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Surginal Procedures > Orthopedic Surgery > Flashcards

Orthopedic Surgery Flashcards

1
Q

List the 5 stages of normal bone healing

A 
Inflammation
Cellular proliferation
Callus formation
Ossification
Remodeling
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2
Q

List the two types of casting material

A

Plaster
Heavier; can accommodate some swelling
Fiberglass
Lighter; not so flexible

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3
Q

Why must Webril or stockinette be placed under a cast?

A

Protect skin from•Thermal injury as cast sets up

Abrasion/pressure when wearing cast

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4
Q

List 3 types of traction.

A

Manual
Use hands intra-op to reduce fracture
Skin (AKA: Buck’s traction)
Temporary for hip fracture in ER until patient is cleared for surgery
Skeletal
Done in OR to stabilize fracture for closed femoral rodding; used with OR fracture bed

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5
Q

Antibiotics

A

Prevent SSI or to treat existing infections

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6
Q

Hemostatics

A

Reduce bone bleeding

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7
Q

Steroids

A

Reduce post-op inflammation, swelling

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8
Q

basic bone physiology:

A

Support, movement
Mineral storage
Formation of blood cells (hematopoiesis)

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9
Q

Flexion
Extension
Internal rotation
External rotation

A

Act of bending or being bent, decreasing the angle at a joint
Moving parts of a limb into a straight position, increasing the angle at a joint
rotate a limb medially
rotate a limb laterally

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10
Q

Define Knee Arthroscopy

A

Visual exam of the knee joint

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11
Q

Surgical Anatomy of Knee Arthroscopy:
Bones and bone features
Ligaments
Soft tissues

A 
Bones and bone features:
     Femur
     Femoral condyles
     Tibia
     Tibial plateau
     Patella
 Ligaments
     Anterior cruciate ligament (ACL)
     Posterior cruciate ligament (PCL)
     Medial (tibial) collateral ligament (MCL)
     Lateral (fibular) collateral ligament (LCL)
Soft tissues
     Joint capsule
     Synovium
     Suprapatellar pouch
     Patellar tendon
     Articular cartilage
     Menisci; medial (1) and lateral (2)
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12
Q

Physiology of Knee Arthroscopy

A

Support and movement

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13
Q

Pathophysiology/indication for Knee Arthroscopy

A

Torn meniscus
Loose bodies
Worn patella
Torn ACL

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14
Q

Procedure steps summary for Knee Arthroscopy

A

A tiny incision is made for inflow cannula is made using #11 blade; distend joint with fluid
Another incision is made for sheath; sharp trocar using #11 blade; change to blunt trocar then place arthroscope and camera
Determine the incision site by inserting a spinal needle Make another incision using #11 blade and insert probe for EUA
Treat PRN (provide an example)
Shave away meniscus, cartilage, or patella
Repair meniscus or remove loose body
Remove instruments, arthroscope and trocars
Irrigate, close, dress (FYI: inject for post-op pain control)

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15
Q

Define Shoulder Arthroscopy

A

Visual exam of shoulder joint

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16
Q

Surgical Anatomy for Shoulder Arthroscopy:
Bones and bone features
Joints
Muscles

A 
Bones and bone features:
     Clavicle
     Acromion process
     Scapula
     Coracoid process
     Glenoid fossa (cavity)
     Glenoid labrum (ligament ring surrounding articular cartilage)
     Humerus (Humeral head)
Joints
     Glenohumeral and acromioclavicular
Muscles (rotator cuff)
     Supraspinatus and Infraspinatus
     Teres minor and Subscapularis
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17
Q

Physiology of Shoulder Arthroscopy

A

movement

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18
Q

Pathophysiology/Indication for Shoulder Arthroscopy

A

Torn glenoid labrum
Torn rotator cuff
Impingement syndrome

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19
Q

Procedure Steps Summary for Shoulder Arthroscopy

A

Distend joint with fluid via syringe and spinal needle
Inject local
The spinal needle is removed and an incision is made over the joint capsule using #11 blade
Insert the sheath and sharp trocar into the incision
Change into a blunt obturator and insert scope/camera/with inflow cannula
Additional Incisions is made for the other port sites; insert instruments PRN;
The bicep tendon is identified and examined
The bicep tendon is used as a landmark throughout the procedure.
Treat PRN*
Bankart
(Done for recurrent anterior dislocations; repair torn labrum)
Reattach labrum to glenoid with bone anchors
Rotator cuff repair
Insert anchors; and secure sutures to repair tear
Acromioplasty
(done to correct impingement syndrome; often done in conjunction with other repairs)
Use burr to trim portion of acromion
Change ports w/switching stick PRN
I and remove any loose bodies/Additional local may be inject for post-op pain control/C/D

