abduction injuries. Last but not least, Danis Weber type C injuries start above the level of the ankle joint and correspond with a Lauge-Hansen Pronation External Rotation injury. The Danis Weber classification although more simplistic in nature than the Lauge Hansen classification, is limited by its anatomical focus on the fibula. Danis Weber also fails to take into consideration the soft tissue structures that are often associated with these injuries. The AO group has expanded this classification to include some of the shortfalls of this system. It is important remember that these classification systems are guidelines and atypical fracture patterns do occur. Project Leads: William Hoffman Hummira Hassani Contributing Authors: Julia Bernardini Scott Crismon Technical Advisor: Thomas Vitale Narration: Matrona Giakoumis Producer: Nicholas Giovinco © 2010 www.DrGlass.org [email protected]
Views: 66701 DrGlassDPM
Dr. Sheldon, DC 9-4-13 adjusting anterior impingement of talus,sinus tarsi syndrome
 
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This video is now a part of my written blog in my category " Subtalar Joint Instability" on my website:http://si-instability.com/my-subtalar-joint-instability-talus-impingement-sinus-tarsi-syndrome/ This pertains to my chronic left ankle talus bone/subtalar joint instability/partial dislocation. Please see my websites: www.si-instability.com and www.fibularpain.com for other instability blogs and their 100% successful surgical interventions. This video is the 2nd appointment in one day just to keep my talus neutral. I was pain-free for a couple hours then symptoms came back and Dr. Sheldon proved again that talus had shifted. See my AHEHealth Channel for other youtube video on the x-rays before and after an adjustment. These videos are a series of documentation to DPM's on my instability condition.
Views: 25912 AHEHealth
Tibial plateau fractures 1
 
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Assessment and management of tibial plateau fractures for orthopaedic surgery residents. Lecture 1 of 2. Narrated, annotated video lecture from OrthoClips.com
Views: 8062 OrthoClips
Posterior Elbow Dislocation & Reduction
 
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Dr. Fakhouri of MidAmerica Orthopaedics and MidAmerica Hand To Shoulder Clinic demonstrates Posterior Elbow Dislocation & Reduction.
Views: 101800 MidAmerica Orthopaedics
Tibial Plateau Fracture with Metal Plate Fixation
 
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Open reduction and internal fixation of tibial plateau fracture. Side plate and multiple screws used to hold fracture fragments together. Fracture lines run into the knee joint and, once healed, can develop into an abrasive opposing surface for the femoral condyles. This situation can eventually result in joint arthrosis and possible total knee replacement.
Views: 349346 trialfx .com
Talus fractures 2  - surgical treatment of talar neck fx  (OTA lecture series III l14b)
 
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Narrated, annotated lecture 2 of 4 on talus fractures and dislocations from the OTA resident lecture series (narrated by Saqib Rehman, MD), from Orthoclips.com.
Views: 3837 OrthoClips
Common Foot And Ankle Injections - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Dr. Ebraheim’s educational animated video describes injection techniques for painful conditions of the foot and ankle. Conditions which cause pain and inflammation are treatable with the use of diagnostic and therapeutic injection. Ankle joint The ankle joint is formed by the articulation of the tibia and talus. Injection is done to alleviate pain occurring from trauma, arthritis, gout or other inflammatory conditions. Anterolateral ankle impingement •Can occur due to the build-up of scar tissue in the ankle joint or from the presence of bony spurs. •With the ankle in a neutral position, mark the injection site just above the talus and medial to the tibialis anterior tendon. •The injection site is disinfected with betadine. •The needle is inserted into the identified site and directed posterolaterally. •Injection of the solution into the joint space should flow smoothly without resistance. •Pulling on the foot to distract the ankle joint is helpful. First metatarsophalangeal joint •The MTP joint is a common injection site frequently affected by gout and osteoarthritis. •The injection site is disinfected with betadine. •The needle is inserted on the dorsomedial or dorsolateral surface. •The needle is angled to 60-70 degrees to the plane of the match the slope of the joint. •Injection of the solution into the joint space should flow smoothly without resistance. •Pulling on the big toe is sometimes helpful in distraction of the joint. Peroneal tendonitis •Peroneal tendonitis is an irritation to the tendons that run on the outside area of the ankle, the peroneus longus and peroneus brevis. •The injection site is disinfected with betadine. •Insert the needle carefully in a proximal direction when injecting the peroneus brevis and longus tendon sheath. •Advance the needle distally to inject the peroneus brevis alone at its bony insertion. Achilles tendonitis •Achilles tendonitis is irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common overuse injury that occurs in athletes. •Injection of steroid should be given around the tendon, not through the tendon. •Injections directly into the tendon is not recommended due to increased risk of tendon rupture. •Platelets injection can be done through the tendon with needling and fenestration. Tarsal tunnel syndrome •The condition of pain and paresthesia caused by irritation to the posterior tibial nerve. •Feel the pulse of the posterior tibial artery, the nerve is posterior, find the area of maximum tenderness, 1-2 cm above it will be the injection site that is marked on the medial side of the foot and disinfected with betadine. •The solution is injected at an angle of 30 degrees and directed distally. •Warn the patient that the foot may become numb. •Care should be taken In walking an driving. •Usually performed after a treatment program which can include rest, stretching and the use of shoe inserts. Plantar fasciitis •The plantar fascia is a band of connective tissue deep to the fat pad on the plantar aspect of the foot. •Patients with plantar fascia complain of chronic pain symptoms that are often worse in the morning with walking. •The injection site is identified and marked on the medial side of the foot and betadine used. •Avoid injecting through the fat pad at the bottom of the foot to avoid fat atrophy. •The needle is inserted in a medial to lateral direction one finger breathe above the sole of the foot in a line that corresponds to the posterior aspect of the tibia. •The solution is injected past the midline of the width of the foot.
Views: 107883 nabil ebraheim
TRAUMA WEBINAR Miller/ Orthobullets review Webinars
 
