Download 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
•
•
•
•
•
•
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




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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