1. Introduction to Orthopaedics
Munir Saadeddin , FRCSEd
Associate Professor & Consultant College of Medicine
King Saud University

2. Objectives of this lecture
To explain what is Orthopedic and what conditions will be discussed during this course.
Explain what do we mean by Red Flags.
List the different causes of Orthopedic disease.
Describe some of clinical examination tests.
Introduce titles of Clinical Skills which will be taught during this course.

3. What is the meaning of: Orthopedics
ORTHO = Straight , Upright , Correct Paios = Child First used by Nicolas Andry; a French doctor(1841) in a book titled: Orthopedia : the art to correct and prevent deformities in children

4. Orthopedic Associations Emblem: the British

5. Saudi Orthopedic Association Emblem

6. Orthopedic Surgery = Not only Bone Surgery
Orthopedic specialty is the branch of medicine which manage trauma and disease of Musculoskeletal system.
It includes : bones, muscles, tendons, ligaments, joints, peripheral nerves, vertebral column and spinal cord and its nerves.

7. Orthopedic Specialty Also Known as : Trauma and Orthopedic Surgery.
Sub-Specialties in orthopedic include : Pediatric Orthopedic, Sport and Reconstructive Orthopedic, Orthopedic Trauma, Arthroplasty, Spinal Surgery , Foot and Ankle surgery and Orthopedic Oncology.

8. Red Flags

9. Red Flags Red Flag = Warning Symptom or Sign.
Red flags should always be looked for and remembered.
Presence of a red flag means the necessity for urgent or different action/intervention.

10. Examples of Red Flags
Open Fractures : more serious and very high possibility of infection and complications
Complicated Fractures : fracture with injury to major blood vessel, nerve or nearby structure
Compartment Syndrome : increase in intra-compartment pressure which endangers the blood circulation of the limb and may affect nerve supply
Acute joint Dislocations : requires urgent reduction or may cause serious complications

11. Examples of Red Flags
Multiple Trauma or Pelvic Injury: more than one fracture or injury sustained at the same time ;
consider massive blood loss and associated injuries.
Cauda Equina Syndrome : compression of the nerve roots of the Cauda Equina at the spinal canal which affect motor and nerve supply to lower limbs and bladder (also saddle or peri-anal area).
Infection of Bone, Joint and Soft Tissue :
Osteomyelitis : Infection of the bone.
Septic Arthritis :Infection of the joint.
Cellulitis :spreading Infection of the soft tissue.
May cause septicemia or irreversible damage.

12. Alignment terminology

13. Alignment Terminology: Cubitus Varus

14. Alignment terminology: Cubitus Valgus

15. Orthopedic Diseases: Congenital or Acquired ?
Congenital : present since birth( though may not be evident till some time later).
Acquired : develop or begin after birth.

16. Congenital Anomaly : Talepoequinovarus TEV

17. Acquired Orthopedic Conditions
Acquired conditions include :
Trauma
Developmental
Inflammation
Infection
Neuromuscular
Degenerative
Metabolic
Tumor

18. Traumatic Injuries Fractures. Dislocations.
Fracture dislocation: dislocation associated with nearby fracture.
Soft tissues injuries: ligaments, tendons, menisci.
Nerve injuries.
Epiphyseal injuries.

19. Fractures: Break in the continuity of bone

20. Dislocations Anterior, Posterior, Inferior, Superior.
Complete separation of the articular surface
Distal to proximal fragment
Anterior, Posterior, Inferior, Superior.
Acute dislocation may be complicated by neurovascular injury.
Acute dislocations require urgent reduction

21. Fracture Dislocation

22. Dislocation and Fracture dislocation of the Spine often results in Paralysis

23. Intra-articular Fractures
If displaced ; should always be treated by ORIF=
(Open Reduction and Internal Fixation)
failure to reduce and fix such fracture results in loss of function, deformity and early degenerative changes

24. Epiphyseal Injuries: Salter-Harris classification

25. Soft tissue injuries of the knee

26. Knee effusion, ACL and PCL on MRI sagittal cuts

27. Anterior Cruciate Ligament injury: MRI

28. ACL Injury: Lachman’s test

29. MCL: Value of Stress X-rays

30. (Developmental Dislocation of Hip) DDH

31. Orthosis : Pavlick Harness for DDH

32. Developmental: SCFE (Slipped Capital Femoral Epiphysis)

33. Spinal Deformities: Kyphosis or Hyperlordosis

34. Spinal Deformity: Scoliosis

35. Developmental Foot deformity: Hallux Valgus

36. Degenerative Disorders
Occur at any joint
Can be primary or secondary
Increased wear and tear
Can lead to pain and/or deformity and/or loss of function
Increase with advancing age
Management depends on type and age

37. OA Hip

38. Total Hip Arthroplasty ( THA )

39. Osteoarthosis of Knee

40. Osteoarthritis of Knee

41. Bilateral TKR: AP view

42. Bilateral TKR : lateral view

43. Metabolic Disorders (Rickets): Bow Legs

44. Osteoporosis: Fractured NOF

45. DHS ( Dynamic Hip Screw )

46. Osteoporosis: Displaced Intracapsular Fracture

47. Hemi-Arthroplasty Lt Hip

48. Spinal Osteoporosis

49. Osteoporosis: Colles fracture

50. Bone Tumors

51. Bone Tumor

52. Bone tumors

53. Neurological Evaluation : Sensory

54. Axillary Nerve or Circumflex Nerve

55. Nerve Injury: Muscle wasting

56. Nerve Injury: Sensory Loss

57. Muscle Power Testing : Iliopsoas

58. Muscle Power Testing : Quadriceps

59. Spinal Cord Injury Often results from fracture dislocation of spine.
When injury is at cervical spine it may result in Tetraplegia.
Injury at dorsal spine may result in Paraplegia.

60. Devastating effect of Spinal Cord Injury

61. Neuromuscular disorder: Polio

62. Chronic Osteomyelitis : discharging sinus

63. Chronic Osteomyelitis : Sequestrum

64. Spinal Infection : Tuberculosis: Para Vertebral Abscess

65. Physiotherapy for Orthopedic Patients
Physiotherapy is an important part of orthopedic and trauma management
It is used for : pain relief, prevention of stiffness, muscle strengthening, mobilisation of stiff joint or spine, training non-weight bearing or partial weight bearing
Physiotherapy modalities include: heat, cold, exercise, ultrasound, traction, electrical stimulation

66. Clinical Skills: Cast application

67. Clinical Skills: Knee Aspiration

68. Clinical Skills: Management of Open Fracture
Initial management.
At ER( Emergency Room ).
Lower or Upper limb.

69. Orthopedic Surgeon Income in USA
The lowest reported average salary was $369,905 a year, while the highest reported average was $610,188.
In its own 2012 study recruiting firm Jackson & Coker reported an average salary of $520,475 for orthopedic surgeons, with an additional $104,095 in benefits.

70. Orthopedic Surgeons income in USA
Orthopedic Surgeons average reported income is:
HIGHER than
plastic surgeons,
cardiologists,
general surgeons
and internists.

71. Specialist Orthopedic Surgeon Income at USA
Pediatric orthopedic surgeons averaged $559,422 a year.
Hand surgeons averaged $572,945.
The highest-paid were spinal surgeons, at a reported average salary of $760,782.

72. Female Orthopedic Surgeons

73. Statistics from United Kingdom
According to UCAS ( Universities and Colleges Admission System )
in 2011; 55% of students accepted to do medical degree were females.
In 2011: 26% of surgical trainees were females.
15% of female surgical trainees choose Trauma and Orthopedic as a specialty.

74. In Saudi Arabia
What about you?