Transcript L3. Introduction to Orthopaedicsx

Introduction to Orthopaedics
MUNIR SAADEDDIN , FRCSED
ASSOCIATE PROFESSOR & CONSULTANT
COLLEGE OF MEDICINE
KING SAUD UNIVERSITY
Objectives of this lecture
 To explain what is Orthopedic and what conditions
will be discussed during this course.
 Explain what do we mean by Red Flags.
 List the different causes of Orthopedic disease.
 Describe some of clinical examination tests.
 Introduce titles of Clinical Skills which will be taught
during this course.
What is the meaning of: Orthopedics
ORTHO = Straight , Upright , Correct
Paios
= Child
First used by Nicolas Andry; a French doctor(1841)
in a book titled:
Orthopedia : the art to correct and prevent
deformities in children
Orthopedic Associations Emblem: the British
Saudi Orthopedic Association Emblem
Orthopedic Surgery = Not only Bone Surgery
 Orthopedic specialty is the branch of medicine which
manage trauma and disease of Musculoskeletal
system.
 It includes : bones, muscles, tendons, ligaments,
joints, peripheral nerves, vertebral column and
spinal cord and its nerves.
Orthopedic Specialty
 Also Known as : Trauma and Orthopedic Surgery.
 Sub-Specialties in orthopedic include : Pediatric
Orthopedic, Sport and Reconstructive Orthopedic,
Orthopedic Trauma, Arthroplasty, Spinal Surgery ,
Foot and Ankle surgery and Orthopedic Oncology.
Red Flags
Red Flags
 Red Flag = Warning Symptom or Sign.
 Red flags should always be looked for and
remembered.
 Presence of a red flag means the necessity for urgent
or different action/intervention.
Examples of Red Flags
 Open Fractures : more serious and very high
possibility of infection and complications
 Complicated Fractures : fracture with injury to major
blood vessel, nerve or nearby structure
 Compartment Syndrome : increase in intracompartment pressure which endangers the blood
circulation of the limb and may affect nerve supply
 Acute joint Dislocations : requires urgent reduction
or may cause serious complications
Examples of Red Flags
 Multiple Trauma or Pelvic Injury: more than one fracture or injury
sustained at the same time ;
consider massive blood loss and associated injuries.
 Cauda Equina Syndrome : compression of the nerve roots of the
Cauda Equina at the spinal canal which affect motor and nerve
supply to lower limbs and bladder (also saddle or peri-anal area).
 Infection of Bone, Joint and Soft Tissue :
Osteomyelitis : Infection of the bone.
Septic Arthritis :Infection of the joint.
Cellulitis
:spreading Infection of the soft tissue.
May cause septicemia or irreversible damage.
Alignment terminology
Alignment Terminology: Cubitus Varus
Alignment terminology: Cubitus Valgus
Orthopedic Diseases: Congenital or Acquired ?
 Congenital : present since birth( though may not be
evident till some time later).
 Acquired : develop or begin after birth.
Congenital Anomaly : Talepoequinovarus TEV
Acquired Orthopedic Conditions








Acquired conditions include :
Trauma
Developmental
Inflammation
Infection
Neuromuscular
Degenerative
Metabolic
Tumor
Traumatic Injuries
 Fractures.
 Dislocations.
 Fracture dislocation: dislocation associated with
nearby fracture.
 Soft tissues injuries: ligaments, tendons, menisci.
 Nerve injuries.
 Epiphyseal injuries.
Fractures: Break in the continuity of bone
Dislocations
Complete
separation of the
articular surface
Distal to proximal
fragment
Anterior, Posterior, Inferior,
Superior.
Acute dislocation may be
complicated by
neurovascular injury.
