Introduction to the Clinical exposure at Philippine Orthopedic Center (POC)

Skeletal systemConsists of 206 bones

Function:Serves as body’s frameworkAllows movement & locomotion

Protect vital organs

Stores calciumManufactures new blood cells (red bone marrow)

BoneFirm structure of living tissue with vascular connections

Constantly being remodeled (deposition & resorption)

Osteoblasts – cells that are active in bone formation; deposition of bone

Osteoclasts – bone destroying cells; associated with removal of bone during remodeling

Osteocytes – principal cell of mature bone

Division of human skeleton:1.Axial – body’s upright structure; 80 bones

Skull Vertebral column Ribs

2. Appendicular – body’s appendages; 126 bonesArmsHipslegs

Classification of bones:Long bones – femurShort bones – carpals, tarsals, phalanges

Flat – ribs, sternum, scapula

Irregular – vertebraeSesamoid – patellaConnective Tissue – supports and binds other body tissues

Tendon – attaches muscle to bone

Ligaments – bind joints together; connects articular bones & cartilages

Cartilage – non-vascular tissue, protects bone edges from rubbing vigorously

Joint – a space in which 2 or more bones come together

Provide movement & flexibility in the body

Types of joint:Synarthrodial – completely immovable joints (Ex. Joints in the cranium)

Ampiarthrodial – slightly movable joints (Ex. Pelvis)

Diarthrodial (Synovial) – freely movable joint (Ex.Elbow & knee)

Synovial joints are the only joints lined by synovium; a membrane that secretes synovial fluid for lubrication & shock absorption

Epiphyses – 2 knob-like ends; primarily cancellous bone; assists with bone development

Diaphysis – bone shaft; provides strength; resists bending forces

Plays a role in growth & development

AcetabulumHHead

Neck Greater

trochanter

Lessertrochanter

Midshaft

Proximal 3rd

Distal 3rd

Medial condyleLateral condyle

Diaphysis

Epiphysis

Epiphyseal plate – area between the metaphysis & epiphysis

Periosteum – CT covering the bone

Musculoskeletal Injury – accounts for about 66% of all injuries

One of the primary causes of disability in the US

Fracture – break or disruption in the continuity of bone

Caused by direct blow, crushing force, sudden twisting motion or extreme muscle contraction

Classification of fractures:According to the extent of the break:

Complete fracture – break is across the entire width; bone is divided into 2 distinct sections

Incomplete fracture – partial break in the bone; break is confined through only part of the bone

According to the extent of associated soft tissue damage:

Open (Compound) – skin over broken bone is disrupted; soft tissue injury & infection are common

These are graded to define the extent of tissue damage:

Grade 1 – least severe injury; skin damage is minimal

Grade 2 – accompanied by skin & muscle contusions

Grade 3 – damage to the skin, muscle, nerve tissue & blood vessels

Wound is more than 6-8 cms.

Closed (simple) fracture – skin over the fractured area remains intact

Pathologic ( spontaneous) – occurs after minimal trauma to a bone that has been weakened by a disease

Greenstick fracture – one side of bone is broken, the other is bent, most commonly seen in children

Classification According to pattern:

Transverse fracture – bone is broken straight across

Oblique fracture – the break extends in an oblique direction; slanting direction

Spiral fracture – the break partially encircles the bone

Classification as to appearance:

Comminuted – bone is splintered or crushed with 3 or more fragments

Impacted – when fractured end of bones are pushed into each other

Compression fracture – produced by a loading force applied to the long axis of cancellous bone

Depressed – usually occurs in the skull; broken bone driven inward

Longitudinal – break runs parallel with bone

Fracture dislocation – fracture is accompanied by a bone out of joint

Fatigue or stress fracture results from excessive strain or stress on the bone

Fractures

Classification in relation to the joint:

Intracapsular within the jointExtracapsular – outside the capsule

Intra-articular – within the joint

Classification as to Location:

