Orthopedic Surgery Notes

Objectives

  • At the end of this lecture, students should be able to:
  • Explain the anatomy, physiology, and pathology of common orthopedic cases:
    • Orthopedic trauma including sports injuries
    • Arthritis
    • Bone tumors
    • Congenital/Pediatric orthopedic cases
  • Understand the management of common orthopedic cases

Orthopedics Overview

  • Definition: Medical specialty focused on injuries and diseases of the musculoskeletal system, which includes bones, joints, tendons, and muscles.
  • Subspecialties include: Trauma, Sports Medicine, Spine, Joint, Oncology, and Pediatric Orthopedics.

Orthopedic Trauma

  • Significance: 5th leading cause of death in the US in the first five decades of life.
  • Nature of Injuries: Includes fractures of bones, damage to joints, and injuries to soft tissues.

Key Terminology

  • Fracture: Disruption of normal bone architecture, often from high-energy trauma.
  • Acute vs. Chronic Fracture:
  • Acute Fracture: Sharp edges of fragments.
  • Chronic Fracture: Rounded and sclerotic appearance after resorption.
  • Incomplete Fractures: Greenstick (children) or infractions (adults).
  • Stress Fractures: Result from chronic repetitive trauma.

Types of Fractures

  • Acute Fracture Types:

  • Transverse

  • Oblique

  • Spiral (rotational force)

  • Segmental

  • Comminuted (multiple fragments)

  • Pathologic Fracture: Results from weakened bone due to disease.

  • Fragility/Insufficiency Fracture: Common in osteoporotic bones, often results from lower energy accidents.

  • Open vs. Closed Fractures:

  • Open: Communication between fracture and external environment.

  • Closed: No external communication.

  • Location in Long Bones:

  • Epiphysis: Area between growth plate and articular surface.

  • Metaphysis: Between epiphysis and shaft, includes growth plate.

  • Diaphysis: Shaft section.

Management Goals

  • Restore normal anatomy
  • Immobilize for pain relief and healing (using splints or casts)
  • Utilize implants (screws, plates, pins, rods, external fixators) for repair/reconstruction

Fracture Descriptions

  • Fractures should be described with the following:
  • Open or closed, grade
  • Type (e.g., transverse, comminuted)
  • Laterality (right or left)
  • Location (e.g., condylar, shaft)

Injuries and Patterns

  • Common patterns and associated injuries:
  • Falls, vehicle ejections, and trauma mechanisms leading to specific fractures and complications.

Fixation Principles

  • External Fixation: Utilizes external frames with pins and connectors.
  • Internal Fixation (ORIF): Pins, screws, tension bands, plates, and nails for stabilization.

Complications

  • Open Fractures: Can lead to soft tissue damage and contamination, risk of sepsis. Initial treatment includes irrigation, debridement, and antibiotics.

  • Compartment Syndrome: A surgical emergency indicating significant swelling that jeopardizes blood supply.

  • Causes include fractures and limb compression; treatment involves fasciotomy.

Ligament and Joint Injuries

  • Sprains: Ligament injuries classified by severity (Grade I to III).
  • Strains: Injuries to muscles or tendons, typically treated with rest and elevation.
  • Dislocations: Require urgent management to avoid complications like avascular necrosis.

Sports Medicine

  • Focuses on injury prevention and rehabilitation.
  • Shoulder: Common injuries include rotator cuff tears and instability. Treatment often requires arthroscopic intervention.
  • Knee: Injuries include ACL, MCL, and meniscal tears, with surgical options primarily for ACL repair.

Pediatric Orthopedics

  • Birth Injuries: E.g., Brachial plexus palsy from traumatic birth conditions.
  • Fracture Management: Distinct handling due to developmental considerations.
  • Developmental Dysplasia of the Hip (DDH): Management through non-surgical means like harnessing or surgery for severe cases.

Orthopedic Pathology and Oncology

  • Focuses on primary and metastatic bone tumors.
  • Key Tumors: Osteosarcoma and Ewing’s Sarcoma, requiring surgical management and often chemotherapy.
  • Common sites for tumors: Includes long bones (femur, tibia), pelvis, and spine.