Slide 1

MUNIR SAADEDDIN, FRCSED ASST. PROFESSOR & CONSULTANT COLLEGE OF MEDICINE KING SAUD UNIVERSITY Introduction to Orthopaedics

Slide 2

Orthopaedics 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

Slide 3

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

Slide 4

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 and Foot and Ankle surgery

Slide 5

Red Flags Red Flags = 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

Slide 6

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 intra- compartment pressure which endangers the blood circulation of the limb and may affect nerve supply 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)

Slide 7

Examples of Red Flags 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. Multiple Trauma or Pelvic Injury: more than one fracture or injury sustained at the same time consider massive blood loss and associated injuries. Acute joint Dislocations : requires urgent reduction or may cause serious complications

Slide 8

Alignment terminology

Slide 9

Alignment Terminology: Cubitus Varus

Slide 10

Alignment terminology: Cubitus Valgus

Slide 11

Congenital or Acquired Acquired conditions include : Trauma Developmental Inflammation Infection Neuromuscular Degenerative Metabolic Tumor

Slide 12

Congenital Anomaly : Talepoequinovarus TEV

Slide 13

Traumatic Injuries Fractures Dislocations Soft tissues injuries: ligaments, tendons Nerve injuries Epiphyseal injuries

Slide 14

Fractures: Break in the continuity of bone

Slide 15

Dislocations Complete separation of the articular surface Distal to proximal fragment Anterior, Posterior, Inferior, Superior

Slide 16

Dislocation with fracture of the bone Always X-Ray Joint Above and Below Fracture Dislocation

Slide 17

Fracture Dislocation Dorsal Spine ( thoracic spine )

Slide 18

Force due to Resisted Muscle Action:- Avulsion Transverse pattern Avulsion Fracture

Slide 19

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

Slide 20

External Fixator : Ilizarove: in Trauma or Correction of Deformities

Slide 21

Soft tissue injuries of the knee Remember : ACL : Anterior cruciate ligament its function is preventing the Knee ( patella ) from going FORWARD PCL : posterior cruciate ligament : its function is preventing the Knee from going BACKWARD MCL : medial collateral ligament : its function is preventing the knee from going ( VALGUS ) ( laterally ) LCL : lateral collateral ligament : its function is preventing the knee from going ( VARUS ) ( mediulally ) Meniscus : prevent the joint from friction it affeccted in Osteoarthiritist

Slide 22

Anterior Cruciate Ligament injury: MRI

Slide 23

ACL Injury: Lachmans test

Slide 24

MCL: Value of Stress Xrays

Slide 25

(Developmental Dislocation of Hip) DDH

Slide 26

Orthosis : Pavlick Harness for DDH

Slide 27

Developmental Foot deformity: Hallux Valgus

Slide 28

Developmental: SCFE (Slipped Capital Femoral Epiphysis)

Slide 29

Spinal Deformities: Kyphosis or Hyperlordosis Scoliosis' : Scoliosis is a side-to-side curvature of the spine Kyphosis : Kyphosis is the extreme curvature of the upper back also known as a hunchback. Hyperlordosis : abnormal forward curvature of the spine common in pregnant ladies

Slide 30

Spinal Deformity: Scoliosis

Slide 31

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

Slide 32

OA Hip

Slide 33

Total Hip Arthroplasty ( THA )

Slide 34

Osteoarthosis of Knee

Slide 35

Osteoarthritis of Knee

Slide 36

Metabolic Disorders (Rickets): Bow Legs

Slide 37

Osteoporosis: Fractured NOF

Slide 38

Hemi-Arthroplasty Lt Hip

Slide 39

Spinal Osteoporosis

Slide 40

Osteoporosis: Colles fracture

Slide 41

Bone Tumors Malignant tumors are MORE than Begnin

Slide 42

Bone Tumor

Slide 43

Bone tumors

Slide 44

Neurological Evaluation : Sensory : Dermatomes

Slide 45

Nerve Injury: Muscle wasting

Slide 46

Nerve Injury: Sensory Loss

Slide 47

Slide 48

Muscle Power Testing : Iliopsoas

Slide 49

Muscle Power Testing : Quadriceps

Slide 50

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

Slide 51

Devastating effect of Spinal Cord Injury

Slide 52

Neuromuscular disorder: Polio

Slide 53

Chronic Osteomyelitis : discharging sinus

Slide 54

Spinal Infection : Tuberculosis: Para Vertebral Abscess

Slide 55

Chronic Osteomyelitis : Sequestrum dead bone inside the bone its complication of Chronic bone infection it usually produce Pus

Slide 56

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

Slide 57

Clinical Skill: Cast application

Slide 58

Clinical Skills: Knee Aspiration