Fuller Ch.30: Orthopedic Surgery

aponeurosis

a tendinous sheet that separates muscles or attaches a muscle to bone

biomechanics

The relationship between movement and biological or anatomical structures.

broaches

fin-shaped rasps used to enlarge the medullary canal for insertion of an implant

cannulated

a device having a hollow core; for example, an instrument with a central channel that can be fitted over a guidewire or pin

closed reduction

Alignment of bone fragments into anatomical position by manipulation or traction.

external fixation

a method of maintaining bone fragments in anatomical position from outside the body (cast is an example)

internal fixation

surgical repair of a fracture by implanting a device such as a metal plate, rod, or nail that holds the bone fragments in correct position during healing

open reduction

Surgical access (through an incision) to bring bone fragments into anatomical alignment.

ream

To enlarge a preexisting hole, depression, or channel, such as the medullary canal.

reduction

the process of manipulating bone fragments to restore anatomical position

bone and joint

most orthopedic procedures focus on restoring _________ and __________ function that has been lost or diminished because of traumatic injury or disease

pain

alleviating ________ is also a primary goal of surgical intervention

orthopedic system

a specific set of instruments and a technique specific for one surgical approach

cortical bone

also called compact bone; it is found on the surface of bones and is organized in tubular units called osteons

cancellous bone

it is less dense and has no geometric structure; instead, the structure resembles a sponge, and the spaces are filled with red or yellow marrow, a soft connective tissue

periosteum

the function of the _____________ is to protect the bone surface and provide attachment for tendons

diaphysis and epiphyses

long bones are characterized by a middle shaft, called the ___________, and the two ends, called the ___________

shape

bones can be classified by their ___________

short bones

bones of the wrist and ankles

irregular bones

bones of the vertebrae, spine, and face

sesamoid bones

few irregularly bones that occur singly like the patella

flat bones

usually thin compared to other types of bones; the ribs, cranial bones, scapula, and sternum

red marrow; yellow marrow

in adults, the inner cancellous layer of the flat bones contains ________ _____________ (in other types of bones, it converts to __________ ____________ during childhood and persists into adulthood)

condyle

a knuckle-shaped portion of bone generally found in association with a joint

crest

a ridge of bone

foramen

a rounded orifice in a bone; usually a passageway for blood vessels or nerves

fossa

a depression in a bone

neck

a narrow bridge of bone between two other structures

process

a projection of bone

sinus

a cavity within a bone

spine

a sharp, narrow projection

sulcus

a groove in a bone

tubercle

a small rounded projection

tuberosity

a large rounded projection

synarthrosis (suture joint)

a joint with limited movement or fixed articular surfaces such as between the skull bones

amphiarthrosis (cartilaginous joint)

A joint in which the bones are connected by cartilage and only slightly moveable; symphysis joints are included in this

diarthrosis (synovial joint)

a joint that is freely moveable, such as the hip or shoulder; most joints of the body are this

synovial joint

composed of articulating bone ends and connective tissues that surround them

joint capsule

the __________ ___________ surrounds the joint and contains nerve and blood vessels

synovial membrane

the joint capsule is lined with a ____________ ______________, which produces a viscous fluid that lubricates and nourishes the joint

synovial fluid

the ___________ __________ flows out of the joint capsule when it is injured or incised

joint cavity

the space inside the joint capsule is called the _________ __________

hinge joint

a joint that has rocker and cradle components, which allow extension and flexion only like the elbow

saddle joint

a joint in which the two components have a complementary convex-concave shape, and the bones slide over each other; it allows flexion, extension, abduction, and adduction; there is only one joint in the body- the thumb

gliding joint

a joint in which relatively flat surfaces of bone slide over each other like the vertebrae, movement of which allows the spine to flex

ball-and-socket joint

a joint with a spherical component and a concave component; movement occurs in several planes, making this joint the most freely moveable type like the hip and humerus; allows flexion, extension, abduction, adduction, rotation, and circumduction

pivot joint

a joint composed of a bony protuberance and an open collar component like the first and second vertebrae of the neck; allows rotation

condyloid joint

a joint in which a small protrusion slides within a slightly elliptical component like the carpal bones of the wrist; allows flexion, extension, abduction, and adduction

radiography

the first-level assessment in most cases of orthopedic trauma

orthopedic table/fracture table

the modern _____________ ____________ (also called a ____________ _____________) is used mainly for the surgery of the femur and lower leg

gauze fluffs

made with kerlix or plain gauze squares that are pulled apart from the center to make them fluffy rather than flat; used to provide cushioning in small areas such as between the fingers or toes

thick cotton wrap

used to provide support to a limb

ace type stretchable fabric bandages

used to wrap a limb, usually on tip of cotton wrap to provide extra support and some compression

