Orthopedic Terminology Position and Movement Abduction move a part away from body Adduction move a part toward the body Dorsiflexion bend or flex foot toward leg Plantar flexion ID: 775021
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Slide1
Orthopedic Surgery
The branch of medical science concerned with disorders or deformities of the spine and joints.
Slide2Orthopedic Terminology“Position and Movement”
Abduction
move a part away from body
Adduction
move a part toward the body
Dorsiflexion
bend or flex foot toward leg
Plantar flexion
extend foot with toes pointed down (as when depressing the gas pedal)
Flexion
to bend a part
Extension
make a limb straight
Eversion
turn outward
Inversion
turn inward
Distal
farthest away from point of origin
Proximal
closest to point of origin
Medial
nearest mid-line
Lateral
away from the midline
Slide3Orthopedic Terminology“Position and Movement”
Valgus -abnormal displacement of part of a limb away from the midline of the body – distal from the affected joint – knees togetherVarus - a deformity in which part of a limb is turned inward to an abnormal degree – distal from the affected joint – knees apart
Slide4Orthopedic Terminology
Acetabulum
hollowed area of pelvis that receives head of femur
Acromioclavicular (AC) joint
where clavicle joins acromion process of scapula
Arthritis
inflammation of a joint
Arthrodesis
surgical fusing or fixation of a joint
Arthroplasty
surgical reconstruction of a joint
Arthroscopy
visualization of a joint through an endoscope (diagnostic or operative)
Arthrotomy
surgical incision into a joint
Articulation
joint movement
Atrophy
muscle wasting from lack of use
Bone marrow
found in medullary canal of long bones and
porosites
of cancellous bone
Cartilage
elastic, strong, dense connective tissue
Compact bone
hard outer covering of bone
Cortical bone
hard bone that forms shell of bones/acts as supporting structure
Condyle
rounded part of a bone where ligaments articulate with adjacent bones
Curvature
normal or
abnormal bending
Slide5Orthopedic Terminology
Diaphysis
shaft of a long bone
Dislocation
displacement of a joint
Dysplasia
abnormal tissue growth
Endosteum
inside lining of bones where new bone forms (marrow)
Epiphysis
two ends of a long bone
Exostosis
bony growth arising from a bone’s surface
Fibroma
tumor composed of fibrous or connective tissue
Foramen
normal bone opening through which nerves, vessels, etc. pass
Foramen magnum
occipital bone opening where spinal cord passes to vertebral column
Fossa
shallow depression of a bone
Fracture
break or crack of a bone
Hallux
big toe
Implant
implantation of graft (synthetic or tissue)
Slide6Orthopedic Terminology
Lamina
flat layer or plate of a bone
Ligament
connective tissue that joins bone surfaces
Malleolus
rounded bone process (ankle)
Malunion
faulty union of a fractured bone
Nonunion
failure of fractured bone to unite
Osteogenesis
origination/development of bone (ossification)
Osteomyelitis
inflammation of bone tissue
Osteoporosis
diminished calcium in a bone
Osteotomy
surgical cutting of bone
Slide7Orthopedic Terminology
Pelvic Girdle
bony structure that supports the trunk and provides attachment for the legs
Periosteum
membrane surrounding bone (contains blood vessels)
Polydactylism
more than normal number of digits
Scoliosis
abnormal curvature of spine
Syndactylism
webbing between digits
Synovial membrane
lining of a joint capsule
Tendon
fibrous tissue that connects muscle to bone
Traction
force placed on bones or muscles to align or immobilize parts
Slide8Primary purposes of orthopedic surgery
Repair, revision, reconstruction, reattachment or removal any of the 206 bones of the skeletal structure and surrounding tissue
Bones, joints and affected muscle tissue
Tendons, ligaments or cartilage
Accurately classify treatment
Axial skeletal procedures
Upper extremity procedures
Lower extremity procedures
Limb reattachment procedures
Amputation procedures
Slide9Purposes (continued)
Investigate, preserve and restore form and function to the musculoskeletal structures and associated tissues of the extremities and also the spine. Treatment depends on the type of injury and the duration of necessary immobility.
