Overview of the Orthopedics module

1. Overview of the Orthopedics module Albert Quintos M.D., FPOA

2. The Origin of the Word: Orthopedics/Orthopaedics • Nicholas Andrycoined 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.

3. 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-Romanperiod,attempts to provide artificial prostheses were noted, withaccounts of wooden legs, iron hands and artificial feet.

4. Jean-Andre Venelestablished 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 orthopedicsin 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

5. 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

6. 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

7. 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

8. Importance of recongnition of these conditions as a physician • Conditions necessitating emergent/urgent intervention • High Index of Suspicion

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

11. 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

12. 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

16. FRACTURE PATTERNS

20. Deforming forces

22. SIGNS AND SYMPTOMS PAIN / TENDERNESS SWELLING DEFORMITY LIMITATION OF MOTION OPEN WOUNDS NEUROVASCULAR COMPROMISE

23. 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

28. 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

32. 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

34. Open Fractures • Fractures communicating through a traumatic wound to the surrounding environment • Contamination and soft tissue envelope disruption are special considerations

35. Closed VS. Open

37. 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

39. COMPARTMENT SYNDROME

40. 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

41. 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.

42. SPLINTING SPLINT-Any device used to immobilize a body part Can be commercially manufactured or IMPROVISED

43. REASONS FOR SPLINTING Prevents movement and reduces chance of further injury Reduces pain and discomfort Facilitates transport

44. 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

45. Splint in the functional position

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

47. Apply gentle longitudinal traction to the extremity when warranted

48. When in doubt, splint the injury “Splint them where they lie”

49. SPINE IMMOBILIZATION

50. IMMOBILIZATION AND TRANSFER