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History of Ortho
Primitive Men
- treatment of fractures
- splints + crude amputations
- understood malignancy of bone as a concept
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History of Ortho
Egyptians
- 3 categories of injury
- - fractures they could treat
- - fractures they could contend
- - fractures they could not treat
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History of Ortho
The Greeks
- first scientific approach
- - documented injuries + treatments
- - human dissections
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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
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pes equinovarus
- classical clubbed foot
- pes - foot
- equino - elevated heel (like in horse)
- Varus - turned inwards
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congenital hip dysplasia
- abnormal formation of the hip
- ball (femoral head) is not stable within socket (acetubulum)
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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
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History of Ortho
Galen
father of sports medicine
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Kyphosis
- outwards curvature of spine
- hunchback
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Lordosis
inwards curvature of spine
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Scoliosis
lateral curvature of spine
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History of Ortho
Ambroise Paré - 16th century
developed variety of instruments for ortho
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History of Ortho
Nicholas Andry - 18th Century
first pediatric orthopedics book
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History of Ortho
John Hunter - 18th century London
studied process of bone healing + inflammation in the bone
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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
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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
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History of Ortho
19th century
- inhalation anesthesia
- plaster casts
- asepsis
- endoscopic surgery
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History of Ortho
Prof Chlumsky
1st ortho department in czechoslovakia
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History of Ortho
Prof Tobaisek - 1927
- - first ortho clinic in Bohemia (charles uni clinic)
- - conservatiev treatment of locomotor apparatus
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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
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History of Ortho
Dr Cizek
- - joint replacement
- - itnroduces judet osacryl cups
- introduced austin moore interposition arthroplasty
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History of Ortho
Prof Hnavkovsky - 1842
founded LF2
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Joint capsule
- ligamentous sac that surrounds articular cavity
- attached to bone
- completely encloses joint
- outer fibrous membrane + inner synovial membrane
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Ligament
fibrous connective tissue that connects 2 bones / cartilages
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Tendon
fibrous connective tissue that connects muscle to bone
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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
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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
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Muscle attachments
via tendons
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Joint types
- plane - intercarpal / intertarsal
- hinge - elbow / interphalangeal
- pivot - radioulnar
- condylar - knuckles / wrist
- saddle - carpometacarpal joints of thumb
- ball and socket - shoulder / hip
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joint movements
- gliding
- flexion / extension
- rotation
- abduction / adduction
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bone structure
- periosteum - surrounds bone
- osteon - compact bone unit with central osteonic canal
- osteonic canal - contains nerve + blood vessels
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bone architecture
- central canal surrounded by spongey bone with compact bone around and periosteum surrounding everything
- epiphysis - head
- diaphysis - body of long bone
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bone morphology
- flat or long bones
- spongey or compact
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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
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bone healing complications
- mal-union
- delayed union
- non-union - pseudoarthrosis
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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
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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
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greenstick fracture
deformation of bone without actually breaking in children (more flexible)
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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
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supracondylar humeral fracture
- very seriuos
- must be reduced + stabilized
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torus / buckle fracture
incomplete fracture of shaft of long bone --> angulation + bulging of cortex
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arthrocentesis
joint aspiration of synovial fluid
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biopsy
- fine needle aspiration
- punch biopsy - bone marrow
- surgical biopsy - tumors
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arthroscopy
uses fiber-optic camera to give view of inside of joint.
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soft tissue release
release of contractures of tendons and ligaments
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tendon lengthening
zig-zag cut of the edge of the tendon and joining of " long edges together to elongate it
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tendon transfer
transfer insertion of muscle from one tendon to another
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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
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arthrotomy
opening joint surgically
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arthrodesis
surgical fusion of a joint (stops movement)
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arthroplasty
- artificial joint replacement
- excsion arthroplasty - joint surfaces excised only
- hemiarthroplasty - only one joint surface replaced
- total arthroplasty - both joint surfaces are replaced
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laminectomy
remove laminae of vertebrae to allow access to intervertebral discs through ligamentum flavum
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amputations
- avoid midtarsal amputations
- open - skin not closed over stump
- closed - cut skin and muscle distal to bone and close over stump
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excisions
- curretage
- extralesion excision
- wide excision
- radical excision
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bone grafting
- taken from iliac crest (trabecular) or fibula (cortical)
- autograft - from patients own body
- allograft - from another human
- xenograft - from another animal
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