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Ch 8 Orthopedics/ Orthopaedics Them Bones –

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Ch 8 Orthopedics/ Orthopaedics Them Bones – The Skeletal System Branch of medicine pertaining to study and tx of skeletal/myo abnormalities and dz. nmhm.washingtondc.museum/exhibits. Who does what?. Orthopedic physician- also called Orthopod. - PowerPoint PPT Presentation
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• Ch 8 Orthopedics/ Orthopaedics Them Bones – The Skeletal System Branch of medicine pertaining to study and tx of skeletal/myo abnormalities and dz nmhm.washingtondc.museum/ exhibits
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Page 1: Ch 8  Orthopedics/             Orthopaedics Them Bones –

• Ch 8 Orthopedics/

Orthopaedics

• Them Bones – The Skeletal System

Branch of medicine pertaining to study and tx of skeletal/myo abnormalities and dz

nmhm.washingtondc.museum/exhibits

Page 2: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Who does what?Orthopedic physician- also called Orthopod. -ics means knowledge; practice orth/o means straight; -ped/o means child

We who study bones are called Osteologists! (just for today)

What about an Orthotist? Braces, supports

http://www.stereofoto.de/gallery/index.html

Page 3: Ch 8  Orthopedics/             Orthopaedics Them Bones –

• Medications (Rx) we might expect to see used in this system

• Calcium mineral contained in many OTC antacids Tums, CitraCal, Oystercal, etc. Used to prevent osteoporosis and treat hypocalcemia And let’s talk about drinking sodas…

• Gold Compounds yes, actual gold Treats rheumatoid arthritis by inhibiting dz

progression.

No reversal yet.

• Analgesics (Tylenol/acetominophen) Suppress inflammation, decrease pain

• NSAIDs (nonsteroidal anti-inflammatory drugs) These are not ‘Steroids’ ibuprofin/Motrin/Advil, naproxin/Aleve, ketoprofin/Orudis, Relafen

• COXX 2 inhibitors (Celebrex, Vioxx), Toradol, Relieve mild to moderate pain and reduce inflammation

Page 4: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Pushing more pills• Corticosteroid drugs

(prednisone, hydrocortisone, Depo-Medrol inj.) - suppress inflammation.

p.o. or injected into intra-articular space

• Chemotherapy drugs (Adriamycin, VePesid) Kill ca cells in bones as they rapidly divide

Page 5: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Still more meds• Salicylates (aspirin, ASA, Aspergum, Doan’s Regular Strength

Tablets) Relieve mild to moderate pain; reduce inflammation Oldest arthritis drug – Aspirin is reformulated willow bark

• Narcotic and opioid analgesics (Demerol, Darvon, morphine, codeine, Fiorenal,

Percodan, Vicodin, oxycodone hydrochloride) Relieve moderate to severe pain. Derived from opium or synthetic. Strong addictive properties – used in short term prescription. May be used post-operatively, especially for orthopedic procedures

• Skeletal muscle relaxants (Soma, Parafon Forte, Relaxazone) Relieve myo (muscle) spasms and stiffness. Also used to treat spasticity from palsy, ms, stroke, spinal cord injury

Page 6: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Bone resorption-inhibitor drugs Bisphosphates and Diphosphonates – inhibit

osteoclasts. (Fosamax, Boniva, Miacalcin)

• Associated with mandibular osteonecrosis; twice as affected as maxilla.

• May be associated with dental surgical procedures – talk to your doctors and make them talk to each other!

• Severe bone, joint, musculoskeletal pain is reported months after d/c of Rx, causing misdiagnosis of etiology.

• Some of these rx help bone to thicken, but in some new bone tissue is brittle; begins to thin in a few years.

Page 7: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Changes in bone remodeling following menopause result in bone loss

• Atypical Fractures May Complicate Long-Term Bisphosphonate Therapy

• Laurie Barclay, MD — Another increased risk is contralateral atypical fractures.

• bisphosphonate therapy may suppress bone remodeling to the extent that normal bone repair is impaired, resulting in increased fracture risk.

• These "atypical" fractures associated with suppression of bone turnover often affect sites seldom affected by osteoporotic fractures, such as subtrochanteric femur. Features characteristic of atypical subtrochanteric femur fracture include no history of trauma before fracture, prodromal thigh pain, and radiological findings.

Page 8: Ch 8  Orthopedics/             Orthopaedics Them Bones –

What do our bones do?

