Musculoskeletal Principals and Terminology Dr J G Myburgh

The Tree Of Andry (1741)

Orthopaedia ORTHOS (Straight) + PAIS (Child)

Orthopaedic Surgery Deals with disability in: Bones Joints Muscles Tendons Nerves

Orthopaedic Surgery Congenital and developemental abnormalities Infections Artritis and rheumatic disorders Metabolic and endocrine disorders Tumors and pseudo tumors Sensory disturbance and muscle weakness Injury and mechanical derangement

Symptoms Pain Stiffness Swelling Deformity Weakness Instability Sensory change Loss of function

Examination Look -Skin Feel -Skin Move - Active - Passive -Shape -Position Feel -Skin -Soft tissue -Bones and joints Move - Active - Passive - Abnormal

Muscle power Grade 0 – no movement Grade 1 – flicker Grade 2 – gravity eliminated Grade 3 – against gravity Grade 4 – against resistance Grade 5 – normal power

Flexion & Extention

Abduction & Adduction

Internal & external rotation

Pronation & Supination

Causes of Bone Deformity Congenital (pseudarthrosis) Bone softening (rickets) Displasia (multiple exostosis) Growth plate injury Fracture malunion Paget’s disease

Causes of Joint deformity Skin contracture Fascial contracture Muscle contracture Muscle imbalance Joint instability Joint destruction

Terminology Coxa - Hip Genu – Knee Pes – Foot Hallux – Big toe Pollices - Thumb

Genu valgum & Genu varum

Scoliosis

Kyphosis & kyphos (hump)

Septic artritis

Rheumatoid Arthritis

OA Total Hip Replacement

Giant cell tumor

Osteosarcoma

Operations on bones Bones can be: Cut (Osteotomy) Joined (Osteosynthesis) Grafted Lengthened Drained

Operations on ligaments Ligaments can be: Repaired Reconstructed Shortened

Operations on nerves Nerves can be: Decompressed Sutured Grafted Epineurolysis

Painfull Arc

Nerve Compression

Nerve injury Neurapraxia- caused by a focal lesion, usually demyelinating, and followed by a complete recovery Axonotmesis- Neurotmesis

Subluxation & dislocation

Anterior shoulder dislocation

Rotator cuff arthropathy

AC Dislocation

Fractures Complete or incomplete break in the continuity of bone, associated with an open or closed soft tissue injury of varying severity.

How Fractures Happen Single traumatic event Repetitive stress Abnormal weakening of bone

Trauma Twisting Compression Bending Tension Avulsion

Fracture Patterns

Fracture types

Impacted Fracture

Comminuted Fracture

Fracture displacement Translation Angulation Rotation Length (shortening/impaction)

Fracture displacement

Deforming Forces

How Fractures Heal

Fracture complications Vascular injury Haemarthrosis Compartement syndrome Nerve injury Infection Fat embolism Visceral injury

Fracture Complications Non - union Delayed union Mal union Joint stiffness Heterotopic ossification Avascular necrosis Osteoartritis Regional pain syndrome

Clinical History Look Feel Move

X- Rays Rule of twos: Two views Two joints Two limbs Two injuries Two occasions

Description of fractures Open or closed Fracture pattern Displacement

Fracture Patterns

Treatment Reduce Hold Exercise (Rehabilitation)

Open Fractures Wound debridement Antibiotic prophylaxis For gunshot fractures, do no give corticosteroids Stabilization of fracture Early wound cover

Fracture Immobilisation Plaster of Paris Traction Bracing/ Splinting External Fixation Internal Fixation

Physeal Injuries

Occupational Therapy

MEN WERE BORN TO SUCCEED NOT TO FAIL. HENRY D THOREAU

The End