stephen p. england, md mpd department of orthopaedic surgery park nicollett clinic
TRANSCRIPT
Stephen P. England, MD MPDDepartment 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?
How old do you think the individual is on slide A?A B
Bone Structure: Orthopaedic Implications
Periosteum DiaphysisEpiphysisPeriosteumEndosteumEpiphyseal
plates; bone growth, injury
What is the significance of the epiphyseal plate?
Bone Formation and MaintenanceTypes Bone = cells,
protein matrix, mineral deposits
Types of bone cells
Function of each type bone cell
• Protein matrix: 98% collagen, 2% other
• Mineral salts: insoluble Ca/Phos = hydroxyapitite +
• Process of ossification
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
AmphiarthrosisSynarthrosisDiarthrosis
Significance of Diarthrotic JointJoint Capsule
surrounded by ligaments
Synovial Membrane: secretes synovial fluid; lines tendon and muscle sheaths
• Bursea: painful, but protective!
Othropaedic Terminology
Descriptive Orthopaedic TermsValgus: 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
Hallus valgus
Which foot has a valgus deformity?
How do you describe this foot deformity?
Stressors of theMusculoskeletal 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 AssessmentChief Complaint
Why seeking careAcute and chronic
problem
History taking; its significance
Pain characteristicslocationcharacterwhat effects
Associated conditionsComplications!
•Pain
Principles of AssessmentNormal firstBilateral
comparisionInspect then
gentle palpationshape, size ,
contoursigns inflammation,
ecchymosismuscle conditiondeformity
• 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 KneeFluid 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.
McMurray’s sign
Anterior Drawer test
Diagnostic TestsCT ScanBone ScanMRIDual-Photon AbsorptiometryArthrographyArthrocenthesisArthroscopy
Diagnostic Tests
ArthrographyRadiographic
exam, use air or contrast medium:; 90-95% accuracy
TeachingComplications:
infection, allergyPost-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 /diagnosticVisual recording; surgical removal of
meniscus, foreign bodies, etcRare complications; depends on
procedure, operative length, use of tourniquet
TeachingPost-op care
Orthopaedic Interventions!TractionCastsExternal
FixatorsPin, plates and
screwsCPMCrutch-walking
Assistive DevicesTraction
DefinitionUsesTypes
Counter traction is provided by:a. body weightb. pulleysc. traction weightd. splints
• Crutch-walking– Two-point
– Three-point
– Four-point
– Swing-through
– swing-to
• Safety in crutch-walking
• Cane
CPMPurpose Guidelines
for Use • Teaching
Bone StimulatorsIndicationsElectronegativityBone Remodeling
InternalPercutaneousExternal
External Bone Stimulator
Autologous Blood Transfusions
Indications forOrtho Cell
SaversCriteria for Use
Cell Savers Autologous Blood
Surgical /Medical Interventions
Tissue AllograftsAbductor Pillow, Carter PillowHot Ice Machines that Aren’t!Bone Paste!
Tissue allografts, synthetic grafts
Pins, plates, screws
ORIF (open reduction, internal fixation)
CastsPurposesCasting Material
PlasterFiberglass
Application of CastPrinciples
Skin AssessmentSkin ProtectionHeat GeneratedTime to Dry
•Cast TypesSugar
Tong/SplintSpica Type
Body CastHip spicaGauntletCast-Brace
• Body Cast Care– Cast Syndrome
• Hip Spica
– Turning– Cast Drying
External FixatorsHow They WorkPrinciples of CareThe Iliazarov
External Fixator
Conclusion