Orthopaedic + Plastic Surgical anatomy

Orthopaedic + Plastic Surgical anatomyOutline A system for orthopaedics imaging Common scansCommon orthopaedic surgical exposuresCommon Plastics surgical exposuresSystems for orthopaedics imaging ABCSSAlignmentBony CartilageSoft tissues Special consideration Extra scans needed? Extra-injuries to be considered? NV injuries?Shoulder scansMuscle structureInner muscular layer Rotator cuffIntermediate muscular layer Coracobrachialis, short head of biceps and pectoralis minor. Outer lip Deltoid + Pectoral muscles. NV structuresMain NV bundle

Wrist scansMuscle structure Extensor tendons 6 compartments Flexor tendons Superficial and deep groupsNV structuresRadial arteryRadial nMedian n Ulnar n + Artery

Knee scansMuscle structure Anterior Extensor group Posterior Gastrocnemius Lateral Iliotibial band, Biceps femorisMedial Sartorius, gracilis, semitendinosusNV structuresTibial n Popliteal a + VCommon peroneal n.

Hip scansMuscle structureFlexor Superficial layers; Deep layersLateral Posterior - Deep layers, Superficial layersNV structuresFemoral n Femoral a + VSciatic n

Foot and ankle scansMuscle structure Anterior group Posteromedial Posterolateral Posterior NV structuresAnterior NV bundle Posteromedial NV bundle.

Spine scansAlignment lines Anterior vertebral line, Posterior vertebral line, Spinolaminar lineBony structures Cartilaginous IV discsSoft tissues ALL, PLL, Spinothalmic, Interspinous, SSL

Common Orthopaedics procedures List of proceduresShoulder ElbowWrist Hip Knee Ankle General principle of Orthopaedic surgeryInternervous planes Know your dangersShoulderDangersLayersShoulder

ElbowDangersLayers Elbow

RadiusDangersLayersWrist

HipDangersLayersHip

KneeDangersLayersKnee

AnkleDangersLayersAnkle

Ankle

Common Plastics proceduresList of proceduresCarpal tunnels Median n Forearm Ulnar n ForearmCommon peroneal n leg Sural n leg Flexor tendon sheath exposure Carpal tunnelDangersLayersCarpal tunnel

Median n forearmDangers layersMedian n forearm

Ulnar n forearmDangersLayersUlnar n forearm

Common peroneal n legDangersLayersCommon peroneal n leg

Sural n harvestDangersLayersSural n harvest

Flexor tendon sheath DangersLayersFlexor tendon sheath

Introduction of flaps Reconstructive ladderTypes of flaps Vascular territory of important flapsReconstructive ladder

Types of flapsLocal Regional Distant Direct Free flapsLocal - Free tissues from area immediately adjacent to a defect and use it to reconstruct a defect Regional Free tissues and move it over / under a normal site to fill a defect in the same regionDirect Where a tissue flap is supplied simultaneously by donor and recipient site vesselsFree flap Take tissue and vascular pedicle supplying that tissue and connect it by microvascular anastomoses to the recipient site vessels51

Common flapsForeheadPectoralis majorLatissimus dorsi Lateral arm Radial forearm GastrocnemiusFibular

Vascular territories Forehead flap Supraorbital / Supratrochlear arteryPectoralis major flap Major Sternocostal head Pectoral branch of thoracoacromial artery; Clavicular head Clavicular branch of thoracoacromial artery. Minor Perforating branches of internal mammary artery medially, intercostal and lateral thoracic arteries (laterally) Latissimus dorsi flap Thoracodorsal artery (branch of the subscapular artery) Lateral arm flap- Posterior radial collateral artery (branch off the profunda brachii artery)Radial free forearm flap Radial artery perforators Fibular free flap- peroneal artery (Branch off tibioperoneal trunk from the popliteal artery) Gastrocnemius flap Sural branches of the popliteal artery.