Stephen P. England, MD MPDDepartment of Orthopaedic Surgery

Park Nicollett Clinic

Introduction to Orthopaedics

Test Yourself

List the bones of the body. (More pts more bones!)

Bone forming cells are called ______.Local stress stimulates bone formation.

T or F?The knee is a/an _______joint.

What do you know from the slides?

Which is the hand of the elderly adult?

How old do you think the individual is on slide A?A B

Bone Structure: Orthopaedic Implications

Periosteum DiaphysisEpiphysisPeriosteumEndosteumEpiphyseal

plates; bone growth, injury

What is the significance of the epiphyseal plate?

Bone Formation and MaintenanceTypes Bone = cells,

protein matrix, mineral deposits

Types of bone cells

Function of each type bone cell

• Protein matrix: 98% collagen, 2% other

• Mineral salts: insoluble Ca/Phos = hydroxyapitite +

• Process of ossification

Factors Influencing Bone Growth and Formation

Parathyroid What effect of

low Ca?Calcitonin

Effect on Ca?Source?

Thyroxin

• Estrogen• Glucocorticoids

– What effect on bones with long term use of glucocorticoids?

• Vit C & D

Types of Joints: Identification

AmphiarthrosisSynarthrosisDiarthrosis

Significance of Diarthrotic JointJoint Capsule

surrounded by ligaments

Synovial Membrane: secretes synovial fluid; lines tendon and muscle sheaths

• Bursea: painful, but protective!

Othropaedic Terminology

Descriptive Orthopaedic TermsValgus: part of

body distal to joint directed away from midline

Varus: Part of body distal to joint directed toward midline

• Hallus• Genu varus• Genu valgus• pes varus• metatarus valgus• metatarus varus

Hallus valgus

Which foot has a valgus deformity?

How do you describe this foot deformity?

Stressors of theMusculoskeletal System

Trauma Infection

Altered Metabolism

For the person with a musculoskeletal condition:List effects on

person List “most “

frequent orthopaedic diagnosis

• Peripheral neurovascular dysfunction

• Pain (acute, chronic)

• Impaired skin integrity

• Infection, high risk for

• Disuse syndrome

• Activity intolerance

• Trauma. high risk for

• Knowledge deficit

• Impaired adjustment

• Fear, anxiety

How has orthopedic injury affected this PERSON?

Components of AssessmentChief Complaint

Why seeking careAcute and chronic

problem

History taking; its significance

Pain characteristicslocationcharacterwhat effects

Associated conditionsComplications!

•Pain

Principles of AssessmentNormal firstBilateral

comparisionInspect then

gentle palpationshape, size ,

contoursigns inflammation,

ecchymosismuscle conditiondeformity

• Test your skills– Changes with age

– Nurtitional status

– Skin integrity

– Rashes

– Color changes, esp with cold; arterial vs. venous

– Character of joints

– Bruises, swelling

Assessment of the KneeFluid in the Knee

Bulge sign: medial aspect knee, displace fluid upward, tap lateral patellar margin and note fluid return

Ballottment:force fluid into joint space; displace patella

Ballottment:force fluid into joint space; displace patella

Knee Stability

Anterior cruciate ligament: limits anterior motion

Posterior cruciate ligament: limits posterior motion

Lateral collateral ligament: limits adduction

Medial collateral ligament: limits abduction

Meniscal injury: McMurray’s sign

Knee Support and Stability

Anterior and posterior cruciate ligaments connect the inner surfaces of the head of the femur with the head of the tibia. They cross each other, anterior ligament extend from the inside of the lateral condyle of the femur to the medial side of the tibial head, and posterior ligament extend from the inside of the medial condyle of the femur to the lateral side of the tibial head.

McMurray’s sign

Anterior Drawer test

Diagnostic TestsCT ScanBone ScanMRIDual-Photon AbsorptiometryArthrographyArthrocenthesisArthroscopy

Diagnostic Tests

ArthrographyRadiographic

exam, use air or contrast medium:; 90-95% accuracy

TeachingComplications:

infection, allergyPost-op: Rest

joint 6-12 hrs, use ice

• Arthrocenthesis– Aspiration synovial

fluid; reduce pain; dx; treatment

– Analysis joint fluid: usual clear, high viscosity, scant fluid

– Teaching: no restrictions; consent form; slight pain

– Post-op: RICE

Arthroscopy

Therapeutic /diagnosticVisual recording; surgical removal of

meniscus, foreign bodies, etcRare complications; depends on

procedure, operative length, use of tourniquet

TeachingPost-op care

Orthopaedic Interventions!TractionCastsExternal

FixatorsPin, plates and

screwsCPMCrutch-walking

Assistive DevicesTraction

DefinitionUsesTypes

Counter traction is provided by:a. body weightb. pulleysc. traction weightd. splints

• Crutch-walking– Two-point

– Three-point

– Four-point

– Swing-through

– swing-to

• Safety in crutch-walking

• Cane

CPMPurpose Guidelines

for Use • Teaching

Bone StimulatorsIndicationsElectronegativityBone Remodeling

InternalPercutaneousExternal

External Bone Stimulator

Autologous Blood Transfusions

Indications forOrtho Cell

SaversCriteria for Use

Cell Savers Autologous Blood

Surgical /Medical Interventions

Tissue AllograftsAbductor Pillow, Carter PillowHot Ice Machines that Aren’t!Bone Paste!

Tissue allografts, synthetic grafts

Pins, plates, screws

ORIF (open reduction, internal fixation)

CastsPurposesCasting Material

PlasterFiberglass

Application of CastPrinciples

Skin AssessmentSkin ProtectionHeat GeneratedTime to Dry

•Cast TypesSugar

Tong/SplintSpica Type

Body CastHip spicaGauntletCast-Brace

• Body Cast Care– Cast Syndrome

• Hip Spica

– Turning– Cast Drying

External FixatorsHow They WorkPrinciples of CareThe Iliazarov

External Fixator

Conclusion