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Principles of Orthopaedics

Principles of Orthopaedics. Mr Suheal A Khan Senior Orthopaedic Consultant & Visiting Professor KTPH Singapore. Orthopaedic Elective Procedures. Osteotomy Arthrodesis Arthroplasty: Excision Interposition Amputation. Orthopaedic Trauma Procedures. Conservative

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Principles of Orthopaedics

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  1. Principles of Orthopaedics Mr Suheal A Khan Senior Orthopaedic Consultant & Visiting Professor KTPH Singapore

  2. Orthopaedic Elective Procedures Osteotomy Arthrodesis Arthroplasty: Excision Interposition Amputation

  3. Orthopaedic Trauma Procedures Conservative Operative: Nail Plate External Fixator: Monolateral Multiplaner Amputation

  4. Functions of the Skeleton 1. Protective 2. Locomotion 3. Muscle attachments 4. Metabolic 5. Haematopoetic

  5. What is Bone? A protein scaffold (collagen) or Osteoid (35%) Impregnated with Calcium Salts to give it stiffness (65%) ‘Impregnated’ with ‘latent’ Growths factors Minerals Osteoid Normal Osteoporosis Osteomalacia

  6. Types of Bone • Cortical Bone (compact bone): • 80% of Skeletal System • Thick in the bone’s shaft (diaphysis) areas • Thinner at the ends of bone (epiphysis) • Cancellous Bone (trabecular or spongy bone): • 20% of Skeletal System • Inner surface of bone • Most of the bony structure at the end of bones

  7. Bone Healing The skeleton is the ONLY human organ to heal without scarring TISSUE REGENERATION

  8. Stages of Fracture Healing Initial Trauma Inflammatory Response Formation of New Soft Tissue: Callus Formation of Bone Matrix & Cartilage Ossification of Cartilage to Bone Remodeling Healing with NO scar!

  9. Prerequisites for Bone Healing • Adequate blood supply • Adequate mechanical stability

  10. Bone Healing Indirect Direct

  11. ‘a fracture is a severe soft tissue injury with a broken bone in its midst’ Astley Cooper

  12. Management of Fractures Conservative Operative Internal fixation: Intramedullary nail Plates and screws External fixation

  13. Tibial Fracture

  14. Intramedullary Nail

  15. Plate and Screws

  16. External Fixation

  17. Nail VS Rod • 1st, 2nd and 3rd Generation Nails • Antegrade & Retrograde Hardware – In The Lumen

  18. Hardware – In The Wall • Rigid Fixation • Angle Blade plate • DHS & DCS • Bridge Plating • Locking Plate

  19. Hardware – Outside Wall • Temporary VS Permanent • Uni planer VS Multiplaner

  20. What determines choice of hardware? The Three P’s (Personalities)

  21. The Fracture

  22. The Patient

  23. The Surgeon

  24. Goals of Treatment 1. Prevention of infection 2. Fracture union 3. Restoration of function

  25. QUESTIONS

  26. Classification of Open Fractures

  27. Gustilo and Anderson Wound Size I < 1cm II > 1cm Soft Tissue Crushing None Slight or Moderate Fracture Type Simple Comminuted Segmental Contamination Little Moderate High III Extensive damage to soft tissue, muscle, skin

  28. Classification Grade III A Soft tissue cover. Any segmental # B Periosteal stripping +/- contamination C Neurovascular injury requiring repair

  29. Summary 3 ways to fix a bone: Within the bone On the surface of the bone Outside the bone The 3 Personalities: Fracture Patient Surgeon

  30. Clinical Cases

  31. Subtrochanteric Fracture LAT

  32. CASE 28 yr old RTA motorcyclist Adonis

  33. Fracture:- • Closed Pilon 2. Patient:- Alcoholic

  34. 3. Surgeon:- Locking Plate

  35. AP Open Tibial Fracture15cm by 5cm wound over posterior aspect of calf LAT

  36. AP Distal Femoral Fractureand Midshaft Tibial Fracture LAT

  37. AP Distal Femoral Fracture LAT

  38. Mid shaft Open Femoral Fracture LAT

  39. AP Distal Femoral Fracture LAT

  40. Distal Femoral Fracture LAT

  41. AP Ankle Fracture LAT

  42. AP Ankle Fracture LAT

  43. AP Too Low! Too Medial! Valgus Procurvatum LAT

  44. CASE 1 47 yr Old Fell off a back of a lorry 1.5 m high Grade 1 Open Distal Tibial Fracture Wounds over posterior aspect of calf, a transvere wound

  45. 17/11/20122

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