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Orthopedic Surgery. The branch of medical science concerned with disorders or deformities of the spine and joints. Orthopedic Terminology “Position and Movement”. Abduction move a part away from body Adduction move a part toward the body Dorsiflexion bend or flex foot toward leg - PowerPoint PPT Presentation
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ORTHOPEDIC SURGERY
The branch of medical science concerned with disorders or
deformities of the spine and joints.
Orthopedic Terminology“Position and Movement”
Abduction move a part away from body Adduction move a part toward the body Dorsiflexion bend or flex foot toward leg Plantar flexion extend foot with toes pointed down (as
when depressing the gas pedal) Flexion to bend a part Extension make a limb straight Eversion turn outward Inversion turn inward Distal farthest away from point of origin Proximal closest to point of origin Medial nearest mid-line Lateral away from the midline
Orthopedic Terminology“Position and Movement”
Valgus -abnormal displacement of part of a limb away from the midline of the body – distal from the affected joint – knees together
Varus - a deformity in which part of a limb is turned inward to an abnormal degree – distal from the affected joint – knees apart
Orthopedic Terminology Acetabulum hollowed area of pelvis that receives head of femur Acromioclavicular (AC) joint where clavicle joins acromion process
of scapula Arthritis inflammation of a joint Arthrodesis surgical fusing or fixation of a joint Arthroplasty surgical reconstruction of a joint Arthroscopy visualization of a joint through an endoscope (diagnostic
or operative) Arthrotomy surgical incision into a joint Articulation joint movement Atrophy muscle wasting from lack of use Bone marrow found in medullary canal of long bones and porosites of
cancellous bone Cartilage elastic, strong, dense connective tissue Compact bone hard outer covering of bone Cortical bone hard bone that forms shell of bones/acts as supporting
structure Condyle rounded part of a bone where ligaments articulate with
adjacent bones Curvature normal or abnormal bending
Orthopedic Terminology Diaphysis shaft of a long bone Dislocation displacement of a joint Dysplasia abnormal tissue growth Endosteum inside lining of bones where new bone forms
(marrow) Epiphysis two ends of a long bone Exostosis bony growth arising from a bone’s surface Fibroma tumor composed of fibrous or connective tissue Foramen normal bone opening through which nerves,
vessels, etc. pass Foramen magnum occipital bone opening where spinal
cord passes to vertebral column Fossa shallow depression of a bone Fracture break or crack of a bone Hallux big toe Implant implantation of graft (synthetic or tissue)
Orthopedic Terminology Lamina flat layer or plate of a bone Ligament connective tissue that joins bone
surfaces Malleolus rounded bone process (ankle) Malunion faulty union of a fractured bone Nonunion failure of fractured bone to unite Osteogenesis origination/development of bone
(ossification) Osteomyelitis inflammation of bone tissue Osteoporosis diminished calcium in a bone Osteotomy surgical cutting of bone
Orthopedic Terminology Pelvic Girdle bony structure that supports the
trunk and provides attachment for the legs Periosteum membrane surrounding bone
(contains blood vessels) Polydactylism more than normal number of
digits Scoliosis abnormal curvature of spine Syndactylism webbing between digits Synovial membrane lining of a joint capsule Tendon fibrous tissue that connects muscle to
bone Traction force placed on bones or muscles to
align or immobilize parts
Primary purposes of orthopedic surgery
1. Repair, revision, reconstruction, reattachment or removal any of the 206 bones of the skeletal structure and surrounding tissue
Bones, joints and affected muscle tissue Tendons, ligaments or cartilage
2. Accurately classify treatment Axial skeletal procedures Upper extremity procedures Lower extremity procedures Limb reattachment procedures Amputation procedures
Purposes (continued)3. Investigate, preserve and restore form and function to the
musculoskeletal structures and associated tissues of the extremities and also the spine. Treatment depends on the type of injury and the duration of necessary immobility.
