Orthopedic Surgery: An Overview

• Orthopedic surgery treats musculoskeletal system conditions.
• The musculoskeletal system includes bones, joints, ligaments, tendons, muscles, and nerves.
• Orthopedic surgeons use surgical and nonsurgical methods to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital conditions.

Scope of Orthopedic Surgery

• Diagnosis of musculoskeletal conditions is essential.
• Treatment includes medication, exercise, casting, and surgery.
• Rehabilitation through physical therapy is part of orthopedic care.
• Prevention strategies and education are part of the orthopedic approach.

Common Orthopedic Procedures

• Arthroscopy is a minimally invasive procedure used to visualize and treat joint problems.
• Joint replacement involves replacing a damaged joint with an artificial joint (prosthesis).
• Fracture repair stabilizes broken bones, often with implants like plates, screws, or rods.
• Soft tissue repair mends damaged ligaments, tendons, or muscles.
• Spinal surgery addresses spinal conditions like herniated discs or spinal stenosis.

Specialization in Orthopedics

• Some orthopedic surgeons focus on specific body areas:
  • Hip and knee
  • Shoulder and elbow
  • Foot and ankle
  • Spine
  • Hand and wrist
• Other specializations include:
  • Sports medicine
  • Trauma
  • Pediatrics
  • Oncology

Diagnosis in Orthopedics

• Physical examination assesses range of motion, stability, and pain.
• Imaging tests aid diagnosis:
  • X-rays visualize bones.
  • MRI visualizes soft tissues like ligaments and tendons.
  • CT scans provide detailed images of bones and joints.
  • Ultrasound evaluates soft tissues and guides injections.
• Nerve conduction studies assess nerve function.
• Diagnostic arthroscopy directly visualizes joint structures.

Non-Surgical Treatment Modalities

• Medications include:
  • Pain relievers (analgesics) like acetaminophen and NSAIDs.
  • Anti-inflammatory medications like corticosteroids.
  • Disease-modifying antirheumatic drugs (DMARDs) for conditions like rheumatoid arthritis.
• Physical therapy involves exercises to improve strength, range of motion, and function.
• Braces and orthotics support and stabilize injured areas.
• Injections:
  • Corticosteroid injections reduce inflammation.
  • Hyaluronic acid injections lubricate joints.
  • Platelet-rich plasma (PRP) injections promote healing.

Surgical Treatment Options

• Arthroscopic surgery:
  • Uses a small camera and instruments via small incisions.
  • Allows visualization and treatment of joint problems, such as meniscus tears, ligament damage, and cartilage defects.
• Joint replacement surgery:
  • Replaces a damaged joint with a prosthetic joint.
  • Common replacements include hip, knee, and shoulder replacements.
• Fracture fixation:
  • Surgically stabilizes broken bones using implants like plates, screws, rods, or external fixators.
• Soft tissue repair:
  • Surgically repairs torn ligaments, tendons, or muscles.
  • Examples are ACL reconstruction, rotator cuff repair, and tendon transfers.
• Spinal surgery:
  • Includes laminectomy, discectomy, spinal fusion, and spinal decompression.
  • Treats conditions like herniated discs, spinal stenosis, and scoliosis.

Post-Operative Care and Rehabilitation

• Post-operative pain management is crucial, utilizing medications and other techniques.
• Wound care prevents infection.
• Physical therapy restores strength, range of motion, and function.
• Assistive devices like crutches, walkers, or braces may be needed.
• Gradual return to activity is typical, following the surgeon's instructions.

Common Orthopedic Conditions

• Osteoarthritis is a degenerative joint disease causing pain, stiffness, and limited motion.
• Rheumatoid arthritis is an autoimmune disease causing joint inflammation.
• Osteoporosis reduces bone density, increasing fracture risk.
• Fractures are broken bones caused by trauma or underlying conditions.
• Sprains are ligament injuries, and strains are muscle/tendon injuries.
• Bursitis and tendinitis are inflammations of bursae (fluid-filled sacs) or tendons.
• Carpal tunnel syndrome is compression of the median nerve in the wrist, causing hand pain, numbness, and tingling.
• Rotator cuff tears affect tendons surrounding the shoulder joint.
• ACL tears affect the anterior cruciate ligament in the knee.
• Meniscus tears affect cartilage in the knee.
• Hip dysplasia is a congenital condition where the hip socket doesn't fully cover the upper thighbone.
• Scoliosis involves curvature of the spine.
• Bone tumors are abnormal bone growths and can be benign or malignant.

Advances in Orthopedic Surgery

• Minimally invasive surgery uses smaller incisions for less pain, faster recovery, and reduced scarring.
• Computer-assisted surgery uses computer navigation to improve surgical precision.
• Robotics in surgery uses robotic arms to assist surgeons with complex procedures.
• Biologic therapies use growth factors, stem cells, and other biologic materials to promote healing.
• 3D printing creates custom implants and surgical guides.

Risks and Complications of Orthopedic Surgery

• Infection can occur at the surgical site.
• Bleeding can occur during or after surgery.
• Blood clots can form in the legs or lungs.
• Nerve damage can occur during surgery.
• Implant failure can occur.
• Post-operative stiffness can limit range of motion.
• Post-operative pain can persist.
• Anesthesia-related complications are a risk.