Orthopedics [V. Basic Surgical Techniques] (PDF)

Orthopedics [V. Basic Surgical Techniques] MADE BY: NAGHAM EL SHENNWAY Types of bone repair: Steps of bone repair:  Biology of bone healing: Absolute Stability = Relative Stability = 20 Bone Healing 10 Bone Healing Haversian Remodeling...

Orthopedics [V. Basic Surgical Techniques] MADE BY: NAGHAM EL SHENNWAY Types of bone repair: Steps of bone repair:  Biology of bone healing: Absolute Stability = Relative Stability = 20 Bone Healing 10 Bone Healing Haversian Remodeling Fibrous Matrix > Cartilage > Calcified Cartilage > Woven Bone > Lamellar Bone Minimal callus Spectrum of Healing callus  Notes: During bone repair, remodeling is done by osteoclast. In primary repair, we shouldn’t see callus. Fixation stability:  Relative Stability (flexible): o IM nailing o Ex fix o Bridge plating o Cast  Absolute stability (Rigid): o Lag screw/ plate o Compression plate  Fixation Constructs: Operative o External Fixation o Plates o Intramedullary Nails Open segmental tibia fracture treated with IM Nail. Intertrochanteric/ Subtrochanteric fracture treated with closed IM Nail. It is important to keep the angle between the head and neck stable. Plate and screw fixation: Screws o Cortical o Cancellous o Cannulated o Locking Screws Conventional Plates Locking Plates Screw: Anatomy of a Screw o Head o Thread Height Z o Inner (Core) Diameter -X o Outer(Thread) Diameter-Y o Pitch (P)  Cortical Screws Cancellous Screws Smaller pitch Larger pitch Smaller thread Larger thread height height Smaller core diameter Plate Fixation: Compression Neutralization Buttress Anti-Glide  1) Screws compress plate to bone Plates: Compression of fracture Maintenance relies on pullout strength of screws 2) Neutralization Plates: Neutralizes/protects screws from shear, bending, and torsional forces across fx It is used when the screw is weak. “Protection Plate" 3) Buttress / Antiglide Plates: “Hold” the bone up Resist shear forces during axial loading. 4) Bridge Plates: o “Bridge”/bypass comminution o Proximal & distal fixation o Goal: o Maintain length, rotation,  axial alignment o Avoids soft tissue disruption at fx = maintain fx blood supply o bridge plate makes micromotion secondary repair and callus formation. Operative rituals:  Videos for illustrations: https://youtu.be/WpZqLbWL0c0 https://youtu.be/wXJRBD_7Xvo https://youtu.be/cxklzKlV_qM https://youtu.be/30Wev9UqnfY https://youtu.be/A0NyzNFNA3M Notes: 1. When you are in the operative room, the name of the patient should be said out loud. 2. You check that the patient is not sensitive from any drug. 3. When the screws or plates are made of titanium, the patient so doesn’t have any problem in entering the MRI. 4. Sleeve is used to maintain the soft tissues.  Questions: 1. Remodeling of the bone is done by: a) Osteoblast b) Osteocyte c) Osteoclast 2. Cortical screw has: a) Lower pitch b) Higher pitch c) Smaller core diameter 3. Which of the following is called the protective plate: a) Bridge plate b) Neutralization plate c) Buttress plate 4. It is better to remove hair with: a) Shaving b) Removal hair cream 5. When moving in the OR you should move: a) Side to side b) Face to face c) Back to back  Answers: 1) C 2) A 3) B 4) B 5) C