stephen p. england, md mpd department of orthopaedic surgery park nicollett clinic
TRANSCRIPT
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Stephen P. England, MD MPDDepartment of Orthopaedic Surgery
Park Nicollett Clinic
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Introduction to Orthopaedics
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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.
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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
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Bone Structure: Orthopaedic Implications
Periosteum DiaphysisEpiphysisPeriosteumEndosteumEpiphyseal
plates; bone growth, injury
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What is the significance of the epiphyseal plate?
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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
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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
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Types of Joints: Identification
AmphiarthrosisSynarthrosisDiarthrosis
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Significance of Diarthrotic JointJoint Capsule
surrounded by ligaments
Synovial Membrane: secretes synovial fluid; lines tendon and muscle sheaths
• Bursea: painful, but protective!
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Othropaedic Terminology
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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
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Hallus valgus
Which foot has a valgus deformity?
How do you describe this foot deformity?
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Stressors of theMusculoskeletal System
Trauma Infection
Altered Metabolism
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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
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How has orthopedic injury affected this PERSON?
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Components of AssessmentChief Complaint
Why seeking careAcute and chronic
problem
History taking; its significance
Pain characteristicslocationcharacterwhat effects
Associated conditionsComplications!
•Pain
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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
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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
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Ballottment:force fluid into joint space; displace patella
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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
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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.
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McMurray’s sign
Anterior Drawer test
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Diagnostic TestsCT ScanBone ScanMRIDual-Photon AbsorptiometryArthrographyArthrocenthesisArthroscopy
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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
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Arthroscopy
Therapeutic /diagnosticVisual recording; surgical removal of
meniscus, foreign bodies, etcRare complications; depends on
procedure, operative length, use of tourniquet
TeachingPost-op care
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Orthopaedic Interventions!TractionCastsExternal
FixatorsPin, plates and
screwsCPMCrutch-walking
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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
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CPMPurpose Guidelines
for Use • Teaching
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Bone StimulatorsIndicationsElectronegativityBone Remodeling
InternalPercutaneousExternal
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External Bone Stimulator
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Autologous Blood Transfusions
Indications forOrtho Cell
SaversCriteria for Use
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Cell Savers Autologous Blood
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Surgical /Medical Interventions
Tissue AllograftsAbductor Pillow, Carter PillowHot Ice Machines that Aren’t!Bone Paste!
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Tissue allografts, synthetic grafts
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Pins, plates, screws
ORIF (open reduction, internal fixation)
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CastsPurposesCasting Material
PlasterFiberglass
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Application of CastPrinciples
Skin AssessmentSkin ProtectionHeat GeneratedTime to Dry
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•Cast TypesSugar
Tong/SplintSpica Type
Body CastHip spicaGauntletCast-Brace
• Body Cast Care– Cast Syndrome
• Hip Spica
– Turning– Cast Drying
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External FixatorsHow They WorkPrinciples of CareThe Iliazarov
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External Fixator
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Conclusion