ProximalDistalMid-shaft

Clinical Manifestations:Pain or tenderness over the involved area

SwellingLoss of function

Obvious deformityCrepitus – grating sensation either heard or felt

Erythema, EdemaMuscle spasm/impaired sensation

Bleeding from an open wound with protrusion of fractured bone

Principles of fracture treatment:

Reduction of bone fragments to normal position & immobilization

Maintenance of reduction until healing is sufficient to prevent displacement

Preservation & restoration of musculoskeletal function

Stages of bone healing: 1. Hematoma formation – blood accumulates into the area between & around the fragments. The clot begins 24 hrs after the fracture occurs

2. Cellular proliferation – (within 5 days) hematoma undergoes organization. Fibrin strand form with the clot creating a network for revascularization & invasion of fibroblast & osteoblast.

Beginning of external cartilaginous callus formation.(osteoid tissue)

3. Callus formation – (2-3 weeks) minerals are being deposited in the osteoids forming a large

mass of differentiated tissue bridging the fractured bone.

4. Ossification – mineral deposition continues & produces a firmly reunited bone. Final ossification takes

3-4 months.

5. Consolidation & remodeling – final stage of fracture repair consists of removal of any remaining devitalized tissue & reorganization of new bone

Complications of Healing:Interruption in the sequence of healing are caused by:

Original injuryDebridement

Loss of bone substanceInfectionLoss of circulationImproper immobilization

Inadequate fixationNecrosisMetabolic disturbance

Possible Complications from Fractures:

Pulmonary Embolism Caused by immobility; precipitated by fracture

Clinical Manifestations:Restlessness & Apprehension

Substernal painDyspnea

DiaphoresisABG changesImplementation:Administer O2, notify the doctor, prepare to administer anti coagulant therapy

Fat Embolism An embolism originating from bone marrow (fat globules); occluding the small blood vessels of lungs, brain, kidneys etc.

Occurs 24-72 hrs following an injury

Respiratory failure is the most common cause of death

Occurs frequently in young adults (20-30 years old) Elderly with fracture of long bones

Clinical manifestations:Mental confusionRestlessness due to hypoxiaTachycardia, tachypnea, dyspnea

Cough, chest painThick white sputumPetechial rash over the upper chest & neck

ABG – decrease PaO2Implementations:Early surgical fixationAdminister O2 as orderedAdminister morphine/corticosteroids

Compartment SyndromeIncreased pressure within one or more compartments causing massive compromise of circulation to an area

Enclosing muscle/fascia is too tight or cast/dressing is constrictive

Increased compartment content due to hemorrhage/edema

Forearm/leg muscles frequently affected

4-6 hrs. after the onset of compartment syndrome, neuromuscular damage is irreversible

Clinical Manifestations:ParesthesiaThrobbing painCyanosis of nail beds, pallor, cold finger or toes

Pulselessness

Implementation:Notify physician immediately

Elevate leg above level of heart

Remove restrictive devices

Prepare client for fasciotomy

Passive ROM q 4-6 hrs.Wound closure in 3-5 days

Infection & OsteomyelitisCan be caused by interruption of integrity of the skin, infection invades bone tissue

Clinical Manifestation:Fever> 38° CPainErythema in the area surrounding the fracture

TachycardiaIncrease WBC Count

Implementation:Notify the physicianPrepare to initiate aggressive IV antibiotic therapy

Delayed Complications:Non-union Fibrous tissue exists between bone fragments; no bone salts have been deposited

Reinforce information regarding bone grafts, immobilization & non-weight bearing

Avascular NecrosisInterruption in the blood supply to the bony tissue; resulting to death of bone tissue

Clinical Manifestation:Pain Decrease sensation

Implementation:Notify physicianPrepare the client for removal of necrotic tissue (sequestration)

Mechanical Aids for Walking:Canes:Standard straight-legged caneTripod or crab caneQuad cane – provides the best support

Standard cane – 36 inches in length

The length should permit the elbow to be slightly flexed

Health Teachings:Hold the cane with the hand on the stronger side of the body

Position the standard cane 6 inches to the side & 6 inches in front of the near foot.

