MUNIR SAADEDDIN, FRCSED ASST. PROFESSOR & CONSULTANT
COLLEGE OF MEDICINE KING SAUD UNIVERSITY Introduction to
Orthopaedics
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Orthopaedics ORTHO = Straight, Upright, Correct Paios = Child
First used by Nicolas Andry a French doctor(1841) in a book titled
Orthopedia : the art to correct and prevent deformities in
children
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Orthopedic Surgery = Not only Bone Surgery Orthopedic specialty
is the branch of medicine which manage trauma and disease of
Musculoskeletal system It includes : bones, muscles, tendons,
ligaments, joints, peripheral nerves, vertebral column and spinal
cord and its nerves
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Orthopedic Specialty Also Known as : Trauma and Orthopedic
Surgery Sub-Specialties in orthopedic include : Pediatric
Orthopedic, Sport and Reconstructive Orthopedic, Orthopedic Trauma,
Arthroplasty, Spinal Surgery and Foot and Ankle surgery
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Red Flags Red Flags = Warning Symptom or Sign Red flags should
always be looked for and remembered Presence of a red flag means
the necessity for urgent or different action/intervention
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Examples of Red Flags Open Fractures : more serious and very
high possibility of infection and complications Complicated
Fractures : fracture with injury to major blood vessel, nerve or
nearby structure Compartment Syndrome : increase in intra-
compartment pressure which endangers the blood circulation of the
limb and may affect nerve supply Cauda Equina Syndrome :
compression of the nerve roots of the Cauda Equina at the spinal
canal which affect motor and nerve supply to lower limbs and
bladder (also saddle or peri-anal area)
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Examples of Red Flags Infection of Bone, Joint and Soft Tissue
Osteomyelitis : Infection of the bone Septic Arthritis :Infection
of the joint Cellulitis :spreading Infection of the soft tissue May
cause septicemia or irreversible damage. Multiple Trauma or Pelvic
Injury: more than one fracture or injury sustained at the same time
consider massive blood loss and associated injuries. Acute joint
Dislocations : requires urgent reduction or may cause serious
complications
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Alignment terminology
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Alignment Terminology: Cubitus Varus
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Alignment terminology: Cubitus Valgus
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Congenital or Acquired Acquired conditions include : Trauma
Developmental Inflammation Infection Neuromuscular Degenerative
Metabolic Tumor
Force due to Resisted Muscle Action:- Avulsion Transverse
pattern Avulsion Fracture
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Intra-articular Fractures If displaced ; should always be
treated by ORIF= Open Reduction and Internal Fixation failure to
reduce and fix such fracture results in loss of function, deformity
and early degenerative changes
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External Fixator : Ilizarove: in Trauma or Correction of
Deformities
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Soft tissue injuries of the knee Remember : ACL : Anterior
cruciate ligament its function is preventing the Knee ( patella )
from going FORWARD PCL : posterior cruciate ligament : its function
is preventing the Knee from going BACKWARD MCL : medial collateral
ligament : its function is preventing the knee from going ( VALGUS
) ( laterally ) LCL : lateral collateral ligament : its function is
preventing the knee from going ( VARUS ) ( mediulally ) Meniscus :
prevent the joint from friction it affeccted in
Osteoarthiritist
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Anterior Cruciate Ligament injury: MRI
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ACL Injury: Lachmans test
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MCL: Value of Stress Xrays
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(Developmental Dislocation of Hip) DDH
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Orthosis : Pavlick Harness for DDH
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Developmental Foot deformity: Hallux Valgus
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Developmental: SCFE (Slipped Capital Femoral Epiphysis)
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Spinal Deformities: Kyphosis or Hyperlordosis Scoliosis' :
Scoliosis is a side-to-side curvature of the spine Kyphosis :
Kyphosis is the extreme curvature of the upper back also known as a
hunchback. Hyperlordosis : abnormal forward curvature of the spine
common in pregnant ladies
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Spinal Deformity: Scoliosis
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Degenerative Disorders Occur at any joint Can be primary or
secondary Increased wear and tear Can lead to pain and/or deformity
and/or loss of function Increase with advancing age Management
depends on type and age
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OA Hip
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Total Hip Arthroplasty ( THA )
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Osteoarthosis of Knee
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Osteoarthritis of Knee
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Metabolic Disorders (Rickets): Bow Legs
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Osteoporosis: Fractured NOF
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Hemi-Arthroplasty Lt Hip
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Spinal Osteoporosis
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Osteoporosis: Colles fracture
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Bone Tumors Malignant tumors are MORE than Begnin
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Bone Tumor
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Bone tumors
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Neurological Evaluation : Sensory : Dermatomes
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Nerve Injury: Muscle wasting
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Nerve Injury: Sensory Loss
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Muscle Power Testing : Iliopsoas
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Muscle Power Testing : Quadriceps
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Spinal Cord Injury Often results from fracture dislocation of
spine When injury is at cervical spine it may result in Tetraplegia
Injury at dorsal spine may result in Paraplegia
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Devastating effect of Spinal Cord Injury
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Neuromuscular disorder: Polio
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Chronic Osteomyelitis : discharging sinus
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Spinal Infection : Tuberculosis: Para Vertebral Abscess
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Chronic Osteomyelitis : Sequestrum dead bone inside the bone
its complication of Chronic bone infection it usually produce
Pus
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Physiotherapy for Orthopedic Patients Physiotherapy is an
important part of orthopedic and trauma management It is used for :
pain relief, prevention of stiffness, muscle strengthening,
mobilisation of stiff joint or spine, training non-weight bearing
or partial weight bearing Physiotherapy modalities include: heat,
cold, exercise, ultrasound, traction, electrical stimulation