Orthopaedic + Plastic Surgical anatomy

Outline  A system for orthopaedics imaging  Common scans  Common orthopaedic surgical exposures  Common Plastics surgical exposures

Systems for orthopaedics imaging  ABCSS  Alignment  Bony  Cartilage  Soft tissues  Special consideration  Extra scans needed?  Extra-injuries to be considered?  NV injuries?

Shoulder scans  Muscle structure  Inner muscular layer – Rotator cuff  Intermediate muscular layer – Coracobrachialis, short head of biceps and pectoralis minor.  Outer lip – Deltoid + Pectoral muscles.  NV structures  Main NV bundle

Wrist scans  Muscle structure  Extensor tendons – 6 compartments  Flexor tendons – Superficial and deep groups  NV structures  Radial artery  Radial n  Median n  Ulnar n + Artery

Knee scans  Muscle structure  Anterior – Extensor group  Posterior – Gastrocnemius  Lateral – Iliotibial band, Biceps femoris  Medial – Sartorius, gracilis, semitendinosus  NV structures  Tibial n  Popliteal a + V  Common peroneal n.

Hip scans  Muscle structure  Flexor – Superficial layers; Deep layers  Lateral  Posterior - Deep layers, Superficial layers  NV structures  Femoral n  Femoral a + V  Sciatic n

Foot and ankle scans  Muscle structure  Anterior group  Posteromedial  Posterolateral  Posterior  NV structures  Anterior NV bundle  Posteromedial NV bundle.

Spine scans  Alignment lines – Anterior vertebral line, Posterior vertebral line, Spinolaminar line  Bony structures  Cartilaginous – IV discs  Soft tissues – ALL, PLL, Spinothalmic, Interspinous, SSL

Common Orthopaedics procedures

List of procedures  Shoulder  Elbow  Wrist  Hip  Knee  Ankle

General principle of Orthopaedic surgery  Internervous planes  Know your dangers

Shoulder  Dangers  Layers

Shoulder

Elbow  Dangers  Layers

Elbow

Radius  Dangers  Layers

Wrist

Hip  Dangers  Layers

Hip

Knee  Dangers  Layers

Knee

Ankle  Dangers  Layers

Ankle

Common Plastics procedures

List of procedures  Carpal tunnels  Median n Forearm  Ulnar n Forearm  Common peroneal n leg  Sural n leg  Flexor tendon sheath exposure

Carpal tunnel  Dangers  Layers

Carpal tunnel

Median n forearm  Dangers  layers

Median n forearm

Ulnar n forearm  Dangers  Layers

Ulnar n forearm

Common peroneal n leg  Dangers  Layers

Common peroneal n leg

Sural n harvest  Dangers  Layers

Sural n harvest

Flexor tendon sheath  Dangers  Layers

Flexor tendon sheath

Introduction of flaps  Reconstructive ladder  Types of flaps  Vascular territory of important flaps

Reconstructive ladder

Types of flaps  Local  Regional  Distant  Direct  Free flaps

Common flaps  Forehead  Pectoralis major  Latissimus dorsi  Lateral arm  Radial forearm  Gastrocnemius  Fibular

Vascular territories  Forehead flap – Supraorbital / Supratrochlear artery  Pectoralis major flap –  Major – Sternocostal head – Pectoral branch of thoracoacromial artery; Clavicular head – Clavicular branch of thoracoacromial artery.  Minor – Perforating branches of internal mammary artery medially, intercostal and lateral thoracic arteries (laterally)  Latissimus dorsi flap – Thoracodorsal artery (branch of the subscapular artery)  Lateral arm flap- Posterior radial collateral artery (branch off the profunda brachii artery)  Radial free forearm flap – Radial artery perforators  Fibular free flap- peroneal artery (Branch off tibioperoneal trunk from the popliteal artery)  Gastrocnemius flap – Sural branches of the popliteal artery.