Overview of the Orthopedics module

Albert Quintos M.D., FPOA

The Origin of the Word: Orthopedics / Orthopaedics

• Nicholas Andry coined the word "orthopaedics", derived from Greek words for "correct" or "straight" ("orthos") and "child" ("paidion")

• In 1741, when at the age of 81 he published Orthopaedia: or the Art of Correcting and Preventing Deformities in Children.

• In ancient Eqypt, splints have been found on mummies made of bamboo, reeds, wood or bark, padded with linen

• Ancient Greece,- Hippocrates details the treatment for dislocations of the shoulders, knees, and hips, as well as treatments for infections resulting from compound fractures.

• Rome, Galen (129-199 BC), a Greek, became a gladiatorial surgeon. His learning helped provide the best care possible for the Roman army.

• Often referred to as the father of modern medicine• He studied the skeleton and the muscles that moved it• During this Greco-Roman period, attempts to provide

artificial prostheses were noted, with accounts of wooden legs, iron hands and artificial feet.

Jean-Andre Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities

He is considered by some to be the father of orthopedics in consideration of the establishment of his hospital and for his published methods.

Antonius Mathysen, a Dutch military surgeon, invented the plaster of Paris cast in 1851.Many developments in orthopedic surgery resulted from experiences during wartime

• Middle Ages: the injured were treated with bandages soaked in horses' blood which dried to form a stiff splint.

• Traction and splinting developed during World War I

• Since WWII, treatments have evolved to include joint replacements, arthroscopy, and a whole host of technologies.

• Improvements in biomaterials-titanium,polyethylene, ceramics- have produced better and more robust implants and prostheses over the years

• However, the basic principles on which these advances are based have remained the same

THE COST OF MUSCULOSKELETAL TRAUMA

• TRAUMA- the “neglected disease”• Leading cause of death for ages 1-44, of all races and

socioeconomic levels• Those affected must deal with :

-physical and psychological effects of pain, limitation of activities, loss of independence-direct cost of diagnosis and treatment-indirect cost of decreased productivity

THE R.P. SETTING

• “HILOTS” / BONE SETTERS-still play an important role in the community-Often may see and manage before doctors / health personnel

• 911 system not as well developed• Cost of implants / prostheses

• Importance of recongnition of these conditions as a physician

• Conditions necessitating emergent/urgent intervention

• High Index of Suspicion

Nov 29 Mon Nov 30 Tues Dec 1 Wed Dec 2 Thurs Dec 3 Fri8;30-9:30

No classes Introduction to the module-Dr Quintos

Inflammaory disorders-Dr. Azores

Pediatric conditions-Dr Dungca

Module exam

9;30-10:30

Upper extremity trauma

Musculoskeletal radiology

Spine disorders-Dr. Lumawig

Module exam

10:30-11:30

Lower extrmity trauma

musculoskeletal radiology

SGD hand feedback

11:30-12:30

Sports injuries-Dr. Bengzon

Musculoskeletal radiology-Dr. Hernandez

SGD hand feedback

1;30-2:30

Degenerative disorders-Dr Asedillo

Hand disorders- Dr. Estrella

LEC pm

2:30-3:30

Musculoskeletal tumors-Dr. Dimayuga

Orthopedic Rehab

3:30-4:30

SGD trauma Orthopedic Rehab-Dr. Dela fuente

4:30-5:30

SGD trauma

SCOPE

• Definition of terms• Common fracture patterns• Presenting signs and symptoms• Review of first aid principles

DEFINITION OF TERMS

• FRACTURE- a soft tissue injury with a concomitant break in the cortex of the affected bone

• CLOSED FRACTURE- no break in the skin surrounding the bone

• OPEN FRACTURE- with the presence of an external wound which communicates with the fracture site

• DISLOCATION- a complete disruption of articular congruity of a joint

• SUBLUXATION- an “incomplete” dislocation

• SPRAIN- an injury to ligaments or joint capsule structures, with progessive gradations of injury

• STRAIN- an injury to the musculo-tendinous unit

FRACTURE PATTERNS

Deforming forces

SIGNS AND SYMPTOMS

• PAIN / TENDERNESS• SWELLING• DEFORMITY• LIMITATION OF MOTION• OPEN WOUNDS• NEUROVASCULAR COMPROMISE

PAIN and SWELLING

• Results from the trauma of the initial injury and resulting inflammation of tissues

• Pain from a fracture- much more• Bleeding from bone- greater swelling• Therefore, the need to rest / immobilize the

area• COMPARTMENT SYNDROME-increasing pain

not responsive to pain medications

DEFORMITY

• Loss of the normal appearance of the extremity or joint from fractures or dislocations

• Correction of the deformity ASAP can help minimize soft tissue damage, pain

• Must check pulses, sensation, motion of the affected area before and after any intervention

LIMITATION OF MOTION

• Due to pain!• Due to a dislocated / subluxed joint• Due to a ruptured tendon, torn muscle or

ligament• Unable to put weight on the lower extremity /

use the arm

Open Fractures

• Fractures communicating through a traumatic wound to the surrounding environment

• Contamination and soft tissue envelope disruption are special considerations

VS.

Closed

Open

Compartment Syndrome• Mubarak defined

compartment syndrome as an elevation of the interstitial pressure in a closed osseofascial compartment that results in microvascular compromise.

• Usually anterior and deep posterior compartments of the leg

• Volar compartment of the forearm

COMPARTMENT SYNDROME

Causes

• Acute– Soft tissue trauma– Arterial injury– Limb compression during

altered consciousness– burns

• Chronic Exertional Compartment Syndrome– recurrence of increased

pressure– Long distance runners

and military recruits

Recognition

• tightness of the involved compartment• pain with passive motion of those muscles

passing through the compartment• weakness of the muscles• Hypesthesia or paresthesia (evaluated with

pinprick, light touch and two point)• The most important sign is pain out of

proportion to that expected with the injury.

SPLINTING• SPLINT-Any device used to immobilize a body

part• Can be commercially manufactured or

IMPROVISED

REASONS FOR SPLINTING

• Prevents movement and reduces chance of further injury

• Reduces pain and discomfort• Facilitates transport

GENERAL RULES OF SPLINTING

• Assess pulse, motor function, and sensation before AND after splinting

• Immobilize the joints above and below the injured bone

• Immobilize the bones above and below the injured joint

• Remove clothing, jewelry around area of injury

Splint in the functional position

• Cover wounds with dressings before splint application• Use well padded splints• Immobilize the joint above and below the affected area

Apply gentle longitudinal traction to the extremity when warranted

When in doubt, splint the injury

“Splint them where they lie”

SPINE IMMOBILIZATION

IMMOBILIZATION AND TRANSFER

Thank

You