When Maximum Support is Required:

Move the cane forward 1 foot while the body weight is borne by both legs

Move the weak leg forward to the cane while weight is borne by the cane & stronger leg

Move the stronger leg forward ahead of the cane & weak leg while the weight is borne by the cane & weak leg.

Walkers – for ambulatory clients needing more support than a cane provides.

Client needs to bear at least partial weight on both legs

Hand bar below the client’s waist & client’s elbow slightly flexed

Crutches Axillary crutch with hand bars

Loftstrand bar – extends only to the forearm; substitute to cane

Canadian or Elbow Extensor Crutch – made of single tube of aluminum with lateral attachments, a hand bar, cuff for the forearm & has a cuff for the upper arm

Nursing Alert:The weight of the body must be borne by the arms rather than the axillae (can injure the radial nerve, eventually can cause crutch palsy)

Crutch Palsy – weakness of the muscles of the forearm, wrist & hand

Measuring Clients for Crutches:

To obtain the correct length for the crutches & the correct placement of the handpieces

2 ways to measure the crutch length:

Client in supine position, the nurse measures from the anterior axillary fold to the heel of the foot & add 1 inch.

The client stands erect. The shoulder rest of the crutch is at least 3 finger widths, that is 1-2 inches below the axilla.

The angle of the elbow flexion must be 30 degrees.

Crutch stance (Tripod Position) –proper standing position with crutches.

Crutches are placed 6 inches in front of the feet & 6 inches laterally.

Crutch gait – gait a person assumes on crutches by alternating body weight on one or both legs & the crutches.

5 Standard Crutch Gaits:Four Point GaitThree Point Gait2 Point GaitSwing toSwing through

Four Point- Alternate Gait – most elementary, safest gait; client needs to bear weight on both legs

The nurse ask the client to:Move the right crutch ahead 4-6 inches.

Move the left front foot forward, to the level of the left crutch

Move the left crutch forward

Move the right foot forward

3 Point GaitClient bears entire body weight on the unaffected leg

Both crutches & affected leg advances

Unaffected leg advances

Two-Point Alternate Gait Partial weight bearing on each foot

Faster than 4 point gait

Move the left crutch & the right foot together

Move the right crutch & the left foot ahead together

Swing – To Gait – paralysis of the legs & hips

Move both crutches ahead together

Lift body weight by the arms & swing to the crutches

Swing –Through Gait Move both crutches forward together

Lift body weight by the arms & swing through beyond the crutches

Going up the StairsNurse stands behind the client

Placing weight on crutches while moving the unaffected leg onto the step

Going down the StairsThe nurse stands 1 step below

Moving the crutches & affected leg to the next step

Interventions for Fracture:ReductionFixationTractionCasts

Reduction – restoring the bone to proper alignment

Closed Reduction – performed by manual manipulation

Maybe performed under local/general anesthesia

Open Reduction – involves surgical intervention

Treated with internal fixation devices

Client may be placed in traction or cast following the procedure

Fixation Internal fixation – follows open reduction

Involves the application of screws, plates, pins, nails to hold the bone fragments in alignment

May involved the removal of damaged bone & replacement with a prosthesis

Provides immediate bone strength

Risk of infection is associated with this procedure

External fixation – an external frame is utilized with multiple pins applied through the bone

Provides more freedom of movement than with traction

Roger Anderson External Fixator (RAEF)

For fracture of the tibia, radius, ulna done under anesthesia

Ilizarov fixator – for severe comminuted fracture, bone lengthening

Traction – is the act of pulling and drawing which is usually associated with counter traction

