Surgeries on ,bones , joints , amputations Flashcards
explain , DF of Fracture , Absolute signs of a fracture
—DF : Fracture is a damage of a continuity of the bone Fractures are the most common in long bones: femur, humerus, bones of the forearm and the leg
–Absolute signs of a fracture :
1. Crepitation ( its sound when the farctured bones conatct to each other and move )
2. Deformity of the limb ( change of shape and its sign of displcemnet )
3. Shortening of the limb
4. Pathological mobility ( movabli bone when there isno joint in this place Ex the bone get meilted )
5. Pain during axial load ( its when we try to push the limb to the axial location ex Hand or calanius in the foot )
Classification of fractures
- we have 3 classifaction
1-According to the mechanism:
1) Traumatic fracture – due to sustained trauma , fractures caused by a fall, road traffic accident, fight,
2) Pathologic fracture – caused by concomitant disease (osteoporosis, bone cancer, osteomyelitis)
3) Periprosthetic fracture is a fracture at the point of mechanical weakness at the end of an implant
2-According to the
soft-tissue involvement: - closed ( no skin injury or soft tissue )
- open/compound
3-According to the presence of displacement: - Non-displaced ( there is no such a i non displacment is just clinically signifcnt or not
- Displaced
Types of displacement of bone fragments
1-Translated (lateral)
displacement: a line drawn
down the center of the bone is not continuous
2- along the length: (shortening - lengthening - , wedge - ) is
caused by the contraction of
adjacent muscles
3-Angular displacement:
axes of bone fragments form
an angle at the point of a
fracture
4-Rotation (peripheral) :
displacement is caused by a rotation of one of the bone fragments along the longitudinal axis
Anatomical justification of the displacement of bone fragments after the fractures of long bones
1-Humerus fractures :
-In a case of humerus diaphysis fracture displacement of bone fragments will depend whether line of fracture passes above or below the insertion of deltoid muscle
2-Forearm fractures :
Displacement of bone fragments in a case of forearm fractures will depend whether the line of fracture is located proximally or distally to the insertion of (m. pronator teres)
3-Femur fractures :
Specific feature of femur fractures is a shortening of the limb. It’s due to very strong muscles which originate from the pelvis and insert in the leg
4-Fractures of the leg :
In a case of fracture in both leg bones in proximal 1/3 central bone fragment gets displaced significantly anteriorly due to the tension of m. quadriceps femoris. Peripheral bone fragment is
displaced slightly anteriorly too, but it is located behing the central one
Stages of osteoreparation
(bone healing)
– we need to know first of all that in order the bone to get healed we need compelete immoblazation ( thats why when the bone get fractrured they get covered by a sorten type of ( GIBS )
-Stages :
1-Hematoma after 1 week of the fracture ( mobility level 100% )
2-Fibero Cartilegenous Callus : after 2-3 weeks but sill very mobili
( mobobility 30%)
3-Ossuose callus : its new tissue formed in the place of fracrture
After 4-16 week (mobility LVL 2%)
4- remodeling : after 17 week appeard and there is no scar this is the dirrfrince between bone tissue and other tissue
types of bony callus
1- inter mediate callus : its inthe middle of the bony cavity
2-Endoeastal callus : it grows under the endostum in the internal linnig
3-periosteal callus : grows under the periosteium
4-periossial callus : its pathological it grows in under the soft tissue thats serround the bone
what is the Surgeries on the bones
- Osteotomy
- Resection of the bone
- Osteosynthesis
- Osteoplasty
explain , Osteotomy , tools , indications ,types , surgical approach
– Osteotomy (Greek osteon — bone, tomo — dissection)
–tools: is usually performed by
1-osteotome
2-chisel ( dilated along the side )
–indications :
1. Correction of deformities of bone
diaphyses (angular, rotation, along he width and length)
2. Correction of deformities of metaphyses of long bones (after the wrong healing of epymetaphyseal fractures, some systemic diseases )
3. Arthrogenic contractures
4. Elongation and shortening of the limbs
–types :
1-transverse;
2-oblique;
3- Zshaped;
4- segmental (by N.A. Bogoraz);
5-arcuate
–Surgical approach :
1-Surgical approach should correspond scope of operation
(principle of «sufficiency») intervention that big eanoguh to good miepulation and in the same time small aspassoable for fast recovery
2-Dissection of soft tissues should be
performed out of projectional lines of
neurovascular bundles
3-It’s necessary to put a roller under a
corresponding segment of the limb
explain Osteotomy surgeries by
( Khakhutov , abbrevians Bogoraz ,Springer )
1-Osteotomy scalene prolongans (by M.D. Khakhutov, 1962) :
Step-shaped dissection of a diaphysis is performed by a chisel or osteotome, after that the ends are connected by means of bone suture This method causes a significant elongation of the limb segment
2-Osteotomia scalene abbrevians ( shortining ) :
Step-shaped fragment of the long bone is removed by chisel or osteotome, that causes shortening of the limb segment
3-Segmental osteotomy of the femur by N.A. Bogoraz :
Dissection of soft tissues is performed along the lateral surface of the thigh. Femur is exposed and dissected by a sharp osteotome (chisel) or electric saw in 2-4 places (depending on the degree of deformity). Dissection of the bone is started from its distal end by parallel incisions on the distance 4-5 cm from each other. Limb is tracted and placed in a correct position. A metallic rod is introduced into the medullary cavity for the fixation. Wound is stitched. Skeletal traction is applied with a load 10-15 kg. Location of bone fragments is controlled by X-ray
