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INTRODUCTION TO ORTHOPAEDICS
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INTRODUCTION TO ORTHOPAEDICS

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  1. INTRODUCTION TO ORTHOPAEDICS DR. KhaledAta,MD CONSULTANT ORTHOPAEDICS ONCOLOGY & LIMB SALVAGE SURGERY

  2. WHAT DOES IT MEAN 1743 • ORTHO=> STRAIGHT • PAEDICS=> CHILD

  3. Bone Structure • Periosteum • Diaphysis • Epiphysis • Periosteum • Endosteum • Epiphyseal plates; bone growth, injury

  4. Bone Formation and Maintenance • Types : • Lamellar Bone:Cortical80%,Cancellous. • Woven Bone:Immature,Pathologic • Bone Matrix: • Organic:40% of dry weight, collagen. • Minerals component:60%,Ca hydroxyapatite,Ca phosphate • Types of bone cells Function of each type bone cell

  5. Orthopedic Terminology

  6. 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

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

  8. 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!

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

  10. Diagnostic Tests • Plain x- ray: rule of 2s • CT Scan • Bone Scan • MRI • Arthrography • Arthrocenthesis • Arthroscopy

  11. ORTHOPAEDIC DISORDERS • Locomotive system • Bone • Joints • Tendons • Nerves • muscles

  12. WHAT CONDITIONS AFFECTING THESE STRUCTURES • Congenital and developmental anomalies • Infection and inflammation • Arthritis and inflammatory disorders • Metabolic dysfunction • Tumors and tumor like condition • Sensory and motor disorders • Injuries and mechanical derangement

  13. CONGENITAL ANOMALIES

  14. CONGENITAL ANOMALIES

  15. CONGENITAL ANOMALIES

  16. CONGENITAL ANOMALIES

  17. CONGENITAL

  18. INFECTION

  19. PIP Swelling

  20. Ulnar Deviation, MCP Swelling, Left Wrist Swelling

  21. Nodules

  22. ARTHRITIS

  23. ARTHRITIS

  24. ARTHRITIS

  25. METABOLIC DYSFUNCTION

  26. TUMOURS

  27. TUMORS

  28. NEUROMUSCULAR DISORDERS

  29. NEUROMUSCULAR DISORDERS

  30. NEUROMUSCULAR DISORDERS

  31. TRAUMA • Leading cause of death in young • Hundred of thousands die each year 1/10000 • Half of deaths from RTA • 10-15 % multitrauma • Deaths • 1st hour • Sever head injury • Sever bleeding • 1-4 hour • Uncompensated blood loss • Days to weeks • complication

  32. EXTENT OF INJURY • Age • Skeletally immature • Young but skeletally mature • Elderly • Direction of force • Determine which structure injured • Magnitude • Determine extent of injury

  33. TRAUMA OF THE MUSCULOSKELETAL SYSTEM • Bone • Joint • Ligament • Muscle • Nerve • Vascular

  34. Bone • Fracture • Definition • Complete vs incomplete • Open Vs Closed • Pattern • Cause(injury, fatigue, pathological)

  35. TRAUMA OF THE MUSCULOSKELETAL SYSTEM • Bone • Direct • Simple contusion • Sever commonution • Indirect • Bending => transverse fracture • Compression => depressed fracture • Twisting=> spiral fracture • Combination=> oblique, commonution, • Penetrating • Stab & laceration • Missiles • Low v: < 300 m/s • damage along the tract • commonution • High v: • Wide soft tissue damage • Sever commonution with loss

  36. Diaphyseal Fractures • Type A • Simple fractures with two fragments • Type B • Wedge fractures • After reduced, length and alignment restored • Type C • Complex fractures with no contact between main fragments

  37. TRAUMA OF THE MUSCULOSKELETAL SYSTEM • Joint: • Dislocation • Subluxation • Fracture-Dislocation

  38. TRAUMA OF THE MUSCULOSKELETAL SYSTEM • Ligament: • Sprain: some fibers torn remains stable • Partial rupture • Complete rupture

  39. TRAUMA OF THE MUSCULOSKELETAL SYSTEM • Muscle • Direct • Simple contusion • Sever crush • Viability: remove all devitalised muscles • Indirect: • By sharp end of fractured bone • Penetrating • Laceration • Muscle • Musculotendinous junction • tendon • Missiles • Low velocity • High velocity=> major damage

  40. TRAUMA OF THE MUSCULOSKELETAL SYSTEM • Nerves • Neuropraxia • conduction block, (no axonal loss focal demyelination; rapid & complete return of sensation or function 3 to 6 weeks; • Axonotemesis • axonal injury with subsequent degeneration,no disruption of the endoneurial sheath, perineurium, or epineurium,complete recovery may take as long as 12 months • Neurotemesis • severe disruption of the connective tissue components of the nerve trunk with compromised sensory and functional recovery , poor prognosis for recovery, and sensory and functional recovery is never complete

  41. TRAUMA OF THE MUSCULOSKELETAL SYSTEM • Isolated or combination • Injury to vital organs • Survival of the limb • Neurovascular • Integrity of skin • Bone • Prevention of complication • => limb salvage ( functioning limb) or amputation ( source of trouble)

  42. Thank You! C u in the 5th year