Stages of treatment Investigation – diagnosis of structural issues
External Internal
Preservation Restoration
Types of treatment Fracture management
Reduction Immobilization Rehabilitation
Corrective surgeries Bone grafts Implants Internal and external fixation
The Skeleton
Function of Skeletal System
Support Protection Movement Storage Hematopoiesis -
the formation of blood cells in the living body (especially in the bone marrow)
Bone Histology Bone is a type of
connective tissue 2 Types of Bone: Dense/Compact
Bone/ Corticalhard on outside/canal on insidecomposed of Haversian Units or Osteon
Spongy/Cancellous Bone
Bone Formation Osteogenesis is bone formation Two Types: Intramembranous Endochondral More Terms:
Osteoblast :a cell from which bone develops Osteocytes: a star-shaped cell, is the most abundant
cell found in bone. They are osteoblasts that have completed their bone-forming function and have become trapped in new bone tissue, evolving into structural bone cells and is involved in the maintenance of that bone. A mature bone cell.
Osteoclasts: cells break down and assimilate bone. They are located in minute, bony chambers called lacuna.
Intramembranous Ossification Sheets of primitive connective tissue form at site of
future bone Primitive connective cells collect around blood
vessels in these layers Connective tissue cells differentiate into osteoblasts,
which deposit spongy bone Osteoblasts become osteocytes when bony matrix
surrounds them (lacunae) Connective tissue on surface of each developing
structure forms a periosteum Osteoblasts on the inside of periosteum deposit
compact bone
Endochondral Ossification Masses of hyalin cartilage form models of future
bones Cartilage tissue breaks down/Periosteum
develops Blood vessels and differentiating osteoblasts
from the periosteum invade the disintegrating tissue
Osteoblasts form spongy bone in space occupied by cartilage
Osteoblasts become osteocytes when bone matrix completely surrounds them
Osteoblasts beneath periosteum deposit compact bone around spongy bone
Relevant anatomy1. Skeletal system – articulated skeleton
comprised of 206 bones Axial skeleton – skull, spine and ribs
Skull – includes cranial and maxillofacial bones Cranial bones – 8 cranial bones Facial bones – 13 facial bones Middle ear bones – 6 middle ear bones Mandible – one jaw bone
Hyoid bone Vertebral column – 26 backbones
Verebral – 24 backbones: 7 cervical, 12 thoracic, and 5 lumbar
Sacrum – one sacrum bone Coccyx – one tailbone
Thoracic cage – 25 thoracic bones Sternum one cartilaginous bone that supports most ribs Rib cage – 24 rib bones; 12 pair posteriorly attached to the
spine
Relevant anatomy - Cervical C-1 : a.k.a. Atlas:
like Atlas man (Greek mythology), the bone supporting the skull.
C-2 Axis: bone that
allows the head to pivot.
Axial Skeleton
Appendicular Skeleton The appendicular skeleton
consists of 126 bones in the human body which make motion possible and protects the organs of digestion, excretion, and reproduction.
The word appendicular refers to an appendage or anything attached to a major part of the body, such as the upper and lower extremities.
The appendicular skeleton has four major regions:
Pectoral Girdles(4 bones) Upper Limbs (60 bones) Pelvic Girdle(2 bones) Lower Limbs(60 bones)
Anatomy (continued) Appendicular Skeleton Upper extremities –shoulder,
arm and hand bones of the appendicular skeletal system Pectoral girdle – four pectoral or
collar bonesScapula – two posterior collar
bonesGlenoid fossaCoracoid processAcromion process
Clavicle – two anterior collar bones
Upper limbs –arm, wrist and hand bonesHumerusRadiusulna
Anatomy (continued) Lower extremities –hip
and leg bones of the appendicular skeletal system Pelvic girdle
IliumPubisIschium
Lower limbs – leg and foot bonesFemurPatellaTibiaFibulaTarsalsMetatarsalsphalanges
Anatomy of a Bone
Bone Marrow Within the long
bones are two types of bone marrow: red marrow and yellow marrow.
The yellow marrow is fatty tissue.
During starvation, the body uses the fat in yellow marrow for energy.
Bone Marrow The red marrow of some
bones is an important site for blood cell production.
Here all red blood cells, platelets, and white blood cells form in adults. Red blood cells carry
oxygen and nutrients to the body tissues.
Platelets help in blood clotting.
White blood cells help fight disease and infection.
