Ch 23 Orthopedics

Bone and Bone Tissue

• Provides a framework to support the body 

• Serves as points of attachment for muscles 

• Protects internal organs 

• Produces red blood cells (hematopoiesis) 

• Stores calcium and minerals 

Osteocytes

Mature bone cells that maintain bone tissue

Osteoblasts

Responsible for bone formation

Osteoclasts

Responsible for bone resorption (breaking down)

Compact (Cortical)

Hard, dense bone that surrounds the bone marrow cavity

Cancellous (Spongy)

Porous bone found at the ends of long bones and lining the medullary cavity

Epiphyses

The joint ends of long bones, covered in articulating cartilage

Metaphysis

The area containing the epiphyseal (growth) plate

Diaphysis

The shaft of the bone

Long Bones

femur, humerus

Flat Bones

ribs, sternum

Irregular Bones

vertebrae

Cuboid Bones

carpals, tarsals

Synarthrosis

Immovable joints (e.g., sutures of the skull)

Amphiarthrosis

Slightly movable joints (e.g., intervertebral discs)

Diarthrosis

Freely movable joints

Ball and Socket

Shoulder, hip

Condyloid

Wrist (movement in one plane)

Gliding

Intercarpal joints (side-to-side movement)

Hinge

Elbow, knee (pivoting in one direction)

Saddle

Thumb (movement in many planes)

Pivot

Atlantoaxial joint (rotational movement)

Superior/Cephalic

Toward the head

Inferior/Caudal

Toward the feet

Anterior/Ventral

Toward the front of the body

Posterior/Dorsal

Toward the back of the body

Medial

Toward the midline of the body

Lateral

Away from the midline

Proximal

Closer to the point of attachment to the trunk

Distal

Further from the point of attachment

Flexion

Bending a joint

Extension

Straightening a joint

Supination

Palm up or forward

transverse fracture

oblique fracture

spiral fracture

comminuted fracture

segmental fracture

avulsed fracture

impacted fracture

torus fracture

greenstick fracture

fracture healing

• take 8-12 weeks Fractures

• Should be completely immobilized, in proper alignment, pt should be in good health for best healing

Open (compound) fracture

Bone pierces the skin

Closed fracture

Bone does not break the skin

Healing Phases

1. Inflammation

2. Cellular Proliferation

3. Callus Formation

4. Ossification

5. Remodeling

Distraction

• Fragments pulled apart

• Bone fragments are separate from the bone

Avascular Necrosis

Bone death from reduced blood flow

Perthes Disease

Pediatric avascular necrosis

Delayed Union

• increased time for fracture healing

• Healing takes longer

Nonunion

Fracture fails to heal

• Tobacco use, age, anemia, diabetes, medications

Malunion

Fracture heals improperly or in strange psotion

Compartment Syndrome

• Increased pressure in a closed space

• Can lead to infection, ischemia, nerve damage

Casts

• Short Arm

• Long Arm

• Short Leg

• Long Leg

Cylinder Cast

cast used for femur injuries

Hip Spica cast

cast to immobilizes hip and thigh

Human Skeleton

206 Bones

Axial Skeleton

• 80 bones

• Skull, vertebrae, ribs, sternum

Appendicular Skeleton

• 126 bones

• Limbs and girdles

Vertebral Column

• Cervical (C1–C7)

• Thoracic (T1–T12)

• Lumbar (L1–L5)

• Sacral (S1–S5)

Ribs (cost/o)

• True : First 7 pairs (attach to sternum)

• False : Last 5 pairs (indirect or no attachment)

• Floating: Last 2 pairs

Sternum

midline breastbone

Clavicle

• Collarbone

• Acts as a brace for the scapula

Scapula

Shoulder blade

Pectoral Girdle joints

• Glenohumeral Pectoral Girdle

• Sternoclavicular

• Acromioclavicular

Humerus

• Longest bone of upper extremity

• Scapula to elbow

Radius

Thumb side; articulates with humerus and ulna

• Extends from the elbow to the wrist

Ulna

Medial bone; articulates with trochlea

• Trochlea – proximal end that articulates with humerus

Hand and Wrist

• Carpals – wrist bones

• Metacarpals – palm

• Phalanges – fingers

• 27 Bones in all

Pelvic Bones

Provide support and attachments for the femur

• Ilium, ischium, and pubis fuse to form the innominate bone

Femur

• Largest joint in the body

• Ball and socket joint

• Largest and strongest bone in the body

• Femoral head fits perfectly inside the acetabulum

Tibia and Fibula

• medial and weight-bearing

• lateral and smaller

Patella

Sesamoid bone embedded in the quadriceps tendon

• Posterior surface articulates with the femur

femoral head and neck and greater and lesser trochanters

Proximal end of femur consists of

lateral and medial condyles

Distal end of femur consists of

Condyles of the femur and tibia

form the knee joint

patellar surface

Condyles separate into

Ankle joint

• Consists of seven tarsal bones

• Largest is the calcaneus

  • Aids in supporting weight

Knee is stabilized

• Anteriorly by patellar and quadriceps tendon

• Laterally and medially by the Medial and lateral collateral ligaments

• Posteriorly by the popliteus and gastrocnemius muscles

PCL

prevents femur from sliding anterior on the tibia

ACL

attached to posterior lateral condyle of the femur

Meniscus

thick pads of cartilage that cushion the knee

• Lateral meniscus

• Medial meniscus

Foot

• Five metatarsals

• 3 phalanges per toe

• Big toe has only 2

Fracture Table

Used for lower extremity surgeries

Andrews Table/Wilson Frame

Used for prone spine surgeries

Shoulder Traction Devices

Used for shoulder arthroscopy

Bean Bag Positioner

Used for lateral positioning

Wilson Frame

Andrews Table

Tourniquet Use

• Provides bloodless field

• Applied proximal to surgical site

• Use Esmarch or Ace wrap to exsanguinate limb

Tourniquet Use Max times

• Upper extremity: 1 hour

• Lower extremity: 1.5–2 hours

• Every 15 mins thereafter

Traction

Maintains bone alignment pre-op, intra-op, and post-op

• Immobilizes the joint

• Reduces a fracture

• Realigns the bones

Radiography

• Used on most orthopedic cases

• May use fluoroscopy (C Arm) or cassette hard plate

• You are required to wear a lead apron to protect yourself

• Thyroid shield is also available

C-arm Fluoroscopy

Used in most orthopedic procedures

Battery, nitrogen, or electricity

Power Tools Powered by

Lead apron and thyroid shield required

PPE

Side-to-side motion

Oscillating Saws

Forward and backward motion

Reciprocating Saws

Reamers

Used to enlarge canals for implants

• A rotating tool used to shape or

enlarge holes

Arthroscopic Equipment

• Video monitor

• Light Source

• Fluid pump and tubing (May just use gravity)

• Camera system

• Video recording system

• Photo printer