1. Musculoskeletal Principals and Terminology
Dr J G Myburgh

2. The Tree Of Andry (1741)

3. Orthopaedia
ORTHOS (Straight) + PAIS (Child)

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

6. 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

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

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

10. 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

11. Flexion & Extention

12. Abduction & Adduction

13. Internal & external rotation

14. Pronation & Supination

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

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

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

18. Genu valgum & Genu varum

19. Scoliosis

20. Kyphosis & kyphos (hump)

21. Septic artritis

22. Rheumatoid Arthritis

23. OA Total Hip Replacement

24. Giant cell tumor

25. Osteosarcoma

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

29. Operations on ligaments
Ligaments can be:
Repaired
Reconstructed
Shortened

31. Operations on nerves Nerves can be: Decompressed Sutured Grafted
Epineurolysis

32. Painfull Arc

33. Nerve Compression

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

35. Subluxation & dislocation

36. Anterior shoulder dislocation

37. Rotator cuff arthropathy

38. AC Dislocation

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

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

41. Trauma
Twisting
Compression
Bending
Tension
Avulsion

42. Fracture Patterns

43. Fracture types

44. Impacted Fracture

45. Comminuted Fracture

46. Fracture displacement
Translation
Angulation
Rotation
Length (shortening/impaction)

47. Fracture displacement

48. Deforming Forces

49. How Fractures Heal

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

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

52. Clinical
History
Look
Feel
Move

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

54. Description of fractures
Open or closed
Fracture pattern
Displacement

55. Fracture Patterns

56. Treatment
Reduce
Hold
Exercise (Rehabilitation)

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

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

59. Physeal Injuries

60. Occupational Therapy

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

62. The End