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Stephen P. England, MD MPD Department of Orthopaedic Surgery Park Nicollett Clinic.

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Presentation on theme: "Stephen P. England, MD MPD Department of Orthopaedic Surgery Park Nicollett Clinic."— Presentation transcript:

1 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 Periosteum 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 Hallus valgus Which foot has a valgus deformity? 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: List effects on person List “most “ frequent orthopaedic diagnosis 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

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 Complications! Pain

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

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


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 McMurray’s sign Anterior Drawer test

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

26 Diagnostic Tests Arthrography Radiographic exam, use air or contrast medium:; 90-95% accuracy Teaching Complications: infection, allergy Post-op: Rest joint 6-12 hrs, use ice Arthrocenthesis –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

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 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 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

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