Acute dislocations require
urgent reduction
Fracture Dislocation
Dislocation and Fracture dislocation of the
Spine often results in Paralysis
Intra-articular Fractures
 If displaced ; should
always be treated by
ORIF=
(Open Reduction and
Internal Fixation)
failure to reduce and fix
such fracture results in
loss of function,
deformity and early
degenerative changes
Epiphyseal Injuries: Salter-Harris classification
Soft tissue injuries of the knee
Knee effusion, ACL and PCL on MRI sagittal cuts
Anterior Cruciate Ligament injury: MRI
ACL Injury: Lachman’s test
MCL: Value of Stress X-rays
(Developmental Dislocation of Hip) DDH
Orthosis : Pavlick Harness for DDH
Developmental: SCFE (Slipped Capital Femoral
Epiphysis)
Spinal Deformities: Kyphosis or Hyperlordosis
Spinal Deformity: Scoliosis
Developmental Foot deformity: Hallux Valgus
Degenerative Disorders
 Occur at any joint
 Can be primary or secondary
 Increased wear and tear
 Can lead to pain and/or deformity and/or loss of
function
 Increase with advancing age
 Management depends on type and age
OA Hip
Total Hip Arthroplasty ( THA )
Osteoarthosis of Knee
Osteoarthritis of Knee
Bilateral TKR: AP view
Bilateral TKR : lateral view
Metabolic Disorders (Rickets): Bow Legs
Osteoporosis: Fractured NOF
DHS
( Dynamic Hip Screw )
Osteoporosis: Displaced Intracapsular Fracture
Hemi-Arthroplasty Lt Hip
Spinal Osteoporosis
Osteoporosis: Colles fracture
Bone Tumors
Bone Tumor
Bone tumors
Neurological Evaluation : Sensory
Axillary Nerve or Circumflex Nerve
Nerve Injury: Muscle wasting
Nerve Injury: Sensory Loss
Muscle Power Testing : Iliopsoas
Muscle Power Testing : Quadriceps
Spinal Cord Injury
 Often results from fracture dislocation of spine.
 When injury is at cervical spine it may result in
Tetraplegia.
 Injury at dorsal spine may result in Paraplegia.
Devastating effect of Spinal Cord Injury
Neuromuscular disorder: Polio
Chronic Osteomyelitis : discharging sinus
Chronic Osteomyelitis : Sequestrum
Spinal Infection : Tuberculosis: Para Vertebral
Abscess
Physiotherapy for Orthopedic Patients
 Physiotherapy is an important part of orthopedic and
trauma management
 It is used for : pain relief, prevention of stiffness,
muscle strengthening, mobilisation of stiff joint or
spine, training non-weight bearing or partial weight
bearing
 Physiotherapy modalities include: heat, cold,
exercise, ultrasound, traction, electrical stimulation
Clinical Skills: Cast application
Clinical Skills: Knee Aspiration
Clinical Skills: Management of Open Fracture
 Initial management.
 At ER( Emergency Room ).
 Lower or Upper limb.
Orthopedic Surgeon Income in USA
 The lowest reported average salary was $369,905 a
year, while the highest reported average was
$610,188.
 In its own 2012 study recruiting firm Jackson &
Coker reported an average salary of $520,475 for
orthopedic surgeons, with an additional $104,095 in
benefits.
Orthopedic Surgeons income in USA
 Orthopedic Surgeons average reported income is:
HIGHER than
plastic surgeons,
cardiologists,
general surgeons
and internists.
Specialist Orthopedic Surgeon Income at USA
 Pediatric orthopedic surgeons averaged $559,422 a
year.
 Hand surgeons averaged $572,945.
 The highest-paid were spinal surgeons, at a reported
average salary of $760,782.
Female Orthopedic Surgeons
Statistics from United Kingdom
 According to UCAS ( Universities and Colleges
Admission System )
 in 2011; 55% of students accepted to do medical
degree were females.
 In 2011: 26% of surgical trainees were females.
 15% of female surgical trainees choose Trauma and
Orthopedic as a specialty.
In Saudi Arabia
What about you?