Muscles
Anatomy (continued)2. Muscular anatomy
Neck muscles – sternocleidomastoid, platysma and trapezius
Torso muscles – deltoid, pectoralis, serratus anterior, latissimus dorsi, transverse abdominus, rectus abdominus and levator ani
Arm muscles – biceps brachii, triceps brachii, brachialis, brachioradialis, carpi, digitorium and pollicis
Leg muscles – gluteus, sartorius, quadriceps femoris, adductor, hamstring, gastrocnemius, tibialis anterior and digitorium, both flexor and extensor
Muscles Functional unit of a muscle is the sarcomere 3 Types:
Skeletalvoluntary/conscious movementstriated in appearancefound along-side skeletal system
Cardiac involuntary/unconscious movementfound only in myocardium of heart
Smoothinvoluntary/unconscious movementfound in the viscera
4 muscles of the Rotator Cuff
Knee anatomyANTERIOR POSTERIOR
Knee Anatomy
FootExtensor digitorum longus (EDL) – MUSCLE -The EDL extends or lift the toes
Hand
Bone composition types1. Membranous bone – highly specialized
connective osseous tissue that originally is membrane, then ossifies to bone
Cranial Facial – maxilla (upper jaw), mandible (lower),
nasal and lacrimal bones2. Cartilaginous bone
Long bones Flat bones
Irregular bones Short bones Sesamoid bones
Bone Types
Types of Joints
Joint Classification1. Functionally
based on degree of movement*synarthroses-no movement*amphiarthroses-slight movement*diarthroses-freely moveable
2. Structurallybased on type of connective tissue and type of joint cavity*fibrous-no movement, no joint cavity, dense fibrous connective tissue, synarthoses*cartiligenous-slight to no movement, can be synarthroses or amphiarthroses*synovial-joint cavity, diarthroses
Diarthroses Joints The 6 types of diarthroses joints:
• Ball-and-Socket• Condyloid• Saddle• Pivot• Hinge• Gliding
Ball-and-Socket Joint The ball-shaped end of
one bone fits into a cup shaped socket on the other bone allowing the widest range of motion including rotation.
Examples include the shoulder and hip.
Condyloid Joint Oval shaped condyle fits into
elliptical cavity of another allowing angular motion but not rotation.
Saddle Joint This type of joint occurs
when the touching surfaces of two bones have both concave and convex regions with the shapes of the two bones complementing one other and allowing a wide range of movement.
The only saddle joint in the body is in the thumb.
Pivot Joint Rounded surfaces of
one bone fit into a ring of one or tendon allowing rotation.
An example is the joint between the axis and atlas in the neck.
Hinge Joint A hinge joint allows
backward and forward movement in only one direction, much like a door opening and closing.
Examples Knee joint Elbow joint
Gliding Joint Flat surfaces move
against each other allowing sliding or twisting without any circular movement
Joints and surrounding tissue
1. Joints – points of articulation where movement between bones can occur
Axial skeleton Skull
Cranial and facial sutures Temporomandibular
Vertebral column Atlanto-occipital Intervertebral
Ribs and sternum Sternoclavicular sternocostal
Joints and surrounding tissue (continued)
Upper extremities Pectoral girdle
AcromioclavicularShoulder (glenohumeral or humeroscapular)
Elbow Hand
Wrist (radiocarpal)Digit
Lower extremities Pelvic girdle
SacroiliacPubic symphysisHip
Knee (tibiofemoral and femoropatellar)
Joints and surrounding tissue (continued)
Tibiofibular (proximal and distal) Ankle Foot
Intertarsal Metatarsophalangeal Toe (interphalangeal)
2. Joint structure Articular hyaline cartilage Fibrous capsule
Fat pad Articular joint disc Ligaments – connecting bone to bone Tendons – connect muscle to the bone
Synovial membrane and fluid
Joints and surrounding tissue (continued)3. Joint articulation types
Synovial – allow free movement/have a joint cavity
Cartilaginous – allow little movement/no joint cavity
Fibrous – allow no movement/No joint cavity4. Surrounding soft tissue
Circulatory – blood vessels Peripheral nerves Foramen muscles
Pathology1. Pathologic
Congenital Dysplasia – abnormal tissue growth Hip dislocation Polydactylism Scoliosis, kyphosis and lordosis – abnormal
curvature of the vertebral column Syndactylism – webbing between digits
Acquired disease Arthritis – inflammation of a joint
Osteoarthritis (OA) Rheumatoid arthritis (RA)
Bursitis – inflammation of the synovial fluid herniation
Pathology (continued)• Infection
Osteomyelitis – inflammation of bone tissue• Calcium disorders
Rickets – vitamin D and calcium deficiency Osteomalacia – soft bones Osteoporosis – fragile and porous bones
• Tumors Osteochondroma – generally benign Osteoma – benign tumor of the bone Fibroma – composed of fibrous tissue Osteosarcoma – malignant tumor of the bone Myeloma – cancer in the bone marrow Chondrosarcoma – tumors of the hyaline cartilage, often