• Skeletal system • AKA skeletomuscular system • AKA musculoskeletal system• Structural support, aids muscles and nerves to

initiate movement (leverage, right?), maintain position, protect vital organs (with a few holes)

• National Museum of Health and Medicine

“The Human Body Revealed” http://www.nmhm.washingtondc.museum

Page 9: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Marrow

• Hematopoiesis = formation of blood cells takes place in red marrow of long and flat bones. • In infants, red marrow is found in bone cavities. Mostly replaced by yellow marrow for fat storage with age. • In adults, red marrow is limited to spongy (Cancellous) bone in skull, ribs, sternum, clavicles, vertebrae and that donor site, the pelvis.

Page 10: Ch 8  Orthopedics/             Orthopaedics Them Bones –

2 Skeletons?

Appendicular Skeleton

Bones of

Appendages:

Shoulder

Girdle,

Pelvic Girdle,

Legs

Axial Skeleton

Cranial and Facial

Auditory ossicles

Hyoid

Vertebral Column

Thoracic Cage

(sternum and ribs)

Page 11: Ch 8  Orthopedics/             Orthopaedics Them Bones –

L o n g bones

• Humerus Your ‘Popeye’ muscle attaches here

• Radius Your forearm

• Ulna Your forearm, part ll

• Femur Your thighbone

• Tibia Your shinbone

• Fibula The lateral lower leg - ends at your lateral ankle

• Phalanges Your fingers or toes

Page 12: Ch 8  Orthopedics/             Orthopaedics Them Bones –

S

e d s i

a om

BonesYour lovely little sesame-shaped patella

Page 13: Ch 8  Orthopedics/             Orthopaedics Them Bones –

S H O R T Bones

• Carpals Think ‘wrist’ Carpal tunnel syndrome

• Tarsals Think ‘ankle’

Page 14: Ch 8  Orthopedics/             Orthopaedics Them Bones –

F L A T BONES

• Sternum - joins to ribcage on your

anterior

• Ribs (yes, I know they are curved)

• Scapula (again, I don’t make the rules)

Page 15: Ch 8  Orthopedics/             Orthopaedics Them Bones –

I r r e g u l a r Bones

• Vertebrae

bones of the spine

• Facial bones

think of those zygomatic bones!

Page 16: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Let’s look at a bone Page 412

• Let’s find these landmarks:• Epiphyses - * Cancellous distal and or spongy bone proximal * Compact bone• Articular * Red bone marrow cartilage * Yellow bone marrow• Diaphysis * Epiphyseal lines• Periosteum What kind of bone is this? http://www.pediatricorthopedics.com/Topics/Bones/Hip/hip.html

Page 17: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Cranial bones and sutures

• Remember how we learned where the Coronal Plane was?

• See the Zygomatic bone of the cheek?

Page 18: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Mo bones-cranium & facial bones • Your Cranium - Frontal,

parietal,temporal, occipital -AKA occiput

• Sphenoid, frontal, ethmoid, and maxilla –home to sinuses

• Sutures or sulces: (started as fontanels) Coronal or Sagittal • Foramen magnum

• Facial bones – Maxilla – upper jaw Mandilla – lower jaw –

the movable one, thank goodness!

• Etthmoid bone with Olfactory nerve

• http://training.seer.cancer.gov/module_anatomy/unit3_8_quiz_dd_01.html• http://www.getbodysmart.com/ap/skeletalsystem/skeleton/axial/skull/menu/

animation.html

Page 19: Ch 8  Orthopedics/             Orthopaedics Them Bones –

links

• http://training.seer.cancer.gov/module_anatomy/unit3_8_quiz_dd_01.html

• http://www.getbodysmart.com/ap/skeletalsystem/skeleton/axial/skull/menu/animation.html

Page 20: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Get some backbone• Vertebral column – protector of spinal cord 24 vertebrae, sacrum and coccyx • Cervical – your neck - first 7 vertebrae C1-C7• Thoracic – next 12 – provide site for posterior rib attachments T1-T12• Lumbar – next 5 - low back L1-L5• Intervertebral disks –made of cartilage to pad between vertebrae• Sacrum – triangular or wedge shaped bone of lower spine• Coccyx – tailbone

Page 21: Ch 8  Orthopedics/             Orthopaedics Them Bones –

The shoulder

• Clavicle (collarbone) – anterior

• Scapula (shoulder blade)

• Joined together at most lateral and highest point of shoulder by Acromion Process (part of scapula)

www.drloweshoulder.com/.../bone_shoulder.gif

Page 22: Ch 8  Orthopedics/             Orthopaedics Them Bones –
Page 23: Ch 8  Orthopedics/             Orthopaedics Them Bones –

See where shoulder bursitis happens?

