microsoft powerpoint operations optimised ppt · arthrodesis -wrist indications • rheumatiod •...

Orthopaedic Operations 2nd Friday of 5-weekly rotation

ICM Robertsonhttp://www0.sun.ac.za/ortho 1

http://www0.sun.ac.za/ortho

Orthopaedic Operations

• MB ChB 5 & 6

• ICM Robertson


Choice of Operation

Painful Joint• Osteotomy

• Arthrodesis

• Excision Arthroplasty

• Joint Replacement– Hemi

– Total


Osteotomy

Indications– Young Patient

– Mobile joint

– Malalignment




Osteotomy - knee

Macquet - proximal tibial


Osteotomy - Hip

• Indications– Young / middle

age

– More than 60 deg flex

Valgus osteotomy


Arthrodesis

• Surgical fusion of a joint

• Indications– Pain

– Limitation of movement




Arthrodesis - Hip

Pre-requisites

• Young• Nor mal contralateral

hip

• Nor mal I psilater lalKnee

• No Backache


Arthrodesis - Wrist

Indications

• Rheumatiod

• TB

• Degenerative


Excision Arthroplasty

• One or both sides of joint are excised

• Sepsis

• Allows movement

• Always – Shor tening– Instability





• Girdlestone - Hip

• Salvage operation– septic hip



Kellers - hallux valgus

Problem

• Shor tening

• Transfer metatarsalgia

Joint Replacement

Types• Hemi - one side only

• Total




Joint Replacement

I ndications Moores• Trauma

• Elder ly • Debilitated


Joint Replacement

I ndications Total Hip• Age >60

• Pain > Grade 3• L imited Walking

distance


Joint Replacement

Contraindications Total Hip

• Age <60 yr• Neuromuscular

disease• Any Sepsis




Joint Replacement


Bone Grafts

Bone Grafts

Uses of Bone Grafts

• To fill cavities eg Cysts

• To bridge joints - arthrodesis

• To bridge major defects and restore continuity of a long bone

• To provide a bone block and limit joint motion (arthrodesis)

• To promote union in a pseudoarthrosis(nonunion)

• To promote union in delayed union , non union or fresh fractures or osteotomies.




Bone Grafts

Functions of Bone Grafts•Mechanical Strength - to immobilisea bone cor tical graft eg an intact fibula can be used.

•Ostogenesis- marrow bone such as bone removed from the pelvis. eg delayed union of a tibial fracture. This is laid about he fracture gap.

•Replacement - loss of a section of long bone may be bridged by bone graft. .If the gap is significant a vascurarised graft is indicated.


Bone Grafts

Terminology

• Autografts ... in the same individual

• Allograft ... between different individuals of the same species.

• Xenograft ...from an individual of one species ...to different specie


Bone Grafts

Donor SitesPoster ior site

•Useful in back operations

•Yields more bone




Bone Grafts

Donor Site Complications - Pelvis

• Fracture eg Sartorius - fractures off SIAS

• Hernia - through pelvic defect

• Nerve damage eg lat. cutaneous thigh

• Pain

Tendon Suture

Severed tendons.. best sutured primarily.

Zone 2 hand - use Kessler suture

Kessler Suture

Tendon Suture

Bunnell suture

Suitable for most tendons




Tendon Transfer

Pre-requsites for a successful tendon transfer

•Sability of proximal joints

•Prior correction of any fixed deformity

• Power ..At least grade 4/5 power

• Direct line of pull

• Firm point of fixation - preferably bone


Tendon


Nerve

Classification of nerve damage

Neurotmesis- (complete division.

• eg knife wound

Axonotmesis -incomplete division Only the axons

eg traction injury

Neurapraxia -(physiological interruption Axons are intact injury is degradation of the axon sheaths.

• motor > sensory




Nerve


Neurotmesis- (complete division.

• e.g. knife wound


Nerve


Axonotmesis -incomplete division Only the axons

e.g. traction injury


Nerve


Neurapraxia -(physiological interruption Axons are intact injury is degradation of the axon sheaths.

• motor > sensory



Nerve

Nerve suture

Primary Suture

•Attempt in all open injuries

• Avoid tension


Nerve

Timing of repair• Immediate exploration and suture of open injuries

•Closed nerve injuries

• observe

• physiotherapy

• late repair (if necessary)


Nerve

Signs of nerve recovery

• Return sensory or motor function

• Progressive Tinnel sign.

• Speed of growth +- 6mm per week.




Internal fixation

Indications for ORIF

• inability to obtain reduction

• intra-articular #

• pathological #

• neurovascular

• multitrauma

• advanced age


Internal fixation

Plates and screws

• Tension side

• Screw 8 cortices both sides of #

• Bone graft on Oppositeside

ORIF - failures

Plate #

Bone # at plate end



ORIF -IM Pins

Advantages of closed pins

• Less sepsis - # not opened

• Less plate failures - no stress risers

• Muscle blood supply intact

OREF -External fixators

Indications

• Open fractures - wound problem

• Distal radius fractures - shortening

• Other - bone transport / lengthening



Pin Care• Clean the skin regularly

• Antiseptic dressings - "

• Septic skin (not loose) -antibiotic

• Septic Loose Pin -- replace





Radius Indications

• Unstable distal radius fractures

• Shortening

• Open or closed

Orthopaedic OperationsFurther information – visit:-


http://webct.sun.ac.za

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microsoft powerpoint operations optimised ppt · arthrodesis -wrist indications • rheumatiod •...

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