Provides proper bone alignment & reduces muscle spasm

For support, reduce bone fracture

Nursing responsibility:Maintain proper body alignment

Ensure that the weights are hanging freely

Ensure that pulleys are not obstructed; pulleys move freely

Place knots in the ropes to prevent slipping

Types of traction:Manual traction – done with the use of the hands of the operator

Skeletal traction – pin is driven across the bone to provide an excellent hold while a weight is attached

Use of pins, tongs & wires

Crutchfield tongsFor fracture of cervical spineC1-C5 cervical spine tensionUse for 4 weeks

Vinke’s skull caliperC1-C5 cervical spine tension

Use for 4 weeks

Nursing responsibility:Monitor color, motion & sensation of affected extremity

Monitor the insertion site for redness, swelling or infection

Provide insertion site care as prescribed

Skin traction – applied by the use of elastic bandages or adhesive straps to the skin while a pull is applied by a weight

2 Types:Non-adhesive type – uses laces, buckles, leather & canvas

Ex. Head halter strap

Adhesive type – uses adhesive tape or elastic bandages

Ex. Dunlop skin traction

Cervical skin traction – relieved muscle spasm & compression in the upper extremities & neck

Uses a head halter & chin pad

For cervical spine affectation

For Pott’s disease

Head halter + Pelvic girdle for Scoliosis

Pelvic guilder – for lumbosacral affectation/slip disc

Buck’s skin traction- used to alleviate muscle spasm

Immobilize a lower limb by maintaining a straight pull on the limb

Boot appliance is applied to attached the traction

Not more than 8-10 lbs. of weight must be applied

Elevate the foot of the bed to provide traction

Bryant’s skin tractionUsed to stabilize a fractured femur or correct a congenital hip dislocation in children

Position child with a 90° hip flexion

For congenital hip dislocation

0-6 yrs/0-3 yrs old – minimum of 4 weeks

Note: buttocks must not be touching the mattress

Russell’s skin tractionUsed to stabilized a fractured femur before surgery

Similar to Buck’s traction; provides a double pull with the use of a knee sling

Traction pulls at the knee & foot

Dunlop’s skin tractionFor supracondylar fracture of the humerus

Minimum 4 weeks of application

Boot leg traction – fracture of hip and or femur

Post poliomyelitis with residual paralysis

Halo-pelvic tractionFor scoliosisTemporal to occipital part of pelvic area

Minimum 4 weeks of application in preparation for surgery

Halo-femoral tractionFor severe scoliosisAvoid progression of scoliosis

From temporal to femural area

90-90 degrees tractionFor subtrochanteric fracture of femur or intertrochanteric fracture of femur

Stove in chestFor multiple rib fracture

Parts of an Orthopedic bed:Firm mattressFracture boardBed elevator or shock block

Balkan frame:4 vertical bars2 horizontal bars1 diagonal bar1 straight bar or cross bar

Pulleys (3)Clamps – to hold bars in place

Overhead trapeze

Traction equipments:Thomas splintPearson attachmentRest splintCord sash (3)

Safety pinsClipsFoot restSlings (2 sizes)Weights

Plaster cast – a temporary immobilization device which is made up of gypsum sulfate

Undergoes unhydrous calcinations when mixed with water, swells & forms into a hard cement

Made of rolls of plaster bandage, wet in cool water & applied to the body

Cools after 15 minutesRequires 24-72 hrs to dry completely

Non-plaster cast –(fiberglass cast)

Lighter in weight, stronger, water resistant & durable

Impregnated with cool water-activated hardeners & reach full rigidity in minutes

Diminish skin problems

Functions:To immobilizeTo prevent or correct deformity

To support, maintain & protect realigned bone

To promote healing & early weight bearing

Materials for casting:StockinetteWadding sheetPlaster of Paris

Complications of cast:1.Neurovascular compromise

Watch out for 6 P’s:PainPulselessnessPallor

ParesthesiaParalysisPoikilothermia

2. Incorrect alignment3. Cast syndrome – (Superior

mesenteric artery syndrome) occurs with body casts; any cast that involves the abdomen