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FOLLOW ME in my TWITTER to be updated https://twitter.com/elbisagra85 @elbisagra85 Starting new Project here try to STUDY LEARN an SUCCEED in Orthopedics and as you can see i don t want to be alone i want all of my orthopedic colleague to Succeed with me . i want to share all the info i grasp and any kind of knowledge i have and share all i need is supporting from you my colleagues :) . LIKE Comment to improve all of us myself you and other orthopedic surgeon Subscribe Share my channel no no no its not mine from now on its yours SHARE it to all your Colleagues make the value knowledge be allover Help me to make a constant content weekly by sharing, like and commenting
What Is Anterior Hip Dislocation?
 
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Hip dislocation background, epidemiology, functional anatomy. Radiology reference article dislocations of the hip, a tutorial for medical students. A detailed review of hip reduction maneuvers a focus on amfs what is anterior dislocation? Youtube. Read this lesson to learn more about the signs and symptoms of nerve injury related 10 may 2017 anterior dislocation (10. Radiographic and ct anterior hip dislocation in children with neurological disordersposterior precautions & nerve injury core em. Googleusercontent searchposterior dislocation. Read this lesson to learn more about different patient presentations and courses of nerve injury is a common complication hip dislocation. The thigh and leg act as a lever, with the fulcrum being posterior edge of acetabular socket, popping femoral head out socket anteriorly anterior hip dislocation is much less common than. As the femur head is either anterior in groin or obturator fossa it can obstruct femoral vein causing thrombosis and possible pulmonary embolism dislocations require same inline traction on femur; However, flexion of hip not usually dislocation occurs from a direct blow to posterior aspect or, more commonly, force applied an abducted leg that levers 31 aug 2017. Anterior dislocation of the hip. Hip dislocation trauma orthobullets 1035 hip "imx0m" url? Q webcache. Dec 2009 most hip dislocations are posterior, caused by impaction of the femoral head upon acetabulum from direct force to distal femurhip dislocation accounts for only 5when thighbone slips out its socket in a forward direction, will be bent slightly, and leg rotate away clinically radiologically evaluate outcomes conservative (orthopaedic without revision surgery) treatment anterior after total all patients (three girls three boys) who had been operated (seven hips) or subluxation with an underlying may occur as posterior injuries. Post reduction ct must be performed for all traumatic hip dislocations to look forloose bodies 6 sep 2012 discussion see frx of the comprise 10 15. Hip dislocation background, epidemiology, functional anatomyanterior hip wheeless' textbook of orthopaedicship anatomy. The hip joint includes the articulation of femoral head (of femur) and acetabulum pelvis. It constitutes for only 5 18with an anterior dislocation the lower limb is lengthened, hip abducted and foot in external rotation. This is most common when the femur adducted and internally rotated. Anterior hip dislocation in a football player case report hindawi. Traumatic hip dislocations are uncommon injuries in the paediatric population, requiring urgent reduction to reduce risk of avascular necrosisHip dislocation background, epidemiology, functional anatomyanterior wheeless' textbook orthopaedicship anatomy. The opposite is true for the shoulder, where most common dislocation occurs in anterior and inferior directions 30 jan 2018 dislocations occur when an athlete's hip flexed, with leg abducted externally rotated. Learningradiology anterior, hip, dislocation, dislocated, radiologyanterior dislocation of a total hip replacement. Traumatic anterior hip dislocation in an adolescent with.
Views: 91 E Answers
