Orthopedic Surgery Flashcards
List the 5 stages of normal bone healing
Inflammation Cellular proliferation Callus formation Ossification Remodeling
List the two types of casting material
Plaster
Heavier; can accommodate some swelling
Fiberglass
Lighter; not so flexible
Why must Webril or stockinette be placed under a cast?
Protect skin from•Thermal injury as cast sets up
Abrasion/pressure when wearing cast
List 3 types of traction.
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
Antibiotics
Prevent SSI or to treat existing infections
Hemostatics
Reduce bone bleeding
Steroids
Reduce post-op inflammation, swelling
basic bone physiology:
Support, movement
Mineral storage
Formation of blood cells (hematopoiesis)
Flexion
Extension
Internal rotation
External rotation
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
Define Knee Arthroscopy
Visual exam of the knee joint
Surgical Anatomy of Knee Arthroscopy:
Bones and bone features
Ligaments
Soft tissues
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)Physiology of Knee Arthroscopy
Support and movement
Pathophysiology/indication for Knee Arthroscopy
Torn meniscus
Loose bodies
Worn patella
Torn ACL
Procedure steps summary for Knee Arthroscopy
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)
Define Shoulder Arthroscopy
Visual exam of shoulder joint
Surgical Anatomy for Shoulder Arthroscopy:
Bones and bone features
Joints
Muscles
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 SubscapularisPhysiology of Shoulder Arthroscopy
movement
Pathophysiology/Indication for Shoulder Arthroscopy
Torn glenoid labrum
Torn rotator cuff
Impingement syndrome
Procedure Steps Summary for Shoulder Arthroscopy
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
Define Acromioplasty
Surgical repair of the acromion
Define Bankart
Aprocedure used to correct recurrent anterior shoulder dislocation
Define ORIF radius
Open Reduction and Internal Fixation of the radius
Procedure summary ORIF radius
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
Procedure summary for ORIF hip fracture
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)
Define Total Hip Arthroplasty (THA)
Surgical repair/replacement of the acetabulum and femoral head of the hip joint.
Anatomy/physiology of THA
Parts of the femur
Femoral head
Femoral neck
Femoral shaft
Intramedullary canal
Greater trochanter
Joint capsule
AcetabulumPathophysiology/indication of THA
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.
Procedure steps and summary for THA
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
Anatomy/physiology of TKA
Femur Intercondylar notch Condyles Intramedullary canal Tibia Tibial plateau
Pathophysiology/Indication for TKA
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
Procedure steps and summary for TKA
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
Anatomy/physiology for Bunionectomy
Matatarsal head
Phalanx (aka. great toe)
Support and Movement
Procedure steps and summary Bunionectomy
I/H/D/R osteotomy to remove exostosis Release soft tissues realign joint; fixate with screws I/H/C/D
Define Achilles tendon repair
Repair of a torn achilles tendon
Anatomy/physiology for Achilles tendon repair
Gastrocnemius and soles muscle
Achilles tendon
Calcaneus
Pathophysiology/Indication for Achilles tendon repair
Torn Achilles tendon
Procedure steps and summary for Achilles tendon repair
I/H/D/R
Identify torn segments; trim edges
Reattach or re-anastomose tendon, reinforce
I/H/C/D, cast
Define Amputation, Below the knee (BK)/Above the knee (AK)
Excision of a part of the leg, above or below the knee
Pathophysiology/Indication for Below the knee (BK)/Above the knee (AK)
Ischemia; gangrene; necrosis
Mostly due to poorly managed diabetes
Trauma (if limb cannot be salvage)
Procedure steps and summary for Below the knee (BK)/Above the knee (AK)
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
Define Carpal Tunnel release
Surgical procedure where they incise the flexor retinaculum of the hand to release pressure that is being exerted on the median nerve
Anatomy/physiology Carpal Tunnel release
Median nerve
transversals carpal ligament
Sensory and motor movement
Pathophysiology/indication for Carpal Tunnel release
release pressure that is being exerted to the median nerve.
procedure steps summary for Carpal Tunnel release
I/H/D/R
Define Tenorrhaphy
Surgical repair/suture of a torn tendon on the hand
Anatomy/physiology Tenorrhaphy
Flexor or extensor tendons of the hand
Pathophysiology/indication for Tenorrhaphy
Torn/divided (cut) tendon on the hand due to trauma
Procedure steps summary for Tenorrhaphy
I/H/D/R
Identify ends of the tendon
Secure ends; trim edges
Define Dupuytren’s contracture (palmar fibromatosis)
release of contracture of palmar fascia
Pathophysiology/indication for Dupuytren’s contracture (palmar fibromatosis)
Contracture pf palmar fascia; forming cords
Procedure steps summary for Dupuytren’s contracture (palmar fibromatosis)
I/H/D/R (Z-PLASTY)
Dissect to release affected fascia
Repeat
Define syndactyle & polydactyl
Congenital webbing or fusion of digits
Anatomy/physiology
Digits only
Procedure steps summary for
Syndactyl:
I/H/D/R
develop skin flaps, obtain full-thingness skin graft PRN
I/H/C/D
Periosteum
Ligament
Tendon
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
Cartilage
Cortical bone
Cancellous bone
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
Long bone
Short bone
Flat bone
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
Irregular bone
Sesamoid bone
Diaphysis
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
Epiphysis
Joint
Synarthrosis
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
Amphiarthrosis
Diarthrosis
Axial skeleton
Appendicular skeleton
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