malignant• Volkmann’s contracture
Strain – stretching of joint tendons
Pathology (continued)2. Traumatic
Damaged or dislocated joints Fracture
Closed (simple) – bon does not protrude the skin
Open (compound) Complete or incomplete Multiple
fragmentation
Bone fracture pathology1. Fractured bones
Simple (closed) Compound (open) Compression – bone is crushed Comminuted – bone breaks into more than 2
pieces Depressed – bone forced inward Greenstick – partially bent or broken Impacted – driven into another bone
fragment2. Fracture geometry
Longitudinal (linear) – fracture line runs along the length of the bone
Bone fracture pathology (continued)
Oblique – fracture line lies at an angle Spiral Transverse
3. Stages of bone healing after fracture Hematoma or hemorrhage (stage 1) Granulation (stage 2) Bony callus formation (stage 3) Consolidation, calcification and bone remodeling
(stage 4)4. Osteogenesis – bone growth stimulated by use
of electrical impulses5. Complications in bone healing
Delayed union of bone Mal-union of bone Non-union of bone
Fracture management methods
1. Closed reduction (CR) procedures Closed reduction via external fixation (CREF)
– manipulation of fracture of bone using external devices such as casts or traction
Closed reduction via internal fixation (CRIF) externally manipulated fracture of bone using internal devices such as pins or rods
2. Open reduction (OR) procedures Open reduction with external fixation (OREF) Open reduction with internal fixation (ORIF)
External Fixation
External Fixation
External ManipulationTraction Techniques
Closed Reduction Via External Fixation
Fracture management stabilization devices
1. External fixation Casts
Plaster (fast, medium, slow-setting) Fiberglass Types
Shoulder spica Minerva jacket Body cast Short arm/leg Long arm/leg Hip spica Cylinder cast
Hip Stabilization
Goals of Casting/Splinting Relieve pain Augment healing Stabilize fracture Prevent further injury
Splinting is better if practical because it is easier to manage swelling considering the entire limb is not isolated by a circumferential cast
Casting Considerations Casts
– Proper placement of cast brings patient safety issues• Patient’s limb should be elevated• Webril should be placed so no wrinkles are in cotton to
cause pressure sores• As plaster or fiberglass is placed, assistant must not
make marks in plaster as it dries—these may cause pressure sores
• Reflective materials will reflect heat given off by casting material if fiberglass and may burn patient’s limb
• Tip of limb should be cleaned of all prepping solution so patient may be monitored for signs of circulatory disruption: increasing pain, pain that progresses into numbness, cyanotic skin, cold skin, poor capillary refill
Casting Differences Plaster
webril first
wet casting with warm water before application
primarily used on children or where a lot of swelling is anticipated because can split if necessary (poor circulation due to swelling)
Fiberglass
webril first
can wet with warm or cold water
cannot split if needed/must be removed and reapplied
Combo Casting “Orthoglass” Outer soft sleeve (sock-like on outside) Inside composed of moldable fiberglass Wet, apply, wrap with ace
Fracture management (continued)
Splints Abduction splint
Braces Frames and external fixation devices Traction
Buck’s traction – skin traction Skeletal traction
Fracture management (continued)
Grafts – human material used to stabilize bone Bone grafts
Autogenous graft – bone from own bodyCotrical graft – “matchsticks” or small narrow slices of cortical
boneCancellous graft – spongy boneHomogenous graft – donor bone from another human
Fracture management (continued)
Orthopedic implants Metal, ceramic, silicone or high-density molecular plastic
prostheticsHumeral endoprosthesis for shoulderUlnar prosthesis for elbowSilastic implant for finger jointsFemoral endoprosthesis for hipKnee arthroplasty implants – total kneePress-fit implants – secured to area without cement
Fixation options – cemented or non-cemented
Common diagnostics performed prior to surgery
1. Lab studies – blood cultures, urine samples, spinal fluid or synovial fluid tests
Biopsy, bone marrow Erythrocyte sedimentation rate (ESR) –
measures rate of RBC fall, since inflammations cause them to fall faster than normal
Serum alkaline phosphates (SAP) – check for increased levels of SAP, which indicated multiple kinds of bone disease
Diagnostics (continued)2. Diagnostics
Arthrocentesis - procedure of using a syringe to collect synovial fluid from a joint capsule. It is also known as joint aspiration. Arthrocentesis is used in the diagnosis of gout, arthritis, and synovial infections.
