Describe a Total Knee Arthroplasty.
What are the common indications for Total Knee Replacement?
Instability, degenerative, rheumatoid or traumatic arthritis
What patient position is most frequently used for total knee replacement?
supine so the knee may be flexed to check for range of motion
Describe the two principle methods of implant fixation used for joint arthroplasty.
a) cemented b) nocemented
Describe the ideal candidate (patient) for each of the above.
a) older patient b) younger more active
What is bone cement (P.M.M.A.)
poly methyl methacrylate monomer
How is it used to ensure fixation?
adheres to metal not bone
List the adverse reactions to use of PMMA.
hypersensitivity, thrombo phlebitis, cardiac arrhythmias
degeneration of joint cartilage and the underlying bone
Describe rheumatoid arthritis.
a chronic progressive disease causing inflammation in the joints and resulting in painful deformity
softening of the bones due to defiencies of vitamin D and calcium
. Describe osteoporosis.
bones become brittle and fragile from loss of tissue- typically a result of hormonal changes or calcium, vitamin D defiency
What is Continuous Passive Motion (CPM) and why is it used?
a form of physical and rehabilitation- more continuous movement that stimulates healing of articulating cartilage, tendons, and ligaments
What are the benefits of CPM?
prevents the developing of stiffness, provide continuous motion, decreased recovery time
What is osteomyelitis?
bone infection- caused by bacteria or other germs
What is a diarthrotic joint?
always a joint cavity, end of bone covered in hyaline carttilage
What is an amphiarthrotic joint?
slightly movable joints-found in the axel skeleton
Describe an avulsion fracture.
injury to the bone in a place where the tendon or ligament attatches to the bone. when an avulsion occurs the tendon or ligament pulls off the bone
Describe a luxation.
a condition in which the patella or knee cap dislocated or moves out of its normal location ( dislocation) - complete not only knee cap (patella)
Describe a subluxation.
incomplete or partial dislocation
Describe a monteggia fracture.
proximal ulnar FX with radial head disslocation
Describe a Colles' fracture.
a fracture of the distal radius in the forearm with dorsale displacement of the wrist and hand
Describe a Compound fracture.
an open fracture is an injury that occurs when there is a break in the skin around a broken bone
Describe a Comminuted fracture.
one in which the bone is splintered or crushed
Describe a Spiral (Oblique) fracture.
the bone has twisted apart
Describe a Pathologic fracture.
due to weakening of the bone structure by pathological process. Such as - neoplasia, osteomalacia
Describe a Greenstick fracture.
one side of the bone is broken, the other is being bent
Describe a Stress fracture.
caused by unusual stress or repeated stress on a bone
Describe the five stages of bone healing.
1)Hematoma formation 2)Fibrin network formation 3)Invasion of osteoblasts 4)Callus formation 5)Remodeling
Incomplete union or union in a faulty position after a fracture or wound
the failure of a fractured bone to heal normally
Describe delayed union.
a delay in the healing of the ends of a fracture
Describe the injury known as the "terrible triad" as it happens in the knee.
torn- ACL, Medial Meniscus, MCL
Where is a Baker's cyst located?
behind the knee- popliteal fossa
What type of cast is most commonly employed for complete knee immobilization?
What type of cast is most commonly used for complete hip immobilization?
Describe the anatomy of the knee joint.
What is another name for supraspinatus syndrome?
impingement syndrome, painful arc ayndrome
Why might a tourniquet be used during appendicular surgery?
to reduce blood loss, bloodless surgical field
Why is an Esmarch bandage used in conjunction with a tourniquet?
to achieve limb exsangunation
List 3 contraindications of tourniquet use.
compartment syndrome, McArdle disease, hypertension
List 3 considerations for safe use of the tourniquet.
pre-op assessment, check machine for function
What is the recommended maximum time limit for tourniquet inflation?
less than 1 hour on an upper extremity and less than 2 on a thigh
What should be done when this limit has expired?
deflate for 5 min for every 30 min of inflation
Give 3 examples of commonly used antibiotic therapy used in orthopedic surgery.
IV, Irrigation, Ointments,
Give two examples of antibiotics commonly used in irrigation for orthopedic surgery.
polymixin and bacitration
How many bones are found in the human skeletal system?
206 adult born with 300
What is the appendicular skeleton?
the portion of the skeleton that includes the limbs
How many bones are in the appendicular skeleton?
What is the axial skeleton?
the portion of the skeleton that includes the skull, spinal column, sternum and ribs
How many bones are found in the axial skeleton?
Describe cortical bone.
a compact type of bone tissue. denser than other types of bone. mostly present in the shaft portion of long bones. arms-bones
Describe cancellous bone.
spongy interior of the bone that protects the bone marrow. its also called spongy bone or trabecular bone. resembles honey comb.
Describe the difference between cortical and cancellous bone screws (used for internal fixation).
cortical- closely spaced, shallow threads and larger core to outer diameter ratio stronger than cancellous screws, blunt ended
cancellous- more deeply cut and widely spaced threads. the screws cut their path in the bone when the screw is inserted. self tapping
What is the difference between allograft and autograft bone?
allograft- obtained from a doner. acts as a temporary calcium depostit (not living)
autograft- taken from patients body pertains osteophytes
From where is the autogenous bone graft harvested?
The patients own body- illiac crest, femoral head, acetabulum, posterior patella
Describe the anatomy of the hip joint and the proximal femur.
ball and socket
What are the 3 bones fused to form the os coaxes (hip bone or innominate bone)?
pubis, ischium, ilium
What is the acetabulum?
the cup shaped cavity at the base of the hip bone into which the ball shaped head of the femur fits
Describe Total Hip arthroplasty.
