Introduction to Orthopaedics

1. Introduction to Orthopaedics Stephen P. England, MD MPD Department of Orthopaedic Surgery Park Nicollett Clinic

2. Introduction to Orthopaedics

3. Test Yourself • List the bones of the body. (More pts more bones!) • Bone forming cells are called ______. • Local stress stimulates bone formation. T or F? • The knee is a/an _______joint.

4. What do you know from the slides? Which is the hand of the elderly adult? How old do you think the individual is on slide A? A B

5. Bone Structure: Orthopaedic Implications • Periosteum • Diaphysis • Epiphysis • Periosteum • Endosteum • Epiphyseal plates; bone growth, injury

6. What is the significance of the epiphyseal plate?

7. Bone Formation and Maintenance • Types • Bone = cells, protein matrix, mineral deposits • Types of bone cells • Function of each type bone cell • Protein matrix: 98% collagen, 2% other • Mineral salts: insoluble Ca/Phos = hydroxyapitite + • Process of ossification

8. Factors Influencing Bone Growth and Formation • Parathyroid • What effect of low Ca? • Calcitonin • Effect on Ca? • Source? • Thyroxin • Estrogen • Glucocorticoids • What effect on bones with long term use of glucocorticoids? • Vit C & D

9. Types of Joints: Identification • Amphiarthrosis • Synarthrosis • Diarthrosis

10. Diarthroidal Joint

11. Significance of Diarthrotic Joint • Joint Capsule surrounded by ligaments • Synovial Membrane: secretes synovial fluid; lines tendon and muscle sheaths • Bursea: painful, but protective!

12. Othropaedic Terminology

13. Descriptive Orthopaedic Terms • Valgus: part of body distal to joint directed away from midline • Varus: Part of body distal to joint directed toward midline • Hallus • Genu varus • Genu valgus • pes varus • metatarus valgus • metatarus varus

14. Which foot has a valgus deformity? Hallus valgus How do you describe this foot deformity?

15. Stressors of theMusculoskeletal System Trauma Infection Altered Metabolism

16. For the person with a musculoskeletal condition: • List effects on person • List “most “ frequent orthopaedic diagnosis • Peripheral neurovascular dysfunction • Pain (acute, chronic) • Impaired skin integrity • Infection, high risk for • Disuse syndrome • Activity intolerance • Trauma. high risk for • Knowledge deficit • Impaired adjustment • Fear, anxiety

17. How has orthopedic injury affected this PERSON?

18. Components of Assessment • Pain • Chief Complaint • Why seeking care • Acute and chronic problem • History taking; its significance • Pain characteristics • location • character • what effects • Associated conditions Complications!

19. Principles of Assessment • Test your skills • Changes with age • Nurtitional status • Skin integrity • Rashes • Color changes, esp with cold; arterial vs. venous • Character of joints • Bruises, swelling • Normal first • Bilateral comparision • Inspect then gentle palpation • shape, size , contour • signs inflammation, ecchymosis • muscle condition • deformity

20. Assessment of the Knee • Fluid in the Knee • Bulge sign: medial aspect knee, displace fluid upward, tap lateral patellar margin and note fluid return • Ballottment:force fluid into joint space; displace patella

21. Ballottment:force fluid into joint space; displace patella

22. Knee Stability • Anterior cruciate ligament: limits anterior motion • Posterior cruciate ligament: limits posterior motion • Lateral collateral ligament: limits adduction • Medial collateral ligament: limits abduction • Meniscal injury: McMurray’s sign

23. Knee Support and Stability Anterior and posterior cruciate ligaments connect the inner surfaces of the head of the femur with the head of the tibia. They cross each other, anterior ligament extend from the inside of the lateral condyle of the femur to the medial side of the tibial head, and posterior ligament extend from the inside of the medial condyle of the femur to the lateral side of the tibial head.

24. Anterior Drawer test McMurray’s sign

25. Diagnostic Tests • CT Scan • Bone Scan • MRI • Dual-Photon Absorptiometry • Arthrography • Arthrocenthesis • Arthroscopy

26. Diagnostic Tests • Arthrocenthesis • Aspiration synovial fluid; reduce pain; dx; treatment • Analysis joint fluid: usual clear, high viscosity, scant fluid • Teaching: no restrictions; consent form; slight pain • Post-op: RICE • Arthrography • Radiographic exam, use air or contrast medium:; 90-95% accuracy • Teaching • Complications: infection, allergy • Post-op: Rest joint 6-12 hrs, use ice

27. Arthroscopy • Therapeutic /diagnostic • Visual recording; surgical removal of meniscus, foreign bodies, etc • Rare complications; depends on procedure, operative length, use of tourniquet • Teaching • Post-op care

30. Orthopaedic Interventions! • Traction • Casts • External Fixators • Pin, plates and screws • CPM • Crutch-walking

31. Assistive Devices • Crutch-walking • Two-point • Three-point • Four-point • Swing-through • swing-to • Safety in crutch-walking • Cane • Traction • Definition • Uses • Types • Counter traction is provided by: • a. body weight • b. pulleys • c. traction weight • d. splints

33. CPM • Purpose • Guidelines for Use • Teaching

34. Bone Stimulators • Indications • Electronegativity • Bone Remodeling • Internal • Percutaneous • External

36. External Bone Stimulator

37. Autologous Blood Transfusions • Indications for • Ortho Cell Savers • Criteria for Use

38. Cell Savers Autologous Blood

39. Surgical /Medical Interventions • Tissue Allografts • Abductor Pillow, Carter Pillow • Hot Ice Machines that Aren’t! • Bone Paste!

40. Tissue allografts, synthetic grafts

41. Pins, plates, screws ORIF (open reduction, internal fixation)

42. Casts • Purposes • Casting Material • Plaster • Fiberglass

43. Application of Cast • Principles • Skin Assessment • Skin Protection • Heat Generated • Time to Dry

44. Cast Types • Sugar Tong/Splint • Spica Type • Body Cast • Hip spica • Gauntlet • Cast-Brace • Body Cast Care • Cast Syndrome • Hip Spica • Turning • Cast Drying

45. External Fixators • How They Work • Principles of Care • The Iliazarov

46. External Fixator

47. Conclusion