Introduction to Orthopedics (HUE) - Dr. Kamel PDF

Orthopedics Introduction   Articulation between two or more bones.  Characters:  articulating bones are connected together by fibrous tissue.  Types: A- Suture: Joints between bones of skull....

Orthopedics Introduction   Articulation between two or more bones.  Characters:  articulating bones are connected together by fibrous tissue.  Types: A- Suture: Joints between bones of skull. B- Syndesmotic (Syndesis = Bound Together): bones connected by strong ligaments.. ① FIBROUS JOINTS Primary cartilaginous joints Secondary cartilaginous joints Bones are connected by Bones are connected by hyaline cartilage fibrocartilage ② CARTILAGINOUS JOINTS (AMPHIARTHROSIS)   Characters:  Articular surfaces of bones are covered by thin layer of hyaline cartilage.  Articulating bones are separated by a joint cavity.  Joint is surrounded by a fibrous tissue capsule. ③ SYNOVIAL JOINTS Joints are classified according to the tissue between the bones.   Surgical subspecialty diseases which focuses on diseasesand trauma of the musculoskeletal system. ORTHOPAEDIC  The musculoskeletal system consists of bones, joints, ligaments, SURGERY tendons, muscles and nerves. "Orthopedics" is from the Greek words 'Ortho' = straight & 'Pedia' = Child. 1. Pediatrics orthopedics. 5. Spinal surgery unit. 2. Ankle and foot surgery unit. 6. Tumor unit. 3. Reconstruction and deformity 7. Arthroplasty unit. correction unit. 8. Trauma surgery. 4. Surgery of upper limb and hand unit. 9. Knee and sport medicine units. CONGENITAL AND  Congenital talipes equinovarus (CTEV). DEVELOPMENTAL ABNORMALITIES  Developmental dysplasia hip (DDH).  Fractures. TRAUMATIC  Dislocations  fracture dislocations  Osteomyelitis. INFECTION  Pyogenic arthritis INFLAMMATORY  Rheumatic disorders. NEOPLASTIC  Osteosarcoma & Giant cell tumor. NEUROMUSCULAR DISORDERS  Cerebral palsy & spina bifida. DEGENERATIVE  Osteoarthritis. METABOLIC AND ENDOCRINE  Rickets. DISORDERS  Osteoporosis.  Planes of the Body  = median plane. 1. Sagittal  Divides the body vertically into left plane: and right halves of equal size.  = coronal plane. 2. Frontal  Divides the body equally into front plane: and back halves.  = horizontal plane. 3. Transverse  Divides the body equally into top plane: and bottom halves. Abduction: Adduction: Rotation: Movement away from the Movement towards the midline Movement along the long axis of midline of the body. of the body a limb Eversion: Pronation: Upward and outward movement Turning hand so that the palm Circumduction: at the sub talar joint. faces downwards. Movement of a joint in a circular Inversion: Supination: motion. Down and inwards movement of Turning the hand so that the the foot at sub talar joint. palm is uppermost DEFINITION:  Abnormality of the shape & / or posture of the spine and limbs. VARIETIES OF DEFORMITIES: POSTURAL DEFORMITY FIXED DEFORMITY  can be actively corrected by the patient  cannot be corrected actively or passively or passively by the surgeon  e.g. FFF  e.g. Rigid flat foot CAUSES OF DEFORMITIES 1) Genetic:  Gene disorders have characteristic patterns of inheritance. (autosomal or X- linked and dominant or recessive). 2) Environmental:  Some teratogenic agents which damage placenta or embryo during the first few months of gestation are: A- CONGENITAL a. Mechanical factors (malposition in utero, amniotic bands, oligo-or hydrohydraminos). b. Viral infection (rubella). c. Certain drugs (thalidomide). d. Ionizing radiation. 3) Combined genetic and environmental. 1- Posttraumatic: Malunited fracture, unreduced dislocation. 2- Post infection: Osteomyelitis causing disturbance of growth, Arthritis. 3- Paralytic: Poliomyelitis, peripheral nerve injury, Spastic paralysis. 4- Bone softening diseases: Rickets, Osteomalacia, Fibrous B- ACQUIRED dysplasia, Hyperparathyroidism 5- Contracture  Skin (burns, scars)  Fascial ( Dupytren’s contracture).  Muscle (Muscle dystrophies and Volkmann’s contracture).  VARUS VALGUS  Deviation towards the midline.  Deviation away from the midline. TORSION (ROTATION IN ITS AXIS) Internal torsion External torsion  If rotation occurs in inward direction.  If rotation occurs in outward direction. VESION (ANGLE OF INCLINATION OF LONG AXIS OF THE FEMORAL NECK WITH REFERENCE TO TRANSCONDYLAR PLANE OF DISTAL FEMUR.) ANTEVERSION RETROVERSION  If this inclination is anterior.  If the inclination is posterior.  At birth: 30° & in adults 5-20°  PES PLANUS PES PLANO-VALGUS  Loss of normal arch of the foot  Along with planus, the foot has deviated in an outward direction (laterally). EQUINUS CALCANEUS  Foot is fixed in plantar flexion.  Foot is fixed in dorsiflexion. PES CAVUS PES CAVOVARUS  The arch is exaggerated.  along with exaggerated arch and the foot has deviated in an inward direction (medially). EQUINOCAVOVARUS DEFORMITY :  as a result of combination of deviations. KYPHOSIS:  Excessive backward (posterior) curvature of the spine. LORDOSIS:  Excessive forward (anterior) curvature of the spine. SCOLIOSIS:  Sideward (lateral) bending of the spine. Orthosis: A splint or brace. Osteotomy: Surgically cutting the bone Arthroscopy: An operation to directly view a joint, minimal access. Arthroplasty Austin Moore’s prosthesis Thompson’s prosthesis. Arthroplasty Arthrodesis Closed reduction and external immobilization: U-SHAPED PLASTER SLAB CAST BRACE HANGING CAST K.WIRES PLATE AND SCREWS DYNAMIC HIP SCREW (DHS) MULTIPLE CANCELLOUS SCREWS  LOCKED IMN EXTERNAL FIXATOR 1. Calcaneus deformity of the foot refers to: a) The normal arch of the foot is lost b) The foot is fixed in dorsiflexion. c) The foot is fixed in plantar flexion. d) The arch is exaggerated. e) The foot has deviated in an inward direction along with exaggerated arch 2. Anterior inclination of the long axis of the femoral neck with reference to the transcondylar plane of the distal femur is known as: a) Anteversion. b) Retroversion c) Reurvatum d) Valgum e) Varus 3. The type of hip joint is: a) Syndesmosis b) Synchondrosis c) Condylar d) Synovial e) Pivot