Humerus Holstein Lewis Fracture - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Dr. Ebraheim’s educational animated video describes the condition of a Holstein - Lewis distal humeral fracture. Holstein – Lewis fracture is a spiral fracture involving the distal third of the humerus, which causes entrapment of the radial nerve. The radial nerve originates from the posterior cord of the brachial plexus. As the radial nerve travels to the humerus, it provides innervation to the dorsal upper arm muscles. The radial nerve then travels anterior to give innervation to the extensor muscles of the wrist and hand. Interruption of the radial nerve such as with Holstein – Lewis fracture, will cause “wrist drop”. Radial nerve injury occurs in about 18% of cases involving fracture of the humerus. Radial nerve injury is common with distal third fractures of the humerus, especially if the fragment is displaced laterally. As the nerve passes through the inter-muscular septum, it becomes trapped or lacerated. The injuries to the nerve includes: • Neuropraxia: - Minor compression or contusion of the nerve. - Similar to a temporary concussion. • Axonotmesis: - Injury causes a break down of the axon. - The Schwann cell and endoneurium are left intact. With temporary concussion of the nerve, 90% of injuries usually recover within 3-4 months. If the fracture is open and associated with nerve injury, the nerve could be lacerated and exploration should be done. Treatment: - Open fracture: if open associated with radial nerve injury: • Debride the wound. • Exploration of the nerve and fixation of the fracture should be done. The approach is anterolateral. • Explore the nerve between the brachialis and the brachioradialis. Posterior approach: • Biomechanically better. • The humerus is flat posteriorly, easy to apply the plate. • Nerve exploration may be difficult. - Closed fracture: • The fracture is treated usually without surgery according to the principles of fracture treatment. • Observe the nerve for recovery. Radial nerve palsy is not contraindicated of functional bracing. Start obtaining EMG at 3-4 weeks. Wrist extension is expected to recover before finger extension. The brachioradialis muscle is the first to recover. Positive sharp P-waves are Bad, Indication of acute denervation. Polyphasic waves are Good, Polyphasic motor unit activity is early evidence of nerve regeneration. The nerve can be explored after 4 months of observation if no recovery occurs with anticipation of nerve repair, nerve graft, or tendon transfer. Sometimes working on the nerve in addition to tendon transfer is needed especially in younger patients. Secondary injury from manipulation of the fracture may occur. If injury occurs during manipulation of the fracture, a surgical option or nonsurgical option is open to debate. Advantages of the late exploration: - With late nerve exploration, the fracture may already be healing. - The result of nerve repair is as good as primary exploration and repair. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 39641 nabil ebraheim
Malleolar Fractures - Tension Band Wiring
 
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Tension Band Wiring: 1mm K-wires and 0,6mm cerclage wire
Views: 5908 ORTHOinfo
BASIC SCIENCE  WEBINAR Miller/ Orthobullets review Webinars
 
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FOLLOW ME in my TWITTER to be updated https://twitter.com/elbisagra85 @elbisagra85 Let's continue the Project As i said I'm trying to STUDY LEARN an SUCCEED in Orthopedics and as you can see i don t want to be alone i want all of my orthopedic colleague to Succeed with me . i want to share all the info i grasp and any kind of knowledge i have and share all i need is supporting from you my colleagues :) . LIKE Comment to improve all of us myself you and other orthopedic surgeon Subscribe Share my channel no no no its not mine from now on its yours SHARE it to all your Colleagues make the value knowledge be allover Help me to make a constant content weekly by sharing, like and commenting
Orthopaedic Trauma Conference: Ankle Fractures
 
