1. Overview of the Orthopedics module
Albert Quintos M.D., FPOA

2. The Origin of the Word: Orthopedics / Orthopaedics
Nicholas Andry coined the word "orthopaedics", derived from Greek words for "correct" or "straight" ("orthos") and "child" ("paidion")
In 1741, when at the age of 81 he published Orthopaedia: or the Art of Correcting and Preventing Deformities in Children.

3. In ancient Eqypt, splints have been found on mummies made of bamboo, reeds, wood or bark, padded with linen
Ancient Greece,- Hippocrates details the treatment for dislocations of the shoulders, knees, and hips, as well as treatments for infections resulting from compound fractures.
Rome, Galen ( BC), a Greek, became a gladiatorial surgeon. His learning helped provide the best care possible for the Roman army.
Often referred to as the father of modern medicine
He studied the skeleton and the muscles that moved it
During this Greco-Roman period, attempts to provide artificial prostheses were noted, with accounts of
wooden legs, iron hands and artificial feet.

4. Jean-Andre Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities
He is considered by some to be the father of orthopedics in consideration of the establishment of his hospital and for his published methods.
Antonius Mathysen, a Dutch military surgeon, invented the plaster of Paris cast in Many developments in orthopedic surgery resulted from experiences during wartime
Middle Ages: the injured were treated with bandages soaked in horses' blood which dried to form a stiff splint.
Traction and splinting developed during World War I

5. Since WWII, treatments have evolved to include joint replacements, arthroscopy, and a whole host of technologies.
Improvements in biomaterials-titanium,polyethylene, ceramics- have produced better and more robust implants and prostheses over the years
However, the basic principles on which these advances are based have remained the same

6. THE COST OF MUSCULOSKELETAL TRAUMA
TRAUMA- the “neglected disease”
Leading cause of death for ages 1-44, of all races and socioeconomic levels
Those affected must deal with :
-physical and psychological effects of pain,
limitation of activities, loss of independence
-direct cost of diagnosis and treatment
-indirect cost of decreased productivity

7. THE R.P. SETTING
“HILOTS” / BONE SETTERS-still play an important role in the community
-Often may see and manage before doctors / health personnel
911 system not as well developed
Cost of implants / prostheses

8. Importance of recongnition of these conditions as a physician
Conditions necessitating emergent/urgent intervention
High Index of Suspicion

9. Nov 29 Mon
Nov 30 Tues
Dec 1 Wed
Dec 2 Thurs
Dec 3 Fri
8;30-9:30
No classes
Introduction to the module-Dr Quintos
Inflammaory disorders-Dr. Azores
Pediatric conditions-Dr Dungca
Module exam
9;30-10:30
Upper extremity trauma
Musculoskeletal radiology
Spine disorders-Dr. Lumawig
10:30-11:30
Lower extrmity trauma
musculoskeletal radiology
SGD hand
feedback
11:30-12:30
Sports injuries-Dr. Bengzon
Musculoskeletal radiology-Dr. Hernandez
1;30-2:30
Degenerative disorders-Dr Asedillo
Hand disorders- Dr. Estrella
LEC pm
2:30-3:30
Musculoskeletal tumors-Dr. Dimayuga
Orthopedic Rehab
3:30-4:30
SGD trauma
Orthopedic Rehab-Dr. Dela fuente
4:30-5:30

10. SCOPE Definition of terms Common fracture patterns
Presenting signs and symptoms
Review of first aid principles

11. DEFINITION OF TERMS
FRACTURE- a soft tissue injury with a concomitant break in the cortex of the affected bone
CLOSED FRACTURE- no break in the skin surrounding the bone
OPEN FRACTURE- with the presence of an external wound which communicates with the fracture site

12. DISLOCATION- a complete disruption of articular congruity of a joint
SUBLUXATION- an “incomplete” dislocation
SPRAIN- an injury to ligaments or joint capsule structures, with progessive gradations of injury
STRAIN- an injury to the musculo-tendinous unit

16. FRACTURE PATTERNS

20. Deforming forces

22. SIGNS AND SYMPTOMS PAIN / TENDERNESS SWELLING DEFORMITY
LIMITATION OF MOTION
OPEN WOUNDS
NEUROVASCULAR COMPROMISE

23. PAIN and SWELLING
Results from the trauma of the initial injury and resulting inflammation of tissues
Pain from a fracture- much more
Bleeding from bone- greater swelling
Therefore, the need to rest / immobilize the area
COMPARTMENT SYNDROME-increasing pain not responsive to pain medications

28. DEFORMITY
Loss of the normal appearance of the extremity or joint from fractures or dislocations
Correction of the deformity ASAP can help minimize soft tissue damage, pain
Must check pulses, sensation, motion of the affected area before and after any intervention

32. LIMITATION OF MOTION Due to pain! Due to a dislocated / subluxed joint
Due to a ruptured tendon, torn muscle or ligament
Unable to put weight on the lower extremity / use the arm

34. Open Fractures
Fractures communicating through a traumatic wound to the surrounding environment
Contamination and soft tissue envelope disruption are special considerations

35. Closed
VS.
Open

37. Compartment Syndrome
Mubarak defined compartment syndrome as an elevation of the interstitial pressure in a closed osseofascial compartment that results in microvascular compromise.
Usually anterior and deep posterior compartments of the leg
Volar compartment of the forearm

39. COMPARTMENT SYNDROME

40. Causes Acute Chronic Exertional Compartment Syndrome
Soft tissue trauma
Arterial injury
Limb compression during altered consciousness
burns
Chronic Exertional Compartment Syndrome
recurrence of increased pressure
Long distance runners and military recruits

41. Recognition tightness of the involved compartment
pain with passive motion of those muscles passing through the compartment
weakness of the muscles
Hypesthesia or paresthesia (evaluated with pinprick, light touch and two point)
The most important sign is pain out of proportion to that expected with the injury.

42. SPLINTING SPLINT-Any device used to immobilize a body part
Can be commercially manufactured or IMPROVISED

43. REASONS FOR SPLINTING
Prevents movement and reduces chance of further injury
Reduces pain and discomfort
Facilitates transport

44. GENERAL RULES OF SPLINTING
Assess pulse, motor function, and sensation before AND after splinting
Immobilize the joints above and below the injured bone
Immobilize the bones above and below the injured joint
Remove clothing, jewelry around area of injury

45. Splint in the functional position

46. Cover wounds with dressings before splint application
Use well padded splints
Immobilize the joint above and below the affected area

47. Apply gentle longitudinal traction to the extremity when warranted

48. When in doubt, splint the injury “Splint them where they lie”

49. SPINE IMMOBILIZATION

50. IMMOBILIZATION AND TRANSFER

51. Thank
You