Page 24: Ch 8  Orthopedics/             Orthopaedics Them Bones –

The arm and hand• Humerus - upper arm –what shape bone?• Radius - lateral bone of forearm• Ulna - medial bone of forearm• Carpals - wrist Tarsals - ankle• Metacarpals – (Meta?) bones of palm• Phalanges- finger/toe bones

Page 25: Ch 8  Orthopedics/             Orthopaedics Them Bones –

The chest or thorax (thoracic cavity, remember?)

• Sternum - breastbone

Xyphoid process-projection at distal end.

Manubrium -Curvy notch at proximal end.

• Ribs Protectors of heart and lungs,

among other things

Page 26: Ch 8  Orthopedics/             Orthopaedics Them Bones –

The hip bone’s connected to….• Pelvis – 3 fused bones and 2 parts

of vertebral column

• Ilium –largest of pelvic bones - you feel it as your ‘hip’ bone Red bone marrow donor site

Bone marrow aspiration - aspiration needle used to draw out marrow

Ischium – ‘sit’ bones - lowest and

strongest of pelvic bones Pubis – wrapping around toward

anterior of pelvis and connecting at cartilagenous joint called Symphysis pubis Don’t forget Sacrum and Coccyx

Page 27: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Still with the pelvis….• Acetabulum - socket in pelvis

where femur articulates• Sacrum – 4th segment of vertebral

column joins ilium at SI joint (Sacroiliac joint)• Coccyx – tailbone, remember? ‘As we move caudally’, or ‘toward the coccyx’

• THR Total Hip Replacement • Surgical replacement of • femoral head and • acetabulum with synthetic • components

• So if ‘-plasty’ means surgical repair of, and ‘arthr/o’ means joint, see how T/PHR (Total or Partial Hip Replacement) is a hip arthroplasty?

Page 28: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Shake a leg• Femur –heaviest, strongest, longest

bone • * rounded head fits into acetabulum to articulate with pelvis to form hip joint * neck is part that juts out from acetabulum to meet shaft of this long bone

• Patella – that sesamoid bone- protects knee joint• Tibia - shin bone

• Fibula – lateral lower leg bone – non-weightbearing --you feel its distal end at lateral ankle

• Lateral malleoulus and medial malleolus

library.thinkquest.org/5777/ske5.htm

Page 29: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Tarsals – ankle bones *Talus –joins Tibia and Fibula to make ankle joint; sits on top of

*Calcaneus – largest foot bone, normally called heelMetatarsals – bones of foot

Phalanges - toe bones - share same name as fingers

www.eorthopod.com

Page 30: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Roots in the skeletal system

• Kypho hunchback, humpback • kyphosis – abnormal condition of a dorsally rounded or hunched thoracic spine

• Lordo swayback, swayed back lordosis – abnormal condition of lumbar spine curving anteriorly Scolio crooked, bent side to side

scoliosis – abnormal condition where spine is crooked or bent laterally, and perhaps also twisted or rotated

Page 31: Ch 8  Orthopedics/             Orthopaedics Them Bones –

More roots

carpo wrist bones chondro cartilageclaviculo clavicle coccygo coccyxcosto rib cranio skullfemoro femur fibulo fibulahumero humerus

Page 32: Ch 8  Orthopedics/             Orthopaedics Them Bones –

And……..

ilio iliumischio ischium lamino lamina thin flat platelumbo lumbar maxillo maxilla or upper jaw - think ‘maxillary sinuses’

mandibulo mandible - lower jawmetacarpo hand bonesmetatarso foot bones

Page 33: Ch 8  Orthopedics/             Orthopaedics Them Bones –

still more roots• myelo bone marrow• myo muscle• ortho straight• osteo bone• arthro joint• patello patella• phalangeo finger or toe bone • pubio/pubo pubis;anterior pelvis• radio radius• scapulo scapula• sterno sternum• tarso tarsals; ankle• vertebro vertebra; vertebrae

Page 34: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Skeletal System Prefixes and Suffixes

Prefixes; sub- remember that one?and supra- above

• Suffixes: -blast immature -clasis surgical fracture -malacia softening -oma tumor -osis abnormal condition

Page 35: Ch 8  Orthopedics/             Orthopaedics Them Bones –

putting some things together

• sub meaning under, below• ar,al meaning pertaining to

SUBMANDIBULAR pertaining to below mandible

SUBSTERNAL pertaining to below sternum SUPRACLAVICULAR pertaining to

above clavicle

Page 36: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Joints – more in Ch 9

• Articulators – like the bus….• Suture joint – immovable, no cartilage• Pubic symphysis and intervertebral joints -

slightly moveable with fibrocartilagenous disks.• Synovial p411– fully moveable – joins bones with

articulating cartilage, a meniscus maybe (like in knee), ligaments, synovial membrane and synovial fluid, and a joint capsule.

