1. Introduction to Orthopaedics
Stephen P. England, MD MPD
Department of Orthopaedic Surgery
Park Nicollett Clinic

2. Introduction to Orthopaedics

3. Test Yourself List the bones of the body. (More pts more bones!)
Bone forming cells are called ______.
Local stress stimulates bone formation. T or F?
The knee is a/an _______joint.

4. What do you know from the slides?
Which is the hand of the elderly adult?
How old do you think the individual is on slide A? A B

5. Bone Structure: Orthopaedic Implications
Periosteum
Diaphysis
Epiphysis
Endosteum
Epiphyseal plates; bone growth, injury

6. What is the significance of the epiphyseal plate?

7. Bone Formation and Maintenance
Types
Bone = cells, protein matrix, mineral deposits
Types of bone cells
Function of each type bone cell
Protein matrix: 98% collagen, 2% other
Mineral salts: insoluble Ca/Phos = hydroxyapitite +
Process of ossification

8. Factors Influencing Bone Growth and Formation
Parathyroid
What effect of low Ca?
Calcitonin
Effect on Ca?
Source?
Thyroxin
Estrogen
Glucocorticoids
What effect on bones with long term use of glucocorticoids?
Vit C & D

9. Types of Joints: Identification
Amphiarthrosis
Synarthrosis
Diarthrosis

10. Diarthroidal Joint

11. Significance of Diarthrotic Joint
Joint Capsule surrounded by ligaments
Synovial Membrane: secretes synovial fluid; lines tendon and muscle sheaths
Bursea: painful, but protective!

12. Othropaedic Terminology

13. Descriptive Orthopaedic Terms
Valgus: part of body distal to joint directed away from midline
Varus: Part of body distal to joint directed toward midline
Hallus
Genu varus
Genu valgus
pes varus
metatarus valgus
metatarus varus

14. Which foot has a valgus deformity?
Hallus valgus
How do you describe this foot deformity?

15. Stressors of the Musculoskeletal System
Trauma Infection Altered Metabolism

16. For the person with a musculoskeletal condition:
Peripheral neurovascular dysfunction
Pain (acute, chronic)
Impaired skin integrity
Infection, high risk for
Disuse syndrome
Activity intolerance
Trauma. high risk for
Knowledge deficit
Impaired adjustment
Fear, anxiety
List effects on person
List “most “ frequent orthopaedic diagnosis

17. How has orthopedic injury affected this PERSON?

18. Components of Assessment
Chief Complaint
Why seeking care
Acute and chronic problem
History taking; its significance
Pain characteristics
location
character
what effects
Associated conditions
Pain
Complications!

19. Principles of Assessment
Test your skills
Changes with age
Nurtitional status
Skin integrity
Rashes
Color changes, esp with cold; arterial vs. venous
Character of joints
Bruises, swelling
Normal first
Bilateral comparision
Inspect then gentle palpation
shape, size , contour
signs inflammation, ecchymosis
muscle condition
deformity

20. Assessment of the Knee Fluid in the Knee
Bulge sign: medial aspect knee, displace fluid upward, tap lateral patellar margin and note fluid return
Ballottment:force fluid into joint space; displace patella

21. Ballottment:force fluid into joint space; displace patella

22. Knee Stability Anterior cruciate ligament: limits anterior motion
Posterior cruciate ligament: limits posterior motion
Lateral collateral ligament: limits adduction
Medial collateral ligament: limits abduction
Meniscal injury: McMurray’s sign

23. Knee Support and Stability Anterior and posterior cruciate ligaments connect the inner surfaces of the head of the femur with the head of the tibia. They cross each other, anterior ligament extend from the inside of the lateral condyle of the femur to the medial side of the tibial head, and posterior ligament extend from the inside of the medial condyle of the femur to the lateral side of the tibial head.

24. Anterior Drawer test
McMurray’s sign

25. Diagnostic Tests CT Scan Bone Scan MRI Dual-Photon Absorptiometry
Arthrography
Arthrocenthesis
Arthroscopy

26. Diagnostic Tests Arthrocenthesis Arthrography
Aspiration synovial fluid; reduce pain; dx; treatment
Analysis joint fluid: usual clear, high viscosity, scant fluid
Teaching: no restrictions; consent form; slight pain
Post-op: RICE
Arthrography
Radiographic exam, use air or contrast medium:; 90-95% accuracy
Teaching
Complications: infection, allergy
Post-op: Rest joint 6-12 hrs, use ice

27. Arthroscopy Therapeutic /diagnostic
Visual recording; surgical removal of meniscus, foreign bodies, etc
Rare complications; depends on procedure, operative length, use of tourniquet
Teaching
Post-op care

30. Orthopaedic Interventions!
Traction
Casts
External Fixators
Pin, plates and screws
CPM
Crutch-walking

31. Assistive Devices Traction Crutch-walking
Definition
Uses
Types
Counter traction is provided by:
a. body weight
b. pulleys
c. traction weight
d. splints
Crutch-walking
Two-point
Three-point
Four-point
Swing-through
swing-to
Safety in crutch-walking
Cane

33. CPM
Purpose
Guidelines for Use
Teaching

34. Bone Stimulators Indications Electronegativity Bone Remodeling
Internal
Percutaneous
External

36. External Bone Stimulator

37. Autologous Blood Transfusions
Indications for
Ortho Cell Savers
Criteria for Use

38. Cell Savers Autologous Blood

39. Surgical /Medical Interventions
Tissue Allografts
Abductor Pillow, Carter Pillow
Hot Ice Machines that Aren’t!
Bone Paste!

40. Tissue allografts, synthetic grafts

41. Pins, plates, screws
ORIF (open reduction, internal fixation)

42. Casts
Purposes
Casting Material
Plaster
Fiberglass

43. Application of Cast Principles Skin Assessment Skin Protection
Heat Generated
Time to Dry

44. Cast Types Sugar Tong/Splint Spica Type Body Cast Care Cast Syndrome
Hip spica
Gauntlet
Cast-Brace
Body Cast Care
Cast Syndrome
Hip Spica
Turning
Cast Drying

45. External Fixators
How They Work
Principles of Care
The Iliazarov

46. External Fixator

47. Conclusion