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CHAPTER 21

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  1. CHAPTER 21 Orthopedic Surgery

  2. Objectives • After studying this chapter, you will be able to: • Recognize the relevant anatomy and physiology of the musculoskeletal system • Summarize the pathology of the musculoskeletal system that prompts surgical intervention and the related terminology • Determine any preoperative orthopedic diagnostic procedures/tests

  3. Objectives (cont’d.) • Determine any special preoperative preparation related to orthopedic procedures • Indicate the names and uses of orthopedic instruments, equipment, and supplies • Determine the intraoperative preparation of the patient undergoing an orthopedic procedure • Summarize the surgical steps of the orthopedic procedures

  4. Objectives (cont’d.) • Interpret the purpose and expected outcomes of the orthopedic procedures • Recognize the immediate postoperative care and possible complications of the orthopedic procedures

  5. Bone and Bone Tissue • Characteristics of bones • Living tissue • Provide form and structure to the human body • Actively involved in maintenance of homeostasis • Skeletal system • Comprises bones and other structures that make up the joints of the skeleton

  6. Bone and Bone Tissue (cont’d.) • Skeleton functions • Provides a framework to support the body • Serves as points of attachment for muscles • Protects some internal organs from injury • Serves as a source of red blood cells • Serves as a storage site and source of calcium

  7. Bone and Bone Tissue (cont’d.) • Bone tissue • Compact or cortical bone: hard, dense tissue of bone that surrounds the marrow cavity • Cancellous or spongy bone: found at ends of bone and lining the medullary marrow cavity • Surrounding bone: thin, fibrous layer of tissue (i.e., periosteum) • Bone marrow: semisolid tissue that is found in the spaces of cancellous bone

  8. Bone and Bone Tissue (cont’d.) • Types of bones: refer to Figures 21-1, 21-3 and 21-4 • Long bones: bones of the arm (humerus), legs (femur), hands, and feet (phalanges) • Short bones are the bones of the wrists (carpals) and ankles (tarsals) • Flat bones: ribs, scapula, sternum, and cranial bones • Sesamoid (round) bones: found within tendons

  9. Bone and Bone Tissue (cont’d.) • Types of joints • Immovable • Slightly Movable • Freely Movable • Ball-and-Socket • Condyloid • Gliding • Hinge and pivot • Saddle

  10. Bone and Bone Tissue (cont’d.) • Terms related to joint movements • Refer to Table 21-1 • Mineral storage • Bone contains large quantities of calcium • Factors that affect bone growth • Hormones, heredity, nutrition, and exercise

  11. Bone and Bone Tissue (cont’d.) • Pathology • Musculoskeletal system is prone to numerous types of pathological conditions • Refer to Table 21-2 • Types of fractures  • Complete or incomplete • Normal bone healing • Complete bone healing of fracture is expected in 8–12 weeks

  12. Bone and Bone Tissue (cont’d.) • Normal process of bone healing • Inflammation • Cellular proliferation • Callus formation • Ossification • Remodeling

  13. Bone and Bone Tissue (cont’d.) • Pathological bone healing • Disruption at any stage can be responsible for a variety of abnormal conditions • Distraction • Avascular necrosis • Compound fracture • Delayed union, nonunion, and malunion • Compartmental syndrome • Casts: refer to Table 21-3 • Method utilized to immobilize a fracture

  14. Diagnostic Procedures and Tests • Common orthopedic diagnostic procedures and tests: refer to Table 21-4 • Radiography • Standard X-rays • Fluoroscopy

  15. Instrumentation, Routine Equipment, and Supplies • Instrumentation: refer to Table 21-5 • Orthopedic procedures • Require a general orthopedic set with soft tissue and basic bone instrumentation • Also require specific sets with instruments for exposure, reduction, and internal fixation of a bone, for replacement of a joint; or for the placement of an intramedullary rod • Procedures for the hand or foot • Typically require a minor orthopedic or hand set

  16. Routine Equipment • Orthopedic surgery has special equipment and instrumentation requirements • Positioning devices • Pneumatic tourniquets • Traction • Lasers • Air flow • Continuous passive range-of-motion machines

  17. Routine Equipment (cont’d.) • Transcutaneous electric nerve stimulation • Electrical stimulation of bone • Saws, drills, and reamers • Arthroscopic equipment • Other routine equipment

  18. Routine Supplies • Field of orthopedics requires a large number of supplies • Implants • Suture • Polymethyl methacrylate • Other routine supplies

  19. Orthopedic Surgical Procedures • Shoulder procedures • Shoulder arthroscopy • Bankart procedure, open • Bankart procedure, arthroscopic with suture anchors • Acromioplasty, open • Acromioplasty, arthroscopic • Total shoulder arthroplasty

  20. Orthopedic Surgical Procedures (cont’d.) • Procedures of the radius • External fixation of a Colles’ fracture • ORIF radius • Hip procedures • ORIF hip fracture • Total hip arthroplasty • Femoral procedures • Repair of femoral shaft fracture with AO titanium femoral nail system

  21. Orthopedic Surgical Procedures (cont’d.) • Knee procedures • Arthroscopy of the knee joint with repair of torn meniscus • ACL repair • Above-the-knee amputation (AKA) • Below-the-knee amputation (BKA) • Total knee arthroplasty (TKA)

  22. Orthopedic Surgical Procedures (cont’d.) • Ankle and foot procedures • Triple arthrodesis • Achilles tendon repair • Bunionectomy

  23. Summary • This chapter reviewed: • Anatomy and physiology of the musculoskeletal system • The pathology of the musculoskeletal system that prompts surgical intervention • Preoperative orthopedic diagnostic procedures/tests • Orthopedic instruments and equipment • Orthopedic procedures