Arthrography – injection of gas or contrast media for inspection of cartilage and ligaments surrounding joints
Arthroscopy Bone densitometers – measuring bone density Computerized tomography (CT) Magnetic resonance imaging (MRI) X-rays
The Operating Room
OR Beds and PositionersCHIC TABLE BLUE ALLEN
OR Beds and PositionersJACKSON FLAT TOP JACKSON FX TABLE
OR Beds and PositionersANDREWS TABLE CLOWARD
OR Beds and PositionersBEACH CHAIR MCCONNEL HEAD REST
OR Beds and PositionersJACKSON SLING VAC PAC OR BEAN BAG
OR Beds and PositionersWILSON FRAME HANA TABLE FOR ANTERIOR
APPROACH TOTAL HIPS
OR Beds and PositionersMAYFIELD HEAD REST PEG BOARD POSITIONER
Special considerations1. General considerations
Preoperative considerations Aseptic technique Full 10 minute scrub (varies per institution/surgeon) Additional scrub attire Protective attire Extra drapes Laminar air flow Ultraviolet irradiation Cast rooms are separated from operating rooms to
reduce plaster dust contamination. If a cast room is not available, preoperatively bivalve the cast in patient’s room or holding area, then remove in OR
Special considerations (continued)
Intraoperative considerations Use antibiotic irrigation solution Magnetic mat may be used for placement of
instruments Postoperative considerations
Elevate the extremity Cooling apparatus
Special considerations (continued)
2. Surgery-specific considerations Implants – require proper selection, handling
and application Methyl methacrylate Handling of implant
Casts Tourniquets Endoscopic equipment Powered equipment Compressed gas cylinders or wall units
Basic orthopedic supplies1. Beanbags, sandbags and pillows2. Sutures
Surgical steel Ethibond, Prolene and Nurolon – used in attaching
tendons, ligaments, bones Vicryl – used for work with periosteum and closure
3. Drapes4. Fixative (bone cement) – Methyl methacrylate or
polymethyl methacrylate (PMMA) 5. Agents
Anti-inflammatory agents – Cortisone steriods Hemostatic agents
Avitene – applied dry directly to bone surface Bone wax Gelfoam thrombin
Basic orthopedic equipment1. Arthroscopic support equipment2. Bone stimulator3. Braces, casts and other immobilizers4. Coblation – a new cauterization method that is non-heat
driven5. Fluoroscope (C-arm)
Mandatory lead apron6. Irrigation7. Specialty positioning devices
Fracture table Andrews frame – maintains patient in modified knee-
chest position Wilson frame – prone position
8. Tourniquet9. Traction devices
Basic orthopedic instrumentation
1. Basic sets Bone sets
Small bone set – used on extremities such as hands and feet
Large bone – long bones and joints Hip set Knee set Shoulder set Bone graft set
2. Minimally invasive surgery Arthroscope Support instrumentation
Basic instruments (continued)3. Bone cutting
Curettes, bone Cutters, bone
Single or double-action Chisels
Hibbs Elevators, periosteal Files, bone Drills Gouges Hooks, bone mallets
Basic instruments (continued)
Knives, orthopedic Amputating knife Smillie meniscus knives
Osteotomes Rasps Reamers Rongeurs
Single or double action
Basic instruments (continued)4. Bone manipulation tools
Bone clamps Lowman Lane
Bone hooks Retractors
Bennett Hohmann
Saws Gigli saw Amputation saw
Tendon pulling forceps Tendon strippers Powered instruments – includes power drills, reamers,
and oscillating and reciprocating saws
Basic instruments (continued)5. Bone piercing tools – generally used to