• Either hinge action, or ball and socket.

Page 37: Ch 8  Orthopedics/             Orthopaedics Them Bones –

general medical terms

• ischiopubic pertaining to ischium and pubis• lumbosacral pertaining to lower back or lumbar region and sacrum• osteoblast immature bone or bone

cells• osteocyte mature bone cell

Page 38: Ch 8  Orthopedics/             Orthopaedics Them Bones –

osteoblast = immature bone or bone cellsosteocyte = mature bone cell

• Osteocytes are mature, nondividing bone cells –

• they come from immature osteoblasts – cells that build new bone

• Osteoclasts – cells that break down

old bone

Page 39: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Dz, disordersavascular necrosis - death of epiphyseal cells (if in femur, as it usually is, it’s called Avascular Necrosis of the Femoral Epiphysis – proximal is assumed) – blood supply interruption

chondromalacia softening of cartilage

herniated disk intervertebral disk protrudes between vertebrae to some degree and puts pressure on spinal nerve root; commonly called slipped disk

myeloma tumor originating from bone marrow

chondroma tumor originating in cartilage -benign

Page 40: Ch 8  Orthopedics/             Orthopaedics Them Bones –

The whole ‘ankylo’/‘spondylo’ thing

Ankylo = just means ‘Stiff’ so Ankylosis = just means stiffness of a joint

Spondylo = just means ‘Vertebra’ so Spondylosis just means condition of Vertebrae -itis = inflammation of , so now what about this one?

Ankylosing spondylitis = inflammation of the vertebrae with

stiffness aka Rheumatoid Arthritis (RA) of the spine (an old-fashioned term) SPONDYLOARTHROPATHY - what?

Page 41: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Spondylolitheses or Spondylolisthesis = ‘slipping vertebra’ -- pathological fx (compression) or injury cause vertebra to ‘slip’

anteriorly over another vertebra Big owie

Page 42: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Osteo – bone Osseous – pertaining to boney tissue

• Ossification - process of bone formation, cartilage becomes bone or bone-like tissue.

• Thus, ossified tissue is invaginated with blood vessels, bringing minerals like calcium.

(Remember those epiphysial plates?)• Bone formation is a dynamic process; • Bone remodeling continues throughout life.

Page 43: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Osteophytes -

• How do we repair?• We don’t, unless ROM is

limited, or nsaids don’t help

• Extra Corporeal Shock Wave Therapy is one tx - Surgery is another

Osteophytes are bone spurs- form along joints -seen in arthritis, areas of wear. Largely responsible for limitation of joint motion, pain.

Why? Body tries to increase joint surface area to better distribute weight across damaged joint surface. Unfortunately, a largely wasted effort, as bone spur

increases restriction and pain.

Page 44: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Osteos• Osteotomy – to make an incision into a

bone

• osteitis inflammation of bone

• osteochondritis inflammation of bone and cartilage

• osteoclasis surgical fracture of a bone: surgical destruction of bone tissue, perhaps to reconstruct a malformed bone, or improperly healed bone.

• osteofibroma tumor of bony and fibrous tissues

• osteomalacia softening of bone

• Osteolysis breaking down of bone tissue

• osteomyelitis inflammation of bone and bone marrow

• osteoma tumor originating in bone – benign• osteosarcoma tumor of bone – malignant Aka Osteogenic sarcoma (think of

‘genesis’)

• Ewing’s sarcoma tumor of bone –malignant also, but occurring in young males

Remember - ‘oma’ just means ‘tumor’ until you know

more. ‘sarco’ means you know more!

Page 45: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Osteitis deformans

• Osteitis deformans AKA Paget's disease of bone, bone metastasis (with/without hypercalcemia)

• Chronic disorder – Excessive breakdown/ formation of bone tissue that occurs causes weakened bone, bone pain, arthritis, deformities, and fracture.

• Viral, may have hereditary factor, rare in women, rare in men younger than 40

Page 46: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Pathological fractures…• Underlying disorder or

disease (such as infection, osteoporosis, noncancerous bone tumor,or cancer) weakens bone, leading to fracture

• Patient with breast cancer metastasized to bone.