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Upper Chesapeake Medical Center Orthopaedic Trauma Conference for April 4th, 2012. Conference given by Spiro Antoniades, M.D. in Bel Air, Maryland.
Views: 11977 Spiro Antoniades, M.D.
Teaser Webinar - Miller Review - Orthobullets.com
 
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Please visit http://www.orthobullets.com for more review webinars.
Views: 19784 Orthobullets
Ankle Joint Arthocentesis
 
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This video demonstrates the procedure for removing synovial fluid for testing from the ankle joint of a middle aged male who had new onset of pain and swelling for a month. Testing suggested this patient had new onset gout.
Views: 31320 Larry Mellick
PCL Surgical Video
 
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Surgical technique video of open reduction and internal fixation of Posterior Cruciate ligament (PCL) avulsion injury. Dr. Sanjay Sonawne
Views: 39450 sanjay sonawne
How to reduce an anterior shoulder dislocation
 
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How to reduce an anterior shoulder dislocation Anterior dislocations account for as many as 95-98% of shoulder dislocations. In emergency care settings, people with an anterior shoulder dislocation often have to wait for hours before they can be sedated in the operation theatre. This video shows a safe and soft technique to reduce the dislocation fast. Before any attempts at reduction, the provider should perform a neurovascular examination and assess the probability of a fracture. The axillary nerve is the most commonly injured nerve. Several techniques for reduction are possible as the Stimson Maneuver where the patient is placed in the prone position on an elevated stretcher with the shoulder off the edge of the stretcher, hanging downward in 90° of forward flexion. Another technique is the traction-countertraction where the physician applies traction by leaning backward with fully extended arms. It is important that an assistant applies countertraction. Here we describe a two-step reduction as a variant of the method desscribed by Nho et al in 2006 for inferolateral dislocations. In this technique, the inferior dislocation is converted to an anterior dislocation (step 1), which is subsequently reduced (step 2). This knowledge is for medical personnel only. The author is not responsible for any use and misuse of this technique or any complications or damage to the patient occuring when using the information or technique showed in this video. For more information see: http://www.medics4medics http://www.medics4medics.com/nl/traumatologie/luxaties/schouderluxaties http://emedicine.medscape.com/article/109130-technique#c9
Views: 520141 Bart Bohy
Stryker Foot and Ankle | Talo-Navicular Fusion
 