4-Transverse segmental osteotomy by K. Springer : Subperiosteal dissection of bone diaphysis into segments 1 cm length. Limb is stretched and bone fragments are put into an even periosteal covering. Periosteum is sutures. Limb gets immobilized
explain Resection of the bone , Indications ,Types of bone resections
– indecations :
1-Pathological processes in the bone
(tumors, posttraumatic osteomyelitis,)
2-Treatment of the bone fragments in a case of false joints and fractures that fail to heal
3-Harvesting of bone autografts
4-Shortening of the limb
5-Elimination of the limbs deformities
–types :
1-. Marginal (partial) resection is
a removal of a bone fragment without a damage of its anatomical continuity
( Ex biopsy )
2- Segmental (expanded)
resection is accompanied by a
damage of bone continuity
3-According to the way of periosteum treatment:
3-1. Subperiosteal : resection when we save periosteum ( bcs its source of osteoclast )
3-2 2. Transperiosteal : resection Bone fragment is resected with periosteum( in case of tuberculosis, malignant tumors)
4-According to the time
factor:
4-1 Final : (with an irrevocable
removal of bone fragment: EX
replacement of mandible defect by
fibula fragment)
4-2 Temporary resection,
resection with a returning of resected
fragment back into the body after an
appropriate treatment EX Ribs in thorasic surgeris
explain Osteosynthesis , DF Indications
–DF : Osteosynthesis (Greek
osteon — bone + synthesis connection) :
is an operative connection of bone fragments by means of a metallic constructions which provide fixation of the fragments after reposition to create favourable conditions for healing of the bone with a restoration of an integrity and function of the bone
–indications :
1-Treatment of acute fractures (when
conservative treatment is not efficient: intraand periarticular, comminuted)
2-Nonunion fractures ( faild to heald )
3-Malunion fractures ( healed wrong ex displaced )
4-False joints
5-Fixation of bone fragments after
osteotomy and other bone surgeries
6-Elongation of the limb
explain Classification of osteosynthesis , Main principles of
osteosynthesis
–Classification :
1-Bone suture
2-Extramedullary osteosynthesis
3-Intramedullary isteosynthesis
4-Osteosynthesis by means of external fixators (compression-distraction osteosynthesis)
–principles :
1. Anatomical approximation of bone fragments
2. Stable fixation of bone fragments (prevention of false joints formation)
3. Atraumatic surgical technique (prevention of complications in postoperative period)
4. Joints, adjacent to the fracture, are freely mobile after the surgical treatment
5. Metals, used for for osteosynthesis, shouldn’t cause immune reactions
6. Bone should repair by primary bone intension
explain Bone suture osteorrhaphy
, Requirements , Suture materials , Types of bone sutures , Advantages and disadvantages , Intramedullary
osteosynthesis tools
–Requirements :
1. Exact reposition of bone fragments
2. Proper approximation of bone
fragments (absence of diastases benween bone fragments)
3. Secure fixation of bone fragments
by sutures for the whole period of
treatment, plaster immobilization untill the complete consolidation of bone callus
4. Preservation of periosteum in the
zone of sutures (prevention of
osteomyelitis development in
postoperative period)
–Suture matreials:
1-Stainless steel wire, titanium, tantalum , Chromic catgut
2-Synthetic threads
(nylon, letilene, dacron, )
-types :
1. Circular nodular
2. U-shaped
3. Cross-shaped
4. Trapezium-shaped
5. Combined
–Advantages :
1. Simplicity and reliability
2. Fast application
–Disadvantages:
1. If plane of the suture is
not perpendicular to the line of
fracture, deviation of bone
fragments with a formation of
false joint is possible
2. Traumatization of
periosteum, local disruption of
bone blood supply
3. Possibilty of wedge
displacement in case of an
uneven distribution of force
–Intramedullary osteosynthesis tools:
1-Kirschner wire( for smallbone such a finger )
2-Intramedullary nail
3-Screw
4-Pin
explain intramedullary , approaches methods , fixators methods
–approaches : we have 2 ways :
1-Closed (wire is introduced away from a fracture place through a small incision)
2-Open (fracture zone gets exposed, bone fragments are repositioned, and then the rod is introduced into the
medullary cavity)
– fixators : we have 3 methods :
1-Antegrade –can beperformed by open and closed approach (Ex femuer farction )
2- Retrograde : (can be performed only by open approach)
3-Along the conductor - can be performed by open and closed approach
explain Extramedullary osteosynthesis , DF , Stages ,
–DF ; Compression, neutral and support plates are used, fixed by screws
–stages :
1-Surgical approach to bone fragments, that corresponds to the sizes of fixator
2-Precise matching of bone fragments in an appropriate position
3-Fixation of the plate by screws that pass through both cortical layers of one bone fragment
4-Fixation of the plate to the other bone fragment after the compression of the fracture zone by special device
5-Exit of surgery
explain Osteosynthesis by external
fixators (compressiondistraction osteosynthesis) , DF ,Stages ,advantages
–DF : It is performed by special devices (by G.A. Ilizarov, )
–stages :
1) Transosteal conduction of the pins
2) Fixation of the pins in arches or circles;
3) Installation of connecting rods
–Advantges :
1-Stable fixation of bone fragments
2-Dynamic possibility to manage their location
rules of pins introduction
1-Pins should be introduced from the side of neurovascular bundles location ( to not damage it )
2-The end of an every pin should be very sharp
3-Number of pin turns during bone drilling should be small
4-While pin passes through flexor-muscles limb should be extended. —–While pin passes through extensor muscles limb should be flexed;
5-Before piercing the skin it should Be maximally relocated to the side opposite to the future relocation of
the apparatus circle