Decreases the blood supply to the bowel

Signs/Symptoms:Abdominal pain, nausea & vomiting

4. Compartment syndrome –increased pressure within a limited space, compromises the function & circulation in the area

Long arm circular cast – for fractures of radius/ulna

Fuenster’s cast/Munster cast

Fracture of radius/ulna with callus formation

Long arm posterior moldFracture of radius/ulna with open wound, swelling or infection

Short arm castFracture of the wrist, carpals & metacarpals

Short arm posterior moldFracture of the wrist, carpals & metacarpals with open wound, swelling & infection

Purpose:To change dressingTo adjust the elastic bandage

To assess presence of infection & swelling

Long leg castFracture of tibia fibula

Cylindrical leg castFracture of patella

Quadrilateral/Ischial weight bearing cast

Fracture of femur with callus formation

Cast braceFracture of distal 3rd of femur with callus formation & proximal 3rd of tibia fibula

Long leg posterior moldFracture of tibia fibula with open wound, swelling and infection (OSI)

Basket castFracture of patella with massive bone injury

Short leg cast fracture of ankle, tarsals & metatarsals

Patellar tendon bearing cast

For fracture of tibia fibula with callus formation

Delvit castFracture of distal 3rd of tibia with callus formation

Boot legFor post poliomyelitis with residual paralysis

Internal rotator splint or boardFracture with post op hip surgery

To maintain abduction & prevent internal rotation

With pillow in between legs

Short leg posterior moldFracture of ankle, tarsals & metatarsals with OSI

Rizzer’s jacket scoliosis

Minerva castUpper dorsal lumbar injury

Body castFor lower dorsolumbar injuries

Hanging castFracture of the shaft of humerus

Functional arm castFracture of the shaft of humerus with callus formation

Allows abduction & adduction

Shoulder spica castFracture of upper portion of humerus & shoulder joint

Airplane castFracture of neck of humerus

Fracture with recurrent shoulder dislocation

Body castLower dorsolumbar spineDouble hip spica castFracture of hips & both femur

One & one half hip spica cast

Fracture of ½ hip femur

Unilateral hip spica castFracture of 1 hip & 1 femur

Pantalon castfor pelvic fractureAt level of knees with abduction

Frog castCongenital hip dislocation

Double hip spica posterior mold

Fracture of both hips & both femur with OSI

One & one half hip spica posterior mold

Fracture of 2 hips & 1 femur

Single hip spica posterior mold

Fracture of 1 hip or 1 femur with OSI

Pelvic bone with callus formation

Night splintPost poliomyelitis with residual paralysis

Braces – are mechanical support for weakened muscles, joints & bones

Ex. Milwaukee brace, Yamamoto brace

Milwaukee bracePersonalized/customizedFor scoliosis – thoracic T9 above the thoracic area

Yamamoto braceInvolvement of T9 and below

Forrester braceFor cervico thoracic lumbar spine affection

Pott’s disease

Taylor Knight braceUpper thoracic spine affectation

T1-T3Pott’s disease

Jewett braceLower thoracic spine affection

Chairback braceFor lumbosacral affection

Philadelphia collar braceFor cervical spine affection

Cervical collar/Shuntz collar brace

Cervical spine affection

Cocked-up splintTo prevent wrist dropFor Colle’s fracture – distal radius affected

Banjo splintFor peripheral nerve injuryFor Carpal tunnel syndrome

Lively finger splintFracture of fingers

Dennis Browne SplintFor clubfoot/congenital Talipes Equinovarus

Tendon is short – complete soft tissue release

Congenital Clubfoot

Treatment time – day 1 of life to 7 yrs old

Unilateral leg braceFor post poliomyelitis with residual paralysis

Long leg brace Short leg brace

Bilateral leg brace (long)

Balance Skeletal TractionMaintain the anatomical position of fractured bone

Skeletal traction requires an invasive procedure in which

wires, pins & screws are inserted

Weight ranges from 25-40 lbs. (11-18 kg)