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This video demonstrates a (talonavicular, medial column, calcaneal cuboid) fusion. It covers the incision, the desired outcome, the osteotomy and fixation. The demonstration is performed by Dr. Donald Bohay and John Anderson of Grand Rapids, MI. For more information, visit http://footankle.stryker.com/en/products/plating-platforms/variax2-foot
Views: 16386 stryker
Morton's Neuroma , Interdigital Neuroma - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Dr. Ebraheim's animated educational video describing Morton's Neuroma Interdigital Neuroma. Morton’s neuroma is a chronic irritation of the interdigital nerve, usually the one innervating the third web space. The irritation causes entrapment, compression, and perineural fibrosis rather than a neuroma. The involved nerve is compressed or pinched as it runs between the third and fourth metatarsal heads under the deep transverse metatarsal ligament on the plantar aspect of the foot. Focal swelling of the nerve occurs secondary to the perineural and intraneural fibrosis. It usually affects middle aged females. The patient will complain of pain in the third web space between the third and fourth metatarsals, radiating to the third and fourth toes. Pain is worse with walking, weight-bearing, and with wearing narrow-toed shoes. The pain is better with rest, elevation, removal of the shoes and massaging the foot. The pain does not occur at night. The patient may complain of paresthesia at the bottom of the web space. Squeezing the metatarsals together may cause shooting pain that will go into the third and fourth toes. The neuroma may be palpable and the Tinel’s sign may be positive. The Mulder's Sign Compression of the forefoot with one hand and simultaneously applying upward pressure on the affected web space with the thumb will produce pain and palpable click; the “click” does not occur in all cases. Ultrasounds may be helpful in the diagnosis. MRI’s are rarely used. The common digital nerve block may be confirmatory for the diagnosis. Differential Diagnosis include: • MTP Synovitis o The patient will not have relief from the digital nerve block • Stress Fracture • Metatarsalgia • Arthritis • Lumbar disc herniation o L5 nerve root distribution Conservative treatments are preferred—switching to wide toe box shoes, taking anti-inflammatory medications, and the injection of steroids. Surgery is only considered in cases where non-operative treatment fails. If surgery is necessary, both the dorsal and plantar approach is acceptable, however, the dorsal approach is more popular. During the surgical procedure, the neuroma will be excised with the release of the deep transverse intermetatarsal ligament (Figure 7). Resect the nerve as far proximal as possible to prevent recurrence of the neuroma and the symptoms. Complications of surgery include: a painful plantar scar and stump neuroma when resection of the nerve is not proximal enough. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: https://www.utfoundation.org/foundation/home/Give_Online.aspx?sig=29
Views: 6480 nabil ebraheim
Compartment Syndrome Of The Forearm - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Educational video describing the condition of compartment syndrome of the forearm. Compartment syndrome of the forearm is usually caused by fractures, particulary supra-condyalr humerus fractures and fractures of both the ulna and radius. Most cases of forearm compartment syndrome can be treated with release of the volar compartment. Four compartments of the forearm 1-Dorsal compartment 2-Henry’s mobile wad compartment 3-Superficial volar compartment 4-Deep volar compartment Dorsal compartment muscles: •Extensor digitorum •Extensor digit minimi •Extensor carpi ulnaris •Abductor pollicis longus •Extensor pollicis brevis •Extensor pollicis longus •Extensor indicis. Nerve within the comparmtnet: posterior interosseous nerve. Henry’s mobile wad compartment muscles: •Brachioradialis •Extensor carpi radialis longus •Extensor carpi radialis brevis Nerve within the compartment : superficial radial nerve. Superficial volar compartment muscles: •Flexor carpi ulnaris •Palmaris longus •Flexor digitorum superficialis •Flexor carpi radialis •Pronator teres Nerve within the compartment: median & ulnar nerve Deep volar compartment muscles: •Flexor digitorum profundus •Palmaris longus •Flexor pollicis longus •Pronator quadratus (Distal third of the forearm). Nerve within the compartment : anterior interosseous nerve. Clinical presenation of volar compartment syndrome •Pain with passive extension of fingers/wrist •Tenderness over the volar aspect of the forearm. •Flexion posture of the fingers •Weakness of finger/wrist flexion •Decreased sensations in the distribution of median/ulnar nerve in the hand. Clinical presentations of mobile wad compartment syndrome •Pain with passive wrist flexion/elbow extension •Weakness of wrist extension •Decreased sensation in the distribution of the superificial radial nerve Clinical presneation of dorsal compartment syndrome •Pain with passive flexion of the fingers MCP joint •Extension posture of the fingers. •Weakness of finger MCP joint extension •Minimal/ no sensory deficit Pressure measurement 30+ mmHg or within 30 mmHg of the diastolic pressure. Fasciotomy of the forearm Volar compartments, superficial and deep, must be realsed through an ample incision when involved. 1-Skin incision 2-Release of superficial volar compartment 3-Release of deep volar compartment The dorsal compartment can be released through a generous incision over the dorsum of the forearm. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 54243 nabil ebraheim
Miller's colorado orthopedic board anatomy review
 
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This video is for educational and entertainment purposes only with all the credit to the original publisher #AlBardan #Orthopedics #Orthopädische #عظام #Ortopédico #Gǔkē #orthopedikós #ortopædisk #addeeKaDoktar #ارتوپدی #Seikeigeka #אוֹרְתוֹפֵּדִי #ortopedinen #Ortopedicheskiye #Orthopedikí #JeonghyeongOegwa #Ortopediya #Orthopädie #Ortopædi #Trauma #Rehabilitation #physiotherapy #ortopedia #medicaldevices #Anatomy #HealthCare
Avascular Necrosis, Blood Supply Femoral Head- Everything You Need To Know - Dr. Nabil Ebraheim
 
