Introduction to Orthopaedics MUNIR SAADEDDIN FRCSED ASSOCIATE PROFESSOR

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

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.

What is the meaning of: Orthopaedics 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

Orthopedic Associations Emblem: the British

Saudi Orthopedic Association Emblem

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.

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.

Red Flags �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.

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 intracompartment 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

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

Alignment terminology

Alignment Terminology: Cubitus Varus

Alignment terminology: Cubitus Valgus

Orthopedic Diseases: Congenital or Acquired ? �Congenital : present since birth( though may not be evident till some time later). �Acquired : develop or begin after birth.

Congenital Anomaly : Talepoequinovarus TEV

Acquired Orthopedic Conditions Acquired conditions include : �Trauma �Developmental �Inflammation �Infection �Neuromuscular �Degenerative �Metabolic �Tumor

Traumatic Injuries �Fractures. �Dislocations. �Fracture dislocation: dislocation associated with nearby fracture. �Soft tissues injuries: ligaments, tendons, menisci. �Nerve injuries. �Epiphyseal injuries.

Fractures: Break in the continuity of bone

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

Fracture Dislocation

Dislocation and Fracture dislocation of the Spine often results in Paralysis

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

Soft tissue injuries of the knee

Anterior Cruciate Ligament injury: MRI

ACL Injury: Lachman’s test

MCL: Value of Stress X-rays

(Developmental Dislocation of Hip) DDH

Orthosis : Pavlick Harness for DDH

Developmental: SCFE (Slipped Capital Femoral Epiphysis)

Spinal Deformities: Kyphosis or Hyperlordosis

Spinal Deformity: Scoliosis

Developmental Foot deformity: Hallux Valgus

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

OA Hip

Total Hip Arthroplasty ( THA )

Osteoarthosis of Knee

Osteoarthritis of Knee

Metabolic Disorders (Rickets): Bow Legs

Osteoporosis: Fractured NOF

Osteoporosis: Displaced Intracapsular Fracture

Hemi-Arthroplasty Lt Hip

Spinal Osteoporosis

Osteoporosis: Colles fracture

Bone Tumors

Bone Tumor

Bone tumors

Neurological Evaluation : Sensory

Axillary Nerve or Circumflex Nerve

Nerve Injury: Muscle wasting

Nerve Injury: Sensory Loss

Muscle Power Testing : Iliopsoas

Muscle Power Testing : Quadriceps

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.

Devastating effect of Spinal Cord Injury

Neuromuscular disorder: Polio

Chronic Osteomyelitis : discharging sinus

Chronic Osteomyelitis : Sequestrum

Spinal Infection : Tuberculosis: Para Vertebral Abscess

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

Clinical Skills: Cast application

Clinical Skills: Knee Aspiration

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

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.

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

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.

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