Stages of treatment
Investigation – diagnosis of structural issues
External
Internal
Preservation
Restoration
Types of treatment
Fracture management
Reduction
Immobilization
Rehabilitation
Corrective surgeries
Bone grafts
Implants
Internal and external fixation
Slide10The Skeleton
Slide11Function of Skeletal System
SupportProtectionMovementStorageHematopoiesis - the formation of blood cells in the living body (especially in the bone marrow)
Slide12Bone Histology
Bone is a type of connective tissue2 Types of Bone:Dense/Compact Bone/ Corticalhard on outside/canal on insidecomposed of Haversian Units or OsteonSpongy/Cancellous Bone
Slide13Bone Formation
Osteogenesis
is bone formation
Two Types:
Intramembranous
Endochondral
More Terms
:
Osteoblast
:
a cell from which bone develops
Osteocytes
: a star-shaped cell, is the most abundant cell found in bone. They are
osteoblasts
that have completed their bone-forming function and have become trapped in new bone tissue, evolving into structural bone cells and is involved in the maintenance of that bone. A mature bone cell.
Osteoclasts
: cells break down and assimilate bone. They are located in minute, bony chambers called lacuna.
Slide14Intramembranous Ossification
Sheets of primitive connective tissue form at site of future bone
Primitive connective cells collect around blood vessels in these layers
Connective tissue cells differentiate into osteoblasts, which deposit spongy bone
Osteoblasts become osteocytes when bony matrix surrounds them (lacunae)
Connective tissue on surface of each developing structure forms a periosteum
Osteoblasts on the inside of periosteum deposit compact bone
Slide15Endochondral Ossification
Masses of hyalin cartilage form models of future bones
Cartilage tissue breaks down/Periosteum develops
Blood vessels and differentiating osteoblasts from the periosteum invade the disintegrating tissue
Osteoblasts form spongy bone in space occupied by cartilage
Osteoblasts become osteocytes when bone matrix completely surrounds them
Osteoblasts beneath periosteum deposit compact bone around spongy bone
Slide16Relevant anatomy
Skeletal system – articulated skeleton comprised of 206 bones
Axial skeleton – skull, spine and ribs
Skull – includes cranial and maxillofacial bones
Cranial bones – 8 cranial bones
Facial bones – 13 facial bones
Middle ear bones – 6 middle ear bones
Mandible – one jaw bone
Hyoid bone
Vertebral column – 26 backbones
Verebral – 24 backbones: 7 cervical, 12 thoracic, and 5 lumbar
Sacrum – one sacrum bone
Coccyx – one tailbone
Thoracic cage – 25 thoracic bones
Sternum one cartilaginous bone that supports most ribs
Rib cage – 24 rib bones; 12 pair posteriorly attached to the spine
Slide17Relevant anatomy - Cervical
C-1 : a.k.a. Atlas: like Atlas man (Greek mythology), the bone supporting the skull. C-2 Axis: bone that allows the head to pivot.
Slide18Axial Skeleton
Slide19Appendicular Skeleton
The appendicular skeleton consists of 126 bones in the human body which make motion possible and protects the organs of digestion, excretion, and reproduction. The word appendicular refers to an appendage or anything attached to a major part of the body, such as the upper and lower extremities.The appendicular skeleton has four major regions:Pectoral Girdles(4 bones) Upper Limbs (60 bones) Pelvic Girdle(2 bones) Lower Limbs(60 bones)
Slide20Anatomy (continued)
Appendicular SkeletonUpper extremities –shoulder, arm and hand bones of the appendicular skeletal systemPectoral girdle – four pectoral or collar bonesScapula – two posterior collar bonesGlenoid fossaCoracoid processAcromion processClavicle – two anterior collar bonesUpper limbs –arm, wrist and hand bonesHumerusRadiusulna
Slide21Anatomy (continued)
Lower extremities –hip and leg bones of the appendicular skeletal systemPelvic girdleIliumPubisIschiumLower limbs – leg and foot bonesFemurPatellaTibiaFibulaTarsalsMetatarsalsphalanges
Slide22Anatomy of a Bone
Slide23Bone Marrow
Within the long bones are two types of bone marrow: red marrow and yellow marrow. The yellow marrow is fatty tissue. During starvation, the body uses the fat in yellow marrow for energy.