Traction Equipments:1.Thomas Splint & Pearson Attachment

2.Rest splint3.5 Slings (variable sizes)

4. 5 paper clips/safety pins5. Cord sash – short – thigh longer - traction longest – for the

suspension

6. Weights & bags – suspension weight is ½ lighter compared to the weight of the traction

7. Foot support – to prevent foot drop

Materials needed:Thomas Splint – placement of the thigh

Pearson Attachment – placement of the leg

Steinman’s holderSteinman’s pinTraction weight

10 % of the body weightInside of the suspension rope

Suspension weight50 % of the traction weight

Rest Splint3 Cord Sash

Thigh rope – the shortest

Suspension rope – the longest

Traction rope Slings & pinsFoot board

Application of traction:1. Verify Doctor’s order2. Inform the patient about the need & purpose of the procedure

3. Preparation

Identify the different parts of the orthopedic bed

Assemble the needed equipmentsThomas splintPearson Attachment

Know the affected extremityWhere to stand? Look for the last pulley & stand on the side

4. Mount the Thomas & Pearson on the rest splint

5 principles in the application of slings to be emphasized:

Not too tight nor too looseMaintain 1 inch distance between the slings to promote ventilation or aeration

Popliteal & heel portion must be free from sling

Smooth & right side must come in contact with the patient’s skin

(2) longer & wider slings in the thigh area

and (3) for the leg areaSling application:Start from the medial to the lateral side

Secure both ends together

Fan fold nicely on the lateral aspect & secure with a pin or clip.

Observe the principle of not too tight or not too loose & avoid hitting the patient’s extremity with the pin

The thigh rope should be attached on the medial aspect to the lateral aspect

5. Insertion of the apparatus under the affected extremity:

Insert the whole apparatus under the affected extremity

Manual traction to be released after the completion of the traction weight on the 3rd pulley

Lift the affected extremity on the count of three

Instruct the patient:Hold on the trapeze, flex the unaffected leg at the count of 3

6. Application of traction weightRope to be attached to the Steinman pin holder to run along the 3rd pulley & attached the prescribed weight

Check the principles of sling application, make necessary adjustments & check the alignment.

Pulleys must be aligned to the area of injury

1st pulley – aligned to the groin area

2nd pulley – aligned to the knee area

7. Apply suspension traction1 end of the thigh rope to be attached to the lateral aspect of the ischial ring with a slip knot

Attach the suspension rope on the midpart of the thigh rope, to the

1st pulley. Insert suspension weight, hang it on the 1st pulley pass it on the 2nd pulley under the rest splint. Clovehitch knot on the Thomas splint & another clovehitch knot on the Pearson. Secure the knot by closing it.

Be sure to maintain the traction rope inside, & the suspension weight should be outside.

9. Remove the rest splint10. Mount foot board to prevent foot drop with a ribbon knot

11. Check for the principles of traction. Swing the affected leg forward, lateral & backward to check the efficiency of traction.

Principles of traction:1.Patient must be in dorsal recumbent position

2.Line of pull should be in line with the deformity. Consider the position of diagonal bar & positioning of pulley.

1st pulley in line with the thigh, 2nd pulley in line with the knee or screw, 3rd pulley in line with the 2nd & 3rd pulleys

Weight bag must be at the level of the bed frame

3.Traction must be continuous. Emphasized the importance of manual traction.

4. Avoid friction – rope should be running along the groove of the pulley, knots away from the pulley. Weights should be hanging freely. Observe for wear & tear of ropes.

5. Provide counter traction. For every traction there must be a counter traction (Patient’s body weight)

Removal of traction:1. Apply rest splint2. Hang suspension weight on the 1st pulley

3. Complete removal of suspension weight – remove the knot on the Pearson & Thomas

4. Manual traction on the Steinman pin holder

5. Remove the traction weight on the (3rd) pulley, secure the traction rope on the rest splint, another on the Thomas & Pearson attachment.

