surgery

Question 1

internal fixation

Answer 1

when closed reduction is not effective/appropriate or to speed up rehab

crate a construct for the fx to heal in proper alignment

screws across fx site create compression (stimulates remodeling), which promotes primary healing (haversain remodeling)

high risk for blood clots and CP problems

plates reduce stress concentration to improve fx stabilization - stress is spread out over plate

intramedullary robs (nail) used for long bone fx

implants - press fit, cemented

Question 2

ligamentous surgey. - reconstruction

Answer 2

create new ligament (synovial) - poor blood supply - ACT, PCL

graft - usually exceeds ultimate failure of native tissue, rarelt has the same viscoelastic properties

if alignment contributed to first tear it could happen again

Question 3

ligamentous surgery - repair

Answer 3

fix injured ligament

good blood supply - MCL, LCL

grade 3 or 2 w instability

must be appropriate tensioned
- balance of mboility vs stability
- risk of other injury OA

Question 4

tendon injury surgery

Answer 4

repaired
- ethesis : suture anchors
- midportion : suture repair
- prone to gappping

poorer tissue - need to be more conservative suture can easily be pulled out

Question 5

cartilaginous surgery

Answer 5

poor healing potenial (fillnig pothole with sand) - replaced with fibrocartilage doesnt have same quality/quanity as hyline cartilage

very slow metabolism, requires load to heal

a cartilage procedure that falls within the wt bearing axis needs to be accompained by an alignment procedure
(ACL w high tibial osteotomy)

highlt individualized usually want to avoid shear forces

Question 6

screws

Answer 6

titanium, stainless steel, platic

best pullout strength

primarily used for bone, doesnt work well for soft tissue

Question 7

plates

Answer 7

titanium or stainless steel

titanium - closer elastic modules to bone, weaker to shear

stainless - stiffer

tension bond - converts tension forces to compression, chinese finger trap

Question 8

rods

Answer 8

titanium or stainless steel

allows micromotion for callus formation

stress sharing

requires reaming of marrow

almost never taken out

Question 9

sutures

Answer 9

Vicryl, nylon, silk
Hold soft tissues together
Mid-portion Achilles rupture
Pulling out of tissue is the concern
Not failure of the suture itself
Poor quality tissue = increased likelihood of repair failure
Various knots and techniques depending on the structures
Can be absorbable

Question 10

suture anchors

Answer 10

Metal, plastic, absorbable
Screw with sutures coming out
Used to hold soft tissue onto bone
Ex. Labral repair, rotator cuff repair

Question 11

stress sharing

Answer 11

Different implants can create a sharing or shielding effect

Stress shielding: “shields” or prevents the bone from seeing stress (The implants take on the stress)

Stress sharing: Allows partial transmission of load across the fracture site

Question 12

stress sheilding

Answer 12

When implants with a higher stiffness than bone results in bone loss

Bone does not see enough load/stress

Can also alter location of forces

Can result in loosening or backing out of screws

Question 13

surgery modified rehab

Answer 13

Post-operative rehabilitation is modified with respect to the surgery that was performed
Ex. Poor tissue quality in rotator cuff repair = No PROM for 6 weeks, No AROM until 12 weeks, No PRE until 16 weeks

Question 14

rehab modified surgery

Answer 14

The surgeon takes extra steps to use more rigid fixation or additional fixation to allow for more aggressive rehab
Using screws to allow early WB status