Slide24Bone Marrow
The red marrow of some bones is an important site for blood cell production. Here all red blood cells, platelets, and white blood cells form in adults. Red blood cells carry oxygen and nutrients to the body tissues. Platelets help in blood clotting.White blood cells help fight disease and infection.
Slide25Muscles
Slide26Slide27Anatomy (continued)
Muscular anatomy
Neck muscles – sternocleidomastoid, platysma and trapezius
Torso muscles – deltoid, pectoralis, serratus anterior, latissimus dorsi, transverse abdominus, rectus abdominus and levator ani
Arm muscles – biceps brachii, triceps brachii, brachialis, brachioradialis, carpi, digitorium and pollicis
Leg muscles – gluteus, sartorius, quadriceps femoris, adductor, hamstring, gastrocnemius, tibialis anterior and digitorium, both flexor and extensor
Slide28Muscles
Functional unit of a muscle is the
sarcomere
3 Types:
Skeletal
voluntary/conscious movement
striated in appearance
found along-side skeletal system
Cardiac
involuntary/unconscious movement
found only in myocardium of heart
Smooth
involuntary/unconscious movement
found in the viscera
Slide294 muscles of the Rotator Cuff
Slide30Knee anatomy
Anterior
Posterior
Slide31Knee Anatomy
Slide32Foot
Extensor digitorum longus (EDL) – MUSCLE -The EDL extends or lift the toes
Slide33Hand
Slide34Bone composition types
Membranous bone – highly specialized connective osseous tissue that originally is membrane, then ossifies to bone
Cranial
Facial – maxilla (upper jaw), mandible (lower), nasal and
lacrimal
bones
Cartilaginous bone
Long bones
Flat bones
Irregular bones
Short bones
Sesamoid
bones
Slide35Bone Types
Slide36Types of Joints
Slide37Joint Classification
Functionally
based on degree of movement
*
synarthroses
-no movement
*
amphiarthroses
-slight movement
*
diarthroses
-freely moveable
Structurally
based on type of connective tissue and type of joint cavity
*fibrous-no movement, no joint cavity, dense fibrous connective tissue,
synarthoses
*
cartiligenous
-slight to no movement, can be
synarthroses
or
amphiarthroses
*synovial-joint cavity,
diarthroses
Diarthroses Joints
The 6 types of
diarthroses
joints
:
Ball-and-Socket
Condyloid
Saddle
Pivot
Hinge
Gliding
Slide39Ball-and-Socket Joint
The ball-shaped end of one bone fits into a cup shaped socket on the other bone allowing the widest range of motion including rotation. Examples include the shoulder and hip.
Slide40Condyloid Joint
Oval shaped condyle fits into elliptical cavity of another allowing angular motion but not rotation.
Slide41Saddle Joint
This type of joint occurs when the touching surfaces of two bones have both concave and convex regions with the shapes of the two bones complementing one other and allowing a wide range of movement.The only saddle joint in the body is in the thumb.
Slide42Pivot Joint
Rounded surfaces of one bone fit into a ring of one or tendon allowing rotation.An example is the joint between the axis and atlas in the neck.
