Chapter 29 Orthopedic

. BONES AND THEIR STRUCTURE

Divisions of the Skeleton

• Axial Skeleton

• Skull

• Spinal column

• Rib cage

• Appendicular Skeleton

• Upper extremities

• Lower extremities

Types of Bones

• Long Bones

• Diaphysis – long shaft

• Epiphyses – ends

• Bone Tissue

• Cortical (Compact) – dense, strong outer layer

• Cancellous (Spongy) – porous, located inside epiphyses and flat bones

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2. BONE LANDMARKS

Purpose

• Serve as attachment sites for muscles and tendons

• Provide passageways for nerves and blood vessels

• Help identify joint surfaces and structural features

Common Landmarks

• Condyle – rounded articular surface

• Crest – prominent ridge

• Foramen – opening for vessels/nerves

• Process – projection from a bone

• Fossa – shallow depression

• Neck – narrowed region near head of bone

• Tubercle – small rounded bump

• Tuberosity – larger roughened bump

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3. JOINTS

Classification by Movement

• Synarthrosis – immovable (e.g., skull sutures)

• Amphiarthrosis – slightly movable (e.g., pubic symphysis)

• Diarthrosis – freely movable (major limb joints)

Synovial Joints (Diarthrodial)

• Features:

• Articular cartilage

• Joint capsule

• Synovial membrane + synovial fluid

• Purpose: Lubrication, shock absorption, smooth movement

Joint Mobility – Types of Movable Joints

• Hinge – elbow, knee

• Saddle – thumb (CMC joint)

• Gliding – wrist, ankle

• Ball-and-socket – shoulder, hip

• Pivot – atlas/axis in neck

• Condyloid – wrist (radiocarpal joint)

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4. SOFT CONNECTIVE TISSUES & JOINT CONDITIONS

Common Soft-Tissue Injuries

• Tears / ruptures of tendons, muscles, or ligaments

• Repaired using:

• Sutures

• Suture-anchor systems

Joint Pathology

• Age-related degeneration

• Trauma

• Autoimmune disorders (e.g., rheumatoid arthritis)

• Osteoarthritis – most common degenerative joint disease

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5. ORTHOPEDIC PATHOLOGY

Important Terms

• Fracture – break in bone continuity

• Rupture – complete tear

• Avulsion – tissue pulled off attachment site

• Overuse injury – repetitive strain

Fracture Classification

Based on:

• Location

• Pattern

• Comminution (how many pieces)

• Displacement

Types of Fractures

• Transverse – straight across

• Oblique – angled

• Spiral – torsion force

• Impacted – ends driven together

• Comminuted – multiple fragments

• Open (compound) – bone breaks skin

• Greenstick – incomplete (common in kids)

• Depressed – bone pushed inward

• Pathological – due to disease (e.g., tumors, osteoporosis)

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6. FRACTURE REPAIR PROCESSES

Reduction (Alignment)

• Closed reduction – manipulation without incision

• Open reduction – surgical exposure of bone

Fixation (Stabilization)

• Internal fixation – plates, screws, rods

• External fixation – casts, external frames

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7. ORTHOPEDIC SURGERY CASE PLANNING

Important Factors

• Correct surgical approach

• Instruments and implants required

• Awareness of special tables (e.g., fracture table)

• Appropriate patient positioning

• Supine, prone, lateral

• Positioning devices as needed

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8. HEMOSTASIS IN ORTHOPEDIC SURGERY

Methods

• Pneumatic tourniquets – control blood flow to extremities

• Hemostatic agents (e.g., bone putty) – reduce bone bleeding

Infection Prevention

• Laminar airflow systems

• Sterile helmet systems

• Strict sterile technique

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9. DRESSINGS AND CASTING

Dressings

• Protect incision

• Absorb drainage

• Provide stability

Casting

• Plaster or synthetic casts

• Used for immobilization

• Risk: compartment syndrome – medical emergency

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10. POWER EQUIPMENT IN ORTHOPEDICS

