1. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1

2. 2 CHAPTER 21 Orthopedic Surgery

3. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3 Objectives After studying this chapter, you will be able to: –Recognize the relevant anatomy and physiology of the musculoskeletal system –Summarize the pathology of the musculoskeletal system that prompts surgical intervention and the related terminology –Determine any preoperative orthopedic diagnostic procedures/tests

4. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 4 Objectives (cont’d.) –Determine any special preoperative preparation related to orthopedic procedures –Indicate the names and uses of orthopedic instruments, equipment, and supplies –Determine the intraoperative preparation of the patient undergoing an orthopedic procedure –Summarize the surgical steps of the orthopedic procedures

5. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 5 Objectives (cont’d.) –Interpret the purpose and expected outcomes of the orthopedic procedures –Recognize the immediate postoperative care and possible complications of the orthopedic procedures

6. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 6 Bone and Bone Tissue Characteristics of bones –Living tissue –Provide form and structure to the human body –Actively involved in maintenance of homeostasis Skeletal system –Comprises bones and other structures that make up the joints of the skeleton

7. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 7 Bone and Bone Tissue (cont’d.) Skeleton functions –Provides a framework to support the body –Serves as points of attachment for muscles –Protects some internal organs from injury –Serves as a source of red blood cells –Serves as a storage site and source of calcium

8. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 8 Bone and Bone Tissue (cont’d.) Bone tissue –Compact or cortical bone: hard, dense tissue of bone that surrounds the marrow cavity –Cancellous or spongy bone: found at ends of bone and lining the medullary marrow cavity –Surrounding bone: thin, fibrous layer of tissue (i.e., periosteum) –Bone marrow: semisolid tissue that is found in the spaces of cancellous bone

9. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 9 Bone and Bone Tissue (cont’d.) Types of bones: refer to Figures 21-1, 21-3 and 21-4 –Long bones: bones of the arm (humerus), legs (femur), hands, and feet (phalanges) –Short bones are the bones of the wrists (carpals) and ankles (tarsals) –Flat bones: ribs, scapula, sternum, and cranial bones –Sesamoid (round) bones: found within tendons

10. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 10 Bone and Bone Tissue (cont’d.) Types of joints –Immovable –Slightly Movable –Freely Movable –Ball-and-Socket –Condyloid –Gliding –Hinge and pivot –Saddle

11. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 11 Bone and Bone Tissue (cont’d.) Terms related to joint movements –Refer to Table 21-1 Mineral storage –Bone contains large quantities of calcium Factors that affect bone growth –Hormones, heredity, nutrition, and exercise

12. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 12 Bone and Bone Tissue (cont’d.) Pathology –Musculoskeletal system is prone to numerous types of pathological conditions –Refer to Table 21-2 Types of fractures –Complete or incomplete Normal bone healing –Complete bone healing of fracture is expected in 8–12 weeks

13. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 13 Bone and Bone Tissue (cont’d.) Normal process of bone healing –Inflammation –Cellular proliferation –Callus formation –Ossification –Remodeling

14. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 14 Bone and Bone Tissue (cont’d.) Pathological bone healing –Disruption at any stage can be responsible for a variety of abnormal conditions Distraction Avascular necrosis Compound fracture Delayed union, nonunion, and malunion Compartmental syndrome –Casts: refer to Table 21-3 Method utilized to immobilize a fracture

15. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 15 Diagnostic Procedures and Tests Common orthopedic diagnostic procedures and tests: refer to Table 21-4 –Radiography Standard X-rays Fluoroscopy

16. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 16 Instrumentation, Routine Equipment, and Supplies Instrumentation: refer to Table 21-5 –Orthopedic procedures Require a general orthopedic set with soft tissue and basic bone instrumentation Also require specific sets with instruments for exposure, reduction, and internal fixation of a bone, for replacement of a joint; or for the placement of an intramedullary rod –Procedures for the hand or foot Typically require a minor orthopedic or hand set

17. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 17 Routine Equipment Orthopedic surgery has special equipment and instrumentation requirements –Positioning devices –Pneumatic tourniquets –Traction –Lasers –Air flow –Continuous passive range-of-motion machines

18. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 18 Routine Equipment (cont’d.) –Transcutaneous electric nerve stimulation –Electrical stimulation of bone –Saws, drills, and reamers –Arthroscopic equipment –Other routine equipment

19. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 19 Routine Supplies Field of orthopedics requires a large number of supplies –Implants –Suture –Polymethyl methacrylate –Other routine supplies

20. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 20 Orthopedic Surgical Procedures Shoulder procedures –Shoulder arthroscopy –Bankart procedure, open –Bankart procedure, arthroscopic with suture anchors –Acromioplasty, open –Acromioplasty, arthroscopic –Total shoulder arthroplasty

21. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 21 Orthopedic Surgical Procedures (cont’d.) Procedures of the radius –External fixation of a Colles’ fracture –ORIF radius Hip procedures –ORIF hip fracture –Total hip arthroplasty Femoral procedures –Repair of femoral shaft fracture with AO titanium femoral nail system

22. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 22 Orthopedic Surgical Procedures (cont’d.) Knee procedures –Arthroscopy of the knee joint with repair of torn meniscus –ACL repair –Above-the-knee amputation (AKA) –Below-the-knee amputation (BKA) –Total knee arthroplasty (TKA)

23. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 23 Orthopedic Surgical Procedures (cont’d.) Ankle and foot procedures –Triple arthrodesis –Achilles tendon repair –Bunionectomy

24. ©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 24 Summary This chapter reviewed: –Anatomy and physiology of the musculoskeletal system –The pathology of the musculoskeletal system that prompts surgical intervention –Preoperative orthopedic diagnostic procedures/tests –Orthopedic instruments and equipment –Orthopedic procedures