Orthopedic Surgery Chapter 21

Skeletal System Provides a framework Provides a framework Point of attachment for muscles Point of attachment for muscles Protects some internal organs Protects some internal organs Source of RBCs Source of RBCs Stores calcium Stores calcium

Types of Bone Tissue Compact or Cortical Bone Compact or Cortical Bone Hard, dense tissue of bone surrounding the marrow cavity. Hard, dense tissue of bone surrounding the marrow cavity. Cancellous or Spongy Bone Cancellous or Spongy Bone Porous bone found at the ends of a bone and lining the medullary cavity. Porous bone found at the ends of a bone and lining the medullary cavity. Periosteum Periosteum Thin fibrous layer surrounding the bone. Thin fibrous layer surrounding the bone.

Orthopedic Surgery

Types of Bones Types of bones Types of bones Long (ex. humerus, femur) Long (ex. humerus, femur) Short (ex. carpals, tarsals) Short (ex. carpals, tarsals) Flat (ex. ribs, sternum, cranial) Flat (ex. ribs, sternum, cranial) Irregular (ex. facial, vertebrae) Irregular (ex. facial, vertebrae) Sesmoid (bones found within tendons)(patella) Sesmoid (bones found within tendons)(patella)

Structures of a Long Bone Diaphysis Diaphysis Shaft portion of a long bone Shaft portion of a long bone Compact bone Compact bone Epiphyses Epiphyses Ends of a long bone Ends of a long bone Cancellous bone Cancellous bone Articular cartilage Articular cartilage Smooth surface on the ends of bones in a joint. Smooth surface on the ends of bones in a joint.

Orthopedic Surgery

Types of Joint (Articulation) Synarthrosis Synarthrosis Immovable joints Immovable joints Ex. Suture lines of the cranium Ex. Suture lines of the cranium Amphiarthrosis (Cartilaginous) Amphiarthrosis (Cartilaginous) Slightly movable Slightly movable Ex. Vertebrae or symphysis pubis Ex. Vertebrae or symphysis pubis Diarthrosis (Synovial) Diarthrosis (Synovial) Freely moveable joint Freely moveable joint

Orthopedic Surgery Diarthrosis (Synovial) Joint Diarthrosis (Synovial) Joint

Synovial Joints (Diarthrosis) Ball and Socket – Shoulder and Hips Ball and Socket – Shoulder and Hips Condyloid – Temporomandibular Condyloid – Temporomandibular Gliding – Carpals of the wrist Gliding – Carpals of the wrist Hinge – Elbow or Knee Hinge – Elbow or Knee Pivot – Radius at the elbow Pivot – Radius at the elbow Saddle – Metacarpal of the thumb Saddle – Metacarpal of the thumb

Orthopedic Surgery Joint Types: Ball and Socket (Hip)

Orthopedic Surgery Joint Types: Hinge (Knee)

Orthopedic Surgery Joint Types: Hinge (Elbow)

Joint Terminology Abduction Abduction Adduction Adduction Eversion Eversion Inversion Inversion Pronation Pronation Supination Supination

Pathology of the Skeletal System Arthrodesis Arthrodesis Arthroplasty Arthroplasty Arthroscopy Arthroscopy Osteomalacia Osteomalacia Osteoporosis Osteoporosis Osteoarthritis Osteoarthritis Dislocations Dislocations

Pathology of the Skeletal System Appendicular skeleton Appendicular skeleton Axial skeleton Axial skeleton Condyle Condyle Foramen Foramen Trochanter Trochanter

Pathology of the Skeletal System Meniscus Meniscus Bucket handle tear Bucket handle tear Joint mice Joint mice Bunion Bunion Ganglion Ganglion

Types of Fractures Simple Simple Transverse Transverse Spiral Spiral Greenstick Greenstick Colle’s Colle’s Comminuted Comminuted Compound Compound

Healing of Fractures Osteogenesis Osteogenesis 5 stages: 5 stages: Inflammation Inflammation Blood clot serves as initial step. Blood clot serves as initial step. Cellular proliferation Cellular proliferation Fibrin mesh Fibrin mesh Callus formation Callus formation Bone fragments grow Bone fragments grow Ossification Ossification Unites the bone Unites the bone Remodeling Remodeling

Healing of Fractures Reduction of Fracture Reduction of Fracture Manipulating bone fragments into normal alignment. Manipulating bone fragments into normal alignment. Open Open Closed Closed Casts Casts Splints Splints

The Skeleton Skull (22) Skull (22) Cranium (8) Cranium (8) Facial bones (14) Facial bones (14) Vertebral column Vertebral column Cervical (7) Cervical (7) Thoracic (12) Thoracic (12) Lumbar (5) Lumbar (5) Sacral (5) Sacral (5) Coccyx (4) Coccyx (4)

The Skeleton Thoracic bones Thoracic bones 12 pairs of ribs 12 pairs of ribs True (7) True (7) False (5) False (5) Floating (2) Floating (2) Sternum Sternum Manubrium Manubrium Middle body Middle body Xiphoid process Xiphoid process

The Skeleton Shoulder (pectoral) Girdle Shoulder (pectoral) Girdle Clavicle Clavicle Scapula Scapula Upper extremity Upper extremity Humerus Humerus Radius Radius Ulna Ulna Wrist and Hand Wrist and Hand

Orthopedic Surgery Shoulder X-Ray Shoulder X-Ray

Orthopedic Surgery Schematic

The Skeleton Pelvic Girdle Pelvic Girdle Ilium Ilium Ischium Ischium Pubis Pubis Hip and Femur Hip and Femur Acetabulum Acetabulum Femoral head Femoral head

Orthopedic Surgery Hip X-Ray (A&P)

Orthopedic Surgery Schematic

The Skeleton Lower extremity Lower extremity Femur Femur Patella Patella Tibia Tibia Fibula Fibula Ankle and foot Ankle and foot

Equipment and Supplies Wilson / Andrews Frame Wilson / Andrews Frame Maintains a patient in the prone or knee chest position. Maintains a patient in the prone or knee chest position. Fracture table Fracture table Hip fracture or femoral nailing Hip fracture or femoral nailing Tourniquet Tourniquet Blood less surgery on extremities Blood less surgery on extremities Exsanguination Exsanguination Notify surgeon after 1 hour of tourniquet time. Notify surgeon after 1 hour of tourniquet time. X-ray / Fluoroscopy (C-Arm) X-ray / Fluoroscopy (C-Arm)

Equipment and Supplies

Powered surgical instruments Powered surgical instruments Air, nitrogen, battery, or electricy. Air, nitrogen, battery, or electricy. Saws, drills, reamers Saws, drills, reamers Implants Implants Methyl Methacrylate Methyl Methacrylate Bone cement Bone cement Antibiotic irrigation Antibiotic irrigation

Equipment and Supplies

Hemostatic agents Hemostatic agents Avitene Avitene Thrombin Thrombin Gelfoam Gelfoam Bone wax Bone wax

Common Procedures Bone Grafts - pg 823 Bone Grafts - pg 823 Arthroscopes of various joints - Knee, Shoulder, etc. Arthroscopes of various joints - Knee, Shoulder, etc. Carpal Tunnel Release – pg 833 Carpal Tunnel Release – pg 833 ORIF of the Humerus- pg 842 ORIF of the Humerus- pg 842 Repair Rotator Cuff – pg 847 Repair Rotator Cuff – pg 847 Total Hip Arthroplasty - pg 853 Total Hip Arthroplasty - pg 853

Common Procedures

Orthopedic Surgery Questions? Questions?