insert fixation devices Cutters Kirschner wires, Rush rods, Steinman pins,
screws, plates Plates Pins (pin cutter must be available)
Steinman pins are smooth or threaded Sizes 1/32”, 1/16”, 3/32”, 1/8”, 5/32”, 3/16” and
¼”
Basic instruments (continued)
ScrewsCortical screwsCancellous screws – common diametes are 32 mm and 64
mmMalleolar screws
Rods or intermedullary nailsKirschner rod or intermedullary nailRush rodVertebral column rod (Harrington)
WiresKirschner wires (K-wires) – available smooth or threadedSizes – 0.032, 0.045, 0.062
Rush awl reamer Screwdrivers Traction bow
Basic instruments (continued)6. Bone measuring devices
Screw gauges Bone screw gauge Depth gauge – used to determined length of
screw needed Calipers rulers
Relevant positions, skin prep and draping
1. General information Position – varies greatly, depending on
surgical area Skin prep – generally one joint above and one
joint below operative site. Shaving may be required. 10-minute skin prep with Betadine scrub and paint is most commonly used
Draping – while still holding the extremity in a raised position, place the “down” sheet, an impervious flat sheet, under the extremity. Apply the impervious stockinette, covering the entire extremity. A variety of large incision sheet may be used (extremity sheet, U-drape, split sheet or laparotomy sheet)
Relevant positions, skin prep and draping (continued)
2. Upper extremities Shoulder and upper arm surgeries
Position Supine or modified supine Fowler’s or “Beach-chair”
Skin prep – prep entire arm and shoulder, requires additional person
Draping – apply impervious “down sheet” tucked under shoulder and axillary area. Follow with sterile stockinette from the fingers to the shoulder. Coban may be used to secure the stockinette. Place split-sheet around the shoulder. Drape the arm free
Elbow, forearm and hand surgeries Position – supine with armboard Skin prep – elevate and prep entire hand and arm to
tourniquet Draping – apply impervious “down sheet” over armboard.
Follow with stockinette and extremity sheet.
Relevant positions, skin prep and draping (continued)3. Lower extremities
Hip surgeries Positions – varies according to procedure
Supine with a rolled towel-covered sand bag placed under the thigh
Full lateral with bean bag Supine or lateral on fracture table
Skin prep – elevate affected leg, enlisting additional personnel if needed. Prep entire leg and foot, prepping toes and groin areas separately and last. When fracture table is used, prep affected side of hip from umbilical line to knee
Draping – isolate perineum with adhesive sterile plastic U-drape. Tuck impervious “down sheet” under hip joint and extend the length of OR table, then apply laparotomy sheet or U-drape
Relevant positions, skin prep and draping (continued)
Knee and lower leg surgeries Position – modified supine with knees at table break,
which is lowered to 90- degrees Skin prep – support affected leg by the foot for entire
prep. Prep from tourniquet on upper thigh to foot and toes
Draping – place impervious “down sheet” under affected leg, covering opposing leg. Apply stockinette over leg and foot to tourniquet, then place extremity sheet or split sheet
Ankle, foot and toe surgeries Position – supine Skin prep – support affected leg using leg holder or
personnel. Prep from knee, including the foot and toes
Draping – apply impervious “down sheet”. Apply stockinette over foot to tourniquet, then place extremity sheet
