Overview of Orthopedic Procedures Lecture Powerpoint

Question 1

Arthroscopy definition

Answer 1

Surgical procedure orthopedic surgeons use to visualize, diagnose, and treat problems inside a joint space, small incisions are made to enter a joint with camera and is preferred to more invasive procedures

Question 2

Problems treated with arthroscopy (4)

Answer 2

• repair resection of torn/damaged cartilage
• reconstruction of ligamentous structures
• removal of inflamed tissue, synovium, etc
• removal of foreign/loose bodies

Question 3

Drawbacks of arthroscopy (3)

Answer 3

• technically challenging
• longer operative times for certain procedures
• possible breakage of instruments inside joint

Question 4

ACL reconstruction

Answer 4

DIFFERENT from repair of ACL which is never done, determine need based on PE and MRI to confirm diagnosis, utilize allograft achilles/patellar tendons or autograft (quadruple hamstring/patellar tendons), long periods of rehab, return to play usually >6 months after surgery

Question 5

Open reduction Internal fixation

Answer 5

An open reduction fracture that requires making opening in the skin and soft tissue to surgically treat fracture because closed reduction failed or injury complex, internal fixation is use of plates, screws, rods, etc to stabilize and reduce/realign fracture anatomically with overall goal of anatomic reduction

Question 6

Absolute vs relative stability

Answer 6

Absolute is putting fragments of bone back together as closely as possible to achieve anatomic reduction, essential for articular fractures, vs relative allows bone to heal with some micromotion to stimulate callus formation essential for comminuted metaphyseal fractures

Question 7

Race against time in fracture surgery

Answer 7

Description of importance for surgery to be done early to place bones back in place so natural biological process can begin and see the body recover itself

Question 8

Drawbacks of ORIF (4)

Answer 8

• requires incision
• risk for neurovascular structures when performing surgical approaches and fixation
• potential for infection
• painful hardware (some even need return to OR for removal of it)

Question 9

Hemiarthroplasty

Answer 9

Half of a joint replacement, generally involves replacing the ball of the ball and socket joints, in hip primarily used for treatment of femoral neck fractures in elderly patients without antecedent hip pain (indicates there is not much arthritis of the acetabulum)

Question 10

Cephalomedullary nail

Answer 10

Gold standard for treatment of intertrochanteric hip fractures almost contained entirely within bone, extremely fast safe and minimally invasive,

Question 11

ORIF can be used anywhere on the body except for these 2 places

Answer 11

• spine

- skull

Question 12

Why is hemiarthroplasty necessary?

Answer 12

Intracapsular femoral neck fractures have disruption of blood supply to the femoral head leading to avascular necrosis

Question 13

Drawbacks of hemiarthropasty (4)

Answer 13

• risk for dislocation
• risk for persistent pain
• possible reduced joint motion compared to total arthroplasty
• increased risk of pulmonary embolism

Question 14

What study is done to confirm placement of ORIF, closed reduction and percutaneous pinning, or cephalomedullary nails?

Answer 14

Fluoroscopy

Question 15

Closed reduction and percutaneous pinning

Answer 15

Utilized in minimally displaced fractures, involves placing pins across fracture once closed reduced in attempt to stabilize, minimally invasive, quick and easy, removed in few weeks via pulling pins that are outside skin

Question 16

Total joint arthroplasty

Answer 16

Definitive treatment for end stage arthritis providing new smooth low resistance surface for hips to move, either posterior or anterior approach

Question 17

Carpal tunnel release

Answer 17

Utilized primarily for treatment of carpal tunnel syndrome,

Question 18

Most common compressive neuropathy

Answer 18

Carpal tunnel syndrome

Question 19

Risk factors for carpal tunnel syndrome (6)

Answer 19

• female
• obesity
• pregnant
• RA
• alcoholism
• repetitive motion

Question 20

Carpal tunnel anatomy

Answer 20

9 flexor tendons (flexor digitorum superficialis, profundus, and flexor pollocis longus)

• median nerve
• scaphoid tubercle and trapezium radially walling
• hookk of hamate and pistiform ulnarly walling
• transverse carpal ligament palmarly walling

Question 21

Kaplans cardinal line

Answer 21

A line marked before surgery going from distal and of thumb to pistiform, indicates not to make incision beyond that point during carpal tunnel release

Question 22

Lumbar fusion

Answer 22

Surgical procedure to correct problems with bones of the spine, goal to create solid construct and promote fusion and eliminate movement and thus eliminate pain, treats degenerative disc dz, spondylothesis, spinal stenosis, scoliosis, fracture, etc

Question 23

Lumbar fusion technique (2)

Answer 23

• Bony landmarks identified and pedicle screws placed, locked in place and incision then closed
• no NSAIDS as this decreases likellihood that fusion takes place

Question 24

Central disc herniations affect the ___ nerve root, far lateral affect the __ nerve root

Answer 24

traversing, exiting