1. MUNIR SAADEDDIN, FRCSED ASSOCIATE PROFESSOR & CONSULTANT COLLEGE OF MEDICINE KING SAUD UNIVERSITY Introduction to Orthopaedics

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 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 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. Metabolic Disorders (Rickets): Bow Legs

42. Osteoporosis: Fractured NOF

43. Osteoporosis: Displaced Intracapsular Fracture

44. Hemi-Arthroplasty Lt Hip

45. Spinal Osteoporosis

46. Osteoporosis: Colles fracture

47. Bone Tumors

48. Bone Tumor

49. Bone tumors

50. Neurological Evaluation : Sensory

51. Axillary Nerve or Circumflex Nerve

52. Nerve Injury: Muscle wasting

53. Nerve Injury: Sensory Loss

54. Muscle Power Testing : Iliopsoas

55. Muscle Power Testing : Quadriceps

56. 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.

57. Devastating effect of Spinal Cord Injury

58. Neuromuscular disorder: Polio

59. Chronic Osteomyelitis : discharging sinus

60. Chronic Osteomyelitis : Sequestrum

61. Spinal Infection : Tuberculosis: Para Vertebral Abscess

62. 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

63. Clinical Skills: Cast application

64. Clinical Skills: Knee Aspiration

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

66. 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.

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

68. 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.

69. Female Orthopedic Surgeons

70. 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.

71. In Saudi Arabia What about you?