Common axial skeletal procedures
1. Craniofacial – maxillofacial or Le Fort fractures (usually performed by plastic surgeon)
2. Vertebral column Laminectomy Disectomy Spinal fusion Trauma scoliosis
Common joint reconstruction procedures
1. Arthrodesis – surgical fixation or fusion of a joint.
2. Arthrotomy – incision into a joint3. Arthroscopy – direct visualization into a
joint4. Arthroplasty – surgical repair of a joint5. Repair of joint dislocations
Common upper extremity procedures
1. Clavicle surgery Acrominoclavicular (AC) separation repair – reattach the
ligaments at the joint between the clavicle and the acromion
Acromioplasty – relieve the impingement of soft tissue in the joint
2. Shoulder joint Glenohumeral dislocation repair
Bristow procedure – the coracoid process (a long, curved projection from the scapula) with its muscle attachments is transferred to the neck of the scapula and creates a muscle sling at the front of the glenohumeral joint
Rotator cuff repair Bankart procedure performed for recurrent dislocation of the
shoulder Putti-Platt procedure – detachment of the subscapularis tendon
and the capsule Arthroplasty of the total shoulder – total replacement of the
shoulder
Common upper extremity procedures (continued)3. Humerus (supracondylar, epicondylar,
intercondylar) and elbow – for all procedures distally of the humerus, a tourniquet is usually applied high on the affected arm. The entire hand and arm to the tourniquet will be prepped and draped
ORIF of the humeral head Arthroplasty of the humeral head Fractured humerus Supracondylar, epicondylar, intercondylar
fracture Arthroplasty of the total elbow Fracture olecranon
Common upper extremity procedures (continued)4. Radius and ulna
Excision of the radial head Fractures of the radius and ulna Ulnar nerve transposition – anterior ulnar
nerve is brought to the posterior position after damage from elbow trauma
Colles fracture of the distal radius near the wrist joint
Excision of ganglionic cyst5. Wrist
Fractures of the carpals Arthroplasty of the wrist
Common upper extremity procedures (continued)6. Hand – involves metacarpals and
phalanges Fractures of the metacarpal and/or phalange Arthroplasty of the metacarpal phalangeal
joint (MPJ) Arthroplasty of the phalangeal joints – similar
to MPJ procedure with silicone implants Palmar fasciectomy (Dupuytren’s release) –
prevents full extension of finger, usually ring and little fingers
Syndactyly release – requires a split-thickness skin graft
Common lower extremity procedures
1. Hip and femur procedures Congenital hip dislocation reduction, open
and closed Fractured hip
Intertrochanteric fracture – very common fracture; located in the area between the greater and lesser trochanteres
Femoral head fractures Subcapital fracture or near the proximal area of the
femoral neck Arthroplasty of the total hip Fractured femoral shaft
Closed ORIF of femur
Common lower extremity procedures (continued)2. Knee procedures
Arthroscopic procedures Diagnositc Shaving of articular cartilage fragments Synovectomy Medial or lateral meniscectomy Removal of loose bodies
Repair of the anterior (ACL) and posterior cruciate ligaments (PCL) with autogenous or homogenous grafts
Open knee surgery Arthroplasty of the total knee Baker’s cyst excision – located in the posterior popliteal
fossa Patellectomy – removal of entire patella
Common lower extremity procedures (continued)3. Tibia and fibual procedures – this area is
prone to open fractures Fractured tibia Ligament repairs connecting the femur Tibial osteotomy – performed to re-align the
tibia Fractured fibula Fractured ankle joint
Common lower extremity procedures (continued)4. Ankle and/or foot procedures
Arthrodesis Arthrodesis, ankle Arthrodesis, triple – fusion of the talocalcaneal,
talonavicular and calcaneocuboid joints Arthroplasty of the total ankle Arthroplasty of the tarsals Fractured metatarsals and phalanges Bunionectomy – excision of exostosis of the
metatarsal-phalangeal joint of the great toe Hammer toe deformity correction
Common tendon and ligament repairs
1. Tendon repairs (Tenorrhaphy) Achilles tendon – most powerful tendon in the foot Tibial tendon Extensor tendon of the forearm Flexor tendon of the forearm
2. Ligament repairs – reconstruction of ligaments may require non-absorbable sutures, wires, staples, and grafts. Grafts may be autographs, allografts, or synthetic
Gamekeeper’s thumb Release of trigger finger
Limb reattachment procedures
1. General background Involves reattachment of severed extremity; every
case is different Extremely delicate and lengthy procedure; often 12 to
24 hours Involves many specialists Exchange in personnel to avoid extensive fatigue May involve two teams Requires extensive, detailed positioning of patient and
affected areas2. Basic sequence of events
Bones – anatomically aligned and stabilized Vasculature and nerves Restructuring – plastic surgeon completes
restructuring process
Amputation procedures1. Disarticulation – amputation through a
joint2. Above-elbow (AE) amputation3. Below-elbow (BE) amputation4. Above-knee (AK) amputation5. Below-knee (BK) amputation6. Transmetatarsal amputation – dissection
through the metatarsals7. Single toe amputation
Any questions Bone Heads?