Surgical Interventions Flashcards
Examples
-arthroplasty **
-arthroscopy **
-wound management **
-subacromial decompression **
-carpal tunnel release **
-fasciotomy *
-osteotomy *
-common trauma operations (such as wrist/ ankle ORIF, sliding hip screw, hip hemiarthroplasty) **
-Conservative interventions
-steroid injections: subacromial, carpal tunnel, knee, hip **
-physiotherapy **
-weightloss/ lifestyle management **
-thromboprophylaxis: TEDS, foot pumps, early mobilisation **
-application of POP cast **
-reduction of fractures and dislocations **
Overview of arthroplasty
-Surgical procedure to restore the function of a joint. A joint can be restored by resurfacing the bones. An artificial joint (called a prosthesis) may also be used.
-Osteoarthritis, or degenerative joint disease, is a loss of the cartilage or cushion in a joint, and is the most common reason for arthroplasty.
-Arthroplasty may be used when medical treatments no longer effectively relieve joint pain and disability.
-Depending on the damage to your knee, it can be used to replace all of your knee joint (total knee replacement) or some of it (partial knee replacement).
Total knee replacement
- The surgeon makes a cut down the front of your knee and moves your kneecap to the side so they can get to the knee joint behind it.
- They cut away the damaged ends of your shin bone and thigh bone.
- New parts are fitted over the ends of both bones to create the new joint. The parts are usually made of metal and plastic. Some people may also have the back of the kneecap replaced with a new part.
- The kneecap is put back into place.
- The surgeon closes the cut on your knee using stitches or clips and covers it with a dressing and bandage.
- After the operation, you’ll stay in a recovery room until you’re fully awake, where you may be given medicines to help with the pain
Overview athroscopy
-Type of keyhole surgery for checking or repairing your joints
-Joint pain, swelling and stiffness, joints locking, moving out of position or giving way
-Indications: damaged your joint, for example a sports injury, a condition that can damage joints over time, such as osteoarthritis
-Repair: removing damaged sections of the tough tissue covering the surface of your joint (cartilage), repairing tears to the strips of tissue connecting the bones of your joint (ligaments), using a sterile liquid to wash out damaged bits of tissue stopping the joint from working properly
- the surgeon will make a small cut or cuts in the skin, around 2mm to 3mm wide, near the joint
- a tiny camera with a light (an arthroscope) is placed into a cut
- the arthroscope sends images of the inside of the joint to a screen
- the surgeon will repair the joint if needed (you may feel some tugging if you’re awake, but it will not hurt)
- the cut is then sealed with tape or stitches and a dressing may be put on it
Overview of subacromial decompression
-The aim of the surgery is to increase the size of the subacromial space and therefore reduce any pressure on the tendons and bursa. This is done by trimming away some of the bone so that the tendons are free to glide between the top of the Humerus and the acromion. The surgery may be done arthroscopically (keyhole surgery) or through an open incision
-Many tendons and a fluid filled cushion (a bursa) sit in the subacromial space which can get pinched and become inflamed with movement.
-Indications: rotator cuff tendonitis (impingement syndrome), bursitis
Overview of carpal tunnel release
-Relieve the pressure of the nerve and by doing so, you should get improvement in the pins and needles in the fingers. You may also get improvement in the strength in the muscles of the hand. This improvement may be instant or gradual over 12-18 months. In cases of advanced compression, the nerve may not recover fully even after release and in those cases, surgery prevents further damage.
-It involves releasing the pressure on the median nerve by cutting the transverse carpal ligament. The procedure may be performed as an open or endoscopic surgery.
Overview of fasciotomy
-Indications: acute compartment syndrome, Dupuytren’s contracture
-During a fasciotomy, the surgeon makes cuts around the muscle to relieve the pressure.
-Sometimes, skin may need to be removed from another part of the body and used to cover the wound. This is known as a skin graft.
Overview of osteotomy
-Indications: slipped capital femoral epiphysis
-Surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture
=Correct the angle, bowing or rotation of your bones.
=Correct the alignment of a deformed or unjoined joint.
=Shorten or lengthen bones.
=Repair a damaged joint.
=Shift your weight from a damaged area of a joint to an area where there’s more normal or healthy cartilage.
=Relieve pain from osteoarthritis (especially in the knee and hip).
=Delay the need for joint replacement surgery in younger, active people.
=Repair or fix other specific bone issues.
Overview of ORIF
-Indications: severely broken bones cannot be treated with cast or splint (displaced, unstable, involve joint, open fracture)
-“Open reduction” means a surgeon makes an incision to re-align the bone. “Internal fixation” means the bones are held together with hardware like metal pins, plates, rods, or screws. After the bone heals, this hardware isn’t removed.
Overview of sliding hip screw
-Internal fixation of fracture
-A femoral head-sparing orthopedic device, is used to treat femoral neck fractures. Alternately referred to as a pin and plate.
-Indications: undisplaced NOF fracture
After reduction, the fracture is internally fixed by application a large lag screw through the neck, this is held laterally by a lateral femoral plate. The DHS can slide in the plate along the longitudinal axis of the femoral neck, permitting compression of the fracture hence aiding healing. If sliding takes place, the lateral end of the lag screw may project laterally from the plate.
Overview of hip hemiarthroplasty
-Replace some of the damaged hip joint with an artificial part
-Indications: displaced intracapsular hip fracture
-Total over hemi when: able to walk independently out of doors with no more than a stick, no comorbidity, expected to carry out activities of daily living independently beyond 2 years
-Hospitals should aim to use a single type of cemented femoral component for hemiarthroplasties as standard treatment for displaced intracapsular hip fracture management
-Favored to dynamic hip screw where risk of femoral head avascular necrosis
