INTRODUCTION TO CLINICAL ORTHOPAEDICS
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Transcript INTRODUCTION TO CLINICAL ORTHOPAEDICS
INTRODUCTION TO
ORTHOPAEDICS
DR. Khaled Ata,MD
CONSULTANT ORTHOPAEDICS
ONCOLOGY & LIMB SALVAGE SURGERY
WHAT DOES IT MEAN 1743
ORTHO=>
STRAIGHT
PAEDICS=> CHILD
Bone Structure
Periosteum
Diaphysis
Epiphysis
Periosteum
Endosteum
Epiphyseal plates;
bone growth, injury
Bone Formation and
Maintenance
Types :
1. Lamellar Bone:Cortical80%,Cancellous.
2. Woven Bone:Immature,Pathologic
Bone Matrix:
1. Organic:40% of dry weight, collagen.
2. Minerals component:60%,Ca
hydroxyapatite,Ca phosphate
Types of bone cells
Function of each type bone cell
Orthopedic 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
•
•
•
•
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•
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?
Components of Assessment
Chief Complaint
Why seeking care
Acute and chronic
problem
•Pain
History taking; its
significance
Pain characteristics
location
character
what effects
Associated conditions
Complications!
Principles of Assessment
Normal first
• Test your skills
Bilateral
– Changes with age
comparison
– Nutritional status
Inspect then gentle
– Skin integrity
palpation
shape, size ,
contour
signs inflammation,
ecchymosis
muscle condition
deformity
– Rashes
– Color changes, esp
with cold; arterial vs.
venous
– Character of joints
– Bruises, swelling
Diagnostic Tests
Plain
x- ray: rule of 2s
CT Scan
Bone Scan
MRI
Arthrography
Arthrocenthesis
Arthroscopy
ORTHOPAEDIC DISORDERS
Locomotive
Bone
Joints
Tendons
Nerves
muscles
system
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
CONGENITAL ANOMALIES
CONGENITAL ANOMALIES
CONGENITAL ANOMALIES
CONGENITAL ANOMALIES
CONGENITAL
INFECTION
PIP Swelling
Ulnar Deviation, MCP Swelling,
Left Wrist Swelling
Nodules
ARTHRITIS
ARTHRITIS
ARTHRITIS
METABOLIC DYSFUNCTION
TUMOURS
TUMORS
NEUROMUSCULAR DISORDERS
NEUROMUSCULAR DISORDERS
NEUROMUSCULAR DISORDERS
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
EXTENT OF INJURY
Age
Skeletally immature
Young but skeletally mature
Elderly
Direction
of force
Determine which structure injured
Magnitude
Determine extent of injury
TRAUMA OF THE
MUSCULOSKELETAL SYSTEM
Bone
Joint
Ligament
Muscle
Nerve
Vascular
Bone
Fracture
Definition
Complete vs incomplete
Open Vs Closed
Pattern
Cause (injury, fatigue, pathological)
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
Diaphyseal Fractures
Type A
Type B
Simple fractures with two
fragments
Wedge fractures
After reduced, length and
alignment restored
Type C
Complex fractures with no
contact between main
fragments
TRAUMA OF THE
MUSCULOSKELETAL SYSTEM
Joint:
Dislocation
Subluxation
Fracture-Dislocation
TRAUMA OF THE
MUSCULOSKELETAL SYSTEM
Ligament:
Sprain:
some fibers torn remains stable
Partial rupture
Complete rupture
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
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
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)
Thank You!
C u in the
th
5
year