Summary- Application of Balance Skeletal Traction in Chronological Order:

1.Inform the patient about the purpose of traction

2. Assemble the equipment needed

3. Apply the rest splint to Thomas & Pearson attachments

4. Apply slings on Thomas splint & Pearson attachments

5. Apply traction weight6. Apply suspension weight7. Check alignment of screw of

Pearson’s with knee joint

8. Remove rest splint9. Apply foot board10. Apply initially the

principles of traction

Nursing Care of Patients with Traction:

1. AssessmentAssess patient as to level of understanding/consciousness

2. Provision of general comfort

Skin care – head to toe; focus on the sponging of affected extremity

3. Potential Complications:Upper respiratory – Pneumonia – back tapping & deep breathing

Bed sore – good perineal care; proper skin care, turning, lift buttocks once in a while

Urinary & kidney problem – good perineal care, increase fluid intake

Bowel complication – fear of apparatus, no privacy, lack of fluids/perineal care

Pin site infection – observe for signs & symptoms of infection; loosening pin tract, pus coming out from insertion site, foul smelling odor, fever

Deformity – contracted knees, atrophy of muscles, foot drop, joint contractures

4. Provision of Exercises:ROM exercises with the use of trapeze

Deep breathing exercisesStatic quadriceps exercise – alternate contraction & relaxation of quadriceps muscles

Toe pedal exercises

5. Nutritional status6. Psychological aspectFear of the unknown, fear of death, fear of apparatus, fear of losing a job, financial fear

7. Provision of supportive therapy

Offer books to read, listen to radio or TV, discover interest

8. Spiritual aspect

Know patient’s religion, encourage relatives to give spiritual communication, visiting chaplain

Divertional activities – divert attention for any pain

Surgery Abbreviations & Meaning:ACL – Anterior Cruciate LigamentAEA – Above Elbow AmputationBKA – Below Knee AmputationCHSF – Compression Hip Screw Fixation

CW – Cerclage WiringIMN – Intra Medullary NailingORIF – Open Reduction Internal Fixation

PSF – Posterior Spinal Fusion

ROI – Removal of ImplantRCHSF – Richard Compression Hip Screw Fixation

THRP – Total Replacement & Hip Prosthesis

AKA – Above Knee AmputationBG – Bone GraftingFx - FractureHRI – Harrington Rod InstrumentRAEF – Roger Anderson External Fixation

Anterior Decompression Spinal Fusion (ADSF) - surgical intervention for Pott’s disease

Sequestrum – dead or necrotic bone

Sequestrectomy – removal of dead or necrotic bone

Gibbus formation – classical sign of Pott’s disease; progressive destruction of anterior spine leading to collapse & kyphosis

Axis – 1st cervical vertebraAtlas 2nd cervical vertebraIntertrochanteric fracture – fracture within the greater & lesser trochanter

Supracondylar fracture – fracture above the condyle

Subcondylar fracture - fracture below the condyle

Involucrum – new bone

Screws – used to attach implants such as plates & prosthetic devices to bone; to fix bone to bone, ligaments & tendons to bone

Guideline

in Choosing Absoanchor MIA

for Maxilla : Buccal Area

-06,-07,-08

Diameter: 1.2 - 1.3 mm

-06, -07,-08

Holding power of screw in bone is most dependent on the density & quality of bone

Screw Points:Non-self tapingTrocarStandardPilot point

Plates – stabilize the fracture; provide support to bone as it heals, held in place by screws

Recommended time for removal of plates:

Tibial plates – 1 yearFemoral plates – 2 yearsForearm & humeral plates – 11/2 -2 years

Rods or nails – stabilize diaphysis fractures of middle 2/3 of long bones

Nail-and- plates combination – for rigid immobilization of femoral neck when complete prosthetic replacement is not indicated

Identify the following:

Head halter + Pelvic girdle for Scoliosis