Slide43Hinge Joint
A hinge joint allows backward and forward movement in only one direction, much like a door opening and closing.ExamplesKnee jointElbow joint
Slide44Gliding Joint
Flat surfaces move against each other allowing sliding or twisting without any circular movement
Slide45Joints and surrounding tissue
Joints – points of articulation where movement between bones can occur
Axial skeleton
Skull
Cranial and facial sutures
Temporomandibular
Vertebral column
Atlanto-occipital
Intervertebral
Ribs and sternum
Sternoclavicular
sternocostal
Slide46Joints and surrounding tissue (continued)
Upper extremities
Pectoral girdle
Acromioclavicular
Shoulder (glenohumeral or humeroscapular)
Elbow
Hand
Wrist (radiocarpal)
Digit
Lower extremities
Pelvic girdle
Sacroiliac
Pubic symphysis
Hip
Knee (tibiofemoral and femoropatellar)
Slide47Joints and surrounding tissue (continued)
Tibiofibular (proximal and distal)
Ankle
Foot
Intertarsal
Metatarsophalangeal
Toe (interphalangeal)
Joint structure
Articular hyaline cartilage
Fibrous capsule
Fat pad
Articular joint disc
Ligaments – connecting bone to bone
Tendons – connect muscle to the bone
Synovial membrane and fluid
Slide48Joints and surrounding tissue (continued)
Joint articulation types
Synovial – allow free movement/have a joint cavity
Cartilaginous – allow little movement/no joint cavity
Fibrous – allow no movement/No joint cavity
Surrounding soft tissue
Circulatory – blood vessels
Peripheral nerves
Foramen
muscles
Slide49Pathology
Pathologic
Congenital
Dysplasia – abnormal tissue growth
Hip dislocation
Polydactylism
Scoliosis, kyphosis and lordosis – abnormal curvature of the vertebral column
Syndactylism – webbing between digits
Acquired disease
Arthritis – inflammation of a joint
Osteoarthritis (OA)
Rheumatoid arthritis (RA)
Bursitis – inflammation of the synovial fluid
herniation
Slide50Pathology (continued)
Infection
Osteomyelitis – inflammation of bone tissue
Calcium disorders
Rickets – vitamin D and calcium deficiency
Osteomalacia – soft bones
Osteoporosis – fragile and porous bones
Tumors
Osteochondroma – generally benign
Osteoma – benign tumor of the bone
Fibroma – composed of fibrous tissue
Osteosarcoma – malignant tumor of the bone
Myeloma – cancer in the bone marrow
Chondrosarcoma – tumors of the hyaline cartilage, often malignant
Volkmann’s contracture
Strain – stretching of joint tendons
Slide51Pathology (continued)
Traumatic
Damaged or dislocated joints
Fracture
Closed (simple) – bon does not protrude the skin
Open (compound)
Complete or incomplete
Multiple
fragmentation
Slide52Bone fracture pathology
Fractured bones
Simple (closed)
Compound (open)
Compression – bone is crushed
Comminuted – bone breaks into more than 2 pieces
Depressed – bone forced inward
Greenstick – partially bent or broken
Impacted – driven into another bone fragment
Fracture geometry
Longitudinal (linear) – fracture line runs along the length of the bone
Slide53Slide54Slide55Bone fracture pathology (continued)
Oblique – fracture line lies at an angle
Spiral
Transverse
Stages of bone healing after fracture
Hematoma or hemorrhage (stage 1)
Granulation (stage 2)
Bony callus formation (stage 3)
Consolidation, calcification and bone remodeling (stage 4)
Osteogenesis – bone growth stimulated by use of electrical impulses
Complications in bone healing
Delayed union of bone
Mal-union of bone
Non-union of bone
Slide56Fracture management methods
Closed reduction (CR) procedures
Closed reduction via external fixation (CREF) – manipulation of fracture of bone using external devices such as casts or traction