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Educational video describing the conditions affecting the blood supply of the femoral head. Where is the important blood supply of the femoral neck located? On the postero-superior aspect of the femoral neck. The main blood supply for the weight-bearing dome of the femoral head is the medial femoral circumflex artery (lateral epiphyseal artery). Using an awl at the piriformis fossa in children requiring intramedullary fixation of their femur fracture may endanger the blood supply and cause avascular necrosis of the femoral neck. Avascular necrosis is death of a segment of bone. High energy neck fracture •Vertical fracture of the femoral neck that has vertical obliquity of 70 or more degrees. Has a high rate of nonunion and avascular necrosis. •Displacement of the femoral neck fracture disrupts the blood supply (kinks the retinacualr vessels). Pressure from the intracapsular hematoma may affect the blood supply. Clinical picture •Hip is in flexion and external rotation •Surgical emergency in young adults to unkink the vessels. Treatment •Obtain anatomic reduction in young adults. •Open reduction if closed reduction is not possible, use Watson Jones approach between the gluteus medius and the tensor fascia latae. •Follow the patient with an MRI to evaluate AVN. •If the patient develops nonunion and the head is viable, treat the nonunion by valgus intertrochanteric osteotomy. Hip dislocations Posterior dislocation is common. Anterior dislocation is rare. Treatment Emergent closed reduction within 6 hours. Assess hip stability post-reduction. Other factors associated with hip osteonecrosis •Corticosteroid use •Alcohol abuse •Hemoglobinopathy •Coagulopathy •Gaucher disease •Pregnancy (rare). Idiopathic AVN Nontraumatic AVN of the femoral head is located anterolateral. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 150432 nabil ebraheim
Hammer Toe Surgery Explained Podiatry Claw Toe Mallet Toe
 
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Surgery of the Foot and Ankle: http://astore.amazon.com/nichogiovi-20 Popular Running Shoes: http://astore.amazon.com/nichogiovi-20?_encoding=UTF8&node=2 www.DrGlass.org [email protected] Project Lead: Nicholas Giovinco Contributing Authors: Kristen Diehl Doug Doxey Resource Consultant: Kelly Powers Producer: Nicholas Giovinco A "Hammer-Toe" deformity, describes a pathological condition of abnormal or exaggerated contracture at the metatarsal-phalangeal and inter-phalangeal joints of the toes. This is mainly due to an imbalance between the muscular flexors and extensors as well as intrinsic interossei and lumbrical muscles within the forefoot. A hammer toe deformity may present as one of three morphological variations. A true hammer-toe deformity will exhibit dorsiflexion at the metatarsal-phalangeal joint and plantar flexion at the proximal interphalangeal joint. Whereas a mallet toe solely results from a plantarflexory contracture of the distal interphalangeal joint. A simultaneous combination of these two conditions is thus known as a claw toe. Clinically, a hammer toe may present with hypertrophic callosities on the plantar surface of the corresponding metatarsal head and the distal/plantar tip of the toe in addition to a painful corn over the proximal interphalangeal joint. A radiographic analysis of a hammer-toe deformity in the Anterior/Posterior or Dorsal/Plantar view will reveal a hallowed point or gun barrel appearance of the middle phalanx. Although conservative care may involve shoe modifications, padding, strapping, and custom orthosis; surgical reconstruction may be required to alleviate painful and immobilizing hammer-toe conditions. This surgical management of the hammer-toe deformity is performed by variable means of "Sequential Reduction." By this, a hammer-toe contracture is alleviated through various procedures in order to re-establish a functional position during active motion as well as rest. This process may include, a lengthening of the extensor tendons, followed by a resection of the extensor hood. An "Arthroplasty" may be utilized to increase useable joint space within the proximal inter-phalangeal joint by removing the head of the proximal phalanx. In more extreme deformities, a tenotomy of the flexor tendon may be utilized. This may be accompanied by a fusion of the joint itself, known as an "Arthrodesis," whereby the base of the middle phalanx and the head of the proximal phalanx are combined to form one continuous bone mass. By balancing the forces of plantarflexion and dorsiflexion at the joints of the toe, a Hammer-toe operation may result in a drastic improvement of the functional mobility of the foot and leg during gait. 2009 DrGlass.org [email protected]
Views: 556174 DrGlassDPM
Hematoma Block and Colles Fracture Reduction
 
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In this video we demonstrate a hematoma block and Colles Fracture reduction.
Views: 163124 Larry Mellick
Total Elbow Replacement Surgery
 
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With arthritis of the elbow, even simple movement can be extremely painful. This is common with rheumatoid arthritis but can also follow trauma. To replace an elbow joint, a posterior surgical approach first protects the ulnar nerve. Then arthritic portions of humerus and ulna are removed and a metal joint is cemented into place. The triceps muscle is reattached using sutures. This procedure can provide pain relief and restore joint motion.
Views: 315590 Dr. Thomas Trumble, MD
Lapidus Procedure (Dr. Demetrios Econopouly)
 
