Introduction in Fracture & orthopedics


Dr Mahmood kh yaseen
! Aim of this lecture:
! What do we mean by orthopedics.
! Orthopedics diagnosis:
! Symptoms.
! Signs
! Investigation tools.
! Orthopedics procedures.
! References
! Applys system of orthopedics and fractures
! Campblles operative orthopedics
! Internet search
Orthopedics:
concerns with bones, joints, muscles, 

tendon & nerves i.e. skeletal system & all
that make it move.
Diagnosis begins with systematic gathering
of information from history, physical
examination, X-ray & special investigations.
Symptoms:
History can be very informative as
examination or laboratory tests.
 Orthopedics symptoms:
! Pain: most common symptoms in orthopedics ,
! it can be localized or deep ,
! of different nature
! Grade
! Grade I (mild) Pain that can easily be ignored.
• Grade II (moderate) Pain that cannot be ignored,
! treatment from time to time.
Grade III (severe) Pain that is present most of the
time, demanding constant attention or treatment.
• Grade IV (excruciating) Totally incapacitating

Always ask the patient to point to the site of pain.

! Swellings
! Soft tissue
! Bone
! Joints
! Rapid growth :
! PainfulI
! Deformity:
! Described by the patient himself
! Localized
! Generalized
! Progressive.
! Change in sensibility:
! Hyperasthesia
! Hypothesia
! Due to pressure effect
! Ischemia and entrapment
! Loss of function:
! I can’t stand long time…… backaches
! I can’t put on my soaks…….. Hip stiffness.
Always assess the NEUROVASCULAR status of the part or limb
! Examination:
! In orthopedics examination is part of general patient exam or assessment. We
examine patient in 3 steps:
! look,
a, shape and posture.
! b:skin.
! c.general survey.
! feel :
! a.skin(moist,dry,sensation).
! b.bone and joints.
! c.tenderness.
! move:
! a.active
! b.passive.
! c.Provocative.
! Always assess the NEUROVASCULAR status of the part or limb.
! X-ray examination:
! 1.At least two views AP & lateral.
! 2.Shows two joints one above & one below the area of
examination.
! 3.Show two limbs for comparison.
! 4.Show the two bones in the forearm & leg.
! 5.Taken at two different occasions to diagnose the disease and
follow its progression.

!  Special imaging techniques:

! Contrast radiography: we use opaque liquids to outline
sinuses, arthrography to outline a joint or myelography to
outline spinal canal.
! Tomography: give us a view focused in certain plain only.
 1- show tumor extension & shape in bone & soft tissue
2- important for assessment of spinal canal.
! CT scan:
! Radioisotope scan:
! Ultrasound:
! MRI:
! Electrodiagnosis:

soft tissue mass,

heamatoma,
cysts,
cartilage
joint effusion.
! Orthopedic procedures
! Basic procedures:
! Drilling:
! may be used to evacuate a bone abscess & most commonly drill is
used to prepare a hole in the bone for screw.
! Cutting:
! cancellus bone can be cut by the osteotome while cortical bone cut
by an oscillating saw.
! Modeling or reshaping bone:
! : by a chisel or gouge.
! Reaming meaning widening usually of medullary cavities of bone to
allow introduction of nail or prosthesis.
! Fixing: bone fragments can be firmly joined or fixed by; screw, plate
and screw, long nails, wires, external fixator or others.
!  
! Bony operations.

! Osteotomy: it’s the procedure where we cut bone by

osteotome or saw to correct deformity or reshape the
bone or to relieve pain of arthritis. After osteotomy we
can fix the bone by different fixation methods or by POP.
! The bone cuts are different e.g. transverse, oblique,
wedge like osteotomies (open wedge or closed wedge
sometimes-double wedge).
! Bone graft: by taking bone from one site of body and
putting it in a new site it acts by two ways;
! They replace lost or missed bone. They stimulate new
bone formation
cancellus bone most usually taken from iliac crest or proximal tibia.
Cortical graft is taken from fragments of fibula or sometimes its
mixed corticocancellus graft.
! Leg equalization:
! Fixation of fracture.
! Operations on joints.
! 1. Arthroscopy: the interior of a joint can be visualized by
inserting an endoscope through a small incision. In addition
introducing certain instruments through separate portals can do
certain operative procedures.
! 2. Arthrotomy: it means surgical opening of a joint, its indications
are:
! a) To inspect the inside of the joint or taking synovial
biopsy.
! b) To drain heamatoma or abscess.
! c) To remove loose bodies or damaged structures like torn
meniscus.
! d) To excise inflamed synovium (synovectomy).
! 3.Realignment osteotomy: used for the treatment of mild
osteoarthritis in young patients. We do osteotomy near the
affected joint & realign articular surfaces so that the less
affected sides exposed to the maximum weight bearing
stresses. Usually the osteotomy is held by internal fixation.
! 4. Arthrodesis: it means fusion of the joint in functional
position used for destroyed painful or unstable joint. There
must be good functioning proximal & distal joints & the
principle of surgical procedure is:
! a)Removal of both joint surfaces & exposure of underlying
bone.
! b) The bones are apposed together in a functional position
& fixing it by internal fixation.
! c) Bone graft is added to improve & hasten fusion.
Realignment osteotomy:
! d) The limb is splinted for 3-6 months until joint fusion & union.
!
5. Arthroplasty: these operations aim at pain relief &
improvement of range of movement. There are 3 different types:
! a) Excesional arthroplasty: we excise good amount of bone &
create a gap instead of the joint which later get fibrosed & allow
good painless range of motion but the joint gets unstable e.g. hip
excesional arthroplasty which is called Girdle-stone hip arthroplasty.
! b) Partial replacement arthroplasty: here only one joint surface is
cut & replaced by a prosthesis which is fixed to bone by fitting or
bone cement e.g. Austin-Moore hemiarthroplasty for fracture of
femoral neck.
! c) Total joint replacement arthroplasty: as for the knee or hip. Here
both articular surfaces are cut and replaced by prosthesis that is
fitted to the bone or fixed to it by bone cement.