Theories of Traumatology, Sport Injuries, and Orthopaedics Lecture 2 PDF

The Art of Orthopaedics & Trauma Ahmed Salah El-Din Zaghloul Lecturer of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Mansoura University “The very first step towards success in any occupation is to become interested in it.”...

The Art of Orthopaedics & Trauma Ahmed Salah El-Din Zaghloul Lecturer of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Mansoura University “The very first step towards success in any occupation is to become interested in it.” Sir William Osler (1849–1919)  Orthopaedics ?!! Andry published his introduction to orthopedics in 1741 under the title Orthopédie, translated into English in 1743 as Orthopaedia. Andry explains in the book that he formed its title "of two Greek Words:  Orthos: Straight.  Paidion: Child. Nicolas Andry de Bois-Regard (1658 – 13 May 1742)  Orthopaedics ?! Andry explained Orthopædia as the Art of Correcting and Preventing Deformities in Children. Though the book was read and cited extensively, its main lasting influence in medicine has been its title, which became the name of the field devoted to Musculoskeletal diseases and related injuries Later on, modified to:  Orthopaedics: in British spelling.  Orthopedics: in American spelling.  Orthopaedics ?! Orthopaedic surgeons use both surgical and nonsurgical means to treat musculoskeletal:  Trauma.  Sports Injuries.  Degenerative diseases.  Infections.  Tumors.  Congenital Disorders.  Spine Diseases. The musculoskeletal system consists of bones, joints, ligaments, tendons, muscles and nerves.  Human Skeleton Axial skeleton – Bone forming axis of body:  Skull.  Spine.  Chest Wall. Appendicular skeleton - is made up of everything else, bones that attach (append) to your axial skeleton:  Shoulders.  UL.  Pelvis.  LL.  Osteology Bone Structure Compact = Cortical Bone  Made up of Osteons (Haversian System).  Form Outer layer of most bones.  Accounts for 80% of skeletal bone mass.  Adapted to resist Bending and Torsional Stresses.  Typically located at the Shaft of long bones.  Osteology Bone Structure Spongy = Cancellous = Trabecular Bone  Made up of Trabeculae.  Form Inner layer of most bones.  Accounts for 20% of skeletal bone mass.  Adapted to distribute Compressive forces.  Typically located at the Ends of long bones & Vertebrae.  Osteology Bone Shape  Long Bones e.g. Humerus, Femur.  Short Bones e.g. Carpal, Tarsal Bones.  Irregular Bones e.g. Vertebrae.  Flat Bones e.g. Iliac Bone, Sternum.  Sesamoid Bones e.g. Patella. Osteology Long Bones  Arthrology Joints = Articulations: Unions or Junctions ( ) 2 or more bones or rigid parts of the skeleton. Classification: 3 classes of joints based on the manner & type of material by which the articulating bones are united. Arthrology Synovial Joints A: Ball & Socket. B: Hinge. C: Pivot. D: Ellipsoid/Condyloid. E: Saddle. F: Gliding/Plane.  Arthrology Cartilaginous Joints 1ry Cartilaginous 2ry Cartilaginous Synchondroses Symphyses  Arthrology Fibrous Joints Suture Syndesmosis Gomphosis Anatomical Position & Planes  Common Orthopaedic Disorders Congenital Traumatic Inflammatory Neoplasm ➔ Congenital Talipes Equinovarus (CTEV = Club Foot). Congenital ➔ Developmental Dysplasia of Hip (DDH). ➔ Fracture: Loss of bone continuity. Traumatic ➔ Dislocation: Loss of contact ( ) Articular Surfaces.  Common Orthopaedic Disorders Congenital Traumatic Inflammatory Neoplasm Inflammatory ➔ Osteomyelitis. ➔ Septic Arthritis. ➔ Osteoarthritis. ➔ RA. ➔ Benign: Osteoid Osteoma, Chondroma. Neoplasm ➔ Locally Malignant: Giant Cell Tumor. ➔ Malignant: Osteosarcoma, Chondrosarcoma. Factures Clinical Picture  Fractures Aetiology The Cause of Fracture Traumatic Fractures:  Injuries are caused by Direct or Indirect violence.  An Abnormal force applied to a Normal bone. Pathological Fractures:  Caused by relatively Little violence or energy to abnormal or diseased bone.  May be Localized to one part of the bone e.g. Tumors or Generalized e.g. Osteoporosis and Osteomalacia. Fatigue = Stress Fractures:  Result from cyclic application of Normal forces to Normal bone with excessive frequency.  March Fracture: linear or incomplete fracture 2nd MTB in army recruits.  Fractures Aetiology Traumatic Fracture Pathological Fracture Stress Fracture  Fractures Morphology The Fracture Pattern Oblique Wedge Segmental Spiral Impaction Avulsion  Fractures Morphology The Fracture Pattern Pediatric Fractures:  Immature bones of children are far more flexible than adult bones with thicker periosteum.  Torus=Buckle fracture: an applied force causes the compression side of a bone to buckle.  Greenstick fracture: tension side of the fracture also fails, causing the periosteum to tear and the tension cortex to gap.  Physeal injuries: Injury of Growth plates.  Fractures Severity The degree of comminution or involvement of soft tissue or a joint Comminution Intra-articular Sprain Dislocation Fracture  Fractures Severity The degree of comminution or involvement of soft tissue or a joint Fracture-dislocation Open Fracture “Gustilo & Anderson Classification”  Fractures Location Which part of the bone is affected ➔ Anatomical regions: described in relation to the Physis (Growth Plate). ➔ Epi: Upon. Child ➔ Meta: Adjacent. ➔ Dia: Away. There is no physis or epiphysis, and the  entire end region of the bone is termed Adult the metaphysis. Müller’s box: A square with sides =the  widest part of the metaphysis..  Fractures Displacement How the bone fragments have moved in relation to one another Undisplaced Fracture Fracture is complete but has not moved. Displaced Fracture The position of the distal fragment is described in relation to proximal fragment. Length Shift = Translation Tilt = Angulation Twist = Rotation Length Shift= Translation Distraction/Shortening A/P/M/L  Fractures Displacement Twist = Rotation Internal / External Tilt= Angulation Varus/Valgus (coronal plane) Flexion/Extension (sagittal plane)  Fractures Healing Inflammatory Phase Soft Callus Phase  Haematoma Formation.  UMCs migration.  Inflammation.  Bone, Cartilage and Fibrous tissue formation.  Granulation Tissue.  External/ Intermediate/ Internal Callus.  Fractures Healing Hard Callus Phase Remodeling Phase  Osteoblast Migration.  Osteoclast Migration.  More Bone Formation.  Remodeling Unit.  Hard Callus (Woven Bone).  Lamellar Bone.