coban-type dressin

common roller bandage with superior stretching and self-sticking capability; doesnt offer as much support but conforms more easily to the shape of the limb

stockinet

commonly used under splits and casts; stretchable tube-shaped fabric that is fitted over the limb and folded over at the top to form a smooth padded edge

name; area

the distinguishing features are the ________ of the bone and the anatomical _______

pattern

fractures may be described by the _____________ of the break; this helps identify the forces involved and the methods required for repair

level of comminution

the extent of fragmentation

displacement

this factor describes whether the bone fragments are in anatomical alignment

pathological

a ______________ fracture can occur with normal load; it is caused by any disease that weakens the structure and composition of the bone

transverse

the fracture is perpendicular to the long axis of the bone

oblique

a type of transverse fracture that occurs at an angle

spiral

fracture of the long bone that occurs around the bone; the result of twisting or torsion on the bone

impacted

A fracture in which a bone fragment is driven into another bone fragment

comminuted

a fracture with two or more pieces

open

a fracture in which the fractured end penetrates the skin

greenstick

fracture of immature bone that is soft and less brittle than mature bone; incomplete or the impact results in severe bending and bruising

depressed

refers to cranial fracture in which the fragments are displaced inwardly

open reduction and external fixation

in this procedure, reduction requires an incision to align the bones. however, an external device is used to stabilize and hold the bone fragments during healing

closed reduction and external fixation

the fracture is reduced manually or with a traction device. except for casting and other types of noninvasive splinting

power; irrigation

___________ instruments generate heat as a result of friction between the tissue and tip; the temp can be high enough to destroy tissue in the vicinity of the tip so the tip must be continually ____________ while in use

orthopedic drill

an _____________ __________ is similar to a carpenter's drill

reciprocating saw

the blade moves in and out of the handpiece

sagittal saw

the blade is fixed at a right angle to the handpiece and moves along a perpendicular axis

oscillating saw

the blade is mounted along the same axis as the handle and moves back and forth

retraction

because bone does not yield to _____________ the way soft tissue does, the surgeon most often moves the surrounding tissue away from the bone or uses a bone-holding clamp or hook to grasp a bone for manipulation

rongeurs and bone cutters

used for trimming and modeling bone and cartilage

double-action

instruments that have two hinges for increased force at the tips

periosteal elevator

is used in nearly every ortho procedure; it has many uses, its main function is to remove or scrape away the periosteum from the bone surface

implants or hardware

orthopedic ___________ or ______________ are the devices used to attach or fix bone and other connective tissue

screw

the orthopedic ____________ is the most commonly used type of orthopedic implant; they are supplied in different types, sizes, shapes, and designs; they are made of titanium, stainless steel, or bioabsorbable; the function is to fix and orthopedic implant to a bone or bone to bone

cancellous

used in dense bone; large diameter and greater pitch to increase contact with the bone; used to fix a plate to the bone

cortical

small diameter and decreased pitch; used to fix a plate

kirschner wires (k-wires) and steinmann pins

thick wires that are inserted with a drill

anchor screw

provides a means of placing a suture in the bone

joint implants

metal or synthetic components used to replace the diseased or injured tissue

cobalt-chromium-molybdenum, titanium-aluminum-vanadium, pure titanium, tantalum

the metals and alloys most commonly used are (4):

polyethylene

______________ is a highly durable, low-friction plastic in the form of ultrahigh molecular weight, highly crosslinked ________________.

ceramic

____________ materials were developed in orthopedic technology to increase resistance to wear; alumina, zirconium, and oxidized zirconium are currently used

cemented

implants used in arthroplasty may be _____________ in place wtih polymethylmethacrylate (PMMA)

PMMA

___________ is a hazardous chemical and must be handled according to regulations established by the national institute for occupational and safety health (NIOSH) and the hospital's policies and protocols; exposure to its vapor is an occupational risk and use of the cement is associated with toxic and cardiovascular events in patients

casting

__________ is a method of external fixation in which a limb is immobilized by applying plaster or synthetic resin

compartment syndrome

the single largest patient risk associated with casting is ______________ ____________; this is edema (swelling) of tissue within a closed part of the body or inside an external cast

traction

a mechanical method of applying a pulling force

joint distention

_________ ____________ with saline or lactated ringer solution is necessary for arthroscopy of the shoulder and knee; fluid is instilled into the joint through one port and out through another

inflow and outflow

__________ tubing and ___________ tubing are required to maintain continuous flushing of the joint

recurrent dislocation

__________ ____________ requires surgical treatment in most cases and is the main reason to perform a bankart procedure

oblique

oblique