Closed reduction via internal fixation (CRIF) externally manipulated fracture of bone using internal devices such as pins or rods
Open reduction (OR) procedures
Open reduction with external fixation (OREF)
Open reduction with internal fixation (ORIF)
Slide57External Fixation
Slide58External Fixation
Slide59External ManipulationTraction Techniques
Closed Reduction Via External Fixation
Slide60Fracture management stabilization devices
External fixation
Casts
Plaster (fast, medium, slow-setting)
Fiberglass
Types
Shoulder spica
Minerva jacket
Body cast
Short arm/leg
Long arm/leg
Hip spica
Cylinder cast
Slide61Slide62Hip Stabilization
Slide63Goals of Casting/Splinting
Relieve pain
Augment healing
Stabilize fracture
Prevent further injury
Splinting is better if practical because it is easier to manage swelling considering the entire limb is not isolated by a circumferential cast
Slide64Casting Considerations
Casts
Proper placement of cast brings patient safety issues
Patient’s limb should be elevated
Webril should be placed so no wrinkles are in cotton to cause pressure sores
As plaster or fiberglass is placed, assistant must
not
make marks in plaster as it dries—these may cause pressure sores
Reflective materials will reflect heat given off by
casting material if fiberglass and may burn patient’s limb
Tip of limb should be cleaned of all prepping solution so patient may be monitored for signs of circulatory disruption: increasing pain, pain that progresses into numbness, cyanotic skin, cold skin, poor capillary refill
Slide65Casting Differences
Plasterwebril firstwet casting with warm water before applicationprimarily used on children or where a lot of swelling is anticipated because can split if necessary (poor circulation due to swelling)
Fiberglass
webril first
can wet with warm or cold water
cannot split if needed/must be removed and reapplied
Slide66Combo Casting
“Orthoglass”Outer soft sleeve (sock-like on outside)Inside composed of moldable fiberglassWet, apply, wrap with ace
Slide67Fracture management (continued)
SplintsAbduction splintBracesFrames and external fixation devicesTractionBuck’s traction – skin tractionSkeletal traction
Slide68Fracture management (continued)
Grafts – human material used to stabilize boneBone graftsAutogenous graft – bone from own bodyCotrical graft – “matchsticks” or small narrow slices of cortical boneCancellous graft – spongy boneHomogenous graft – donor bone from another human
Slide69Fracture management (continued)
Orthopedic implantsMetal, ceramic, silicone or high-density molecular plastic prostheticsHumeral endoprosthesis for shoulderUlnar prosthesis for elbowSilastic implant for finger jointsFemoral endoprosthesis for hipKnee arthroplasty implants – total kneePress-fit implants – secured to area without cementFixation options – cemented or non-cemented
Slide70Common diagnostics performed prior to surgery
Lab studies – blood cultures, urine samples, spinal fluid or synovial fluid tests
Biopsy, bone marrow
Erythrocyte sedimentation rate (ESR) – measures rate of RBC fall, since inflammations cause them to fall faster than normal
Serum alkaline phosphates (SAP) – check for increased levels of SAP, which indicated multiple kinds of bone disease
Slide71Diagnostics (continued)
Diagnostics
Arthrocentesis - procedure of using a syringe to collect synovial fluid from a joint capsule. It is also known as joint aspiration. Arthrocentesis is used in the diagnosis of gout, arthritis, and synovial infections.