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20
Q

Define Acromioplasty

A

Surgical repair of the acromion

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21
Q

Define Bankart

A

Aprocedure used to correct recurrent anterior shoulder dislocation

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22
Q

Define ORIF radius

A

Open Reduction and Internal Fixation of the radius

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23
Q

Procedure summary ORIF radius

A

I/H/D until the fracture is exposed/R; EXPOSE FRACTURE
Reduce fracture with self-retaining bone reduction forceps
Malleable plates are placed against the bone and contoured to the radius using a plate benders
The plate is placed on the bone and held in place with a self-retaining bone holding forceps
The first hole is made using a drill and drill guide.
Depth gauge is used to determine the size of the screw
The screw is selected and placed on the bone
Fixate fracture by applying plat and screw
The wound is thoroughly irrigated
The tourniquet is released
Hemostasis is achieved PRN using ESU
The incision is closed and dressings are applied

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24
Q

Procedure summary for ORIF hip fracture

A

I/H/D until the fracture is exposed/R: expose fracture
Place guide pin into femoral head with guide angle
Determine the reaming and tapping depth and screw length
Assemble the appropriate triple reamer and place it on the power drill
The reamer is placed over the guide pin and drilled into the femoral head
Assemble the lag screw insertion together and place it over the guide pin to insert the lag screw
The wrench, guide shaft, and guide pin are removed
The plate is seated using an impactor and mallet
Fixate the plate against the femur using screws
The wound is thoroughly irrigated
Hemostasis is achieved PRN using ESU
The incision is closed and dressings are applied (xeroform, 4x4 gauze, and ABD pad)

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25
Q

Define Total Hip Arthroplasty (THA)

A

Surgical repair/replacement of the acetabulum and femoral head of the hip joint.

26
Q

Anatomy/physiology of THA

A 
Parts of the femur
     Femoral head
     Femoral neck
     Femoral shaft
     Intramedullary canal
     Greater trochanter
Joint capsule
Acetabulum
27
Q

Pathophysiology/indication of THA

A

Osteoarthritis (degenerative joint disease)
Wear and tear over time; previous injury to joint; usually just one.
Rheumatoid arthritis
Auto-immune disease; body attacks its own synovial membranes; all synovial joints affected.

28
Q

Procedure steps and summary for THA

A

I/H/D/R; dislocate hip
Femoral osteotomy (saw) to remove femoral head
Ream acetabulum; place tails to determine implant size
Ream femur; trials for size; relocate hip joint; do ROM
Prepare acetabulum; place implant
Prepare femoral canal; place implants
Relocate hip joint and perform final ROM
I/H/Drain (PRN)/C/D

29
Q

Anatomy/physiology of TKA

A 
Femur
Intercondylar notch
Condyles
Intramedullary canal
Tibia
Tibial plateau
30
Q

Pathophysiology/Indication for TKA

A

Osteoarthritis (degenerative joint disease)
Wear and tear over time; previous injury to joint; usually just one.
Rheumatoid arthritis
Auto-immune disease; body attacks its own synovial membranes; all synovial joints affected

31
Q

Procedure steps and summary for TKA

A

I/H/D/R; expose joint; reflect patella
Align the femur
Place a remear into the femoral canal
ream
Position and secure a femoral valgus angle guide
Trim the distal femur
Place a, A-P femoral sizer against the resected femur; size by trial
Align the tibia
Position and secure the tibial resection guide to the tibia
Resect and size tibia; place trial
Measure, trim, and size patella
Place trip and confirm its placement with an alignment rod
Test the trials ROM Once the surgeon is satisfied with the ROM remove the trials
Place implants and perform ROM
I/H/Drains PRN/C/D

32
Q

Anatomy/physiology for Bunionectomy

A

Matatarsal head
Phalanx (aka. great toe)
Support and Movement

33
Q

Procedure steps and summary Bunionectomy

A 
I/H/D/R
osteotomy to remove exostosis
Release soft tissues
realign joint; fixate with screws
I/H/C/D
34
Q

