1. MUNIR SAADEDDIN, FRCSED ASSOCIATE PROFESSOR & CONSULTANT COLLEGE OF MEDICINE KING SAUD UNIVERSITY Introduction to Orthopaedics

2. Objectives of this lecture To explain what is Orthopedic and what conditions will be discussed during this course. Explain what do we mean by Red Flags. List the different causes of Orthopedic disease. Describe some of clinical examination tests. Introduce titles of Clinical Skills which will be taught during this course.

3. 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

5. 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.

6. 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, Foot and Ankle surgery and Orthopedic Oncology.

7. Red Flags Red Flag = 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.

8. 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 Acute joint Dislocations : requires urgent reduction or may cause serious complications

9. Examples of Red Flags Multiple Trauma or Pelvic Injury: more than one fracture or injury sustained at the same time ; consider massive blood loss and associated injuries. 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). 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

10. Alignment terminology

11. Alignment Terminology: Cubitus Varus

12. Alignment terminology: Cubitus Valgus

13. Orthopedic Diseases Congenital : present since birth( though may not be evident till some time later). Acquired : develop or begin after birth.

14. Congenital Anomaly : Talepoequinovarus TEV

15. Acquired Orthopedic Conditions Acquired conditions include : Trauma Developmental Inflammation Infection Neuromuscular Degenerative Metabolic Tumor

16. Traumatic Injuries Fractures. Dislocations. Fracture dislocation: dislocation associated with nearby fracture. Soft tissues injuries: ligaments, tendons, menisci. Nerve injuries. Epiphyseal injuries.

17. Fractures: Break in the continuity of bone

18. Dislocations Complete separation of the articular surface Distal to proximal fragment Anterior, Posterior, Inferior, Superior. Acute dislocation may be complicated by neurovascular injury. Acute dislocations require urgent reduction

19. Fracture Dislocation

20. Dislocation and Fracture dislocation of the Spine often results in Paralysis

21. 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

22. Soft tissue injuries of the knee

23. Anterior Cruciate Ligament injury: MRI

24. ACL Injury: Lachman’s test

25. MCL: Value of Stress Xrays

26. (Developmental Dislocation of Hip) DDH

27. Orthosis : Pavlick Harness for DDH

28. Developmental: SCFE (Slipped Capital Femoral Epiphysis)

29. Spinal Deformities: Kyphosis or Hyperlordosis

30. Spinal Deformity: Scoliosis

31. Developmental Foot deformity: Hallux Valgus

32. 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

33. OA Hip

34. Total Hip Arthroplasty ( THA )

35. Osteoarthosis of Knee

36. Osteoarthritis of Knee

37. Metabolic Disorders (Rickets): Bow Legs

38. Osteoporosis: Fractured NOF

39. Hemi-Arthroplasty Lt Hip

40. Spinal Osteoporosis

41. Osteoporosis: Colles fracture

42. Bone Tumors

43. Bone Tumor

44. Bone tumors

45. Chronic Osteomyelitis : discharging sinus

46. Chronic Osteomyelitis : Sequestrum

47. Spinal Infection : Tuberculosis: Para Vertebral Abscess

48. Neuromuscular disorder: Polio

49. Neurological Evaluation : Sensory

51. Nerve Injury: Muscle wasting

52. Nerve Injury: Sensory Loss

53. Muscle Power Testing : Iliopsoas

54. Muscle Power Testing : Quadriceps

55. 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

56. Devastating effect of Spinal Cord Injury

57. 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

58. Clinical Skill: Cast application

59. Clinical Skills: Knee Aspiration