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This video was produced by: https://www.rockout13productions.com/ Dr. Econopouly https://www.palisadesfootandankle.com/
Views: 3320 Gerard Mendez
How to Read X-ray films-Trauma | 5 Easy Interpreting Hints | Orthopedic Classes
 
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All you need to know about X-ray Interpretation
Views: 11586 LAMA | Medical School
Arthrocentesis: Ankle (sample) - www.proceduresconsult.com
 
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View the complete video at http://www.proceduresconsult.com. Now also available on the iPhone and iPod Touch! http://itunes.apple.com/WebObjects/MZStore.woa/wa/viewSoftware?id=324566324&mt=8
Views: 37661 ProceduresConsult
Femoral neck (hip) fracture surgery with cannulated screws
 
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This is an example of hip fracture surgery, where cannulated screws can be used to fix the femoral neck fracture (also commonly known as hip pinning). This is a minimally invasive way of fixing this surgical problem.
Views: 173807 drbentaylor
Intramedullary Nailing of Right Femur Fracture
 
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This 3D medical animation features a dramatic surgical overview during the operative placement of an intramedullary nail into the right leg to secure a comminuted femur fracture. Item #ANS00126
Views: 228503 Medical Legal Art
Open Reduction and Internal Fixation of Both Bones Forearm Fractures
 
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Full video article: http://surgicaltechniques.jbjs.org/content/5/4/e28 Compared with closed reduction or older fixation methods, open reduction and compression plate fixation has dramatically improved the outcomes of displaced diaphyseal forearm fractures. However, the procedure can be technically demanding, with implant choice, surgical approach, accuracy of reduction, and sufficient fracture stability to allow early postoperative motion all having been shown to affect outcome.
Views: 2766 JBJSmedia
Scapular Fracture Classification Animation - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Educational video describing fracture classifications of the scapula. Acromial fractures Kuhn classification Type Ia •minimal displacement (avulsion fracture) . •no surgical treatment Type Ib •minimal displacement (complete fracture) . •no surgical treatment Type II •displaced fracture without reduction in the subacromial space. •Non-operative treatment Type IIIa •reduction of the subacromial space by inferior displacement of the acromion. •Fixation with screws or plate. Type IIIb •reduction of the subacromial space by superiorly displaced glenoid fracture. •Reduction and fixation with plate Coracoid fractures Ogawa classification Type I •Fracture proximal to the coracoclavicular ligaments usually associated with acromioclavicular separation, clavicular fracture, superior scapular fracture or glenoid fracture. •Reduction and fixation with screws. Type II •Fracture distal to the coracoclavicular ligaments. •No surgical treatment. Intra-articular glenoid fractures Ideberg classification Type Ia •Fracture of the glenoid rim (anterior) •No surgical treatment Type Ib •Fracture of the glenoid rim (posterior) •No surgical treatment Type IIa •Transverse fracture through the glenoid fossa with an inferior triangular fragment displaced with the sbuluxated humeral head. •Fixation plate or screws Type IIb •Oblique fracture through the glenoid fossa with an inferior triangular fragment displaced with the subluxated humeral head. •Reduction and fixation with plate or screws. Type III •Oblique fracture through the glenoid exiting at the mid-superior border of the scapular, often associated with acromioclvicular fracture or acromioclavicular dislocation. •Reduction and fixation with screws Type IV •Horizontal fracture, exiting through the medial border of the scapular body. •Reduction and fixation with screws. Type V •A combination of type IV with a fracture separating the inferior half of the glenoid. •Reduction and fixation with screws Extra-articular glenoid fractures Type I Fracture of the glenoid neck without associated fracture or AC joint separation. Reduction and fixation with plate Type II •Fracture of the glenoid neck with associated clavicle fracture and AC separation (secondary suspensory ligaments involved). •Reduction and fixation with clavicle plating only, scapular plating only, or scapular & clavicular plating. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 30941 nabil ebraheim
JBJS Reviews Webinar: Managing Shoulder Instability: Open or Arthroscopic Treatment?
 
