Orthopedics Notes PDF

1 ORTHOPAEDICS NOTES Orthopaedic Nomenclature Pathology - Sprain: An injury to a ligament ligament - Strain: An injury to an muscle - Subluxation: Partial dislocation of the articular surfaces of a joint - Dislocation: Complete dissociation of the articular surfaces of a joint -...

1 ORTHOPAEDICS NOTES Orthopaedic Nomenclature Pathology - Sprain: An injury to a ligament ligament - Strain: An injury to an muscle - Subluxation: Partial dislocation of the articular surfaces of a joint - Dislocation: Complete dissociation of the articular surfaces of a joint -Osteoarthritis = Degenerative condition that causes inflammation, breakdown of synovial fluid, and destruction of the articular cartilage with resultant abnormal new bone formation. Osteocyte formation. -Osteochondritis dissecans: Injury (often traumatic) to the joint surface of bone that involves detachment of the subchondral bone and its overlying articular cartilage. Commonly affected sites include the knee (femur), elbow (ulna), and ankle (talus). Tendinitis: Acute inflammation of a tendon Tendonosis/tendonopathy: Degenerative breakdown of the tendon Bursitis: Inflammation of the synovial sac (bursa) Common areas of involvement include the shoulder, knee, elbow and hip. - Spondylolisthesis: The abnormal translation of one vertebra with respect to another. - Spondylolysis: A fracture of the pars inter-articularis of the vertebra. This injury is usually caused by repetitive stress and most commonly affects the lower lumbar vertebrae. - Spondylosis: Osteoarthritis of the spine Movement - Abduction: Movement away from the body’s midline - Adduction: Movement toward the body’s midline  2 - Eversion: Rotation of the foot and ankle outward - Inversion: Rotation of the foot and ankle inward -Pronation: Rotary movement described at the forearm, where the palm of the hand rotates from a superior facing position to one facing inferiorly. - Supination: Rotary movement described at the forearm, where the palm of the hand rotates from an inferior facing position to one facing superiorly.  3 Procedures - Debridement: Surgical removal of all contamination, ischemic/necrotic tissue and irrigation to decrease bacterial load (“solution to pollution is dilution”) - Arthrocentesis: Aspiration of synovial fluid from a joint with a needle. - Arthroscopy: A surgical technique that uses a small camera (endoscope) in a joint space for the diagnosis and treatment of joint-related conditions - Arthrotomy: Surgical incision into a joint through the joint capsule. - Arthrodesis: Surgical fusion of a joint - Open reduction: Surgical incision with physical visualization of the fracture site or joint. - Closed reduction: Reduction of fracture with surgery, may be done under x-ray imaging. - Internal fixation: Surgical stabilization devices (implants) placed internally, directly on or in the bone. - External fixation: Bulk of stabilization device outside of soft tissues and skin. Connected to bone with pins or wires.  4 Principles of fracture management NB - Indication for Open Reduction and Internal Fixation: - Open Fractures (sometimes external fixation used but always requires surgery) - Intra-articular fractures - Diaphyseal fractures of long bones (Femur, Tibia, Radius/Ulna, Humerus) - Fractures in polytrauma patients - Fracture-dislocation of joints (dislocations associated with a periarticular fracture) Types of ORIF - K-wires - Interfragmentary screws - Tension band wires (Olecranon or patella) - Plates and screws - Intra-medullary nails (Femur, Tibia, Humerus) - Pin-and-Plate (Intertrochanteric proximal femur fractures)  5 Open fractures (NB) Definition Any fracture where the fracture haematoma is communicating with the external environment. Management Specific treatment: o Analgesia: Morphine IV o Anti-tetanus: Tetanus prophylaxis o Antibiotics: o Inspect wound (classify) and remove any gross contamination o Irrigate wound with saline (at least 3 litres) o Apply sterile gauze dressing (DO NOT SUTURE and do not expose the wound multiple times) o Align the limb (perfect reduction not necessary) o Backslab o Consent for surgery o Contact orthopedic surgeon for urgent debridement in theatre. A3I2A2BC2  6 Factors that decrease infection rate in open fractures: - Quality of debridement - Timing of debridement (should be within 24 hours of injury) - Timing of soft tissue closure (should be within 5 days of injury) - Timing of initiation of antibiotics (delay increases infection) Compartment syndrome (NB)  7 Pathogenesis: Pressure in soft tissue compartment exceeds capillary pressure (>30 mmHg) Diagnosis: Clinical diagnosis based on the presence of the following: o Pain out of proportion to the injury not responding to analgesia o Pain on passive stretch of the muscles in the affected compartment o Paresthesia followed by anesthesia o A tensely swollen soft tissue compartment NOTE: Pulselessness, Palor, Poikilothermia, Paralysis is a sign of arterial injury NOT compartment syndrome. In patients with decreased consciousness intra-compartmental pressures can be monitored through: Whitesides technique Management of compartment syndrome: - Pre-operative o Fluid resuscitation to maintain perfusion pressure o Remove constrictive bandages / split plaster o Elevate limb to level of the heart o Prepare patient for theater  8 - Surgery o Fasciotomy of all compartments in the involved segment o Immobilize fracture with external fixator Fat embolism syndrome (NB) Definition: Clinical syndrome caused by inflammatory response to embolized fat globules, characterized by: ARDS (Acute respiratory distress syndrome) Encephalopathy Petechiae DIC (Diffuse intravascular coagulopathy) “PAED” Pathogenesis: Two theories regarding the causes of fat embolism include Mechanical theory = embolism is caused by droplets of bone marrow fat released into venous system Metabolic theory = stress from trauma causes changes in chylomicrons which result in formation of fat embolism Diagnosis: Clinical diagnosis Single or multiple long bone fractures (especially femur), typically young active patients (10-40 yrs of age), typically (12-72 hours after fracture or fracture-fixation) Hypoxia (tachypnoea and eventually full-blown ARDS) CNS depression (confusion) Petechial rash (Conjunctival and skin of the axilla or upper trunk) Special investigations Lab tests Arterial blood gas is the most important special investigation (other adjunctive role only). 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