Devices

• Drills – for screws

• Saws – for bone cutting

• Must understand:

• Correct attachments

• Safety principles

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11. ORTHOPEDIC IMPLANTS (must not be processed using immediate-use steam sterilization- except in extreme emergency )

Materials

• Stainless steel

• Titanium alloys

• Bioactive materials for grafting

Documentation

• Implant tracking for patient safety (lot numbers, serial numbers)

Bone Grafting

• Types:

• Autograft

• Allograft

• Synthetic grafts

• Mechanisms:

• Osteogenesis

• Osteoinduction

• Osteoconduction

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12. SUTURES & SUTURE DEVICES

Soft Tissue Repair

• Uses primarily nonabsorbable materials in orthopedics

• Modern devices:

• Suture anchors

• Barbed sutures

• High-strength materials

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13. COMMON ORTHOPEDIC SURGICAL PROCEDURES

Includes detailed approaches & considerations for:

• Shoulder surgeries (rotator cuff repair, labrum repairs)

• Fracture repairs (ORIF, external fixation)

• Knee arthroplasty (TKA)

• Hip procedures

• Arthroscopy

Type of Plates

  • Reconstruction Plate - bent to fit the contours of the bone surface, aluminum template , commonly used in pelvic and in cranial and fascial trauma

  • locking plate- threaded screw holes that lock the screws into the plate,

  • dynamic compression plate - provides reduction and compression of the fragments

  • low-contact dynamic - is designed to reduce contact between the plate and the bone—

  • tension band plate —- provides a mechanical advantage in the fixation of the long bones—

  • buttress plate — is a supporting structure that prevents an adjoining object or structure from collapsing ( in orthopedic — is used to give added strength

  • condylar plate - used in conjunction with compression screws for the fixation of fractures of the condyle ( rounded end of the a long bone )

  • intertrochanteric nail and plate combination - jewett nail - two primary pieces —- lag screw , locking plate

intramedullary nail or rod - provide structure support from the inside of the bone ( fractures of femur, tibia and humerus ( long bones )

modular rod and pin fixation - used for external stabilization of a fracture.

Procedures -

  • Bankart (open ) - glenoid rim is reattached to the joint capsule with a biosynthetic or other anchoring device : path - the tearing or separation of the labrum from the joint capsule

  • Rotator cuff repair - ( tendons are attached to the humerus with sutures or anchor-suturing devices ) one or more tendons may be damaged due to traumatic injury or recurrent dislocation of shoulder

  • total shoulder arthroplasty - humeral head and glenoid capsule are replaced with artificial components to restore function and relieve pain (osteoarthritis )

  • hemiarthroplasty - only humeral component used

  • open reduction internal fixation of forearm ( -functional joint )usually repaired using dynamic compression plate (closed reduction - external fixation applied for children only )

  • open reduction and internal fixation of the wrist - scaphoid most common sire of a wrist fracture -

  • release dupuytren contracture - constricted palmar fascia is incised and released to restore mobility to the hand and fingers ( contracts )

  • femoral neck fracture - ( trochanteric fracture - compression screw and plate system ) Femoral neck fracture - dynamic compression screws ) displaced fracture - arhtoplasty

  • Hip ( total ) arthoplasty - replaced diseased components of hip joint , path - to treat osteoarthritis, osteonecrosis, acetabular, femoral, avascular necrosis

  • fracture of the pelvis - open reduction

  • arthroscopic menisectomy - may be partial or complete - leave the medial rim of the structure to share load bearing and stabilize the knee

  • cruciate ligament repair - restore the stability of the joint, graft taken from central portion of patellar tendon to replace torn ACL

  • triple arthrodesis - removing cartilage from each joint ( bone grafts or biosynthetic graft used)

  • bunionectomy - to alleviate pain and increase patient immobility ( path - deformity of the first metatarsal head )