Orthopaedic SurgeryPrinciples and Definitions

Dr.Metwally Shaheen ( FRCSI) Ortho. Consultant

( Head 0f Orthopedic Department SGH-J )

Scope of our course:

1. General Orthopaedics2. Regional Orthopaedics3. Fractures and joint injuries

General Orthopaedics

1. Infection2. Metabolic and endocrine disorders3. Rheumatic disorders4. Osteoarthritis and related disorders5. Tumours6. Osteonecrosis and osteochondritis7. Neuromuscular disorders8. Peripheral nerve injuries9. Principles of operative treatment

Regional Orthopaedics

1. Shoulder2. Elbow3. Wrist and Hand4. Spine5. Hip6. Knee7. Ankle and Foot

Fractures and Joint Injuries• Management of major injuries• Fractures and joint injuries• Principles of fracture treatment• Complications of fractures• Injuries of the shoulder and upper arm• Injuries of the elbow and forearm• Injuries of the wrist and hand• Injuries of the spine• Fractures of the Pelvis

Fractures and Joint Injuries

• Injuries of the hip and femur• Injuries of the knee and leg• Injuries of the ankle and foot

Definitions

Parts of a Long Bone:1. Epiphysis:The end part of a long bone which is first separated from the

main part by a layer of cartilage but later fuses with it by ossification.

1. Metaphysis:It is a wider portion of a long bone adjacent to the epiphyseal

plate . It is this part of the bone that grows during the childhood.as it grows ,it ossifies near the diaphysis and the epiphysis at roughly 18- 25 years of age.

1. Diaphysis:The shaft of a long bone.

Biological Types of Bone

• Cortical (Compact):It is the dense outer surface of bone that forms a

protective layer arround the internal cavity.

• Cancellous (Trabecular) :It is the spongy interior layer of bone that protects

the bone marrow.

Fracture

It is a break in the structural continuity of bone.It may be classified according to displacement

into:Incomplete (crack,cortical crumpling)Complete with displaced fragmentsAccording to associated soft tissue injury into:Closed (simple)Open (Compound)

Causes of fractures:

• Fracture due to sudden trauma• Stress or fatigue fractures• Pathological fractures

Fracture Displacement

• Translation (shift)• Alignment (angulation)• Rotation (twist)• Length.

Fracture Healing• Healing with callus that passes through:

1.Tissue destruction and haematoma formation

2.Inflammation and cellular proliferation3.Callus formation4.Consolidation5.Remodelling• Healing without callus (in absolute

immobilization)• Gap healing

Testing for fracture union

• Absent pain during daily activity• Absent tenderness at fracture site• Absent pain on fracture stressing• Absent mobility at the fracture site• X-ray shows callus formation

Diagnosis of fractures:

HistoryHistory of injuryInability to use the injured limbPain, bruising and swellingDeformityAssociated injuriesPrevious injuriesAny other musculoskeletal abnormalityGeneral medical history

Diagnosis of fractures:

ExaminationExaminationExamine the most obviously injured partExamine the most obviously injured partCheck for arterial damageCheck for arterial damageTest for nerve injuryTest for nerve injuryLook for local injuriesLook for local injuriesLook for distant injuriesLook for distant injuriesLook Feel MoveLook Feel Move

Diagnosis of fractures:

• Imaging:Two viewsTwo jointsTwo limbs• CT• MRI• Isotopic scanning.

Joint Injuries

• Sprain• Strain• Rupture• Subluxation• Dislocation

Operations on Bone

Bone Fixation• Internal FixationPlate and screwsIntramedullary nailsK. Wire fixation.• External fixationTubular fixator.Ring fixators.

Osteotomy

• Creating a bone discontinuity to:Correct deformityChange the shape of boneTo redirect the load trajectories• Can be open wedge, closed wedge ,

or dome osteotomy• Cut bones need to be fixed in the

desired position

Bone grafting

• AutograftAllows both osteoinduction and

osteoconduction• Allograft• Xenograft• Artificial bone

Distraction Histogenesis

• Bone transport• Bone lengthening

Operations on joints

• Injections• Arthroscopy• Arthrotomy• Joint realignment• Joint fusion (arthrodesis)• Joint replacement (arthroplasty)• Excision Arthroplasty

Thank You