• Note proximal femoral bone on left side of image looks thinner than on right side.

• This femoral pathological fx is due to metastasis of breast cancer.

Page 47: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Osteoporosis - decreased bone density/ loss of bone massGuess which is normal and which is osteoporotic?

Page 48: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Fractures – 2 things Simple/Closed -Skin is not

torn –fx contained within the tissue

• Complicated/Compound/Open-Skin, soft tissue, periosteum are torn; dirt, debris, or bacteria can easily contaminate wound/bone itself

AND**************************• Displaced fx -broken ends

of bones are separated or bent at an angle

• Nondisplaced fx -bone’s

normal shape and alignment is maintained despite fx completely through bone

Page 49: Ch 8  Orthopedics/             Orthopaedics Them Bones –

http://orthopedics.about.com/cs/brokenbones/a/compression.htm

• Avulsion Small fragments of

bone detach from where tendons or ligaments attach to bones; usually affect hand, foot, ankle, knee, shoulder

• If intra-articular; leads

to loss of motion and onset of osteoarthritis

Page 50: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Cracked, broken, smushed• Displaced fx -broken ends of

bones are separated or bent at an angle

• Nondisplaced fx – bone’s normal shape and alignment is maintained despite cracks completely through bone

• Stress fx - bone becomes stressed repeatedly over time because of certain activities, such as walking with a heavy pack or running

• Occult fx -difficult or impossible for a doctor to see on initial x-ray; may appear as dark or white lines days to weeks after injury

• Growth plate fx -Break through growth plate may cause bone to stop growing/grow crookedly in children

Page 51: Ch 8  Orthopedics/             Orthopaedics Them Bones –

MVA > compound displaced fx

Page 52: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Crack me up

• Comminuted: Bone fragments into several piece

• Oblique: Latin for “slant” – you see why!

• Spiral: fx line actually spirals up or down bone

Page 53: Ch 8  Orthopedics/             Orthopaedics Them Bones –

• Greenstick –both partially bent and partially broken

most commonly seen in children

• Transverse – travels across the axis of the bone(s)

• Simple

Page 54: Ch 8  Orthopedics/             Orthopaedics Them Bones –

more fxs

• Colles’ fx - always at distal end of

radius --- Hey, where’s that??

• Greenstick fx – the bone is both partially bent and partially broken

Page 55: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Cracked up

• Depressed fx – think of hitting a pumpkin with a hammer. Makes a sunken area.

• Hairline fx – such a fine fx line that the pieces remain together.

Page 56: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Stress fracture

• Overuse injury. With repeated micro–trauma, bone fails to absorb shock and is weakened.

• Hairline break is often invisible on x-ray for first six weeks after onset of pain

• Most seen in tibia, tarsals, metatarsals. • Athletes at highest risk, but new group of rising

risk is young adult soda drinkers, leading to a new risk group for Pathological fx. (See “Osteoporosis”, previously discussed)

Page 57: Ch 8  Orthopedics/             Orthopaedics Them Bones –

yes, still more

• impacted fx bone is broken and

wedged into interior of

another bone or

piece of bone

(think ‘telescoping’)

Page 58: Ch 8  Orthopedics/             Orthopaedics Them Bones –

About Compression fxCommonly a spinal fx. Vertebra collapses in on itself in dz, or is compressed by other vertebrae in a jarring fall or a great weight• May be tx’d by

Vertebroplasty or Kyphoplasty - inserting a glue–like material into center of collapsed spinal vertebra to stabilize and strengthen crushed bone.

Page 59: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Impacted fx Posterolateral instrumentation

Figure 1.

Surgical treatment. A, Lateral radiograph showing posterolatera l instrumentation (Group 2). B, Lateral radiograph showing posterolateral fusion + TLIF (Group 3).

A, Lateral radiograph showing posterolateral instrumentation B, Lateral radiograph showing posterolateral fusion

Page 60: Ch 8  Orthopedics/             Orthopaedics Them Bones –

So what is this? Proximal humeral fracture

Page 61: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Arthritis -• Arthritis -

Inflammation of joint. • Osteoarthritis -

noninflammatory degenerative joint disease characterized by breakdown of cartilage. Cartilage erodes, eventually allowing bones to grind or rub together,causing hip pain and stiffness. That grinding is called Crepitus.

