Orthopedics

• treatment of fractures 
• splints + crude amputations 
• understood malignancy of bone as a concept

• 3 categories of injury 
• - fractures they could treat 
• - fractures they could contend 
• - fractures they could not treat

• first scientific approach 
• - documented injuries + treatments 
• - human dissections

• 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

• classical clubbed foot 
• pes - foot 
• equino - elevated heel (like in horse)
• Varus - turned inwards

• abnormal formation of the hip 
• ball (femoral head) is not stable within socket (acetubulum)

• - 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

father of sports medicine

• outwards curvature of spine 
• hunchback

inwards curvature of spine

lateral curvature of spine

developed variety of instruments for ortho

first pediatric orthopedics book

studied process of bone healing + inflammation in the bone

• 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

• 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

• inhalation anesthesia 
• plaster casts 
• asepsis 
• endoscopic surgery

1st ortho department in czechoslovakia

• - first ortho clinic in Bohemia (charles uni clinic)
• - conservatiev treatment of locomotor apparatus

• greatest ortho surgeon of czechia 
• - developed intensive surgical care 
• - therapy of congenital hip dislocation 
• - surgery of non-unions 
• - developed own external fixations

• - joint replacement 
• - itnroduces judet osacryl cups 
• introduced austin moore interposition arthroplasty

founded LF2

• ligamentous sac that surrounds articular cavity 
• attached to bone 
• completely encloses joint 
• outer fibrous membrane + inner synovial membrane

fibrous connective tissue that connects 2 bones / cartilages

fibrous connective tissue that connects muscle to bone

• 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

• 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

via tendons

• plane - intercarpal / intertarsal 
• hinge - elbow / interphalangeal 
• pivot - radioulnar 
• condylar - knuckles / wrist
• saddle - carpometacarpal joints of thumb 
• ball and socket - shoulder / hip

• gliding 
• flexion / extension 
• rotation 
• abduction / adduction

• periosteum - surrounds bone 
• osteon - compact bone unit with central osteonic canal 
• osteonic canal - contains nerve + blood vessels

• central canal surrounded by spongey bone with compact bone around and periosteum surrounding everything 
• epiphysis - head 
• diaphysis - body of long bone

• flat or long bones 
• spongey or compact

• 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

• mal-union 
• delayed union 
• non-union - pseudoarthrosis

• 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

• 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

deformation of bone without actually breaking in children (more flexible)

• 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

• very seriuos 
• must be reduced + stabilized

incomplete fracture of shaft of long bone --> angulation + bulging of cortex

joint aspiration of synovial fluid

• fine needle aspiration 
• punch biopsy - bone marrow 
• surgical biopsy - tumors

uses fiber-optic camera to give view of inside of joint.

release of contractures of tendons and ligaments

zig-zag cut of the edge of the tendon and joining of " long edges together to elongate it

transfer insertion of muscle from one tendon to another

• 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

opening joint surgically

surgical fusion of a joint (stops movement)

• artificial joint replacement 
• excsion arthroplasty - joint surfaces excised only
• hemiarthroplasty - only one joint surface replaced 
• total arthroplasty - both joint surfaces are replaced

remove laminae of vertebrae to allow access to intervertebral discs through ligamentum flavum

• avoid midtarsal amputations 
• open - skin not closed over stump 
• closed - cut skin and muscle distal to bone and close over stump

• curretage 
• extralesion excision 
• wide excision 
• radical excision

• taken from iliac crest (trabecular) or fibula (cortical)
• autograft - from patients own body 
• allograft - from another human 
• xenograft - from another animal