Arthrography – injection of gas or contrast media for inspection of cartilage and ligaments surrounding joints
Arthroscopy
Bone densitometers – measuring bone density
Computerized tomography (CT)
Magnetic resonance imaging (MRI)
X-rays
Slide72The Operating Room
Slide73OR Beds and Positioners
Chic Table
Blue Allen
Slide74OR Beds and Positioners
Jackson Flat Top
Jackson FX table
Slide75OR Beds and Positioners
Andrews Table
Cloward
Slide76OR Beds and Positioners
Beach chair
McConnel head rest
Slide77OR Beds and Positioners
Jackson Sling
Vac Pac or Bean bag
Slide78OR Beds and Positioners
Wilson Frame
Hana Table for Anterior Approach Total Hips
Slide79OR Beds and Positioners
Mayfield head rest
Peg board positioner
Slide80Special considerations
General considerations
Preoperative considerations
Aseptic technique
Full 10 minute scrub (varies per institution/surgeon)
Additional scrub attire
Protective attire
Extra drapes
Laminar air flow
Ultraviolet irradiation
Cast rooms are separated from operating rooms to reduce plaster dust contamination. If a cast room is not available, preoperatively bivalve the cast in patient’s room or holding area, then remove in OR
Slide81Special considerations (continued)
Intraoperative considerations
Use antibiotic irrigation solution
Magnetic mat may be used for placement of instruments
Postoperative considerations
Elevate the extremity
Cooling apparatus
Slide82Special considerations (continued)
Surgery-specific considerations
Implants – require proper selection, handling and application
Methyl methacrylate
Handling of implant
Casts
Tourniquets
Endoscopic equipment
Powered equipment
Compressed gas cylinders or wall units
Slide83Basic orthopedic supplies
Beanbags, sandbags and pillows
Sutures
Surgical steel
Ethibond
,
Prolene
and
Nurolon
– used in attaching tendons, ligaments, bones
Vicryl
– used for work with
periosteum
and closure
Drapes
Fixative (bone cement) – Methyl methacrylate or
polymethyl
methacrylate (PMMA)
Agents
Anti-inflammatory agents – Cortisone
steriods
Hemostatic agents
Avitene
– applied dry directly to bone surface
Bone wax
Gelfoam
thrombin
Slide84Basic orthopedic equipment
Arthroscopic support equipment
Bone stimulator
Braces, casts and other immobilizers
Coblation – a new cauterization method that is non-heat driven
Fluoroscope (C-arm)
Mandatory lead apron
Irrigation
Specialty positioning devices
Fracture table
Andrews frame – maintains patient in modified knee-chest position
Wilson frame – prone position
Tourniquet
Traction devices
Slide85Basic orthopedic instrumentation
Basic sets
Bone sets
Small bone set – used on extremities such as hands and feet
Large bone – long bones and joints
Hip set
Knee set
Shoulder set
Bone graft set
Minimally invasive surgery
Arthroscope
Support instrumentation
Slide86Basic instruments (continued)
Bone cutting
Curettes, bone
Cutters, bone
Single or double-action
Chisels
Hibbs
Elevators, periosteal
Files, bone
Drills
Gouges
Hooks, bone
mallets
Slide87Basic instruments (continued)
Knives, orthopedic
Amputating knife
Smillie meniscus knives
Osteotomes
Rasps
Reamers
Rongeurs
Single or double action
Slide88Basic instruments (continued)
Bone manipulation tools
Bone clamps
Lowman
Lane
Bone hooks
Retractors
Bennett
Hohmann
Saws
Gigli saw
Amputation saw
Tendon pulling forceps
Tendon strippers
Powered instruments – includes power drills, reamers, and oscillating and reciprocating saws
Slide89Basic instruments (continued)
Bone piercing tools – generally used to insert fixation devices
Cutters
Kirschner wires, Rush rods, Steinman pins, screws, plates
Plates
Pins (pin cutter must be available)
Steinman pins are smooth or threaded
