Orthopedics

  1. History of Ortho 
    Primitive Men
    • treatment of fractures 
    • splints + crude amputations 
    • understood malignancy of bone as a concept
  2. History of Ortho 
    Egyptians
    • 3 categories of injury 
    • - fractures they could treat 
    • - fractures they could contend 
    • - fractures they could not treat
  3. History of Ortho
    The Greeks
    • first scientific approach 
    • - documented injuries + treatments 
    • - human dissections
  4. History of Ortho 
    Hippocrates
    • dedicated a book to ortho 
    • - describe injuries 
    • - methods of closed reduction in dislocation + fracture
    • - traction + counter-traction (Hippocrates bench)
    • - tools for external fixation 
    • - described pes equinovarus + congenital hip dysplasia
  5. pes equinovarus
    • classical clubbed foot 
    • pes - foot 
    • equino - elevated heel (like in horse)
    • Varus - turned inwards
  6. congenital hip dysplasia
    • abnormal formation of the hip 
    • ball (femoral head) is not stable within socket (acetubulum)
  7. History of Ortho 
    Romans
    • - recognised muscular involvement in mobility problems, bone deformities and fractures 
    • - recognised + treated spinal problems (lordosis, kyphosis, scoliosis) 
    • - artificial prosthesis 
    • - subcutaneous tenotomy 
    • - developed saws + tools for ortho
  8. History of Ortho 
    Galen
    father of sports medicine
  9. Kyphosis
    • outwards curvature of spine 
    • hunchback
  10. Lordosis
    inwards curvature of spine
  11. Scoliosis
    lateral curvature of spine
  12. History of Ortho
    Ambroise Paré - 16th century
    developed variety of instruments for ortho
  13. History of Ortho 
    Nicholas Andry - 18th Century
    first pediatric orthopedics book
  14. History of Ortho 
    John Hunter - 18th century London
    studied process of bone healing + inflammation in the bone
  15. Thomas Test
    • patient lies on back at edge of examination table and brings knees into chest 
    • patient drops one knee so the leg is hanging off the end of the table 
    • - leg does not drop to level of table - tight hip flexors 
    • - no 90° angle in knee - tight quadriceps
  16. History of Ortho
    Hugh Thomas - 19th century
    • most important role in modern era 
    • - developed many instruments + techniques 
    • - developed splints 
    • - therapy for TB in bones (rest) 
    • - concealed flexion of hip joint = first indication of hip disease 
    • - Thomas test
  17. History of Ortho
    19th century
    • inhalation anesthesia 
    • plaster casts 
    • asepsis 
    • endoscopic surgery
  18. History of Ortho
    Prof Chlumsky
    1st ortho department in czechoslovakia
  19. History of Ortho 
    Prof Tobaisek - 1927
    • - first ortho clinic in Bohemia (charles uni clinic)
    • - conservatiev treatment of locomotor apparatus
  20. History of Ortho
    Prof Zahradnicek - 1933
    • greatest ortho surgeon of czechia 
    • - developed intensive surgical care 
    • - therapy of congenital hip dislocation 
    • - surgery of non-unions 
    • - developed own external fixations
  21. History of Ortho
    Dr Cizek
    • - joint replacement 
    • - itnroduces judet osacryl cups 
    • introduced austin moore interposition arthroplasty
  22. History of Ortho 
    Prof Hnavkovsky - 1842
    founded LF2
  23. Joint capsule
    • ligamentous sac that surrounds articular cavity 
    • attached to bone 
    • completely encloses joint 
    • outer fibrous membrane + inner synovial membrane
  24. Ligament
    fibrous connective tissue that connects 2 bones / cartilages
  25. Tendon
    fibrous connective tissue that connects muscle to bone
  26. Articular Cartilage
    • hyaline cartilage 
    • covered by synovial membrane (contains blood vessels)
    • made of 
    • - type 2 collagen 
    • - chondroitin sulphate 
    • strong fairly inflexible structure on surface of joints 
    • breakdown --> osteoarthritis
  27. Synovial Fluid
    • viscous non-newtonian fluid 
    • found in joint cavities 
    • role 
    • - reduce friction 
    • - shock absorption 
    • - transport waste + nutrient 
    • produced by synovial membrane 
    • made of 
