Operating Room Personnel

(Orthopaedic Department)

Yudha Mathan Sakti

 PREREQUISITES
FOR SURGICAL CARE
• Proper operating room
environment
• Trained surgeon
• Trained personnel
• Appropriate instruments
and implants
• Adequate aftercare
• TEAMWORK!
 BONE -- A LIVING TISSUE

• Supports soft tissues

• Enables locomotion
 ANATOMY OF BONE

• Diaphysis

• Metaphysis

• Epiphysis --
growth area
 BONE STRUCTURE

• Cancellous Bone

• Cortical Bone
 CANCELLOUS BONE

• Spongy bone
• Metaphyseal location
• ¼ the mass and 10% the
strength of cortical
bone
 CORTICAL BONE

• Shell around all bones

• Thickest in diaphyseal
location
• Very strong
 BLOOD SUPPLY
• Diaphysis
– Nutrient artery, 2/3 of blood
supply
– Periosteal vessels, 1/3 of blood
supply

• Metaphysis
– Rich blood supply
– Endosteal vessels, periosteal
vessels and soft tissues
 BONE PROPERTIES
• Bones contain biomechanical properties of
stiffness & strength but break under very little
deformation
 FRACTURES

• Overload of bone
• Loss of bony continuity
• Loss of support
• Soft tissue damage
• Damage to blood
supply
 TYPES OF FRACTURES
• Amount of force, direction of force, and soft tissue
attachments determine fracture patterns:
• Transverse
• Oblique & Spiral
• Impacted
• Comminuted
• Each pattern requires an implant with different
biomechanical properties to resist body’s forces
TYPES OF FRACTURES

Transverse

Oblique
Spiral
TYPES OF FRACTURES

Impacted
Comminute
 BONE HEALING

• How bone heals depends on the stability of

the fracture fixation and the motion
between the fragments

– Relative stability – some motion

– Absolute stability – no motion
 BONE HEALING

• 2 Types:
– Indirect bone healing
– Direct bone healing
 INDIRECT BONE HEALING

• Usual picture of bone

healing
• Callus formation
• “Relative” stable fixation
(some motion)
 INDIRECT BONE HEALING

• Examples of “relative” stable fixation:

– Casting
– External fixation
– Intramedullary nailing
 DIRECT BONE HEALING

• Contact healing between

bones
• No callus
• Requires “absolute” stability
between fracture fragments
(no motion)
 DIRECT BONE HEALING
• Absolute stability comes
from compression of
bone fragments

• Achieved with lag screws

and compression plates
 1883
(W.A. Lane – a surgeon)  developed a system of
metal screws and plates for internal fixation

 Early plates and screws were made of vanadium steel

 tissue TOXIC and teratogenic
(Vanadium is a soft, ductile, silver-gray metal, good resistance to
corrosion and stable against alkalis, sulfuric and hydrochloric acids)

 1926
Design improvement  switched to newly-invented
stainless steel

 1950
Titanium alloy was developed
 1969 - DCP (dynamic compression plate)
 new hole design for axial compression

The screw can slide along the hole

Create compression effect

  Application of drill guide on DCP

The Position of your screw will affect the compression

 Limited contact
dynamic compression
plate
(LC – DCP)

 More biological friendly

 Has trapeziodeal cross

section
 easier during removal

 Easier to bend
Limited contact dynamic compression plate
(LC – DCP)

Damaged periosteal
blood supply
Tubular plate
› 1/3 tubular : 3,5
1 mm thickness, limited
stability, useful in minimal
soft tissue covering, each
hole surrounded by small
collar
› Semi tubular : 4,5
Reconstruction plate
 Available in 3,5 and 4,5

 Characterized by deep
notches  for contouring

 Have dynamic compression

hole

 For fracture in complex 3D

geometry structure
(pelvis, acetabulum, distal
humerus and clavicle)
 Specific plate
For several location is
developed based on
the anatomical and
biomechanical
requirements
 More Stability

Lag Screws

Compression
Bridge Plates
IM Nail Plate
Ext Fix
K-wires

Less vascular & biological damage

 Compression

 Neutralization

 Tension

 Buttressing
 Compression
  A plate provide interfragmentary
compression
Compression

+5M
 Neutralization
  reduces torsional, bending and
axial forces on an interfragmentary
compression screw
 Neutralization

Lag Screw

&

Interfragmentary
Compression Neutralisation Plate
 Buttress
  maintains or supports the lag screw
fixation against axial loads
Buttress
 Tension Band
  the plate converts tensile forces
into compression

(applied on femur, humerus, radius)

 Summary

• Lag screws & compression plates provide absolute

stability & direct bone healing

• Casts, ex fix and IM nails provide relative stability &

indirect bone healing

• Both have their place in internal fixation

When Should You Consider Surgery?
(Indications)

• Internal fixation should be used only if the

disadvantages of conservative treatment can be
overcome by surgical treatment

• Requires knowledge of the techniques &

adherence to the principles
 FRACTURES
• Which MUST be operated on:
– Open fractures
– Intra-articular (in the joint) fractures
 FRACTURES
• Which MAY be operated on:
– Tibia shaft fractures
– Humeral shaft fractures
 FRACTURES

• Which should NOT be operated on:

– Simple vertebral fractures
– Uncomplicated clavicle fxs
– Most children’s fractures