Sizes 1/32”, 1/16”, 3/32”, 1/8”, 5/32”, 3/16” and ¼”
Slide90Basic instruments (continued)
Screws
Cortical screws
Cancellous screws – common diametes are 32 mm and 64 mm
Malleolar screws
Rods or intermedullary nails
Kirschner rod or intermedullary nail
Rush rod
Vertebral column rod (Harrington)
Wires
Kirschner wires (K-wires) – available smooth or threaded
Sizes – 0.032, 0.045, 0.062
Rush awl reamer
Screwdrivers
Traction bow
Slide91Basic instruments (continued)
Bone measuring devices
Screw gauges
Bone screw gauge
Depth gauge – used to determined length of screw needed
Calipers
rulers
Slide92Relevant positions, skin prep and draping
General information
Position – varies greatly, depending on surgical area
Skin prep – generally one joint above and one joint below operative site. Shaving may be required. 10-minute skin prep with Betadine scrub and paint is most commonly used
Draping – while still holding the extremity in a raised position, place the “down” sheet, an impervious flat sheet, under the extremity. Apply the impervious stockinette, covering the entire extremity. A variety of large incision sheet may be used (extremity sheet, U-drape, split sheet or laparotomy sheet)
Slide93Relevant positions, skin prep and draping (continued)
Upper extremities
Shoulder and upper arm surgeries
Position
Supine or modified supine
Fowler’s or “Beach-chair”
Skin prep – prep entire arm and shoulder, requires additional person
Draping – apply impervious “down sheet” tucked under shoulder and axillary area. Follow with sterile stockinette from the fingers to the shoulder. Coban may be used to secure the stockinette. Place split-sheet around the shoulder. Drape the arm free
Elbow, forearm and hand surgeries
Position – supine with armboard
Skin prep – elevate and prep entire hand and arm to tourniquet
Draping – apply impervious “down sheet” over armboard. Follow with stockinette and extremity sheet.
Slide94Relevant positions, skin prep and draping (continued)
Lower extremities
Hip surgeries
Positions – varies according to procedure
Supine with a rolled towel-covered sand bag placed under the thigh
Full lateral with bean bag
Supine or lateral on fracture table
Skin prep – elevate affected leg, enlisting additional personnel if needed. Prep entire leg and foot, prepping toes and groin areas separately and last. When fracture table is used, prep affected side of hip from umbilical line to knee
Draping – isolate perineum with adhesive sterile plastic U-drape. Tuck impervious “down sheet” under hip joint and extend the length of OR table, then apply laparotomy sheet or U-drape
Slide95Relevant positions, skin prep and draping (continued)
Knee and lower leg surgeries
Position – modified supine with knees at table break, which is lowered to 90- degrees
Skin prep – support affected leg by the foot for entire prep. Prep from tourniquet on upper thigh to foot and toes
Draping – place impervious “down sheet” under affected leg, covering opposing leg. Apply stockinette over leg and foot to tourniquet, then place extremity sheet or split sheet
Ankle, foot and toe surgeries
Position – supine
Skin prep – support affected leg using leg holder or personnel. Prep from knee, including the foot and toes
Draping – apply impervious “down sheet”. Apply stockinette over foot to tourniquet, then place extremity sheet
Slide96Common axial skeletal procedures
Craniofacial – maxillofacial or Le Fort fractures (usually performed by plastic surgeon)
Vertebral column
Laminectomy
Disectomy
Spinal fusion
Trauma
scoliosis
Slide97Common joint reconstruction procedures
Arthrodesis – surgical fixation or fusion of a joint.