Page 62: Ch 8  Orthopedics/             Orthopaedics Them Bones –

• Patients closely related to someone with psoriatic arthritis are 50 times more likely to develop the disease themselves. Recent studies have located genetic markers shared by most people who have the disease.

• Sometimes injuries seem to set off psoriatic arthritis, as may infections.

• It is known that strep infections in children can cause psoriasis.

• Some researchers think that the arthritis may be an immune system response to bacteria from the skin lesions of psoriasis.

Page 63: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Rheumatoid arthritis

• Acute/chronic, autoimmune dz characterized by inflammation of joint synovium, swelling.

• Tissue/cartilage damage around joint, displace alignment.

• Risk factors? Genetic, tobacco smoke exposure, and possibly, long-term statin use.

Page 64: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Speaking of ‘Arths’ -• Arthropathy - any dz or suffering of joint until you know more

• Arthralgia - P in joint

• Arthroscopy visualizing within, remember? What’s the tool?

• Arthrocentesis surgical puncture of joint to withdraw fluid

• Arthrodesis (AKA syndesis, artificial ankylosis) surgical procedure to fuse bones of unstable joint. Spinal fusion is a major surgery that fuses two or more vertebrae.

• What if there were bleeding into the joint? Hemarthrosis

Page 65: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Arthrodesis (AKA syndesis, artificial ankylosis) major surgical procedure to fuse bones of unstable joint.

• This triple arthrodesis fuses three bones together: calcaneus, navicular and cuboid. Don’t you love that “Internal Fixation Device”?

Page 66: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Reduction- Are we losing

weight?

• closed reduction process of aligning fractured bone through manual manipulation and/or traction

• open reduction process of aligning fractured bone through a surgically created opening

• open reduction and internal fixation (ORIF) As ‘open reduction’, but the pieces are aligned using screws, pins, wires, nails or plates Great picture on 440

Page 67: Ch 8  Orthopedics/             Orthopaedics Them Bones –

More dx, tx terms

Bone scan visualizing bone structure using a radioisotope

DEXA scan dual-energy x-ray absorptiometry• non-invasive x-ray procedure to

• measure bone density • Why would we want to do that?

Gonimetry – a measuring of contact angle in a joint

Page 68: Ch 8  Orthopedics/             Orthopaedics Them Bones –

-ectomies

• diskectomy - surgical removal of a herniated disk

• intervertebral disk laminectomy surgical removal of posterior arch of vertebra

• patellectomy - surgical removal of patella

Page 69: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Genu Valgus

• What are we seeing?

The lower leg displaces laterally….

Page 70: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Genu Varum

• What are we seeing?

The lower leg displaces medially

Page 71: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Hallux Valgus/Bunion

Painful swelling or bulging out of bursa at base of big toe laterally. Distal hallux tilts medially.

If this were in the shoulder, we would just call it a Bursitis. But, I DO NOT MAKE THE RULES………. To repair this, we perform a _______________?

Oh, those pointed shoes and high heels ! They don’t cause bunions, but if you are predisposed (family hx), they worsen your odds!

Page 72: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Talipes • Talipes - Foot is both pulled downward

and laterally – aka Clubfoot. May affect

one or both feet.

Congenital condition.

Page 73: Ch 8  Orthopedics/             Orthopaedics Them Bones –

A study finding to consider:• Smoking, waist circumference and waist-to-hip ratio

were related to increased prevalence of male and female shoulder pain. Metabolic syndrome, type 2 diabetes mellitus and carotid intima-media thickness were associated with male shoulder pain as well as increased waist circumference and type 1 diabetes.

• High levels of C-reactive protein was associated with female shoulder pain.

•Conclusions Our findings showed associations of abdominal obesity, some other metabolic factors and carotid intima-media thickness with shoulder pain. Disturbed glucose metabolism and atherosclerosis may be underlying mechanisms.

Page 74: Ch 8  Orthopedics/             Orthopaedics Them Bones –

Non medical

The pt had a broken bone in the lower leg. The ends were not lined up. The doctor took hold of his leg and pulled the leg to line up the broken ends, without having to cut into the pt. Then he put a wet cloth soaked in something on his leg that dried

up and held the bones in place. But, heck, I was passed out by then.

• Medical version:

• The x-ray revealed a displaced fx of the fibula that required closed reduction and casting. Observing, I lost consciousness briefly.

Page 75: Ch 8  Orthopedics/             Orthopaedics Them Bones –

You just studied bones

• Does that mean

you are

some sort

of

skeletologist?

Let’s give our bones a “break”!


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