    • - water 
    • - hyaluronan 
    • - lubricin
  28. Muscle attachments
    via tendons
  29. Joint types
    • plane - intercarpal / intertarsal 
    • hinge - elbow / interphalangeal 
    • pivot - radioulnar 
    • condylar - knuckles / wrist
    • saddle - carpometacarpal joints of thumb 
    • ball and socket - shoulder / hip
  30. joint movements
    • gliding 
    • flexion / extension 
    • rotation 
    • abduction / adduction
  31. bone structure
    • periosteum - surrounds bone 
    • osteon - compact bone unit with central osteonic canal 
    • osteonic canal - contains nerve + blood vessels
  32. bone architecture
    • central canal surrounded by spongey bone with compact bone around and periosteum surrounding everything 
    • epiphysis - head 
    • diaphysis - body of long bone
  33. bone morphology
    • flat or long bones 
    • spongey or compact
  34. bone healing
    • 1. hematoma formation - necrosis + death 
    • 2. organisation - inflammation + granulation tissue
    • 3. callus formation - fibroblasts (stroma), osteoid, mineralisation 
    • 4. remodeling - osteoclasts (resorb), osteoblasts (lay down
    • 5. modeling
  35. bone healing complications
    • mal-union 
    • delayed union 
    • non-union - pseudoarthrosis
  36. tendon healing
    • no blood vessels so slow to heal 
    • never regain original mechanical properties (decreased strength) 
    • 1 inflammation - neutrophils + macrophages (angiogenesis) 
    • 2. proliferation - tenocytes (type 3 collagen)
    • 3. remodeling - consolidation (type 1 collagen)
    • 4. maturation
  37. ligament healing
    • no blood vessels so slow to heal 
    • never regain original mechanical properties (decreased strength) 
    • 1 inflammation - neutrophils + macrophages (type 3 collagen)
    • 2. proliferation (type 1 collagen)
    • 3. remodeling 
    • 4. maturation
  38. greenstick fracture
    deformation of bone without actually breaking in children (more flexible)
  39. salter harris fracture
    • fracture of the growth plate 
    • type 1 - across growth plate 
    • type 2 - growth plate + metaphysis (most common)
    • type 3 - growth plate + epiphysis 
    • type 4 - growth plate = epiphysis + metaphysis 
    • type 5 - crushing growth plate fracture
  40. supracondylar humeral fracture
    • very seriuos 
    • must be reduced + stabilized
  41. torus / buckle fracture
    incomplete fracture of shaft of long bone --> angulation + bulging of cortex
  42. arthrocentesis
    joint aspiration of synovial fluid
  43. biopsy
    • fine needle aspiration 
    • punch biopsy - bone marrow 
    • surgical biopsy - tumors
  44. arthroscopy
    uses fiber-optic camera to give view of inside of joint.
  45. soft tissue release
    release of contractures of tendons and ligaments
  46. tendon lengthening
    zig-zag cut of the edge of the tendon and joining of " long edges together to elongate it
  47. tendon transfer
    transfer insertion of muscle from one tendon to another
  48. osteotomy
    • cutting bone to correct deformity 
    • McMurrey's - fracture of neck of femur 
    • Salter operation - restore acetubular alignement 
    • Wyer operation - correct inversion of foot in clubfoot
  49. arthrotomy
    opening joint surgically
  50. arthrodesis
    surgical fusion of a joint (stops movement)
  51. arthroplasty
    • artificial joint replacement 
    • excsion arthroplasty - joint surfaces excised only
    • hemiarthroplasty - only one joint surface replaced 
    • total arthroplasty - both joint surfaces are replaced
  52. laminectomy
    remove laminae of vertebrae to allow access to intervertebral discs through ligamentum flavum
  53. amputations
    • avoid midtarsal amputations 
    • open - skin not closed over stump 
    • closed - cut skin and muscle distal to bone and close over stump
  54. excisions
    • curretage 
    • extralesion excision 
    • wide excision 
    • radical excision
  55. bone grafting
    • taken from iliac crest (trabecular) or fibula (cortical)
    • autograft - from patients own body 
    • allograft - from another human 
    • xenograft - from another animal
Author
Marine
ID
340894
Card Set
Orthopedics
Description
Orthopedics (5th Year)
Updated