Post on 07-Apr-2018
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Orthopaedic Operations 2nd Friday of 5-weekly rotation
ICM Robertsonhttp://www0.sun.ac.za/ortho 1
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Orthopaedic Operations
• MB ChB 5 & 6
• ICM Robertson
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Choice of Operation
Painful Joint• Osteotomy
• Arthrodesis
• Excision Arthroplasty
• Joint Replacement– Hemi
– Total
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Osteotomy
Indications– Young Patient
– Mobile joint
– Malalignment
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Osteotomy - knee
Macquet - proximal tibial
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Osteotomy - Hip
• Indications– Young / middle
age
– More than 60 deg flex
Valgus osteotomy
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Arthrodesis
• Surgical fusion of a joint
• Indications– Pain
– Limitation of movement
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Arthrodesis - Hip
Pre-requisites
• Young• Nor mal contralateral
hip
• Nor mal I psilater lalKnee
• No Backache
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Arthrodesis - Wrist
Indications
• Rheumatiod
• TB
• Degenerative
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Excision Arthroplasty
• One or both sides of joint are excised
• Sepsis
• Allows movement
• Always – Shor tening– Instability
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Excision Arthroplasty
• Girdlestone - Hip
• Salvage operation– septic hip
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Excision Arthroplasty
Kellers - hallux valgus
Problem
• Shor tening
• Transfer metatarsalgia
Joint Replacement
Types• Hemi - one side only
• Total
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Joint Replacement
I ndications Moores• Trauma
• Elder ly • Debilitated
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Joint Replacement
I ndications Total Hip• Age >60
• Pain > Grade 3• L imited Walking
distance
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Joint Replacement
Contraindications Total Hip
• Age <60 yr• Neuromuscular
disease• Any Sepsis
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Joint Replacement
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Bone Grafts
Bone Grafts
Uses of Bone Grafts
• To fill cavities eg Cysts
• To bridge joints - arthrodesis
• To bridge major defects and restore continuity of a long bone
• To provide a bone block and limit joint motion (arthrodesis)
• To promote union in a pseudoarthrosis(nonunion)
• To promote union in delayed union , non union or fresh fractures or osteotomies.
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Bone Grafts
Functions of Bone Grafts•Mechanical Strength - to immobilisea bone cor tical graft eg an intact fibula can be used.
•Ostogenesis- marrow bone such as bone removed from the pelvis. eg delayed union of a tibial fracture. This is laid about he fracture gap.
•Replacement - loss of a section of long bone may be bridged by bone graft. .If the gap is significant a vascurarised graft is indicated.
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Bone Grafts
Terminology
• Autografts ... in the same individual
• Allograft ... between different individuals of the same species.
• Xenograft ...from an individual of one species ...to different specie
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Bone Grafts
Donor SitesPoster ior site
•Useful in back operations
•Yields more bone
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Bone Grafts
Donor Site Complications - Pelvis
• Fracture eg Sartorius - fractures off SIAS
• Hernia - through pelvic defect
• Nerve damage eg lat. cutaneous thigh
• Pain
Tendon Suture
Severed tendons.. best sutured primarily.
Zone 2 hand - use Kessler suture
Kessler Suture
Tendon Suture
Bunnell suture
Suitable for most tendons
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Tendon Transfer
Pre-requsites for a successful tendon transfer
•Sability of proximal joints
•Prior correction of any fixed deformity
• Power ..At least grade 4/5 power
• Direct line of pull
• Firm point of fixation - preferably bone
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Tendon
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Nerve
Classification of nerve damage
Neurotmesis- (complete division.
• eg knife wound
Axonotmesis -incomplete division Only the axons
eg traction injury
Neurapraxia -(physiological interruption Axons are intact injury is degradation of the axon sheaths.
• motor > sensory
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Nerve
Classification of nerve damage
Neurotmesis- (complete division.
• e.g. knife wound
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Nerve
Classification of nerve damage
Axonotmesis -incomplete division Only the axons
e.g. traction injury
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Nerve
Classification of nerve damage
Neurapraxia -(physiological interruption Axons are intact injury is degradation of the axon sheaths.
• motor > sensory
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Nerve
Nerve suture
Primary Suture
•Attempt in all open injuries
• Avoid tension
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Nerve
Timing of repair• Immediate exploration and suture of open injuries
•Closed nerve injuries
• observe
• physiotherapy
• late repair (if necessary)
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Nerve
Signs of nerve recovery
• Return sensory or motor function
• Progressive Tinnel sign.
• Speed of growth +- 6mm per week.
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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Internal fixation
Indications for ORIF
• inability to obtain reduction
• intra-articular #
• pathological #
• neurovascular
• multitrauma
• advanced age
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Internal fixation
Plates and screws
• Tension side
• Screw 8 cortices both sides of #
• Bone graft on Oppositeside
ORIF - failures
Plate #
Bone # at plate end
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ORIF -IM Pins
Advantages of closed pins
• Less sepsis - # not opened
• Less plate failures - no stress risers
• Muscle blood supply intact
OREF -External fixators
Indications
• Open fractures - wound problem
• Distal radius fractures - shortening
• Other - bone transport / lengthening
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OREF -External fixators
Pin Care• Clean the skin regularly
• Antiseptic dressings - "
• Septic skin (not loose) -antibiotic
• Septic Loose Pin -- replace
Orthopaedic Operations 2nd Friday of 5-weekly rotation
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OREF -External fixators
Radius Indications
• Unstable distal radius fractures
• Shortening
• Open or closed
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