Alexanders 782 B&K 775
What are the surfaces replaced?
femoral head and acerabular surfaces alex 782 B&K 775
List the common indications for total hip arthroplasty.
degenerative hip disease, trauma, auascular necrosis
What is a bunion (Hallux valgus)?
a deformity charcterized by lateral deviation of the great toe, often erroneously described as an enlargement of bone. tissue around the joint at the head of the big toe.
What group of patients most frequently experiences bunions?
What is the goal of a bunionectomy?
to reduce pain and fix the deformity of the toe
Briefly describe a Keller procedure.
a release of soft tissue and removal of the medial eminence w/ resection of the proximal end of the proximal pharynx.
Briefly describe a Mayo procedure.
Briefly describe a McBride procedure.
the McBride procedure extends the simple bunionectomy by releasing the adductor tendon from the proximal pharynx
Describe the triple arthrodesis procedure.
surgical fusion of the talocalcaneal, talonavicular, and calcaneocuboid joints in the fact.
Why might a triple arthrodesis be performed?
correction of deformity and creation of a stable balanced plantigrade foot for ambulation
What is the goal of the triple arthrodesis procedure?
releave pain from arthritic, deformed or unstable joint.
Name the four bones and three fusions which are involved in a triple arthrodesis.
talus, calcaneus, cuboid, and navicular bones, tabcalcaneal, talonavicular and calcanealaboid joints
Name the eight carpal bones.
1) lunate 2)capitate 3)trapezium 4)trapezoid 5)scaphoid 6)pisiform 7)triquetral 8)hamate
Which carpal bone is the most frequently fractured?
How is the above bone most commonly fixated internally?
pins and k-wires
. Describe carpal tunnel syndrome.
progressive painful hand and arm condition caused by a pinched nerve in the wrist
How is it treated surgically?
by cutting the ligament at the top of the carpal tunnel
Name the 7 tarsal bones.
1)medial cuneiform 2) intermediate cuneiform 3)navicular 4)talus 5)lateral cuneiform 6)cuboid 7)calcaneus
. Describe shoulder dislocation surgery.
the labrum is evaluated from an inferior position and brought back up onto the glenoid rim. the way in which the labrum and or ligaments are reattached. can be by way of pure sutures passed through, drill holes in the bone and more commonly used anchors
What are the goals of shoulder dislocation surgery?
restore the anatomy and repair the instability
Briefly describe a Putti-Platt procedure.
simple shortening of the muscle
Briefly describe Bankart procedure.
Briefly describe Bristow procedure.
transfer of the corcoid process through the subscapularis tendon
What position is commonly used for shoulder dislocation surgery?
beach chair, supine with cushion in lateral
Name the four muscles of the rotator cuff.
1)supraspinatus 2)infraspinatus 3)teres minor 4)sub scapularis
What function does the rotator cuff serve?
stabalizing the shoulder and elevating and rotating the arm
Name the three bony articulations of the shoulder girdle.
1)glenohomeral 2)sterno clavicular 3)acromio clavicular
Describe the anatomy of the shoulder joint.
most mobile joint in the body. provides upper extremity w/tremendous range of motion. adduction, abduction, flextion, extension, internal rotation, external rotation and 360 circumduction.
the surgeon will insert pencil thin device w/ small lens and lighting system into the incision to look inside the joint. instruments can be inserted to make repairs
On what joints are arthroscopy procedures frequently performed?
shoulders, elbows, hip, knees, and ankles
List three procedures that may be performed via arthroscopy?
ACL meniscal repair, patellar tendon grafts
What types of irrigating solution is preferred for joint distention during arthroscopy?
ringer's lactate, saline
Why might epinephrine be added to the irrigating solution during arthroscopy?
`aid in hemosiesis
What are the advantages and disadvantages to arthroscopic surgery?
less cost, less invasive, faster healing time, less pain post op
Describe open reduction and internal fixation (ORIF).
a method of surgically repairing a fractured bone. plates and screws or an im to stabalize the bone
Describe closed reduction and external fixation.
Describe open reduction and external fixation.
alex 746- 747
What are the common indications for external fixation?
Describe intramedullary fixation (IM).
What are the benefits of closed reduction and intramedullary fixation?
Describe the difference between dynamic and static IM fixation.
dynamic-closest to fracture site
static-both proximal and distal end of the nail
Why might flexible IM rods be beneficial to the healing process.
What is a fracture table?
What are the benefits of using a fracture table in orthopedic surgery?
Describe the use of traction.
ast 855 alex 735 b&k 769-770
What are the benefits of traction?
alex 735 b&k 769-770
How does skeletal traction differ from skin traction?
Name the three commonly used forms of traction and give an example of each.
manual, skin, skeletal
Describe a lumbar laminectomy.
removal of a small portion of bone over the nerve root and or disc material from under the nerve root to give more room
What is the most common indication for a lumbar laminectomy?
back pain, spinal stenonsis, sciatica, removal of herniated disk
What is the most common position used for a lumbar laminectomy?
Describe a spinal fusion.
designed to stop the motion of painful vertebral segment, adding bone graft to an area of spline to stop a biological response that causes bone graft to grow. between the two vertebral element and create fusion, there by stopping the motion of that segment.
List the common indications for a spinal fusion.
degenerative disc disease
mechanical back pain