1. Orthopaedic Surgery Principles and Definitions Dr.Metwally Shaheen ( FRCSI) Ortho. Consultant ( Head 0f Orthopedic Department SGH-J )

2. Scope of our course: 1.General Orthopaedics 2.Regional Orthopaedics 3.Fractures and joint injuri es

3. General Orthopaedics 1.Infection 2.Metabolic and endocrine disorders 3.Rheumatic disorders 4.Osteoarthritis and related disorders 5.Tumours 6.Osteonecrosis and osteochondritis 7.Neuromuscular disorders 8.Peripheral nerve injuries 9.Principles of operative treatment

4. Regional Orthopaedics 1.Shoulder 2.Elbow 3.Wrist and Hand 4.Spine 5.Hip 6.Knee 7.Ankle and Foot

5. Fractures and Joint Injuries Management of major injuries Fractures and joint injuries Principles of fracture treatment Complications of fractures Injuries of the shoulder and upper arm Injuries of the elbow and forearm Injuries of the wrist and hand Injuries of the spine Fractures of the Pelvis

6. Fractures and Joint Injuries Injuries of the hip and femur Injuries of the knee and leg Injuries of the ankle and foot

7. Definitions

8. Parts of a Long Bone: 1.Epiphysis: The end part of a long bone which is first separated from the main part by a layer of cartilage but later fuses with it by ossification. 1.Metaphysis: It is a wider portion of a long bone adjacent to the epiphyseal plate. It is this part of the bone that grows during the childhood.as it grows,it ossifies near the diaphysis and the epiphysis at roughly 18- 25 years of age. 1.Diaphysis: The shaft of a long bone.

10. Biological Types of Bone Cortical (Compact): It is the dense outer surface of bone that forms a protective layer arround the internal cavity. Cancellous (Trabecular) : It is the spongy interior layer of bone that protects the bone marrow.

11. Fracture It is a break in the structural continuity of bone. It may be classified according to displacement into: Incomplete (crack,cortical crumpling) Complete with displaced fragments According to associated soft tissue injury into: Closed (simple) Open (Compound)

12. Causes of fractures: Fracture due to sudden trauma Stress or fatigue fractures Pathological fractures

13. Fracture Displacement Translation (shift) Alignment (angulation) Rotation (twist) Length.

14. Fracture Healing Healing with callus that passes through: 1.Tissue destruction and haematoma formation 2.Inflammation and cellular proliferation 3.Callus formation 4.Consolidation 5.Remodelling Healing without callus (in absolute immobilization) Gap healing

15. Testing for fracture union Absent pain during daily activity Absent tenderness at fracture site Absent pain on fracture stressing Absent mobility at the fracture site X-ray shows callus formation

16. Diagnosis of fractures:  History History of injury Inability to use the injured limb Pain, bruising and swelling Deformity Associated injuries Previous injuries Any other musculoskeletal abnormality General medical history

17. Diagnosis of fractures: Examination Examination Examine the most obviously injured part Check for arterial damage Test for nerve injury Look for local injuries Look for distant injuries Look Feel Move

18. Diagnosis of fractures: Imaging: Two views Two joints Two limbs CT MRI Isotopic scanning.

19. Joint Injuries Sprain Strain Rupture Subluxation Dislocation

20. Operations on Bone Bone Fixation Internal Fixation Plate and screws Intramedullary nails K. Wire fixation. External fixation Tubular fixator. Ring fixators.

21. Osteotomy Creating a bone discontinuity to: Correct deformity Change the shape of bone To redirect the load trajectories Can be open wedge, closed wedge, or dome osteotomy Cut bones need to be fixed in the desired position

22. Bone grafting Autograft Allows both osteoinduction and osteoconduction Allograft Xenograft Artificial bone

23. Distraction Histogenesis Bone transport Bone lengthening

24. Operations on joints Injections Arthroscopy Arthrotomy Joint realignment Joint fusion (arthrodesis) Joint replacement (arthroplasty) Excision Arthroplasty

25. Thank You