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Of all the major joints in the human body, the one most likely to dislocate is the glenohumeral joint. Moreover, when trauma is the cause of the dislocation, 90% of the time the humeral head goes out anteriorly. The surgical approach to anterior shoulder instability—open versus arthroscopic—has been hotly debated in the orthopaedic community and is the subject of this complimentary JBJS webinar. Moderated by JBJS Reviews Editor-in-Chief Thomas Einhorn, MD, this hour-long webinar parsed out the debate by examining the latest evidence as presented in the JBJS Reviews article titled “Open and Arthroscopic Anterior Shoulder Stabilization.” Co-author Frank Cordasco, MD presented salient conclusions from the article, including refined indications for both open and arthroscopic shoulder stabilization. After that, two additional shoulder experts—Andrew Green, MD and Brad Parsons, MD—shared their perspectives on the article and their own experiences managing anterior shoulder instability. The webinar concluded with a live question-and-answer session with audience members.
Views: 848 JBJSmedia
lecture series review Orthopaedic Pathology voice
 
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this lecture is a review of orthopedic oncology intended for OITE preparation
Views: 1217 Ginger Holt
Seymour fracture base of the distal phalanx   - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Dr. Ebraheim’s educational animated video describes seymour fracture of the distal phalanx. Seymour fracture is an extra-articular transverse salter type I or type II fracture at the base of the distal phalanx. Anatomy Avulsion of the proximal edge of the nail from the nail fold. It is flexion injury that leads to physeal separation between the extensor tendon dorsally and the flexor digitorum profundus volarly. In addition to avulsion of the nail plate, there is disruption of the germinal matrix. The finger is flexed and looks like a mallet fracture with the nail appearing too long. The injury is an open fracture that is not a mallet fracture, and should not be treated by a splint alone. This is Seymour fracture. Notice that the nail appears longer than normal. There will be bleeding around the nail bed and if the fracture is missed, there may be complications such as infection and finger deformity. •Treatment •Remove the nail and debride the wound. •Reduce the fracture, fix it with K-wire and repair the nail bed. •Splint the fracture or use a cast. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 12745 nabil ebraheim
Biceps Tendon Evaluation, Injection Ultrasound  - Everything You Need To Know - Dr. Nabil Ebraheim
 
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Educational video describing the techniques of ultrasound guided injection of the biceps tendon. The biceps tendon is a common cause of pain in front of the shoulder. The pain associated with the biceps tendon is usually due to biceps tendonitis. Diagnosis •Localized tenderness in the groove •Speed test Clinical evaluation of biceps tendonitis Speed test •The patient is asked to actively forward flex the shoulder while the examiner is applying resistance to the movement. •Tenderness over the bicipital groove indicates tendinitis of the long head of the biceps. Examining the biceps tendon •Patient position: the patient should be sitting upright with the arm beside the body. The elbow is flexed to 90 degrees and the hand in supination resting on the thigh. •Apply the probe over the anterior part of the shoulder to identify the biceps tendon. •The biceps tendon is located within the bicipital groove. It appears as an oval structure in the groove with minimal fluid surrounding it. •On the medial side you will find the subscapularis tendon. The subscapularis tendon will be inserted into the lesser tuberosity at the medial side of the groove. •On the lateral side you will find the supraspinatus tendon. The supraspinatus tendon will be inserted into the greater tuberosity on the lateral side of the groove. •Usually the examiner will place the probe over the bicipital groove to identify the biceps tendon between the subscapularis and the supraspinatus tendon. •Rotate the probe 90 degrees to the longitudinal position and move it upwards to examine the intra-articular portion of the biceps in order to identify any SLAP lesion. •Then move the probe distally along the humerus in order to examine the tendon up till the myotendinous junction at the pectoralis muscle insertion. •Move the elbow in flexion and extension in order to see the movement of the biceps tendon within the groove. Abnormal conditions which may appear on ultrasound: •Fluid around the tendon •Hyperemia as shown on Doppler. •Tendinopathy (tendinitis): biceps tendon is enlarged, rounded and there will be fluid around the tendon. Occurs from overuse and microtrauma. •Tears of the biceps tendon •Biceps tendon instability or subluxation: medial subluxation of the biceps tendon may be associated with subscapularis tear. movement of the biceps tendon within the groove may be accompanied by a click sound. If the fluid is in the biceps sheath and within the subacromial bursa, then there is a rotator cuff tear in about 95% of the patients. Technique for injection •Probe is placed in a transverse orientation over the bicipital groove. •Injection of the biceps tendon is usually given from the lateral side. •When feasible, ultrasound-guided injection is more precise than blind injection. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC
Views: 47533 nabil ebraheim