Transcript Introduction to Orthapaedics

Stephen P. England, MD MPD
Department of Orthopaedic Surgery
Park Nicollett Clinic
Introduction to Orthopaedics
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.
What do you know from the
slides?
Which is the hand of
the elderly adult?
A
B
How old do you think
the individual is on
slide A?
Bone Structure: Orthopaedic
Implications
 Periosteum
 Diaphysis
 Epiphysis
 Periosteum
 Endosteum
 Epiphyseal plates;
bone growth, injury
What is the
significance of the
epiphyseal plate?
Bone Formation and Maintenance
• Protein matrix: 98%
collagen, 2% other
 Bone = cells, protein
matrix, mineral
• Mineral salts:
deposits
insoluble Ca/Phos =
hydroxyapitite +
 Types of bone cells
• Process of ossification
 Function of each
type bone cell
 Types
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
Types of Joints: Identification
 Amphiarthrosis
 Synarthrosis
 Diarthrosis
Diarthroidal Joint
Significance of Diarthrotic Joint
 Joint Capsule
surrounded by
ligaments
 Synovial
Membrane: secretes
synovial fluid; lines
tendon and muscle
sheaths
• Bursea: painful, but
protective!
Othropaedic Terminology
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
Which foot has a
valgus deformity?
Hallus valgus
How do you
describe this
foot deformity?
Stressors of the
Musculoskeletal System
Trauma
Infection
Altered Metabolism
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
How has orthopedic injury affected this
PERSON?
Components of Assessment
 Chief Complaint
•Pain
 Why seeking care
 Acute and chronic problem
 History taking; its
significance
 Pain characteristics
 location
 character
 what effects
 Associated conditions
Complications!
Principles of Assessment
 Normal first
 Bilateral
comparision
 Inspect then gentle
palpation
 shape, size , contour
 signs inflammation,
ecchymosis
 muscle condition
 deformity
• Test your skills
–
–
–
–
–
Changes with age
Nurtitional status
Skin integrity
Rashes
Color changes, esp
with cold; arterial vs.
venous
– Character of joints
– Bruises, swelling
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
Ballottment:force fluid into joint space; displace patella
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
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.
Anterior Drawer test
McMurray’s sign
Diagnostic Tests
 CT Scan
 Bone Scan
 MRI
 Dual-Photon Absorptiometry
 Arthrography
 Arthrocenthesis
 Arthroscopy
Diagnostic Tests
 Arthrography
 Radiographic exam,
use air or contrast
medium:; 90-95%
accuracy
 Teaching
 Complications:
infection, allergy
 Post-op: Rest joint
6-12 hrs, use ice
• 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
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
Orthopaedic Interventions!
 Traction
 Casts
 External Fixators
 Pin, plates and
screws
 CPM
 Crutch-walking
Assistive Devices
 Traction
 Definition
 Uses
 Types
 Counter traction is
provided by:
 a. body weight
 b. pulleys
 c. traction weight
 d. splints
• Crutch-walking
–
–
–
–
–
Two-point
Three-point
Four-point
Swing-through
swing-to
• Safety in crutchwalking
• Cane
CPM
 Purpose
 Guidelines for
Use
• Teaching
Bone Stimulators
 Indications
 Electronegativity
 Bone Remodeling
 Internal
 Percutaneous
 External
External Bone Stimulator
Autologous Blood Transfusions
 Indications for
 Ortho Cell Savers
 Criteria for Use
Cell Savers
Autologous Blood
Surgical /Medical Interventions
 Tissue Allografts
 Abductor Pillow, Carter Pillow
 Hot Ice Machines that Aren’t!
 Bone Paste!
Tissue allografts, synthetic
grafts
Pins, plates,
screws
ORIF (open
reduction,
internal fixation)
Casts
 Purposes
 Casting Material
 Plaster
 Fiberglass
Application of Cast
 Principles
 Skin Assessment
 Skin Protection
 Heat Generated
 Time to Dry
•Cast Types
 Sugar Tong/Splint
 Spica Type
 Body Cast
 Hip spica
 Gauntlet
 Cast-Brace
• Body Cast Care
– Cast Syndrome
• Hip Spica
– Turning
– Cast Drying
External Fixators
 How They Work
 Principles of Care
 The Iliazarov
External Fixator
Conclusion