Arthrotomy – incision into a joint
Arthroscopy – direct visualization into a joint
Arthroplasty – surgical repair of a joint
Repair of joint dislocations
Slide98Common upper extremity procedures
Clavicle surgery
Acrominoclavicular
(AC) separation repair – reattach the ligaments at the joint between the clavicle and the acromion
Acromioplasty – relieve the impingement of soft tissue in the joint
Shoulder joint
Glenohumeral dislocation repair
Bristow procedure – the coracoid process (a long, curved projection from the scapula) with its muscle attachments is transferred to the neck of the scapula and creates a muscle sling at the front of the glenohumeral joint
Rotator cuff repair
Bankart procedure performed for recurrent dislocation of the shoulder
Putti-Platt procedure – detachment of the subscapularis tendon and the capsule
Arthroplasty of the total shoulder – total replacement of the shoulder
Slide99Common upper extremity procedures (continued)
Humerus (supracondylar, epicondylar, intercondylar) and elbow – for all procedures distally of the humerus, a tourniquet is usually applied high on the affected arm. The entire hand and arm to the tourniquet will be prepped and draped
ORIF of the humeral head
Arthroplasty of the humeral head
Fractured humerus
Supracondylar, epicondylar, intercondylar fracture
Arthroplasty of the total elbow
Fracture olecranon
Slide100Common upper extremity procedures (continued)
Radius and ulna
Excision of the radial head
Fractures of the radius and ulna
Ulnar nerve transposition – anterior ulnar nerve is brought to the posterior position after damage from elbow trauma
Colles fracture of the distal radius near the wrist joint
Excision of ganglionic cyst
Wrist
Fractures of the carpals
Arthroplasty of the wrist
Slide101Common upper extremity procedures (continued)
Hand – involves metacarpals and phalanges
Fractures of the metacarpal and/or phalange
Arthroplasty of the metacarpal phalangeal joint (MPJ)
Arthroplasty of the phalangeal joints – similar to MPJ procedure with silicone implants
Palmar fasciectomy (Dupuytren’s release) – prevents full extension of finger, usually ring and little fingers
Syndactyly release – requires a split-thickness skin graft
Slide102Common lower extremity procedures
Hip and femur procedures
Congenital hip dislocation reduction, open and closed
Fractured hip
Intertrochanteric fracture – very common fracture; located in the area between the greater and lesser trochanteres
Femoral head fractures
Subcapital fracture or near the proximal area of the femoral neck
Arthroplasty of the total hip
Fractured femoral shaft
Closed
ORIF of femur
Slide103Common lower extremity procedures (continued)
Knee procedures
Arthroscopic procedures
Diagnositc
Shaving of articular cartilage fragments
Synovectomy
Medial or lateral meniscectomy
Removal of loose bodies
Repair of the anterior (ACL) and posterior cruciate ligaments (PCL) with autogenous or homogenous grafts
Open knee surgery
Arthroplasty of the total knee
Baker’s cyst excision – located in the posterior popliteal fossa
Patellectomy – removal of entire patella
Slide104Common lower extremity procedures (continued)
Tibia and fibual procedures – this area is prone to open fractures
Fractured tibia
Ligament repairs connecting the femur
Tibial osteotomy – performed to re-align the tibia
Fractured fibula
Fractured ankle joint
Slide105Common lower extremity procedures (continued)
Ankle and/or foot procedures
Arthrodesis
Arthrodesis, ankle
Arthrodesis, triple – fusion of the talocalcaneal, talonavicular and calcaneocuboid joints
Arthroplasty of the total ankle
Arthroplasty of the tarsals
Fractured metatarsals and phalanges
Bunionectomy – excision of exostosis of the metatarsal-phalangeal joint of the great toe
Hammer toe deformity correction
Slide106Common tendon and ligament repairs
Tendon repairs (
Tenorrhaphy
)
Achilles tendon – most powerful tendon in the foot
Tibial
tendon
Extensor tendon of the forearm
Flexor tendon of the forearm
Ligament repairs – reconstruction of ligaments may require non-absorbable sutures, wires, staples, and grafts. Grafts may be autographs,
allografts
, or synthetic
Gamekeeper’s thumb
Release of trigger finger
Slide107Limb reattachment procedures
General background
Involves reattachment of severed extremity; every case is different
Extremely delicate and lengthy procedure; often 12 to 24 hours
Involves many specialists
Exchange in personnel to avoid extensive fatigue
May involve two teams
Requires extensive, detailed positioning of patient and affected areas
Basic sequence of events
Bones – anatomically aligned and stabilized
Vasculature and nerves
Restructuring – plastic surgeon completes restructuring process
Slide108Amputation procedures
Disarticulation – amputation through a joint
Above-elbow (AE) amputation
Below-elbow (BE) amputation
Above-knee (AK) amputation
Below-knee (BK) amputation
Transmetatarsal amputation – dissection through the metatarsals
Single toe amputation
Slide109Any questions Bone Heads?