Define Achilles tendon repair

A

Repair of a torn achilles tendon

35
Q

Anatomy/physiology for Achilles tendon repair

A

Gastrocnemius and soles muscle
Achilles tendon
Calcaneus

36
Q

Pathophysiology/Indication for Achilles tendon repair

A

Torn Achilles tendon

37
Q

Procedure steps and summary for Achilles tendon repair

A

I/H/D/R
Identify torn segments; trim edges
Reattach or re-anastomose tendon, reinforce
I/H/C/D, cast

38
Q

Define Amputation, Below the knee (BK)/Above the knee (AK)

A

Excision of a part of the leg, above or below the knee

39
Q

Pathophysiology/Indication for Below the knee (BK)/Above the knee (AK)

A

Ischemia; gangrene; necrosis
Mostly due to poorly managed diabetes
Trauma (if limb cannot be salvage)

40
Q

Procedure steps and summary for Below the knee (BK)/Above the knee (AK)

A 
I/H/D/R
develop skin flap, evaluate blood supply
elevate periosteum; perform osteotomy/ies; smooth bone edges
Specimen off field
I/H/DRAIN/C/D
41
Q

Define Carpal Tunnel release

A

Surgical procedure where they incise the flexor retinaculum of the hand to release pressure that is being exerted on the median nerve

42
Q

Anatomy/physiology Carpal Tunnel release

A

Median nerve
transversals carpal ligament
Sensory and motor movement

43
Q

Pathophysiology/indication for Carpal Tunnel release

A

release pressure that is being exerted to the median nerve.

44
Q

procedure steps summary for Carpal Tunnel release

A

I/H/D/R

45
Q

Define Tenorrhaphy

A

Surgical repair/suture of a torn tendon on the hand

46
Q

Anatomy/physiology Tenorrhaphy

A

Flexor or extensor tendons of the hand

47
Q

Pathophysiology/indication for Tenorrhaphy

A

Torn/divided (cut) tendon on the hand due to trauma

48
Q

Procedure steps summary for Tenorrhaphy

A

I/H/D/R
Identify ends of the tendon
Secure ends; trim edges

49
Q

Define Dupuytren’s contracture (palmar fibromatosis)

A

release of contracture of palmar fascia

50
Q

Pathophysiology/indication for Dupuytren’s contracture (palmar fibromatosis)

A

Contracture pf palmar fascia; forming cords

51
Q

Procedure steps summary for Dupuytren’s contracture (palmar fibromatosis)

A

I/H/D/R (Z-PLASTY)
Dissect to release affected fascia
Repeat

52
Q

Define syndactyle & polydactyl

A

Congenital webbing or fusion of digits

53
Q

Anatomy/physiology

A

Digits only

54
Q

Procedure steps summary for

A

Syndactyl:
I/H/D/R
develop skin flaps, obtain full-thingness skin graft PRN
I/H/C/D

55
Q

Periosteum
Ligament
Tendon

A

Layer of connective tissue covering bone
Bands of dense connective tissue that hold bone to bone
Strands of fibrous tissue that form ends of muscles and connect muscle to bone

56
Q

Cartilage
Cortical bone
Cancellous bone

A

Avascular, aneural connective tissue found at ends of bones
Hard, dense, bone that forms the outer shell of the bone marrow cavity
Soft spongy bone found inside cortical shell

57
Q

Long bone
Short bone
Flat bone

A

The bones of limbs that have a shaft and 2 ends; examples: femur, tibia, fibula, humerus, radius, ulna, phalanges
Bones of the wrist and ankle that occur in clusters; examples: carpals, tarsals
Bones having a partially flat surface; examples: scapula, sternum, pelvic girdle

58
Q

Irregular bone
Sesamoid bone
Diaphysis

A

Bones having varied shapes; examples: Skull bones, facial bones, vertebrae
Bones found within tendons; examples: patella (large), head of 1st metatarsal (2)
Shaft of a long bone

59
Q

Epiphysis
Joint
Synarthrosis

A

Flared ends of long bone where growth takes place (epiphyseal plate)
a place where 2 bones come together
An immovable, fibrous joint; example: suture lines of cranial bones

60
Q

Amphiarthrosis
Diarthrosis
Axial skeleton
Appendicular skeleton

A

A slightly movable, cartilaginous joint; examples: symphysis pubis; intervertebral; manubriosternal
A freely movable; synovial joint; examples: Knee, hip; shoulder; wrist; C1 and C2
The central portion of the skeleton made up of the skull; vertebral column; ribs
The portion of the skeleton made up of the shoulder; arms; hip; legs

Surginal Procedures (14 decks)

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