1. Orthopedics & Fractures

2. Orthopedics “Orthopedics” is: that branch of surgery which is specially concerned with the preservation and restoration of the function of the skeletal system, its joints, and associated structures like ligaments and tendons

3. Orthopedic Exam Meet Sam & Simon!!

4. BONES Major Functions: 1. Support for body’s vital organs (ie. skull protects the brain, rib cage protects the heart & lungs) 2. Serve as levers in conjunction with joints, tendons, ligaments, and muscles for movement 3. Production of blood cells in bone marrow 4. Storage site for calcium & phosphorous

5. Anatomy of a Typical Bone Types of Bone - Compact Bone – bone’s outer layer, what we can see. It is dense, strong, and heavy - Spongy Bone – bone’s inner layer; self- organizes in response to the direction of weight put on it http://training.seer.cancer.gov/module_anatomy/unit3_4_bone_classifica tion.html

6. Associated Structures Joint – anytime 2 or more bones come together Articular Cartilage – cartilage covering the ends of bones that are in contact with adjacent bones to create smooth movement and shock absorption Tendon – connects muscle to bone Ligament – connects bone to bone

7. Classification of Bones Long Bones – long! Bones of limbs Short Bones – short! Small bones of hands & feet Flat Bones – flat! Sesamoid Bones – small bones embedded in tendon as it crosses a bony prominence. Irregular Bones – jutting processes give these bones an irregular shape.

8. Quiz Can you feel some of these bones in your own body? - where would you feel flat bones? - where would you feel a sesmoid bone (and its associated tendon)? - where would you feel short bones - where would you feel irregular bones?

9. FRACTURES

10. Types of Fractures Open Closed Complete Incomplete Comminuted Segmental Chip Slab Pathologic

11. Open Fracture

12. Closed Fracture

13. Complete Fracture

14. Incomplete Fracture

15. Comminuted Fracture

16. Segmental Fracture

17. Chip Fracture

18. Pathologic Fracture Fracture secondary to another disease process

19. Bone Re-Modeling Osteoblasts – secrete a matrix made up of calcium phosphate crystals Osteocytes – retired osteoblasts; found within bony wall that they have deposited around themselves Osteoclasts – break down bone; release acids to dissolve crystals and enzymes to break down matrix

20. Bone Reacts to Stresses Put on It Greater physical stress placed on a bone at a particular site results in more bone deposition by osteoblasts at that site Another theory suggests electrical field change created by physical stress stimulates osteoblasts & matrix formation

21. Fracture Healing Primary Bone Healing – occurs when there is an anatomic reduction with compression fixation Secondary bone healing – occurs with a fibrous connective tissue “bridge” that is replaced by bone

22. Normal Fracture Healing

23. What Is Necessary to Get Normal Healing?

24. Abnormal Fracture Healing Mal-union – a fracture that heals with abnormal alignment Non-union – fracture healing has STOPPED before completely healed - elephant foot “hypertrophic non-union” - tapered “atrophic non-union” Sequestrum – a dead bone fragment separated from the rest of the bone Osteomyelitis – infection of bone

25. Malunion

26. Sequestrum

27. Non-union

28. Osteomyelitis

29. Treatment Options Fracture Reduction - Closed * temporary (until surgery) * permanent (cast or splint) - Open (orthopedic surgery) Intramedullary Fixation Cerclage External Fixation Devices

30. Fracture Reduction Goals Get bones close enough to heal Proper alignment - avoid mal-union + loss of function Avoid additional trauma - further fracture - infection

31. Closed Fracture Reduction

32. Open Fracture Reduction

33. Intramedullary Fixation

34. Pin Insertion

35. Cerclage

36. External Fixators

38. (view video)

39. TITAN continued … Treatment: Surgery - Wedge osteotomy of femoral condyles, plate applied - Deepening of patellar groove - Tibial crest movement back to cranial, pins applied - Patella was sutured medially to fixate in groove - Extra joint capsule on medial surface of joint was removed

40. Follow-Up Re-Check in 2weeks for range of motion Re-check in 4weeks for progress of healing Recheck in 10weeks for further progress of healing STRICT CAGE REST DURING THIS TIME!!

41. Surgery Tools

42. Animal Orthopedics as Human Model Animals are frequently used as models in clinical studies or experiments in the development of surgical procedures & drugs in veterinary medicine to be used in human medicine! 1 st hip replacement surgery was developed in military dogs

43. Jeopardy!

44. Questions???

45. END All images used from government websites as indicated OR with permission from Dr. Sharon Kerwin & Dr. Ben Young, Texas A&M University College of Veterinary Medicine